1
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Clinical spectrum of female genital malformations in prenatal diagnosis. Arch Gynecol Obstet 2022; 306:1847-1862. [DOI: 10.1007/s00404-022-06441-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 02/09/2022] [Indexed: 11/02/2022]
Abstract
Abstract
Introduction
Fetal genital malformations represent a rare and heterogeneous group of congenital malformations of the disorders of sexual development (DSD) spectrum.
Methods
A thorough literature review on the main topics in the prenatal approach towards DSD was conducted.
Results
First, a thorough overview on prenatal characteristics of the most common fetal genital malformations of ovaries, uterus and external genitalia, and second, a standardized approach for differential diagnosis in the presence of direct and indirect prenatal signs of DSDs.
Conclusions
This review is mainly directed towards the aspects of female genital malformations with aspects of male DSD explained as well to aid in the prenatal differential diagnosis.
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2
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Yu FNY, Li EYY, Kong MCW, Ma TWL, Chan KYK, Man E, Chung BHY, Kan ASY. Increasing prenatal diagnosis of chimeras with the use of noninvasive prenatal screening: Report of two cases. Prenat Diagn 2021; 41:697-700. [PMID: 33527400 DOI: 10.1002/pd.5911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Revised: 12/26/2020] [Accepted: 01/19/2021] [Indexed: 11/09/2022]
Affiliation(s)
- Florrie N Y Yu
- Department of Obstetrics and Gynaecology, Queen Elizabeth Hospital, Hong Kong, China
| | - Elizabeth Y Y Li
- Department of Obstetrics and Gynaecology, United Christian Hospital, Hong Kong, China
| | - Meliza C W Kong
- Department of Obstetrics and Gynaecology, United Christian Hospital, Hong Kong, China
| | - Teresa W L Ma
- Department of Obstetrics and Gynaecology, Queen Elizabeth Hospital, Hong Kong, China
| | - Kelvin Y K Chan
- Department of Obstetrics and Gynaecology, Prenatal Diagnostic Laboratory, Tsan Yuk Hospital, Hong Kong, China.,Department of Obstetrics and Gynaecology, Queen Mary Hospital, Hong Kong, China
| | - Elim Man
- Department of Paediatrics and Adolescent Medicine, Hong Kong Children's Hospital, Hong Kong, China
| | - Brian H Y Chung
- Department of Paediatrics and Adolescent Medicine, The University of Hong Kong, Hong Kong, China
| | - Anita S Y Kan
- Department of Obstetrics and Gynaecology, Prenatal Diagnostic Laboratory, Tsan Yuk Hospital, Hong Kong, China.,Department of Obstetrics and Gynaecology, Queen Mary Hospital, Hong Kong, China
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3
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de Carvalho AFL, Pitanga PML, Alves ES, Miguel DSCG, Santo LDE, de Araújo AEF, Ornellas ACP, Toralles MBP. Chimerism 47,XY, + 8/46,XX: Follow-up for 11 Years. J Pediatr Genet 2020; 12:81-85. [PMID: 36684553 PMCID: PMC9848763 DOI: 10.1055/s-0040-1721440] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 10/16/2020] [Indexed: 01/25/2023]
Abstract
Approximately 30 sex chromosome discordant chimera cases have been reported to date. In particular, there are few reported cases of chimerism involving coexisting normal and abnormal lineages that each carries a distinct sex chromosome complement. To our knowledge, this is the first case of sexual chimerism with a simultaneous chromosomal aneuploidy involving chromosome 8. This report represents the data from 11 years of follow-up.
