An 18-year-old man presents complaining of an inability to keep his balance. A complete neurologic examination is conducted, and funduscopy reveals retinal hemangioblastomas. He reports that his mother has a history of a “brain tumor,” the specifics of which he is unaware. Given the classic evolution of this patient’s disease, for which of the following does this patient require close monitoring?
一名18岁的男子抱怨无法保持平衡。进行了完整的神经系统检查,眼底镜检查显示视网膜血管母细胞瘤。他报告说,他的母亲有“脑瘤”病史,但他不知道具体情况。考虑到该患者疾病的典型演变过程,该患者需要对以下哪项进行密切监测?
(A) Astrocytoma 星形细胞瘤
(B) Colon cancer 结肠癌
(C) Depression 抑郁
(D) Pheochromocytoma 嗜铬细胞瘤
(E) Renal mass 肾肿块
答案解析:
常染色体显性VHL病患者(Von Hippel–Lindau disease,VHL综合征)有血管母细胞瘤,即视网膜、小脑和延髓的海绵状血管瘤。小脑表现为难以保持平衡和视网膜血管母细胞瘤。患有希佩尔·林道综合征的患者患肾细胞癌的风险增加。只有10%的患者出现所谓的“典型三联征”,即胁痛、可触及的胁块和血尿,但这是许多VHL病患者继续发展的肾细胞癌的典型表现。VHL病与3号染色体上VHL基因的缺失有关。
正确答案:E
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