The 4th International
Symposium on Pheochromocytoma (“ISP 2014”) was held in Kyoto, Japan, September
17-20. I just returned from the meeting. This time, I was too tired to write a
meeting report during the meeting but I did take extensive notes.
Public transportation was
amazing there. The meeting organizers provided detailed instructions on using
public transportation which I took seriously. Upon landing at Osaka airport, I
bought an IC card with a little Hello-Kitty on the face. The IC card apparently
was for foreign travelers only (they wrote down my passport number and name).
The card could be used on trains and subways and in some shops. It gave
discount price for round trip between the airport and the Kyoto train station.
Very handy! I could have returned the card and got some refund but I kept it as
a souvenir because I liked it so much. A high-speed rail (JR “Haruka”) took me
from the Osaka airport in 75 minutes to the Kyoto station. Then a 5-minute walk
took me to the meeting venue.
The meeting was wonderful. I
attended every single lecture and discussion except for those on the last day.
I also presented a poster. The meeting featured many Japanese speakers who
shared their experience on pheo. It turned out that the diagnosis and treatment
of pheo in Japan were a little different from those in US and Europe. I was
surprised to know that metanephrines testing was not available in Japan but
some Japanese doctors were developing the assay there. Interestingly Japanese
surgeons had to send in 20 videos of their laparoscopy operations to be
certified. The first-time pass rate was only about 40%!
The following is a list of major
new things I learned from the meeting:
1. Two more new genes were
added to the list of pheo-predisposing genes. I will write about them after the
papers are published. So now a total of 17 genes are known to be associated
with pheo.
2. A new syndrome,
paraganglioma-somatostatinoma-polycythemia was established. The syndrome is
caused by activating mutations in the gene HIF2alpha in some but not all cells
of the body. I was fortunate enough to have an extensive discussion with one of
the lead authors of the paper to understand how they went through the thinking
process. This syndrome is particularly interesting to me as I also have
interests in somatostatinoma and other pancreatic or duodenal neuroendocrine
tumors.
3. Prediction of malignancy
may be possible now. A famous Japanese pathologist literally used the Obama’s “Yes
we can” in describing the scheme that will tell a malignant pheo from a benign
one. This scheme was discussed 3 years ago at the previous meeting but was met
with more skepticism than support. This year, the same scheme seemed to have
garnered more support than skepticism. I, among others, would like to see how
the scheme would pan out in the hands a practicing pathologist.
4. Whole-genome sequencing
seemed to very popular now. A few famous researchers were sold on the
whole-genome sequencing idea. Quite a few others and I viewed the whole-genome
sequencing with guarded optimism. I don’t see much value of whole-genome
sequencing in routine clinical care.
5. A plenary session speaker
described the status quo and predicted future directions of pheo and pheo
research. This speaker thought that routine pheo diagnosis and treatment should
be pretty straightforward if a doctor knew the right stuff. Future research
should address the treatment of malignant pheo and the role of genetic testing
in the care of patients with pheo. I agreed with the speaker full-heartedly.
Dr. Pheo