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Affiliation(s)
- Acácia Fernandes Lacerda de Carvalho
- Laboratory of Human Genetics and Mutagenesis, Institute of Biology, Federal University of Bahia, Salvador, Bahia, Brazil,Address for correspondence Acácia Fernandes Lacerda de Carvalho, PhD Laboratory of Human Genetics and Mutagenesis - Institute of Biology Universidade Federal da BahiaRua Barão de Geremoabo 147, CEP 40170-290 Salvador, BahiaBrazil
| | - Paula Monique Leite Pitanga
- Laboratory of Human Genetics and Mutagenesis, Institute of Biology, Federal University of Bahia, Salvador, Bahia, Brazil,DNA Laboratory – Laboratory Center for Genetics and Molecular Biology, Salvador, Bahia, Brazil
| | - Esmeralda Santos Alves
- DNA Laboratory – Laboratory Center for Genetics and Molecular Biology, Salvador, Bahia, Brazil,Department of Medical Genetics, Edgard Santos Teaching Hospital Academic, Federal University of Bahia, Salvador, Bahia, Brazil
| | | | - Laila Damasceno Espirito Santo
- Laboratory of Human Genetics and Mutagenesis, Institute of Biology, Federal University of Bahia, Salvador, Bahia, Brazil,DNA Laboratory – Laboratory Center for Genetics and Molecular Biology, Salvador, Bahia, Brazil
| | - Ana Eliete Fernandes de Araújo
- Laboratory of Human Genetics and Mutagenesis, Institute of Biology, Federal University of Bahia, Salvador, Bahia, Brazil
| | | | - Maria Betânia Pereira Toralles
- DNA Laboratory – Laboratory Center for Genetics and Molecular Biology, Salvador, Bahia, Brazil,Department of Medical Genetics, Edgard Santos Teaching Hospital Academic, Federal University of Bahia, Salvador, Bahia, Brazil
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4
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Natural human chimeras: A review. Eur J Med Genet 2020; 63:103971. [PMID: 32565253 DOI: 10.1016/j.ejmg.2020.103971] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 05/06/2020] [Accepted: 06/01/2020] [Indexed: 12/24/2022]
Abstract
The term chimera has been borrowed from Greek mythology and has a long history of use in biology and genetics. A chimera is an organism whose cells are derived from two or more zygotes. Recipients of tissue and organ transplants are artificial chimeras. This review concerns natural human chimeras. The first human chimera was reported in 1953. Natural chimeras can arise in various ways. Fetal and maternal cells can cross the placental barrier so that both mother and child may become microchimeras. Two zygotes can fuse together during an early embryonic stage to form a fusion chimera. Most chimeras remain undetected, especially if both zygotes are of the same genetic sex. Many are discovered accidently, for example, during a routine blood group test. Even sex-discordant chimeras can have a normal male or female phenotype. Only 28 of the 50 individuals with a 46,XX/46,XY karyotype were either true hermaphrodites or had ambiguous genitalia. Blood chimeras are formed by blood transfusion between dizygotic twins via the shared placenta and are more common than was once assumed. In marmoset monkey twins the exchange via the placenta is not limited to blood but can involve other tissues, including germ cells. To date there are no examples in humans of twin chimeras involving germ cells. If human chimeras are more common than hitherto thought there could be many medical, social, forensic, and legal implications. More multidisciplinary research is required for a better understanding of this fascinating subject.
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5
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Sakka SD, Mann K, Lachlan K, Davies JH, Bateman M, Holder-Espinasse M, Arya VB. Haematological chimerism masquerading as disorder of sex development. Clin Endocrinol (Oxf) 2020; 92:487-489. [PMID: 31943282 DOI: 10.1111/cen.14160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Accepted: 01/09/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Sophia D Sakka
- Department of Paediatric Endocrinology, Evelina London Children's Hospital, London, UK
- King's College London, London, UK
| | - Kathy Mann
- Viapath Genetics Laboratories, Guy's Hospital, London, UK
| | - Katherine Lachlan
- Wessex Clinical Genetics Service, Princess Anne Hospital, Southampton, UK
| | - Justin H Davies
- Department of Paediatric Endocrinology, Southampton General Hospital, Southampton, UK
| | - Mark Bateman
- Wessex Regional Genetics Laboratory, Salisbury District Hospital, Salisbury, UK
| | | | - Ved Bhushan Arya
- Department of Paediatric Endocrinology, King's College Hospital, London, UK
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6
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A case of a parthenogenetic 46,XX/46,XY chimera presenting ambiguous genitalia. J Hum Genet 2020; 65:705-709. [PMID: 32277176 DOI: 10.1038/s10038-020-0748-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 03/12/2020] [Accepted: 03/12/2020] [Indexed: 11/08/2022]
Abstract
Sex-chromosome discordant chimerism (XX/XY chimerism) is a rare chromosomal disorder in humans. We report a boy with ambiguous genitalia and hypospadias, showing 46,XY[26]/46,XX[4] in peripheral blood cells. To clarify the mechanism of how this chimerism took place, we carried out whole-genome genotyping using a SNP array and microsatellite analysis. The B-allele frequency of the SNP array showed a mixture of three and five allele combinations, which excluded mosaicism but not chimerism, and suggested the fusion of two embryos or a shared parental haplotype between the two parental cells. All microsatellite markers showed a single maternal allele. From these results, we concluded that this XX/XY chimera is composed of two different paternal alleles and a single duplicated maternal genome. This XX/XY chimera likely arose from a diploid maternal cell that was formed via endoduplication of the maternal genome just before fertilization, being fertilized with both X and Y sperm.
