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Sifakis S, Manolakos E, Vetro A, Kappou D, Peitsidis P, Kontodiou M, Garas A, Vrachnis N, Konstandinidou A, Zuffardi O, Orru S, Papoulidis I. Prenatal diagnosis of Wolf-Hirschhorn syndrome confirmed by comparative genomic hybridization array: report of two cases and review of the literature. Mol Cytogenet 2012; 5:12. [PMID: 22373435 PMCID: PMC3307480 DOI: 10.1186/1755-8166-5-12] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2011] [Accepted: 02/28/2012] [Indexed: 01/26/2023] Open
Abstract
Wolf-Hirschhorn syndrome (WHS) is a well known genetic condition caused by a partial deletion of the short arm of chromosome 4. The great variability in the extent of the 4p deletion and the possible contribution of additional genetic rearrangements lead to a wide spectrum of clinical manifestations. The majority of the reports of prenatally diagnosed WHS cases are associated with large 4p deletions identified by conventional chromosome analysis; however, the widespread clinical use of novel molecular techniques such as array comparative genomic hybridization (a-CGH) has increased the detection rate of submicroscopic chromosomal aberrations associated with WHS phenotype. We provide a report of two fetuses with WHS presenting with intrauterine growth restriction as an isolated finding or combined with oligohydramnios and abnormal Doppler waveform in umbilical artery and uterine arteries. Standard karyotyping demonstrated a deletion on chromosome 4 in both cases [del(4)(p15.33) and del(4)(p15.31), respectively] and further application of a-CGH confirmed the diagnosis and offered a precise characterization of the genetic defect. A detailed review of the currently available literature on the prenatal diagnostic approach of WHS in terms of fetal sonographic assessment and molecular cytogenetic investigation is also provided.
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Affiliation(s)
- Stavros Sifakis
- Department of Obstetrics & Gynecology, University of Crete, Heraklion, Greece
| | - Emmanouil Manolakos
- Eurogenetica S.A., Laboratory of Genetics, Athens-Thessaloniki, Greece
- Cattedra di Genetica Medica, Universita di Cagliari, Cagliari, Italia
| | - Annalisa Vetro
- Dipartimento di Patologia Umana ed Ereditaria, Universita di Pavia, Pavia, Italia
| | - Dimitra Kappou
- Department of Obstetrics & Gynecology, University of Crete, Heraklion, Greece
| | | | - Maria Kontodiou
- Eurogenetica S.A., Laboratory of Genetics, Athens-Thessaloniki, Greece
| | - Antonios Garas
- Department of Obstetrics & Gynecology, University of Thessalia, Larissa, Greece
| | - Nikolaos Vrachnis
- 2nd Department of Obstetrics and Gynecology, Aretaieion Hospital, Univeristy of Athens, Athens, Greece
| | | | - Orsetta Zuffardi
- Dipartimento di Patologia Umana ed Ereditaria, Universita di Pavia, Pavia, Italia
| | - Sandro Orru
- Cattedra di Genetica Medica, Universita di Cagliari, Cagliari, Italia
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Shanske AL, Yachelevich N, Ala-Kokko L, Leonard J, Levy B. Wolf-Hirschhorn syndrome and ectrodactyly: New findings and a review of the literature. Am J Med Genet A 2010; 152A:203-8. [PMID: 20034099 DOI: 10.1002/ajmg.a.33159] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Alan L Shanske
- The Center for Craniofacial Disorders, Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, New York, USA.
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Hanprasertpong T, Hanaoka U, Zhang X, Mori N, Inubashiri E, Kanenishi K, Yamashiro C, Tanaka H, Shiota A, Yanagihara T, Hata T. Three-dimensional sonographic features of a fetus with Wolf-Hirschhorn syndrome. J Med Ultrason (2001) 2008; 35:197-9. [PMID: 27278992 DOI: 10.1007/s10396-008-0182-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2008] [Accepted: 05/08/2008] [Indexed: 10/21/2022]
Abstract
We present a case of fetal Wolf-Hirschhorn syndrome diagnosed by conventional two-dimensional and three-dimensional ultrasonography. Conventional two-dimensional ultrasonography revealed a diaphragmatic hernia, nuchal edema, and suspected hypospadias. Three-dimensional ultrasonography clearly showed a flattening of the face, a high forehead, a broad nasal bridge continuing to the forehead, exophthalmos, and micrognathia (resembling the appearance of a Greek warrior helmet), but conventional two-dimensional ultrasonography did not depict these findings. Prenatal chromosomal analysis confirmed the diagnosis of Wolf-Hirschhorn syndrome [46XY, del(4)(p15.2)]. Here we demonstrate how three-dimensional ultrasonography provided a novel visual depiction of the facial dysmorphism, which helped substantially in prenatal counseling.
