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    1. Cousin 2–383929–

      PatientID: None (Cousin 2)

      KindredID: G

      Case: Sex Unknown, 38Y0M, Hungarian

      DiseaseAssertion: Assumed VHL

      FamilyInfo: Large VHL family spanning five generations. The index patient presented with pheochromocytoma, renal cell carcinoma as well as spinal cord, cerebellar, and medulla oblongata hemangioblastomas. Her parents showed no clinical, biochemical, or radiological evidence of the disease, but VHL-associated tumors were detected in five other family members (bilateral renal cell carcinomas in one, renal cysts in one, spinal cord, cerebellar, and medulla oblongata hemangioblastomas in three, retinal hemangioblastomas in four, and pheochromocytomas in two family members).

      CasePresentingHPOs: HP:0010797; HP:0009711; HP:0002666 (Hemangioblastoma, Retinal capillary hemangioma, Pheochromocytoma)

      CaseHPOFreeText: Presented with CNS hemangioblastoma at age 38, pheochromocytoma at age 39 and retinal hemangioblastoma at age 29. No VHL diagnosis noted but assumed to have VHL based on genetic, clinical and familial findings.

      CaseNotHPOs: N/A

      CaseNotHPOFreeText: N/A

      CasePreviousTesting: N/A

      PreviouslyPublished: 18416845

      SupplementalData: N/A

      Variant: p.S80I (c.239G>T)

      LegacyVariant: N/A

      CaseProblemVariantFreeText: N/A

      ClinVarID: 625229, https://www.ncbi.nlm.nih.gov/clinvar/variation/625229/

      CAID: N/A

      gnomAD: N/A

      VariantEvidence: Variant reported as S80I and cDNA change was mapped to c.239G>T.

      MutationType: missense_variant;transversion

      CivicName: S80I (c.239G>T)

      MultipleGeneVariants: N/A

    1. Case 1. A 29-year-old male patient was referred to the retina department. About 1 month previously, percutaneous radiofrequency ablation treatment was performed on the patient due to RCC in his left kidney (Figure 1). Central nervous system involvement was not detected in the patient.Open in a separate windowFigure 1Abdominal computerized tomography image of case 1. Renal cell carcinoma in the left kidney (preoperatively).On ophthalmological examination, best-corrected visual acuity (BCVA) was counting fingers from 2 meters in the right eye and 1.0 in the left eye on the Snellen acuity visual chart. Vitritis was detected in the right eye on slit-lamp biomicroscopy. The fundus examination revealed an extensive lipid exudation on the fovea and macula, and a 3-4 optic disc diameter-sized RH at the equator in the right eye; it was normal in the lefteye. Fundus fluorescein angiography (FFA) showed that the RH in the right eye was responsible for fluorescein staining on the feeding artery and drainage vein and fluorescein leakage. Optical coherence tomography (OCT) showed that there was a foveal detachment in the right eye (Figure 2).Open in a separate windowFigure 2Optical coherence tomography and fundus fluorescein angiography images of Case 1.The patient’s blood sample was collected in vacutainers containing EDTA as anticoagulant. After DNA extraction (EZ1 Advanced Instruments; Qiagen, Hilden, Germany), mutation analysis of the VHL gene ({"type":"entrez-nucleotide","attrs":{"text":"NG_008212.3","term_id":"319803102","term_text":"NG_008212.3"}}NG_008212.3, {"type":"entrez-nucleotide","attrs":{"text":"NM_000551","term_id":"1779521775","term_text":"NM_000551"}}NM_000551) was performed using Sanger sequencing with the ABI PRISM™ 3130 Avant system (Applied Biosystems, Grand Island, NY, USA). The entire coding region and the exon/intron boundaries of the VHL gene (transcript ENST00000256474) were sequenced. The amplicon panel primers and conditions used were established in the laboratory.A heterozygous missense mutation c.202T>C, (p.Ser 68Pro) in exon 1 of the VHL gene was found in the pa-tient’s DNA sample (Figure 3). This mutation is reported in the HGMD-PUBLIC (CM073416) (http://www.hgmd.org).Open in a separate windowFigure 3A heterozygous missense mutation c.202T>C, (p.Ser68Pro) in exon 1 of the VHL gene.The pathogenicity of the variation was tested in the Polyphen database and it was scored as probably damaging [probably damaging with a score of 0.960 (sensitivity: 0.78; specificity: 0.95)]. However, this variation was not listed the in the Exac database.

