Natural History and Management of Von Hippel-Lindau (VHL) Associated Pancreatic Neuroendocrine Tumors

Background:

• Patients with the von Hippel-Lindau (VHL) familial cancer syndrome demonstrate manifestations in a variety of organs, including the pancreas. Pancreatic manifestations can range from benign cysts and micro cystic adenomas to neuroendocrine tumors of the pancreas which are capable of regional and distant metastases. These neuroendocrine tumors can result in life-threatening complications.
• This protocol is designed to identify VHL patients with pancreatic manifestations and to follow these patients with serial imaging studies, germ line genetic analysis, discovery of serum biomarkers, and novel imaging modalities such as 68-Gallium DOTATATE PET/CT scan.

Objective:

• To comprehensively and longitudinally evaluate the natural history of participants with VHL pancreatic neuroendocrine tumors and cystic lesions, estimating and defining their clinical spectrum.

Eligibility:

• Participants greater than or equal to 12 years of age diagnosed with VHL.

Design:

• Demographic data will be collected from the medical record and patient interview for each participant. Data will be securely stored in a computerized database.
• Participants will be evaluated by the urology, neurosurgery, brain oncology and/or ophthalmology personnel as indicated to rule out or manage other manifestations of VHL such as hemangioblastoma, renal cell cancer, and pheochromocytoma.
• Anatomical and functional clinical imaging studies, research blood and urine sample collection will be performed at each scheduled visit. Research 68-Gallium DOTATATE PET/CT imaging studies in adult participants will be performed, no more than once per year.
• Surgical resection of solid lesions of the pancreas will be recommended based on previously published criteria.
• Based on our analysis of likelihood of tumor growth or risk of metastasis, data will be analyzed every two years and appropriate revisions will be made to the surgical management guidelines, if indicated by data analysis.
• Up to 700 participants may receive the research 68-Gallium DOTATATE PET/CT imaging on this protocol.

• INCLUSION CRITIERIA:

• Participants who have been diagnosed with VHL using the following criteria:

-- Identification of a heterozygous germline pathogenic variant in VHL by molecular genetic testing.

or

-- Clinical criteria

• Participants with at least 1 pancreatic manifestation of VHL as documented on any non-invasive imaging study. These manifestations may include:

• Pancreatic cyst(s)
• Solid lesions suspicious for microcystic adenoma(s)
• Solid enhancing lesions suspicious for PNET(s)
• Any other solid lesion(s) of the pancreas
• Age greater than or equal to 12 years.
• Ability of participant to understand and the willingness to sign a written informed consent document.

Exclusion criteria

• Inability of participant to undergo serial non-invasive imaging.