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Affiliation(s)
- Tharangrut Hanprasertpong
- Department of Perinatology and Gynecology, Kagawa University School of Medicine, 1750-1 Ikenobe, Miki, Kagawa, 761-0793, Japan
| | - Uiko Hanaoka
- Department of Perinatology and Gynecology, Kagawa University School of Medicine, 1750-1 Ikenobe, Miki, Kagawa, 761-0793, Japan
| | - Xia Zhang
- Department of Perinatology and Gynecology, Kagawa University School of Medicine, 1750-1 Ikenobe, Miki, Kagawa, 761-0793, Japan
| | - Nobuhiro Mori
- Department of Perinatology and Gynecology, Kagawa University School of Medicine, 1750-1 Ikenobe, Miki, Kagawa, 761-0793, Japan
| | - Eisuke Inubashiri
- Department of Perinatology and Gynecology, Kagawa University School of Medicine, 1750-1 Ikenobe, Miki, Kagawa, 761-0793, Japan
| | - Kenji Kanenishi
- Department of Perinatology and Gynecology, Kagawa University School of Medicine, 1750-1 Ikenobe, Miki, Kagawa, 761-0793, Japan
| | - Chizu Yamashiro
- Department of Perinatology and Gynecology, Kagawa University School of Medicine, 1750-1 Ikenobe, Miki, Kagawa, 761-0793, Japan
| | - Hirokazu Tanaka
- Department of Perinatology and Gynecology, Kagawa University School of Medicine, 1750-1 Ikenobe, Miki, Kagawa, 761-0793, Japan
| | - Atsuko Shiota
- Department of Perinatology and Gynecology, Kagawa University School of Medicine, 1750-1 Ikenobe, Miki, Kagawa, 761-0793, Japan
| | - Toshihiro Yanagihara
- Department of Perinatology and Gynecology, Kagawa University School of Medicine, 1750-1 Ikenobe, Miki, Kagawa, 761-0793, Japan
| | - Toshiyuki Hata
- Department of Perinatology and Gynecology, Kagawa University School of Medicine, 1750-1 Ikenobe, Miki, Kagawa, 761-0793, Japan.
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Elliott AM, Evans JA. The association of split hand foot malformation (SHFM) and congenital heart defects. ACTA ACUST UNITED AC 2008; 82:425-34. [DOI: 10.1002/bdra.20452] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Chen CP, Chen YJ, Chern SR, Tsai FJ, Chang TY, Lee CC, Town DD, Lee MS, Wang W. Prenatal diagnosis of concomitant Wolf–Hirschhorn syndrome and split hand-foot malformation associated with partial monosomy 4p (4p16.1→pter) and partial trisomy 10q (10q25.1→qter). Prenat Diagn 2008; 28:450-3. [DOI: 10.1002/pd.1993] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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South ST, Whitby H, Battaglia A, Carey JC, Brothman AR. Comprehensive analysis of Wolf–Hirschhorn syndrome using array CGH indicates a high prevalence of translocations. Eur J Hum Genet 2007; 16:45-52. [PMID: 17726485 DOI: 10.1038/sj.ejhg.5201915] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Wolf-Hirschhorn syndrome (WHS) is caused by deletions involving chromosome region 4p16.3. The minimal diagnostic criteria include mild-to-severe mental retardation, hypotonia, growth delay and a distinctive facial appearance. Variable manifestations include feeding difficulties, seizures and major congenital anomalies. Clinical variation may be explained by variation in the size of the deletion. However, in addition to having a deletion involving 4p16.3, previous studies indicate that approximately 15% of WHS patients are also duplicated for another chromosome region due to an unbalanced translocation. It is likely that the prevalence of unbalanced translocations resulting in WHS is underestimated since they can be missed using conventional chromosome analyses such as karyotyping and WHS-specific fluorescence in situ hybridization (FISH). Therefore, we hypothesized that some of the clinical variation may be due to an unrecognized and unbalanced translocation. Array comparative genomic hybridization (aCGH) is a new technology that can analyze the entire genome at a significantly higher resolution over conventional cytogenetics to characterize unbalanced rearrangements. We used aCGH to analyze 33 patients with WHS and found a much higher than expected frequency of unbalanced translocations (15/33, 45%). Seven of these 15 cases were cryptic translocations not detected by a previous karyotype combined with WHS-specific FISH. Three of these 15 cases had an unbalanced translocation involving the short arm of an acrocentric chromosome and were not detected by either aCGH or subtelomere FISH. Analysis of clinical manifestations of each patient also revealed that patients with an unbalanced translocation often presented with exceptions to some expected phenotypes.