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7
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Choi EJ, Kim SR, Kim YJ, Kang SM, Kim GY, Kim JH, Lee YJ. Clinical and Genetic Analysis of an Infertile Male with 46,XX/46,XY Chimerism. Andrologia 2018; 51:e13215. [PMID: 30536450 DOI: 10.1111/and.13215] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Revised: 10/25/2018] [Accepted: 11/09/2018] [Indexed: 11/28/2022] Open
Abstract
The sex chromosome-discordant chimerism 46,XX/46,XY is rarely found in humans with a phenotypically normal appearance, and this lack of phenotypic changes and the rarity of chimerism make it difficult to identify its exact incidence. Here, we report a case of this sex chromosome-discordant chimerism diagnosed by cytogenic and molecular analyses of peripheral blood in a phenotypically normal male who was referred to our facility for infertility. Based on the karyotype, fluorescence in situ hybridisation (FISH) and short tandem repeat (STR) analyses, the type of this chimerism was determined to be tetragametic presenting four alleles at two loci on chromosomes 16 and 21.
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Affiliation(s)
- Eun Jung Choi
- iDream Research Center, Mizmedi Hospital, Seoul, Korea
| | | | - Young Joo Kim
- iDream Research Center, Mizmedi Hospital, Seoul, Korea
| | - Soo Man Kang
- iDream Research Center, Mizmedi Hospital, Seoul, Korea
| | - Gi Young Kim
- Department of Urology, Mizmedi Hospital, Seoul, Korea
| | - Jong Hyun Kim
- Department of Urology, Mizmedi Hospital, Seoul, Korea
| | - Young Jin Lee
- iDream Research Center, Mizmedi Hospital, Seoul, Korea
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8
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Fertilization and Early Embryonic Errors. CHIMERISM 2018. [DOI: 10.1007/978-3-319-89866-7_1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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9
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Boujenah J, Benzacken B, Pipiras E, Sifer C, Herbemont C, Cornelis F, Bricou A, Poncelet C. Fetal-maternal chimerism in peritoneal tissue implants after tubal ectopic pregnancy. ACTA ACUST UNITED AC 2016; 44:309-10. [PMID: 27105930 DOI: 10.1016/j.gyobfe.2016.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Indexed: 11/27/2022]
Affiliation(s)
- J Boujenah
- University Hospital Jean-Verdier, Department of Obstetrics, Gynecology and Reproductive Medecine, avenue du 14-Juillet, 93340 Bondy, France.
| | - B Benzacken
- University Hospital Jean-Verdier, Department of Cytogenetic, Embryology and Histology, avenue du 14-Juillet, 93340 Bondy, France
| | - E Pipiras
- University Hospital Jean-Verdier, Department of Cytogenetic, Embryology and Histology, avenue du 14-Juillet, 93340 Bondy, France
| | - C Sifer
- University Hospital Jean-Verdier, Department of Cytogenetic, Embryology and Histology, avenue du 14-Juillet, 93340 Bondy, France
| | - C Herbemont
- University Hospital Jean-Verdier, Department of Cytogenetic, Embryology and Histology, avenue du 14-Juillet, 93340 Bondy, France
| | - F Cornelis
- University Hospital Jean-Verdier, Department of Cytogenetic, Embryology and Histology, avenue du 14-Juillet, 93340 Bondy, France
| | - A Bricou
- University Hospital Jean-Verdier, Department of Obstetrics, Gynecology and Reproductive Medecine, avenue du 14-Juillet, 93340 Bondy, France
| | - C Poncelet
- University Hospital Jean-Verdier, Department of Obstetrics, Gynecology and Reproductive Medecine, avenue du 14-Juillet, 93340 Bondy, France
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10
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Serra A, Denzer F, Hiort O, Barth TF, Henne-Bruns D, Barbi G, Rettenberger G, Wabitsch M, Just W, Leriche C. Uniparental Disomy in Somatic Mosaicism 45,X/46,XY/46,XX Associated with Ambiguous Genitalia. Sex Dev 2015; 9:136-43. [PMID: 26043854 DOI: 10.1159/000430897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/31/2015] [Indexed: 11/19/2022] Open
Abstract
