A 20Y male patient presented with pheochromocytoma and genetic analysis confirmed a germline mutation c.311G>T (p.Gly104Val) in the VHL gene. He also presented with nausea, vomiting, progressively rising blood pressure, an epididymal cyst, scrotal hydrocele, portal/gonadal vein thrombosis and a nonfunctional adrenal mass at 20Y and a history of anxiety and episodic diaphoresis. This mutation was confirmed in the patient's 48Y father who presented with a T1 vertebral body hemangioma, multiple bilateral renal cysts, left adrenal nodularity, hearing loss and an indeterminate right kidney midpole lesion. The paternal first cousin once removed died due to complications from clear cell renal cell carcinoma at 50Y, although genotype for the cousin is not provided. Mother and 2 siblings of the proband tested negative for the VHL mutation.

PatientID: N/A

KindredID: 1

Case: F, 10Y0M, Ethnicity Unknown

DiseaseAssertion: Assumed VHL

FamilyInfo: No family history, authors indicate that the variant occurred de novo.

CasePresentingHPOs: HP:0007514; HP:0000017; HP:0004421; HP:0012594; HP:0002666; HP:0001920 (Edema of the dorsum of hands; Nocturia; Elevated systolic blood pressure; Moderate albuminuria; Pheochromocytoma; Renal artery stenosis)

CaseHPOFreeText: Patient presented with occasional high routine blood pressure at 10Y0M. She noted mild hand edema over the past days and reported recent nocturia. Physical examination appeared normal other than elevated blood pressure of 139/113 mm Hg. Urine tests showed moderate albuminuria (albumin-creatinine ratio of 50 mg/g), as well as high levels of noradrenaline and normetanephrine, suggestive of benign pheochromocytoma. Ultrasound showed normal kidney size and parenchyma, but color duplex sonography revealed increased flow rate of the left renal artery. This finding suggests renal artery stenosis. Magnetic Resonance Angiography of the kidney vessels showed a solid tumor that had cystic features. Tumor resection normalized blood pressure and pathologic examination of the removed tumor confirmed pheochromocytoma. Patient was diagnosed with secondary hypertension due to compression of renal vessels and catecholamine production by vHL-associated pheochromocytoma. Antihypertensive therapy with phenoxybenzamine as α blockade was initiated, along with subsequent expansion of the therapy with a β-blocker. Authors mention that the patient is in complete remission with no other manifestations of VHL disease and is receiving close follow-up.

CaseNotHPOs: N/A

CaseNotHPOFreeText: N/A

CasePreviousTesting: N/A

PreviouslyPublished: N/A

SupplementalData: N/A

Variant: p.G104V (c.311G>T)

LegacyVariant: N/A

CaseProblemVariantFreeText: N/A

ClinVarID: 223183, https://www.ncbi.nlm.nih.gov/clinvar/variation//223183/

CAID: N/A

gnomAD: N/A

VariantEvidence: N/A

MutationType: missense_variant; transversion

CivicName: G104V (c.311G>T)

MultipleGeneVariants: N/A

PatientID: None

KindredID: 1

Case: F, 17Y0M, Ethnicity Unknown

DiseaseAssertion: Retinal hemangioblastoma

FamilyInfo: The heterozygous missense variant NM_000551.3:c.311G>T was identified on her 21-year-old sister and her mother, but not her father. The sister had hypertension and a paraganglioma. The patient’s mother had refused a complete staging.

CasePresentingHPOs:HP:0009711 (Retinal hemangioblastoma)

CaseHPOFreeText: The patient’s evaluation was normal with the exception of a small retinal hemangioblastoma.

CaseNotHPOs: N/A

CaseNotHPOFreeText: N/A

CasePreviousTesting: N/A

PreviouslyPublished: N/A

SupplementalData: N/A

Variant: p.G104V(c.311G>T)

LegacyVariant: N/A

ClinVarID: 223183, http://www.ncbi.nlm.nih.gov/clinvar/variation/223183

CAID: N/A

gnomAD: N/A

VariantEvidence: N/A

MutationType: missense_variant;transversion

CivicName: G104V(c.311G>T)

MultipleGeneVariants: N/A

PatientID: None

KindredID: 1

Case: F, Age Unknown, Ethnicity Unknown

DiseaseAssertion: Asymptomatic

FamilyInfo: The heterozygous missense variant NM_000551.3:c.311G>T was identified on two of her daughters; one was 21Y and one was 17Y. The 21Y daughter had hypertension and a paraganglioma, and the 17Y daughter had a retinal hemangioblastoma.

CasePresentingHPOs: N/A

CaseHPOFreeText: The patient refused a complete staging.

CaseNotHPOs: N/A

CaseNotHPOFreeText: N/A

CasePreviousTesting: N/A

PreviouslyPublished: N/A

SupplementalData: N/A

Variant: p.G104V(c.311G>T)

LegacyVariant: N/A

ClinVarID: 223183, http://www.ncbi.nlm.nih.gov/clinvar/variation/223183

CAID: N/A

gnomAD: N/A

VariantEvidence: N/A

MutationType: missense_variant;transversion

CivicName: G104V(c.311G>T)

MultipleGeneVariants: N/A