An aggressive temporal bone sdhc paraganglioma associated with increased HIF-2α signaling

Brandon Isaacson, Petra Bullova, Megan Frone, Arielle Click, Barbora Hamplova, Jennifer Rabaglia, Stacey Woodruff, Fiemu Nwariaku, Amita Kathuria, Karel Pacak, Hans K. Ghayee

Research output: Contribution to journalArticle

4 Scopus citations

Abstract

Objective: To describe a patient with a germline succinate dehydrogenase (SDHC) gene mutation presenting with primary hyperparathyroidism and a large catecholamine-producing temporal bone paraganglioma (PGL). Methods: Evaluation of a SDHC mutation-positive PGL tumor biology using staining for tyrosine hydroxylase (TH), hypoxia-inducible factors 1α (HIF-1α) and 2α (HIF-2α). Results: A 66-year-old man was noted to have a lytic skull base mass during work-up for his primary hyperparathyroidism. Biochemical evaluation with 24-hour urine catecholamines and metanephrines revealed marked elevation of norepinephrine and normetanephrine. Genetic testing revealed a germline SDHC mutation. A partial excision of skull base tumor was performed, which upon further examination revealed PGL. Immunohistochemistry of skull base PGL demonstrated heavy expression of TH and HIF-2α but reduced expression of HIF-1α. The remaining skull base PGL was treated with adjuvant radiation therapy. The patient's normetanephrine levels significantly decreased after surgery and radiation. Conclusion: Here, we report an unusual case of a patient presenting with a germline SDHC mutation-related functional PGL along with concomitant primary hyperparathyroidism. The present case illustrates that overexpression of HIF-2α but not of HIF-1α is linked to the pathogenesis of SDHC mutation-related PGL, and it may be responsible for the aggressive clinical behavior of a usually indolent course of SDHC-related PGLs.

Original languageEnglish (US)
Pages (from-to)190-195
Number of pages6
JournalEndocrine Practice
Volume22
Issue number2
DOIs
StatePublished - Feb 2016

ASJC Scopus subject areas

  • Endocrinology, Diabetes and Metabolism
  • Endocrinology

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    Isaacson, B., Bullova, P., Frone, M., Click, A., Hamplova, B., Rabaglia, J., Woodruff, S., Nwariaku, F., Kathuria, A., Pacak, K., & Ghayee, H. K. (2016). An aggressive temporal bone sdhc paraganglioma associated with increased HIF-2α signaling. Endocrine Practice, 22(2), 190-195. https://doi.org/10.4158/EP15889.OR