Abstract
Background A 17-year-old male presented with cervical adenopathy and a palpable left flank mass. After an initial biopsy of the neck mass, which revealed metastatic carcinoma, a left radical nephrectomy was performed as well as excision of a left supraclavicular lymph node. Subsequent inquiry revealed that the patient's father had died of metastatic renal cell carcinoma (RCC) at the age of 40 years, and that other family members had also developed skin and uterine leiomyomas.
Investigations Physical examination, CT scans of the chest, abdomen, and pelvis, lymph-node biopsy and genetic counseling, followed by genetic testing.
Diagnosis Papillary type 2 RCC described in the context of hereditary leiomyomatosis and renal cell cancer (HLRCC), an autosomal dominant syndrome attributable to a mutation in the fumarate hydratase (FH) gene on chromosome 1.
Management Radical nephrectomy, immunotherapy, chemotherapy and repeat surgical debulking. Genetic counseling and testing for family members was also undertaken. Annual skin examination of the carriers and radiological evaluation of both kidneys with CT scan and/or MRI.
This is a preview of subscription content, access via your institution
Access options
Subscribe to this journal
Receive 12 print issues and online access
$209.00 per year
only $17.42 per issue
Buy this article
- Purchase on Springer Link
- Instant access to full article PDF
Prices may be subject to local taxes which are calculated during checkout
References
Amato RJ et al. (2002) Irofulven, a novel inhibitor of DNA synthesis, in metastatic renal cell cancer. Invest New Drugs 20: 413–417
Tomlinson IP et al. (2002) Germline mutations in FH predispose to dominantly inherited uterine fibroids, skin leiomyomata and papillary renal cell cancer. Nat Genet 30: 406–410
Launonen V et al. (2001) Inherited susceptibility to uterine leiomyomas and renal cell cancer. Proc Natl Acad Sci USA 98: 3387–3392
Linehan WM et al. (2003) The genetic basis of cancer of the kidney. J Urol 170: 2163–2172
Knudson AG (1997) Hereditary predisposition to cancer. Ann N Y Acad Sci 833: 58–67
Zbar B et al. (2003) Studying cancer families to identify kidney cancer genes. Annu Rev Med 54: 217–233
Abdulrahman M et al. (2006) Identification of novel VHL targets that are associated with the development of renal cell carcinoma. Oncogene [doi: 10.1038/sj.onc.1209932]
Reed WB et al. (1973) Cutaneous leiomyomata with uterine leiomyomata. Acta Derm Venereol 53: 409–416
Toro JR et al. (2003) Mutations in the fumarate hydratase gene cause hereditary leiomyomatosis and renal cell cancer in families in North America. Am J Hum Genet 73: 95–106
Wei MH et al. (2006) Novel mutations in FH and expansion of the spectrum of phenotypes expressed in families with hereditary leiomyomatosis and renal cell cancer. J Med Genet 43: 18–27
Alam NA et al. (2003) Genetic and functional analyses of FH mutations in multiple cutaneous and uterine leiomyomatosis, hereditary leiomyomatosis and renal cancer, and fumarate hydratase deficiency. Hum Mol Genet 12: 1241–1252
Lehtonen HJ et al. (2006) Increased risk of cancer in patients with fumarate hydratase germline mutation. J Med Genet 43: 523–526
Alam NA et al. (2005) Fumarate hydratase mutations and predisposition to cutaneous leiomyomas, uterine leiomyomas and renal cancer. Br J Dermatol 153: 11–17
Isaacs JS et al. (2005) HIF overexpression correlates with biallelic loss of fumarate hydratase in renal cancer: novel role of fumarate in regulation of HIF stability. Cancer Cell 8: 143–153
Brugarolas J (2007) Renal-cell carcinoma—molecular pathways and therapies. N Engl J Med 356: 185–187
Gellera C et al. (1990) Fumarase deficiency is an autosomal recessive encephalopathy affecting both the mitochondrial and the cytosolic enzymes. Neurology 40: 495–499
Kiuru M et al. (2002) Few FH mutations in sporadic counterparts of tumor types observed in hereditary leiomyomatosis and renal cell cancer families. Cancer Res 62: 4554–4557
Pithukpakorn M et al. (2006) Fumarate hydratase enzyme activity in lymphoblastoid cells and fibroblasts of individuals in families with hereditary leiomyomatosis and renal cell cancer. J Med Genet 43: 755–762
Alam M et al. (2002) Gabapentin treatment of multiple piloleiomyoma-related pain. J Am Acad Dermatol 46 (Suppl): S27–S29
Choyke PL et al. (1997) Imaging features of hereditary papillary renal cancers. J Comput Assist Tomogr 21: 737–741
Acknowledgements
We would like to thank David Mitchell, MD, for his help in reviewing the case files, Morag Park, PhD, who performed the MET gene sequencing and Catherine Stolle, PhD, at Children's Hospital of Philadelphia, who did the FH gene sequencing.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Competing interests
The authors declare no competing financial interests.
Supplementary information
Rights and permissions
About this article
Cite this article
Refae, M., Wong, N., Patenaude, F. et al. Hereditary leiomyomatosis and renal cell cancer: an unusual and aggressive form of hereditary renal carcinoma. Nat Rev Clin Oncol 4, 256–261 (2007). https://doi.org/10.1038/ncponc0773
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1038/ncponc0773
This article is cited by
-
Renal cell carcinoma in young FH mutation carriers: case series and review of the literature
Familial Cancer (2020)
-
Genetic variations in genes of metabolic enzymes predict postoperational prognosis of patients with colorectal cancer
Molecular Cancer (2015)
-
Hereditary leiomyomatosis and renal cell cancer (HLRCC): renal cancer risk, surveillance and treatment
Familial Cancer (2014)
-
Potential genetic anticipation in hereditary leiomyomatosis-renal cell cancer (HLRCC)
Familial Cancer (2014)
-
Molecular targets on the horizon for kidney and urothelial cancer
Nature Reviews Clinical Oncology (2013)