Summary
We report a comprehensive molecular characterization of pheochromocytomas
and paragangliomas (PCC/PGLs), a rare tumor type. Multi-platform integration
revealed that PCC/PGLs are driven by diverse alterations affecting multiple
genes and pathways. Pathogenic germline mutations occurred in eight PCC/PGL
susceptibility genes. We identified CSDE1 as a
somatically-mutated driver gene, complementing four known drivers
(HRAS, RET, EPAS1,
NF1). We also discovered fusion genes in PCC/PGL, involving
MAML3, BRAF, NGFR and
NF1. Integrated analysis classified PCC/PGLs into four
molecularly-defined groups: a kinase signaling subtype, a pseudohypoxia subtype,
a Wnt-altered subtype, driven by MAML3 and
CSDE1, and a cortical admixture subtype. Correlates of
metastatic PCC/PGL included the MAML3 fusion gene. This
integrated molecular characterization provides a comprehensive foundation for
developing PCC/PGL precision medicine.