PatientID: II-4

KindredID: 3

Case: M, 38Y0M, Chinese

DiseaseAssertion: VHL

FamilyInfo: The patient's mother (I-2) died as a result of pancreatic cancer. The eldest sister of the patient (II-1) underwent surgery for a brain tumor and had pancreatic and renal cysts. Another sister (II-2) underwent surgery for breast cancer. The patient's two sons (III-6 and III-7) were found to harbour their father's VHL mutation. See Figure 3 for family pedigree.

CasePresentingHPOs: HP:0006770, HP:0001737, HP:0009713, HP:0000107, HP:0000787 (clear cell renal cell carcinoma, pancreatic cysts, spinal hemangioblastoma, renal cysts, nephrolithiasis)

CaseHPOFreeText: The patient was treated for kidney stones at age 33. At age 38 he was found to have a mass in the right kidney. Upper abdominal CT revealed the presence of multiple nodules and lumpy low-density areas in the left and right kidneys with uneven density. Multiple round low-density lesions were observed in the left and right kidneys, and in the pancreas. Brain CT revealed no abnormalities, but sphenoiditis was observed on the right side. Thoracic MRI revealed a round-shaped mixed signal (diameter, 12.0 mm) in the sixth thoracic vertebra. Contrast-enhanced scanning revealed minor enhancement, which appeared to indicate the presence of a hemangioma. Postoperative pathological analysis confirmed that the tumor was a clear cell renal cell carcinoma.

CaseNotHPOs: N/A

CaseNotHPOFreeText: N/A

CasePreviousTesting: N/A

PreviouslyPublished: N/A

SupplementalData: N/A

Variant: p.R167Q (c.500G>A)

LegacyVariant: N/A

CaseProblemVariantFreeText: N/A

ClinVarID: 2216 https://www.ncbi.nlm.nih.gov/clinvar/variation/2216/

CAID: CA020454 http://reg.clinicalgenome.org/redmine/projects/registry/genboree_registry/allele?hgvsOrDescriptor=NM_000551.3%3Ac.500G%3EA

gnomAD: 0.000003977 https://gnomad.broadinstitute.org/variant/3-10191507-G-A

VariantEvidence: N/A

MutationType: missense_variant;transition

CivicName: R167Q (c.500G>A)

MultipleGeneVariants: N/A

PatientID: 4

KindredID: 3

Case: M, 45Y0M, Arab

DiseaseAssertion: VHL

FamilyInfo: No family history of VHL disease was described for this patient. Immediate family members were recommended to genetically test for the relevant variant or monitor for VHL-related symptoms.

CasePresentingHPOs: HP:0006880; HP:0009713; HP:0000107; HP:0001737; HP:0000787 (cerebellar hemangioblastoma; spinal hemangioblastoma; renal cyst; pancreatic cysts; nephrolithiasis)

CaseHPOFreeText: At 40Y, Patient 4 was diagnosed with spinal and cerebellar hemangioblastomas, as well as multiple renal and pancreatic cysts. He was diagnosed with VHL disease type 1. At 43Y, renal cysts and stones were discovered. A year later, more spinal hemangioblastomas and renal stones were found. A year later, cerebellar lesions, as well as renal and pancreatic cysts were reported (see table 1).

CaseNotHPOs: HP:0002088; HP:0001392; HP:0005264; HP:0001743 (abnormal lung morphology; abnormality of the liver; abnormality of the gallbladder; abnormality of the spleen)

CaseNotHPOFreeText: No lesions were observed in the lungs, liver, gallbladder, and spleen.

CasePreviousTesting: N/A

PreviouslyPublished: N/A

SupplementalData:  N/A

Variant: p.N90del (c.268_270del)

LegacyVariant: N/A

CaseProblemVariantFreeText: N/A

ClinVarID: N/A

CAID: CA645524783, https://reg.genome.network/redmine/projects/registry/genboree_registry/by_caid?caid=CA645524783

gnomAD: N/A

VariantEvidence: N/A

MutationType: inframe_deletion

CivicName: N90del (c.268_270del)

MultipleGeneVariants: N/A