Disorders of sex development (DSD) affect the development of chromosomal, gonadal and/or anatomical sex. We analyzed a patient with ambiguous genitalia aiming to correlate the genetic findings with the phenotype. Blood and tissue samples from a male patient with penoscrotal hypospadias were analyzed by immunohistochemistry, karyotyping and FISH. DNA was sequenced for the AR, SRY and DHH genes, and further 26 loci in different sex chromosomes were analyzed by MLPA. The gonosomal origin was evaluated by simple tandem repeat (STR) analysis and SNP array. Histopathology revealed a streak gonad, a fallopian tube and a rudimentary uterus, positive for placental alkaline phosphatase, cytokeratin-7 and c-kit, and negative for estrogen, androgen and progesterone receptors, alpha-inhibin, alpha-1-fetoprotein, β-hCG, and oct-4. Karyotyping showed a 45,X/46,XY mosaicism, yet FISH showed both 46,XX/46,XY mosaicism (gonad and urethral plate), 46,XX (uterus and tube) and 46,XY karyotypes (rudimentary testicular tissue). DNA sequencing revealed intact sequences in SOX9, WNT4, NR0B1, NR5A1, CYP21A2, SRY, AR, and DHH. STR analysis showed only one maternal allele for all X chromosome markers (uniparental isodisomy, UPD), with a weaker SRY signal and a 4:1 ratio in the X:Y signal. Our findings suggest that the observed complex DSD phenotype is the result of somatic gonosomal mosaicism and UPD despite a normal blood karyotype. The presence of UPD warrants adequate genetic counseling for the family and frequent, lifelong, preventive follow-up controls in the patient.
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Affiliation(s)
- Alexandre Serra
- Division of Pediatric Surgery, Department of Surgery, University of Ulm, Ulm, Germany
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11
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Lee HJ, Yoon SC, Ko JM, Seong MW, Park SS, Choi JS, Oh SK. Monochorionic dizygotic twins with discordant sex and confined blood chimerism. Eur J Pediatr 2014; 173:1249-52. [PMID: 24706113 DOI: 10.1007/s00431-014-2312-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2014] [Revised: 03/23/2014] [Accepted: 03/25/2014] [Indexed: 02/05/2023]
Abstract
UNLABELLED Monochorionic (MC) pregnancy in humans is usually considered to be associated only with monozygotic twinning. However, several reports have revealed that dizygotic (DZ) twins can also share a chorion during pregnancy. A chimera is defined as an organism that contains different cells derived from two or more distinct zygotes. As artificial reproductive techniques develop, it can be predicted that the occurrence of MC DZ twins will increase, and DNA-fingerprinting methods, such as short tandem repeat (STR) analysis, will be essential for their accurate diagnosis. We report the first Korean case of MC DZ twins with blood chimerism, 46,XX/46,XY, as a consequence of in vitro fertilization/embryo transfer. The clinical phenotypes of the twins' genitalia were complete female and male, respectively. Monochorionicity was confirmed by pathological analysis of the placenta after delivery. The dizygosity and confined blood chimerism of the twins were confirmed by STR analysis using their peripheral lymphocytes and skin fibroblasts. The confined blood chimerism of the twins can be considered similar to the status of the hematopoietic system in patients after allogenic bone marrow transplantation. CONCLUSION When MC twins with discordant sex are expected during pregnancy, it is important to consider the possibility of DZ twins showing normal sexual development, especially in twins who were fertilized using artificial reproductive techniques.
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Affiliation(s)
- Hye Jin Lee
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 110-769, South Korea,
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12
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Lee KF, Hsu CS, Kuo PL, Chen JL, Jiang YH, Liu IY. The identification of a spontaneous 47, XX, +21/46, XY chimeric fetus with male genitalia. BMC MEDICAL GENETICS 2012; 13:85. [PMID: 22994271 PMCID: PMC3523066 DOI: 10.1186/1471-2350-13-85] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/12/2012] [Accepted: 09/13/2012] [Indexed: 11/29/2022]
Abstract
Background Approximately 30 sex-chromosome discordant chimera cases have been reported to date, of which only four cases carried trisomy 21. Here, we present an additional case, an aborted fetus with a karyotype of 47,XX, +21/46,XY. Case presentation Autopsy demonstrated that this fetus was normally developed and had male genitalia. Major characteristics of Down syndrome were not observed except an enlarged gap between the first and second toes. Karyotyping of tissues cultured from the fetus revealed the same chimeric chromosomal composition detected in the amniotic fluid but with a different ratio of [47,XX,+21] to [46,XY]. Further short tandem repeat analysis indicated a double paternal contribution and single maternal contribution to the fetus, with the additional chromosome 21 in the [47,XX,+21] cell lineage originating from the paternal side. Conclusion We thus propose that this chimeric fetus was formed via the dispermic fertilization of a parthenogenetic ovum with one (Y) sperm and one (X,+21) sperm.
