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Ultrasound and molecular prenatal diagnosis of Beckwith-Wiedemann syndrome: Two case reports. Radiol Case Rep 2022; 17:4914-4919. [PMID: 36281281 PMCID: PMC9586847 DOI: 10.1016/j.radcr.2022.09.066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 09/18/2022] [Indexed: 11/21/2022] Open
Abstract
Beckwith-Wiedemann syndrome (BWS) is a rare genetic disease, characterized by macrosomia, congenital malformations and tumor predisposition, associated with genetic and epigenetic alterations in the 11p15 region. Most cases are diagnosed after birth, with prenatal diagnosis being difficult and depending on the identification of specific ultrasound anomalies, namely macrosomia, macroglossia, omphalocele and renal dysplasia. Case 1: Ultrasound diagnosis at 13 weeks of isolated omphalocele with normal array. At 20 weeks, there were shortened fetal long bones, foot deformity, macroglossia, corpus callosum hypoplasia and bilateral nephromegaly. Due to the polymalformative syndrome, a termination of pregnancy (TOP) was performed. The anatomopathological study of the placenta identified mesenchymal dysplasia. The search for the methylation pattern of the 11p15 region by MS-MLPA was normal and the molecular study of the CDKN1C gene identified a likely pathogenic variant, inherited from the mother. Case 2: Morphological ultrasound at 21 weeks revealed macrosomia, macroglossia, omphalocele, bilateral renal dysplasia, and hydramnios. The cytogenetic study, after amniocentesis, was normal (46,XX karyotype). TOP was performed. The anatomopathological study of the fetus confirmed the described malformations and the one concerning the placenta identified placentomegaly. The search for the methylation pattern of the 11p15 region by MS-MLPA revealed abnormal methylation. These results confirmed the diagnosis of BWS in both cases. Prenatal ultrasound suspicion of this pathology is extremely important to guide the conduct in pregnancy and/or the prevention of perinatal complications. Shortened fetal long bones and foot deformity complement the broad spectrum of this syndrome. Positive molecular tests allow confirming the diagnosis, assessing the risk of recurrence and guiding the surveillance of future pregnancy.
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Style CC, Cruz SM, Lau PE, Lee TC, Wesson DE, Olutoye OO. Surgical Outcomes of Patients with Beckwith-Wiedemann Syndrome. J Pediatr Surg 2018; 53:1042-1045. [PMID: 29551244 DOI: 10.1016/j.jpedsurg.2018.02.041] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Accepted: 02/01/2018] [Indexed: 01/03/2023]
Abstract
PURPOSE The purpose of this study was to evaluate treatment and surgical outcomes of patients of Beckwith-Wiedemann Syndrome (BWS) treated at a tertiary children's hospital. METHODS A retrospective review of infants evaluated at Texas Children's Hospital for BWS from August 2000 to December 2016 was performed. Data collected included demographic information, clinical presentation, genetic evaluation, fetal imaging, operative treatment, and outcomes. RESULTS Forty-seven children with a diagnosis of BWS were identified. Sixty-four percent (n=30) had a genetic mutation in an imprinting domain of chromosome 11p15. Thirty-two patients (68%) underwent at least one operation related to BWS with a median of 2 [range: 0-8] surgical procedures per patient. Sixteen underwent omphalocele repair, 12 had partial glossectomies-, 7 underwent surgeries related to hemihypertrophy, and 6 had resection of an embryonal tumor (two adrenal cortical adenoma, one Wilms' tumor, two hepatoblastoma). Overall, survival was 100% with feeding difficulty (47%) being the most frequent complication. CONCLUSION A substantial number of patients with Beckwith-Wiedemann Syndrome will require surgery. However, overall outcomes are similar between those that require surgery and those that do not. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Candace C Style
- Division of Pediatric Surgery, The Michael E. DeBakey Department of Surgery, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, United States
| | - Stephanie M Cruz
- Division of Pediatric Surgery, The Michael E. DeBakey Department of Surgery, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, United States
| | - Patricio E Lau
- Division of Pediatric Surgery, The Michael E. DeBakey Department of Surgery, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, United States
| | - Timothy C Lee
- Division of Pediatric Surgery, The Michael E. DeBakey Department of Surgery, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, United States
| | - David E Wesson
- Division of Pediatric Surgery, The Michael E. DeBakey Department of Surgery, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, United States
| | - Oluyinka O Olutoye
- Division of Pediatric Surgery, The Michael E. DeBakey Department of Surgery, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, United States.
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Storm DW, Hirselj DA, Rink B, O'Shaughnessy R, Alpert SA. The prenatal diagnosis of Beckwith-Wiedemann syndrome using ultrasound and magnetic resonance imaging. Urology 2010; 77:208-10. [PMID: 20573391 DOI: 10.1016/j.urology.2010.04.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2010] [Revised: 04/19/2010] [Accepted: 04/21/2010] [Indexed: 10/19/2022]
Abstract
Beckwith-Wiedemann syndrome is a rare congenital overgrowth syndrome. It carries important connotations for the pediatric urologist because it is associated with an increased risk for developing certain embryonal tumors. Until recently, these patients were not diagnosed until after birth; however, with newer imaging modalities, this syndrome may be diagnosed prenatally. We present a case of Beckwith-Wiedemann syndrome, depicting the prenatal modalities that may be used to diagnose this unusual condition.
