Abstract
Background A 43-year-old woman presented to a cancer genetics clinic for a genetic risk assessment because of her personal history of multiple neoplasias. At 37 years of age, she was diagnosed with multifocal papillary thyroid cancer, and within a year was further diagnosed with a paraganglioma of the left common carotid artery. Two years later, she was diagnosed with a paraganglioma of the right carotid body. All three tumors were treated with surgical resection. There was no family history of malignancy. Past medical history includes uterine leiomyoma and fibrocystic breast disease. Physical examination revealed macrocephaly and papillomatous papules.
Investigations CT scan of the neck and thorax, 24-hour urine collection for measurement of metanephrines and catecholamines, MRI of the neck, thorax, and abdomen, metaiodobenzylguanidine scan, germline mutation analysis of PTEN, SDHB, SDHC and SDHD.
Diagnosis Cowden syndrome due to a germline mutation of PTEN, and pheochromocytoma–paraganglioma syndrome due to a germline mutation of SDHC.
Management Clinical surveillance for breast, endometrial, thyroid, and renal cell carcinoma risks associated with Cowden syndrome according to the National Comprehensive Cancer Network guidelines, annual MRI of the neck, thorax, abdomen and pelvis, annual metabolic screening, and where available, annual 18-fluorodopamine PET scanning, predictive genetic testing of both PTEN and SDHC for the patient's daughter and parents.
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References
Eng C (2003) PTEN: one gene, many syndromes. Hum Mutat 22: 183–198
The National Comprehensive Cancer Network (2006) Genetic/Familial High-Risk Assessment: Breast and Ovarian Clinical Practice Guidelines in Oncology (Version I.2007). [http://www.nccn.org] (accessed 2 January 2007)
Marsh DJ et al. (1998) Mutation spectrum and genotype–phenotype analyses in Cowden disease and Bannayan–Zonana syndrome, two hamartoma syndromes with germline PTEN mutation. Hum Mol Genet 7: 507–515
Zhou XP et al. (2003) Germline PTEN promoter mutations and deletions in Cowden/Bannayan–Riley–Ruvalcaba syndrome result in aberrant PTEN protein and dysregulation of the phosphoinositol-3-kinase/Akt pathway. Am J Hum Genet 73: 404–411
Starink TM et al. (1986) The Cowden syndrome: a clinical and genetic study in 21 patients. Clin Genet 29: 222–233
Eng C (2000) Will the real Cowden syndrome please stand up: revised diagnostic criteria. J Med Genet 37: 828–830
Baysal BE et al. (1997) Fine mapping of an imprinted gene for familial nonchromaffin paragangliomas, on chromosome 11q23. Am J Hum Genet 60: 121–132
Suzuki A et al. (1998) High cancer susceptibility and embryonic lethality associated with mutation of the PTEN tumor suppressor gene in mice. Curr Biol 8: 1169–1178
Jimenez C et al. (2006) Review: should patients with apparently sporadic pheochromocytomas or paragangliomas be screened for hereditary syndromes? J Clin Endocrinol Metab 91: 2851–2858
Neumann HP et al. (2002) Germ-line mutations in nonsyndromic pheochromocytoma. N Engl J Med 346: 1459–1466
Maher ER and Eng C (2002) The pressure rises: update on the genetics of phaeochromocytoma. Hum Mol Genet 11: 2347–2354
Eng C et al. (2003) A role for mitochondrial enzymes in inherited neoplasia and beyond. Nat Rev Cancer 3: 193–202
Neumann HP et al. (2004) Distinct clinical features of paraganglioma syndromes associated with SDHB and SDHD gene mutations. JAMA 292: 943–951
Schiavi F et al. (2005) Predictors and prevalence of paraganglioma syndrome associated with mutations of the SDHC gene. JAMA 294: 2057–2063
Bayley JP et al. (2006) Mutation analysis of SDHB and SDHC: novel germline mutations in sporadic head and neck paraganglioma and familial paraganglioma and/or pheochromocytoma. BMC Med Genet 7: 1
Bausch B et al. (2006) Genetic and clinical investigation of pheochromocytoma: a 22-year experience, from Freiburg, Germany to international effort. Ann NY Acad Sci 1073: 122–137
Shen WH et al. (2007) Essential role for nuclear PTEN in maintaining chromosomal integrity. Cell 128: 157–170
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Zbuk, K., Patocs, A., Shealy, A. et al. Germline mutations in PTEN and SDHC in a woman with epithelial thyroid cancer and carotid paraganglioma. Nat Rev Clin Oncol 4, 608–612 (2007). https://doi.org/10.1038/ncponc0935
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DOI: https://doi.org/10.1038/ncponc0935
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