VHL and nonpapillary renal cell carcinoma: Historically, patients referred for genetic counseling and germline VHL testing were at risk of a known familial VHL variant, or patients with a personal or family history raising suspicion for VHL disease (eg, early-onset ccRCC [≤46-years-old], hemangioblastoma, pheochromocytoma, or 2+ VHL-associated lesions).