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Affiliation(s)
- Kuei-Fang Lee
- Laboratory for Cytogenetics, Center for Genetic Counseling, Buddhist Tzu Chi General Hospital, Hualien, Taiwan
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13
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Sifakis S, Anagnostopoulou K, Plastira K, Vrachnis N, Konstantinidou A, Sklavounou E. Rare case of XX/XY mosaicism and trisomy 13 in early prenatal diagnosis. ACTA ACUST UNITED AC 2012; 94:245-8. [PMID: 22282126 DOI: 10.1002/bdra.22867] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2011] [Revised: 09/06/2011] [Accepted: 09/07/2011] [Indexed: 11/08/2022]
Abstract
Coexistence of XX/XY sex mosaicism and autosomal trisomy in prenatal diagnosis is particularly rare. Herein, we report the first, to our knowledge, case of a fetus with cyclopia, ambiguous genitalia and a 47,XX,+13,inv9[47]/47,XY,+13[13] karyotype detected at 13 weeks of gestation after chorionic villus sampling. Molecular analysis after prenatal diagnosis suggests that this is a case of sex mosaicism coexisting with trisomy 13, rather than chimera.
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Affiliation(s)
- Stavros Sifakis
- Department of Obstetrics & Gynecology, University Hospital of Heraklion, Crete, Greece
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14
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James PA, Rose K, Francis D, Norris F. High-level 46XX/46XY chimerism without clinical effect in a healthy multiparous female. Am J Med Genet A 2011; 155A:2484-8. [DOI: 10.1002/ajmg.a.34123] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2010] [Accepted: 04/24/2011] [Indexed: 11/06/2022]
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15
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Minelli A, Guala A, Groppo A, Restagno G, Lala R, Einaudi S, Repici M, Merlini E, Sbaiz L, Asnaghi V, Lopez AG, Angellotti P, Cristina S, Danesino C. Mechanism of origin in two cases of chimerism. ACTA ACUST UNITED AC 2011. [DOI: 10.4236/ojped.2011.14019] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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16
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Winberg J, Gustavsson P, Lagerstedt-Robinson K, Blennow E, Lundin J, Iwarsson E, Nordenström A, Anderlid BM, Bondeson ML, Nordenskjöld A, Nordgren A. Chimerism resulting from parthenogenetic activation and dispermic fertilization. Am J Med Genet A 2010; 152A:2277-86. [DOI: 10.1002/ajmg.a.33594] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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17
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Reddy KS, Schwartz GE, Jamedhor M. A fertile XY/XX chimeric male with chronic myeloid leukemia in a minor 46,XX cell line and a history of polycythemia vera and trisomy 9 in the major 46,XY cell line. Leuk Lymphoma 2009; 50:1375-80. [PMID: 19562617 DOI: 10.1080/10428190903047761] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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18
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Elucidation of abnormal fertilization by single-cell analysis with fluorescence in situ hybridization and polymorphic marker analysis. Fertil Steril 2009; 91:932.e3-6. [DOI: 10.1016/j.fertnstert.2008.08.083] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2008] [Revised: 08/14/2008] [Accepted: 08/14/2008] [Indexed: 01/03/2023]
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19
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One person with two DNA profiles: a(nother) case of mosaicism or chimerism. Int J Legal Med 2009; 123:427-30. [DOI: 10.1007/s00414-009-0331-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2008] [Accepted: 02/13/2009] [Indexed: 10/21/2022]
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20
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Ramsay M, Pfaffenzeller W, Kotze E, Bhengu L, Essop F, de Ravel T. Chimerism in black southern African patients with true hermaphroditism 46,XX/47XY,+21 and 46,XX/46,XY. Ann N Y Acad Sci 2009; 1151:68-76. [PMID: 19154517 DOI: 10.1111/j.1749-6632.2008.03570.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
True hermaphroditism is defined by the presence of both testicular and ovarian tissue in an individual. True hermaphrodites usually present at birth with ambiguous genitalia, and subsequent invasive investigations are needed to confirm the diagnosis. Several large cohorts of black South Africans with true hermaphroditism have been described, and by far the majority of those investigated had a 46,XX karyotype, with absence of the SRY sequence. This paper represents the first report of the molecular investigation of mosiacism/chimerism as the cause of hermaphroditism in black southern African patients. It is the second report worldwide of a 46,XX/47,XY,+21 chimera, with the first described in a Japanese infant in 1994. Case 1 in the present study is a child who is a 46,XX/47,XY,+21 tetragametic chimera. Molecular studies revealed two paternal and two maternal alleles at four of ten STR loci investigated and three alleles at four of these loci. The young boy exhibited no features of Down syndrome, other than a unilateral single palmar crease. Cases 2 and 3 both have a 46,XX/46,XY karyotype. Chimerism is supported by molecular analysis in Case 2, and molecular studies were not done for Case 3.
