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Somatic VHL gene alterations in MEN2-associated medullary thyroid carcinoma

Christian A Koch12*, Frederieke M Brouwers3, Alexander O Vortmeyer4, Andrea Tannapfel5, Steven K Libutti6, Zhengping Zhuang4, Karel Pacak3, Hartmut PH Neumann7 and Ralf Paschke1

Author Affiliations

1 Division of Endocrinology and Nephrology, University of Leipzig, Philipp-Rosenthalstr. 27, 04103 Leipzig, Germany

2 Division of Endocrinology, University of Mississippi Medical Center, 2500 N State Str, Jackson, MS 39216, USA

3 Reproductive Biology and Medicine Branch, National Institute of Child Health and Human Development, National Institutes of Health, Center Drive, Building 10, Bethesda, MD 20892, USA

4 Surgical Neurology Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Center Drive, Building 10, Rm 5D37, Bethesda, MD 20892, USA

5 Institute of Pathology, Ruhr-Universität Bochum an den BG Kliniken Bergmannsheil, Bürkle-de-la-Camp-Platz 1, 44 789 Bochum, Germany

6 Surgery Branch, Center for Cancer Research, National Cancer Institute, 10 Center Drive, Room 4W-5940, Bethesda, MD 20892, USA

7 Division of Nephrology and Hypertension, Albert-Ludwigs-Universitaet of Freiburg, Hugstetter Str. 55, 79106 Freiburg, Germany

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BMC Cancer 2006, 6:131  doi:10.1186/1471-2407-6-131

Published: 17 May 2006



Germline mutations in RET are responsible for multiple endocrine neoplasia type 2 (MEN2), an autosomal dominantly inherited cancer syndrome that is characterized by medullary thyroid carcinoma (MTC), pheochromocytoma, and parathyroid hyperplasia/adenoma. Recent studies suggest a "second hit" mechanism resulting in amplification of mutant RET. Somatic VHL gene alterations are implicated in the pathogenesis of MEN2 pheochromocytomas. We hypothesized that somatic VHL gene alterations are also important in the pathogenesis of MEN2-associated MTC.


We analyzed 6 MTCs and 1 C-cell hyperplasia (CCH) specimen from 7 patients with MEN2A and RET germline mutations in codons 609, 618, 620, or 634, using microdissection, microsatellite analysis, phosphorimage densitometry, and VHL mutation analysis.


First, we searched for allelic imbalance between mutant and wild-type RET by using the polymorphic markers D10S677, D10S1239, and RET on thyroid tissue from these patients. Evidence for RET amplification by this technique could be demonstrated in 3 of 6 MTCs. We then performed LOH analysis using D3S1038 and D3S1110 which map to the VHL gene locus at 3p25/26. VHL gene deletion was present in 3 MTCs. These 3 MTCs also had an allelic imbalance between mutant and wild-type RET. Mutation analysis of the VHL gene showed a somatic frameshift mutation in 1 MTC that also demonstrated LOH at 3p25/26. In the 2 other MTCs with allelic imbalance of RET and somatic VHL gene deletion, no somatic VHL mutation could be detected. The CCH specimen did neither reveal RET imbalance nor somatic VHL gene alterations.


These data suggest that a RET germline mutation is necessary for development of CCH, that allelic imbalance between mutant and wild-type RET may set off tumorigenesis, and that somatic VHL gene alterations may not play a major role in tumorigenesis of MEN2A-associated MTC.