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Affiliation(s)
- Douglas W Storm
- Section of Urology, Nationwide Children's Hospital, Columbus, OH 43205, USA.
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Greer KJ, Kirkpatrick SJ, Weksberg R, Pauli RM. Beckwith‐Wiedemann syndrome in adults: Observations from one family and recommendations for care. Am J Med Genet A 2008; 146A:1707-12. [DOI: 10.1002/ajmg.a.32332] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Grati FR, Turolla L, D'Ajello P, Ruggeri A, Miozzo M, Bracalente G, Baldo D, Laurino L, Boldorini R, Frate E, Surico N, Larizza L, Maggi F, Simoni G. Chromosome 11 segmental paternal isodisomy in amniocytes from two fetuses with omphalocoele: new highlights on phenotype-genotype correlations in Beckwith-Wiedemann syndrome. J Med Genet 2007; 44:257-63. [PMID: 17259293 PMCID: PMC2598040 DOI: 10.1136/jmg.2006.046854] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND The phenotypic variability in Beckwith-Wiedemann syndrome (BWS) reflects the genetic heterogeneity of the mechanism which by default leads to the deregulation of genes located at 11p15.5. Genotype-phenotype correlation studies have demonstrated an association between omphalocoele and CDKN1C/p57 mutations or hypermethylation. Paternal uniparental disomy 11 (pUPD11) has been described only in the mosaic condition with both uniparental and biparental cell lines, and no association with omphalocoele has been pointed out. METHODS Two cases are presented here, in which a paternal segmental UPD11 was detected by molecular investigation of amniotic fluid cell cultures after the presence of apparently isolated omphalocoele was revealed in the fetuses by ultrasound scan. Further studies were performed on additional autoptic feto-placental tissues to characterise the distribution of the uniparental cell line and to unmask any biparental lineage in order to document in more detail the as yet unreported association between omphalocoele and pUPD11. RESULTS Results on the UPD distribution profile showed that the abdominal organs have a predominant uniparental constitution. This condition could mimic the effect of CDKN1C/p57 inactivation, causing the omphalocoele. CONCLUSION New genotype-phenotype correlations emerge from the investigated cases, suggesting that molecular analysis be extended to all cases with fetal omphalocoele in order to establish the incidence of pUPD11 in complete BWS and in monosymptomatic/mild forms.
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Affiliation(s)
- F R Grati
- Unita' di Citogenetica e Biologia Molecolare, Laboratorio TOMA, Busto Arsizio, Varese, Italy.
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Abstract
OBJECTIVES The diagnosis of Beckwith-Wiedemann syndrome (BWS) typically is made after birth. To our knowledge, no established guidelines exist for the prenatal diagnosis of this condition. We present two new cases of prenatally diagnosed BWS and propose a diagnostic schema. METHODS Published reports obtained from Medline searches were reviewed and combined with our cases. RESULTS Our proposed schema of two major criteria (abdominal wall defect, macroglossia, macrosomia) or one major plus two minor criteria (nephromegaly/dysgenesis, adrenal cytomegaly, aneuploidy/abnormal loci, polyhydramnios) fits all published reports of prenatally diagnosed BWS. CONCLUSION The prenatal diagnosis of BWS can be reliably made by applying our proposed guidelines. This schema allows for uniform fetal diagnosis of the syndrome and helps prepare for prenatal counseling and peri- and post-natal management strategies.
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Affiliation(s)
- Daniel H Williams
- Department of Urology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois 60614, USA
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Affiliation(s)
- Colleen O'Connor
- Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215, USA
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Hamada H, Fujiki Y, Obata-Yasuoka M, Watanabe H, Yamada N, Kubo T. Prenatal sonographic diagnosis of Beckwith-Wiedemann syndrome in association with a single umbilical artery. JOURNAL OF CLINICAL ULTRASOUND : JCU 2001; 29:535-538. [PMID: 11745867 DOI: 10.1002/jcu.10017] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Beckwith-Wiedemann syndrome is an inherited disorder most commonly characterized by prenatal or postnatal overgrowth, macroglossia, omphalocele, unusual earlobe creases, and increased risk of neoplasia. Several reported cases of this syndrome have been prenatally diagnosed, but no report has described the occurrence of this syndrome in association with a single umbilical artery. We report a case in which prenatal sonographic examination demonstrated fetal overgrowth, macroglossia, and omphalocele together with a single umbilical artery; our prenatal diagnosis of Beckwith-Wiedemann syndrome was confirmed after birth of the infant. The possibility of this syndrome should be considered when performing a detailed sonographic examination of a fetus with a single umbilical artery.
