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paraganglia sites. They can occur as sporadic or hereditary tumors, with the latter accounting for at least 40% of cases. Of all known genetic mutations, those in the succinate dehydrogenase ( SDHx ) complex subunit D ( SDHD ) gene are currently the leading
Department of Endocrinology, Cambridge University NHS Foundation Trust, Cambridge, UK
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et al . 2015 ). It is now recognised that the SDHA gene is the most common SDHx germline mutation implicated in development of SDH-deficient WT GIST ( Boikos et al . 2016 ). Recently, the European-American-Asian Pheochromocytoma
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Department of Nuclear Medicine and Molecular Imaging, Lausanne University Hospital, Lausanne, Switzerland
Health Technology Assessment Unit, General Directorate, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
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Learning points Know the molecular taxonomy of pheochromocytoma and/or paraganglioma (PPGL) and the relationship between various genotypes and imaging phenotypes; Describe imaging features of SDHx -related PPGL; Understand
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. These novel associations are important to recognize in order to direct screening appropriately. For instance, pheochromocytomas and pituitary adenomas can rarely occur together, usually due to germline SDHx mutations ( Dénes et al. 2015 , Xekouki
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Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio, USA
Department of Genetics and Genome Sciences, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
Germline High Risk Cancer Focus Group, CASE Comprehensive Cancer Center, Case Western Reserve University, Cleveland, Ohio, USA
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encoding three of the four subunits of succinate dehydrogenase or mitochondrial complex II ( SDHB , SDHC and SDHD , collectively referred to as SDHx ) ( Ni et al . 2008 ). SDHx mutations and variants caused an increase in reactive oxygen species (ROS
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%) Susceptibility gene pathogenic variant carrier, n (%) 107 (40%) a SDHx, n (%) 94 (88%) b RET , n (%) 4 (3%) NF1 , n (%) 3 (3%) MAX, n (%) 2 (2%) VHL , n (%) 2 (2%) TMEM127 , n (%) 1 (1
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Clinical Genomics Linköping, Linköping University, Linköping, Sweden
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Department of Surgery, Linköping University, Linköping, Sweden
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). Figure 2 The subdivision of cluster 1, 2 and 3 genes in PPGLs according to tumor biology. PPGLs, pheochromocytomas and paragangliomas. Cluster 1 or the pseudohypoxia cluster includes tumors with mutations in VHL, SDHx, FH, EGLN1/2, IDH3B
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: germline mutations of the SDHD gene. Within months, the SDH components B and C (together with SDHD umbrellaed under SDHx) were shown to predispose to similar tumors, if the respective genes (SDHB and SDHC) were mutated ( Niemann & Müller 2000 , Astuti et
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. 2008 , Taieb et al. 2009 ). SDHx -related metastatic PPGL typically exhibit a strong positivity in 18 F-FDG and SSTR PET, and a very limited uptake with specific tracers such as 18 F-FDOPA and 123 I-MIBG. This illustrates that the choice of
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Department of Clinical and Experimental Medicine, Department of Oncology-Pathology, Department of Surgery, Department of Clinical Science, Department of Molecular Medicine and Surgery, Department of Surgery, Faculty of Health Sciences, Linköping University, Linköping SE-58185, Sweden
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Department of Clinical and Experimental Medicine, Department of Oncology-Pathology, Department of Surgery, Department of Clinical Science, Department of Molecular Medicine and Surgery, Department of Surgery, Faculty of Health Sciences, Linköping University, Linköping SE-58185, Sweden
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, and SDHx respectively ( Welander et al . 2011 , Dahia 2014 ). In recent years, additional susceptibility genes for pheochromocytoma and paraganglioma have been discovered, including TMEM127 ( Qin et al . 2010 ), MAX ( Comino-Mendez et al