VHL and cystic kidney disease: Hereditary VHL-related ccRCCs display earlier onset and multifocal and bilateral tumors [88]: Neumann et al. described age at onset as being 25 years less than in sporadic ccRCCs, and an association with renal cyst and cystic organization, low histological grade, absence of metastasis in tumors smaller than 7 cm and better 10-year survival [81].