True hermaphroditism or gonadal intersexuality. Cytogenetic and gonadal analyses of 5 new examples related to 67 known cases studied cytogenetically

A Case Report of a Rare 46,XX/47,XXY Mosaicism With Ovotesticular Disorder of Sex Development and a Literature Review

Klinefelter syndrome (KS) is a common chromosomal abnormality in males, usually presenting as a 47,XXY karyotype and often underdiagnosed. Rarely, KS occurs as mosaic 46,XX/47,XXY. At the same time, ovotesticular disorder of sex development (OT-DSD) is also a rare condition in which both ovarian and testicular structures are present in the same individual, often associated with a 46,XX karyotype. The combination of mosaic 46,XX/47,XXY with OT-DSD is scarce. Herein, we report a new case of a six-month-old infant with unilateral OT-DSD and a 46,XX/47,XXY mosaic karyotype who presented with atypical genitalia at birth. On examination, the external genitalia showed asymmetry of the labioscrotal folds, an empty right fold, a 2.5 cm phallic structure, and a perineal urethral meatus. Imaging studies revealed a uterus and a vaginal cavity, as well as an ovotestis on the left side and an ovarian remnant on the right side. An unexpected increase in testosterone level was observed. Cytogenetics analysis confirmed a mosaic karyotype with 54% of 46,XX and 46% 47,XXY cells. Molecular genetic analysis revealed no mutations in the genes involved in gonadal development. These findings are discussed and the clinical characteristics of the reported cases of 46,XX/47,XXY with OT-DSD are summarized. In conclusion, atypical genitalia leads to the early diagnosis of the rare 46,XX/47,XXY mosaicism with OT-DSD. Mosaicism should be considered in all cryptorchidism cases. Persistent Müllerian structures were common, and the nearly male phenotype of the external genitalia led parents to prefer the male sex of rearing.

Klinefelter Syndrome Mosaicism 46,XX/47,XXY: A New Case and Literature Review

Most cases of Klinefelter syndrome (KS) have 47,XXY karyotype. We reported the first case of 46,XX/47,XXY KS whose genital ambiguity was detected prenatally with postnatal confirmation of the mosaicism and ovotesticular disorder of sex development (OT-DSD). The paternal origin of the extra X chromosome was identified using trio cytogenomic single-nucleotide polymorphism array. Additional 18 cases were also reviewed. The clinical presentation of 46,XX/47,XXY is age-dependent with two age peaks, including ambiguous genitalia during infancy and gynecomastia with or without cyclical hematuria and left scrotal pain and mass in adolescence. The 46,XX is the predominant karyotype both in peripheral blood and gonadal tissue. The risk of germ cell tumor is very high throughout life in these individuals. Individuals with 46,XX/47,XXY mosaicism should be treated more as OT-DSD other than a simple mosaic KS. A multidisciplinary approach and long-term monitoring are necessary.

True hermaphroditism: a rational appraoch to diagnosis and treatment

Eight previously unreported cases of true hermaphroditism are presented, and their basic characteristics are described and discussed with regard to diagnosis and management. Two basic groups are identified: those diagnosed prior to establishment of gender role and those diagnosed at a later date. The latter group should benefit from therapy designed to enhance and maintain their sex of rearing, while the former group should be reconstructed according to functional considerations first and fertility considerations second. Diagnostic criteria are evaluated, and the value of the exploratory laparotomy is stressed.

The diagnosis and management of intersex

The patient whose genitalia are ambiguous or are inappropriate for the assigned sex presents the physician with a set of problems requiring a thorough grasp of sexual differentiation, development and function. Although several reviews have covered various aspects of these matters, these texts do not cover recent advances in understanding normal and abnormal sexual development nor do they provide an integrated guide to the management of intersex cases. Our objectives are to show the clinical relevance of recent advances in understanding the determinants of normal and abnormal sexual differentiation, to indicate the improved diagnostic procedures now available and to provide specific guidelines for optimal case management in the light of current medical knowledge and psychological and ethical understanding.

Asymmetrical gonadal enlargement in adolescent true hermaphrodite with bilateral ovotestes

A case of gynecomastia and asymmetrical gonadal enlargement in a thirteen and one-half-year-old "male" true hermaphrodite with biopsy-proved bilateral ovotestes is presented. The pathology, genetics, endocrinology, and management of this entity are discussed and compared with instances of hermaphroditism in which there is distinct separation of the ovarian and testicular tissues.

True hermaphrodite with multiple gonadal neoplasms: report of a case with cytogenetic study

On account of the functioning bigonads, true hermaphrodites show a wide range of morphological anomalies. The patient under discussion had an ovary on one side and an ovotestis on the other side; both of them functioned to some extent to produce a rudimentary uterus, fallopian tubes and a few Woolfian remnants. The additional point of interest in this report was the presence of three gonadal neoplasms-namely Yolk Sac Carcinoma gonadoblastoma and seminoma. While the ovary on one side was replaced by yolk sac carcinoma, the ovotestis was partly destroyed by the other two. The cytogenetic study revealed a hypodiploid number and a mosaic sex chromosomal pattern. The karyotypic abnormalities noticed in the patient are also reviewed.

Pregnancy and childbirth in a true hermaphrodite following reconstructive surgery

An 18-year-old Tanzanian true hermaphrodite became pregnant one month after reconstructive vaginal surgery. Chromosomal analysis of the mother showed a 46 XX constitution; a chromosome 21 carried a large short arm which might have contained Y chromosome material.

Malignant gonadal tumour formation in intersexual states

Two cases of malignant tumour are reported in phenotypically male hermaphrodites. The importance of establishing the presence of persistent Müllerian duct structures in pseudo-hermaphrodites is discussed in relation to prophylactic castration in anticipation of malignant change.

True hermaphroiditism: cytogenetic analysis, surgical repair, and social implications

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