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Affiliation(s)
- M Ramsay
- Division of Human Genetics, National Health Laboratory Service and School of Pathology, University of the Witwatersrand, Johannesburg, South Africa.
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21
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Ovotesticular Disorder of Sexual Development (True Hermaphroditism). Urology 2009; 73:293-6. [PMID: 18822450 DOI: 10.1016/j.urology.2008.08.428] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2008] [Revised: 07/23/2008] [Accepted: 08/06/2008] [Indexed: 10/21/2022]
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22
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Abstract
We report a healthy and unambiguously female newborn, whose phenotypic sex contradicted the expected male sex based on previously performed prenatal cytogenetic analysis. Both 46,XX and 46,XY cells were detected in a villus sample, the former having been attributed to maternal cell contamination. Postnatal karyotyping in peripheral lymphocytes confirmed the presence of two cell lines, one 46,XX (70%) and one 46,XY (30%). After exclusion of alternative explanations for the observed genotype, a diagnosis of chimerism was made. Chimeras containing cell lines of opposite sex usually feature ovotesticular development with associated genital ambiguity. To account for the normal female appearance of our patient, we postulate the exclusive involvement of 46,XX cells in gonad formation.
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Affiliation(s)
- Mathijs Binkhorst
- Departments of Neonatology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
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23
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Van Opstal D, Boter M, de Jong D, van den Berg C, Brüggenwirth HT, Wildschut HIJ, de Klein A, Galjaard RJH. Rapid aneuploidy detection with multiplex ligation-dependent probe amplification: a prospective study of 4000 amniotic fluid samples. Eur J Hum Genet 2008; 17:112-21. [PMID: 18781187 DOI: 10.1038/ejhg.2008.161] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
The introduction of prenatal screening requires rapid high-throughput diagnosis of common aneuploidies. Multiplex ligation-dependent probe amplification (MLPA) allows for quick, easily automated multiplex testing of these aneuploidies in one polymerase chain reaction. We performed a large prospective study using MLPA on 4000 amniotic fluid (AF) samples including all indications and compared its value to karyotyping and fluorescence in situ hybridization (FISH). MLPA can reliably determine common aneuploidies with 100% sensitivity and 100% specificity. Moreover, some mosaic cases and structural chromosome aberrations were detected as well. In cases of a male fetus, triploidies can be detected by an aberrant pattern of probe signals, which mimics maternal cell contamination (MCC). Macroscopic blood contamination was encountered in 3.2% of the AF samples. In 20% of these samples, an MLPA pattern was found consistent with MCC, although there were no false negatives of the most common aneuploidies. As the vast majority of inconclusive results (1.7%) is due to potential MCC, we designed a protocol in which we determine whether MLPA can be performed on blood-contaminated AF samples by testing if blood is of fetal origin. Then, the number of inconclusive results could be theoretically reduced to 0.05%. We propose an alternative interpretation of relative probe signals for rapid aneuploidy diagnosis (RAD). We discuss the value of MLPA for the detection of (submicroscopic) structural chromosome anomalies. MLPA is a reliable method that can replace FISH and could be used as a stand-alone test for RAD instead of karyotyping.
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Affiliation(s)
- Diane Van Opstal
- Department of Clinical Genetics, Erasmus Medical Center, Rotterdam, The Netherlands
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Liao C, Yang X, Pan M, Li DZ. A 46,XY/46,XX mosaicism diagnosed at amniocentesis: another case report. Prenat Diagn 2007; 28:65-6. [DOI: 10.1002/pd.1908] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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