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Affiliation(s)
- H Hamada
- Department of Obstetrics and Gynecology, Institute of Clinical Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki 305-8575, Japan
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Fremond B, Poulain P, Odent S, Milon J, Treguier C, Babut JM. Short Communication. Prenatal detection of a congenital pancreatic cyst and Beckwith–Wiedemann Syndrome. Prenat Diagn 1997. [DOI: 10.1002/(sici)1097-0223(199703)17:3<276::aid-pd52>3.0.co;2-7] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Weng EY, Mortier GR, Graham JM. Beckwith-Wiedemann syndrome. An update and review for the primary pediatrician. Clin Pediatr (Phila) 1995; 34:317-26. [PMID: 7656512 DOI: 10.1177/000992289503400605] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
- E Y Weng
- Medical Genetics-Birth Defects Center, Steven Spielberg Pediatric Research Center, Los Angeles, California, USA
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Weissman A, Mashiach S, Achiron R. Macroglossia: prenatal ultrasonographic diagnosis and proposed management. Prenat Diagn 1995; 15:66-9. [PMID: 7740001 DOI: 10.1002/pd.1970150114] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
A case in which macroglossia was the sole unusual prenatal sonographic finding in a fetus affected with trisomy 21 is presented. The differential diagnosis of fetal macroglossia is given, emphasizing its strong relationship to fetal aneuploidy, together with the principles for evaluation and management.
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Affiliation(s)
- A Weissman
- Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Tel Hashomer, Israel
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Affiliation(s)
- B Hewitt
- Fetal Diagnostic Unit, Monash Medical Centre, Melbourne
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Yankowitz J, Slagel DD, Williamson R. Prenatal diagnosis of Klippel-Trénaunay-Weber syndrome by ultrasound. Prenat Diagn 1994; 14:745-9. [PMID: 7527539 DOI: 10.1002/pd.1970140816] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Ultrasound examination due to an elevated maternal serum alpha-fetoprotein level showed lower extremity asymmetry. The findings were felt to be consistent with Klippel-Trénaunay-Weber syndrome. The pregnancy was terminated based on these findings. The ultrasound findings, confirming post-mortem examination, and counselling issues are discussed.
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Affiliation(s)
- J Yankowitz
- Department of Obstetrics and Gynecology, University of Iowa Hospitals and Clinics, Iowa City 52242-1080
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Whisson CC, Whyte A, Ziesing P. Beckwith-Wiedemann syndrome: antenatal diagnosis. AUSTRALASIAN RADIOLOGY 1994; 38:130-1. [PMID: 8024507 DOI: 10.1111/j.1440-1673.1994.tb00152.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
The Beckwith-Wiedemann syndrome is an unusual complex with variable features. The major findings include abdominal wall defects, macroglossia and visceromegaly. These features should be amenable to antenatal ultrasound detection. Only a few such cases have been reported to date. Antenatal diagnosis allows optimum perinatal care. Hypoglycaemia in the neonatal period is common in these babies and requires early detection and appropriate management to prevent long-term intellectual complications. We present a case where the diagnosis was suggested prior to delivery.
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Affiliation(s)
- C C Whisson
- Department of Radiology, Flinders Medical Centre, Bedford Park, Australia
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Dahl KR, Rouse GA, de Lange M. Prenatal Sonogra phic Evaluation of Beckwith-Wiedemann Syndrome. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 1993. [DOI: 10.1177/875647939300900506] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Beckwith-Wiedemann syndrome (BWS) was first described by Beckwith in 1963 and Wiedemann in 1964 as a syndrome of macroglossia, visceromegaly,. omphalocele, gigantism, and neonatal hypoglycemia. Additonal features of the syndrome, which occurs in approximately 1 in every 14,000 births, have been subsequently described. The authors report 2 cases of fetal BWS observed sonographically, and review 16 previously reported cases. Pohydramnios and growth acceleration may occur before 20 weeks, but macrlossia has not been reported before 28.5 weeks. Searching for ear creases in a fetus with suspected BWS may be merited, but visualization of normal ear lobes does not exclude the possibility of BWS.
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Affiliation(s)
| | - Glenn A. Rouse
- Department of Diagnostic Ultrasound, Loma Linda University Medical Center, Loma Linda, California
| | - Marie de Lange
- Department of Diagnostic Ultrasound, Loma Linda University Medical Center, 11234 Anderson Street, Loma Linda, CA 92354
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Abstract
A previously unreported family in which seven members in two generations have Beckwith-Wiedemann syndrome (BWS) is documented. Paternal imprinting of the gene responsible for BWS is involved as the mechanism responsible for the aberrant inheritance pattern in this kindred. A review of published reports showed 27 previously published pedigrees with two or more affected subjects with BWS. Paternal imprinting would explain the non-mendelian inheritance of BWS in all but four kindreds. The latter families are examined in more detail and in only one example is the evidence against imprinting totally unexplained.
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Affiliation(s)
- D Viljoen
- Department of Human Genetics, University of Cape Town Medical School, South Africa
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