      PatientID: None

      KindredID: 1

      Case: M, 29Y0M, Ethnicity Unknown

      DiseaseAssertion: VHL

      FamilyInfo: First cousin (male, 33Y) presented with CNS hemangioblastoma, RCC, optic atrophy, vision loss and retinal capillary hemangioblastoma. THis cousin also had the same germline mutation as the proband.

      CasePresentingHPOs: HP:0005584; HP:0011531; HP:0009711; HP:0000541 (Renal cell carcinoma, Vitritis, Retinal capillary hemangioma, Retinal detachment)

      CaseHPOFreeText: About 1 month previously, percutaneous radiofrequency ablation treatment was performed on the patient due to RCC in his left kidney. Vitritis was detected in the right eye on slit-lamp biomicroscopy. The fundus examination revealed an extensive lipid exudation on the fovea and macula, and a 3-4 optic disc diameter-sized RH at the equator in the right eye; it was normal in the left eye. Optical coherence tomography (OCT) showed that there was a foveal detachment in the right eye.

      CaseNotHPOs: HP:0100006 (Neoplasm of the central nervous system)

      CaseNotHPOFreeText: Central nervous system involvement was not detected in the patient.

      CasePreviousTesting: N/A

      PreviouslyPublished: N/A

      SupplementalData: N/A

      Variant: p.S68P (c.202T>C)

      LegacyVariant: N/A

      CaseProblemVariantFreeText: N/A

      ClinVarID: N/A

      CAID: CA16621912, https://reg.clinicalgenome.org/redmine/projects/registry/genboree_registry/by_canonicalid?canonicalid=CA16621912

      gnomAD: N/A

      VariantEvidence: N/A

      MutationType: missense_variant;transition

      CivicName: S68P (c.202T>C)

      MultipleGeneVariants: N/A

    1. missense mutations (1/16)

      PatientID: 6

      KindredID: 6

      Case: 29Y0M, Sex Unknown, Argentinian

      DiseaseAssertion: VHL

      FamilyInfo: Positive family history

      CasePresentingHPOs: HP:0010797; HP:0009711; HP:0001737; HP:0000107 (hemangioblastoma; retinal capillary hemangioma; pancreatic cysts; renal cysts)

      CaseHPOFreeText: Aged 22Y at diagnosis (genetic testing); fulfils type 1 VHL clinical diagnosis. CNS and retinal hemangioblastoma was diagnosed at 22, pancreatic cysts and renal cysts were diagnosed at 29Y (See Table 1 & 2).

      CaseNotHPOs: N/A

      CaseNotHPOFreeText: absence of pheochromocytoma/paraganglioma (pheo/pgl) after 14 years of follow-up.

      CasePreviousTesting: N/A

      PreviouslyPublished: N/A

      SupplementalData: N/A

      Variant: p.C162W (c.486C>G)

      LegacyVariant: N/A

      CaseProblemVariantFreeText: N/A

      ClinVarID: 223227 https://www.ncbi.nlm.nih.gov/clinvar/variation/223227/

      CAID: N/A

      gnomAD: N/A

      VariantEvidence: N/A

      MutationType: missense_variant; transversion

      CivicName: C162W (c.486C>G)

      MultipleGeneVariants: N/A

    1. PMID: 20567917

      PatientID: 2

      KindredID: 2

      Case: F, 29Y0M, Brazilian

      DiseaseAssertion: VHL

      FamilyInfo: VHL type 1. Genetic testing has been performed in her parents and brother with negative results. Her only child has not undergone predictive testing yet.

      CasePresentingHPOs: HP:0030393; HP:0009711; HP:0010797; HP:0000107; HP:0001737; HP:0001407 (endolymphatic sac tumor; retinal capillary hemangioma; hemangioblastoma; renal cysts; pancreatic cysts; hepatic cysts)

      CaseHPOFreeText: endolymphatic sac tumor diagnosed at 11Y, retinal angiomas at 16Y; hemangioblastoma, renal, pancreatic, and hepatic cysts at 29Y

      CaseNotHPOs: N/A

      CaseNotHPOFreeText: N/A

      CasePreviousTesting: N/A

      PreviouslyPublished: N/A

      SupplementalData: Yes

      Variant: p.Q73* (c.217C>T)

      LegacyVariant: N/A

      CaseProblemVariantFreeText: N/A

      ClinVarID: 223164 https://www.ncbi.nlm.nih.gov/clinvar/variation/223164/

      CAID: N/A

      gnomAD: N/A

      VariantEvidence: N/A

      MutationType: stop_gained

      CivicName: Q73* (c.217C>T)

      MultipleGeneVariants: N/A