PHOX2B: a diagnostic cornerstone in neurocristopathies and neuroblastomas

J Clin Pathol. 2024 May 17;77(6):378-382. doi: 10.1136/jcp-2023-209047.


Paired-like homeobox 2B (PHOX2B) is a gene essential in the development of the autonomic nervous system. PHOX2B mutations are associated with neurocristopathies-Hirschsprung disease (HSCR) and congenital central hypoventilation syndrome (CCHS)-and peripheral neuroblastic tumours. PHOXB2 plays an important role in the diagnostics of these conditions.Genotyping of a PHOX2B pathogenic variant is required to establish a diagnosis of CCHS. In HSCR patients, PHOX2B immunohistochemical staining has proven to be a valuable tool in identifying this disease. Furthermore, PHOXB2 is a predisposition gene for neuroblastoma, in which PHOX2B immunohistochemical staining can be used as a highly sensitive and specific diagnostic marker. The utility of PHOX2B immunohistochemistry in pheochromocytoma and paraganglioma has also been studied but yields conflicting results.In this review, an overview is given of PHOX2B, its associated diseases and the usefulness of PHOX2B immunohistochemistry as a diagnostic tool.

Keywords: ONCOGENES; Pathology, Molecular; Pathology, Surgical; Pediatrics.

Publication types

  • Review

MeSH terms

  • Adrenal Gland Neoplasms / diagnosis
  • Adrenal Gland Neoplasms / genetics
  • Adrenal Gland Neoplasms / pathology
  • Biomarkers, Tumor / analysis
  • Biomarkers, Tumor / genetics
  • Genetic Predisposition to Disease
  • Hirschsprung Disease / diagnosis
  • Hirschsprung Disease / genetics
  • Hirschsprung Disease / pathology
  • Homeodomain Proteins* / genetics
  • Humans
  • Hypoventilation* / congenital
  • Hypoventilation* / diagnosis
  • Hypoventilation* / genetics
  • Immunohistochemistry*
  • Mutation
  • Neuroblastoma* / diagnosis
  • Neuroblastoma* / genetics
  • Neuroblastoma* / pathology
  • Sleep Apnea, Central / diagnosis
  • Sleep Apnea, Central / genetics
  • Transcription Factors* / genetics


  • NBPhox protein

Supplementary concepts

  • Congenital central hypoventilation syndrome