This is not a VHL-specific phenomenon and encompasses many cancer-predisposing genes.2,7 Penetrance, namely the percentage of individuals harboring the pathogenic variant who express any phenotype of the disease, may be influenced by many factors, including gender, age, genetic (specific germline variant, genetic background inherited from the parents), and environmental variables.8-10 These “incidental” findings in patients without disease-specific lesions are likely to challenge our established view of the penetrance and expressivity of inherited cancer predisposition syndromes. The gene discussed is VHL; the disease is cancer.