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Affiliation(s)
- Sarah T South
- Division of Medical Genetics, Department of Pediatrics, University of Utah, Salt Lake City, UT, USA.
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Levaillant JM, Touboul C, Sinico M, Vergnaud A, Serero S, Druart L, Blondeau JR, Abd Alsamad I, Haddad B, Gérard-Blanluet M. Prenatal forehead edema in 4p- deletion: the ‘Greek warrior helmet’ profile revisited. Prenat Diagn 2005; 25:1150-5. [PMID: 16258951 DOI: 10.1002/pd.1246] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVES Deletion of short arm of chromosome 4 is difficult to ascertain prenatally, and can be missed. METHODS A prenatal suspicion of 4p- syndrome was thoroughly investigated by using two-dimensional and three-dimensional sonography, with a description of the fetal face dysmorphological pattern. The cytogenetic confirmation, obtained by karyotype and FISH technique, allowed a precise description of the prenatal abnormalities. Post-termination tridimensional helicoidal scanner of the fetal face was performed. RESULTS The main anomaly discovered using two-dimensional sonography was the presence of a strikingly thick prefrontal edema (8 mm, twice the normal values, at 22 weeks: 3.81 +/- 0.62 mm). Three-dimensional sonography showed the classical postnatal profile, with the phenotypic aspect of a 'Greek warrior helmet'. Nasal bones were normal in size and placement, confirmed by helicoidal scanner. CONCLUSION Prenatal diagnosis of 4p deletion syndrome can be difficult, and it is the presence of prefrontal edema, associated with more subtle facial anomalies (short philtrum, microretrognathia) which should trigger cytogenetic investigation for 4p- deletion, even with only borderline growth retardation.
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Affiliation(s)
- J M Levaillant
- Obstetrics, Centre Hospitalier Intercommunal, Créteil, France.
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De Keersmaecker B, Albert M, Hillion Y, Ville Y. Prenatal diagnosis of brain abnormalities in Wolf-Hirschhorn (4p-) syndrome. Prenat Diagn 2002; 22:366-70. [PMID: 12001188 DOI: 10.1002/pd.318] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
OBJECTIVES Although there have been occasional reports of prenatal diagnosis of this syndrome, most cases are diagnosed postnatally. The objective was to evaluate the presence of brain abnormalities in the prenatal diagnosis of Wolf-Hirschhorn syndrome. METHODS Prenatal ultrasound and MRI examination of the fetal brain were performed in a case of Wolf-Hirschhorn syndrome. A comprehensive review of Wolf-Hirschhorn syndrome reported between 1960 and 2000 in the literature was carried out. RESULTS The late diagnosis of a growth-retarded fetus with normal amniotic fluid volume, normal Doppler and negative infection screen calls for a detailed examination of the fetal brain and heart. Multifocal white matter lesions and periventricular cystic changes, which are often attributed to perinatal distress, are possible prenatal features causing suspicion of 4p- syndrome in an IUGR fetus. CONCLUSION Subtle abnormalities on ultrasound may suggest a chromosomal problem. Standard cytogenetics cannot always demonstrate a microdeletion. High-resolution banding and molecular analysis can help to confirm the diagnosis.
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