Natural History and Management of Pancreatic Lesions in Von Hippel-Lindau Disease

Background: Patients with the familial cancer syndrome von Hippel-Lindau (VHL) demonstrate manifestations in a variety of organs among them 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 spread. 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 and germ line and tissue genetic analysis. Objectives: To identify patients with VHL having pancreatic lesions defined by simple cysts, microcystic adenomas, neuroendocrine tumors and other solid lesions of the pancreas. To follow patients with VHL and pancreatic manifestations by serial examination with non-invasive imaging studies. For patients with solid lesions of the pancreas, to determine the rate of growth and to correlate the growth rate with clinical measures of disease progression. To validate non-invasive imaging methods for differentiating benign solid lesions from lesions with malignant potential. To characterize the time from initial presentation with pancreatic tumors to the time that surgery is recommended. Eligibility: Patients greater than or equal to 12 years of age who have been diagnosed with VHL. Patients/parent must be able to sign an informed consent and be willing to return to National Institutes of Health (NIH) for follow-up. Design: Demographic data will be collected from the medical record and patient interview for each patient participant. Data will be securely stored in a computerized database. Patients will be evaluated by the Urologic Oncology Branch personnel as indicated to rule out or manage other manifestations of VHL. Imaging studies of regions other than the chest and abdomen will be dictated by best clinical practice for the workup and management of VHL manifestations as has been previously published. All patients enrolled on this study will be offered genetic counseling by a trained genetic counselor. After their initial on-study evaluation, patients who are not found to have solid lesions of the pancreas but rather have only cystic disease of the pancreas, will be re-screened every two years with non-invasive imaging studies. 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. Projected accrual will be 25 patients per year for a total of 15 years. Thus, we anticipate accruing 600 patients on this protocol.