Three further cases of triploidy in man surviving to birth

Maternal complications in molecularly confirmed diandric and digynic triploid pregnancies: single institution experience and literature review

Objectives

Assessment of the maternal complications in molecularly confirmed diandric and digynic triploid pregnancies.

Methods

Sonographic features, biochemical results, and clinical presentation were analyzed. Beta-hCG level was controlled after diandric triploidy.

Results

The study included nine diandric and twelve digynic triploid pregnancies at the mean gestational age at diagnosis of 14.9 and 18.0 weeks, respectively (p = 0.0391). Mean value of total-hCG was 979 703.6 U/ml in diandric cases and 5 455.4 U/ml in digynic ones (p < 0.000). Maternal complications occurred in 88.9% of diandric triploid pregnancies, including: thecalutein cysts (44.4%), hyperemesis gravidarum (44.4%), symptomatic hyperthyreosis (33.3%), early onset gestational hypertension (22.2%) and vaginal bleeding (11.1%). No case of proteinuria, preeclampsia or HELLP syndrome was observed. Only maternal complication observed in digynic triploidy was vaginal bleeding (50.0%). The mean time of beta-hCG normalization after diandric triploid pregnancies was 84 days (range 11–142 days). No case of gestational trophoblastic neoplasia (GTN) was observed.

Conclusions

Maternal complications (except for vaginal bleeding) are associated with diandric triploidy. The relatively low incidence of hypertensive maternal complications and their less severe course in our cohort may be attributed to the earlier prenatal diagnosis. The frequency of GTN after diandric triploidy may be lower than previously reported.

Flow cytometric studies in spontaneous abortions. Applications in the medico-legal practice

In the medico-legal practice differential diagnosis between spontaneous and non-spontaneous abortion is important because causes of pregnancy wastage are often obscure and, moreover, spontaneous abortion is more common than accidental or voluntary. In all the cases in which the cause of abortion is not otherwise detectable and especially in cases of discovery of fetal adnexa, it is necessary to investigate genetic causes. Recently, DNA flow cytometric analysis has been applied in determining the genetic causes of spontaneous abortions. Among karyotypic abnormalities, flow cytometric analysis on paraffin embedded material can detect only polyploidies (triploidy and tetraploidy). Trisomies, monosomies and structural anomalies cannot be detected. In our study we tried to establish whether flow cytometry could be useful in determining the genetic cause of spontaneous abortions, in the lack of any other detectable cause. Histologic examination and flow cytometric analysis were performed on a series of 395 consecutive spontaneous abortions. Histologic examination allowed the detection of a molar pattern in about 9% of cases. DNA flow cytometric analysis showed diploidy in 346 (87.59%) cases, triploidy in 37 (9.36%) cases and tetraploidy in 12 (3.03%) cases. Combined microscopic and flow cytometric analysis revealed abnormalities in 17.5% of cases. A non-diploid pattern is more frequent in molar cases (P less than 0.001). Flow cytometry seems to be interesting in forensic pathology, as it allows the detection of some frequent genetic abnormalities in dead tissues and cells, when other techniques are no longer practicable.

Triploidy syndrome in a liveborn female

We present the autopsy report of a liveborn triploid female, born after 36 weeks of gestation, who died at the age of 20 hours. External features were diagnostic: fetal hypoplasia, hypertelorism, microstomia, micro-and retrognathia, preauricular skin tag, low-set ears, and 3-4 syndactylia. All internal organs were hypoplastic. There were atrial and ventricular septal defects. Adrenals and kidneys were fused, the gallbladder was absent, and ovarian hilum cell were found to be hyperplastic. Triploidy, 69xxx, was confirmed cytogenetically. The placenta was hypoplastic and, microscopically, revealed a peculiar type of immaturity, so-called hydatidiform villous hypoplasia, findings which have not been previously reported. We suggest that the generalized fetal and placental hypoplasia and the severe hypoplasia of all internal organs are caused by a proliferative deficiency of the triploid cells. In addition, the nuclear DNA content was determined by cytophotometrically from placental stromal cells and was found to be about 50% above the normal diploid DNA value; i.e., a triploid DNA value was confirmed.

Diploid-triploid mosaicism: report of necropsy findings

This is the first report of necropsy findings associated with diploid-triploid mosaicism. The important pathological findings are presented and compared to those of pure triploidy and those noted in noninvasive studies of diploid-triploid mosaics. The clinical findings in this patient are compared with those of other reported cases.

Morphologic anomalies in triploid liveborn fetuses

Analysis of the morphologic features of 43 complete and 11 mosaic triploid infants delivered at or after 22 weeks of gestation revealed, in addition to well-delineated gross features, a number of new or previously little emphasized histopathologic features. These included testicular Leydig cell hyperplasia, increased levels of hematopoiesis, and ovarian, adrenal, and pulmonary hypoplasia. Some of these findings appeared to be linked to partial hydatidiform mole replacing the normal placenta, which was present in about 70 per cent of the triploid cases. It is important to recognize the breadth of the triploidy spectrum, which ranges from near normalcy to multisystem involvement, and to pay special attention to the placenta. The importance of correct morphologic diagnosis of triploidy is stressed in view of the fact that its occurrence apparently does not prejudice the future reproductive performance of the parents.

Prenatal diagnosis of triploidy

Two cases of late midtrimester triploid gestation are presented. This unusual condition might be suspected in cases of first and second trimester bleeding when the uterus appears to be unusually large as estimated by the menstrual history. Early presence of gestational hypertension also points suggestively toward a triploid fetus. Ultrasound examination of the placenta typically shows multiple sonolucent areas. Confirmation of diagnosis is made by karyotyping cells obtained from amniotic fluid. The condition is incompatible with life and termination of pregnancy is indicated. It is considered prudent to follow HCG levels for evidence of persistent trophoblastic tissue.

Human triploidy: association with partial hydatidiform moles and nonmolar conceptuses

A retrospective pathologic review of nearly 100 spontaneous abortions of cytogenetically verified triploid constitution revealed a majority (86 per cent) falling within the category of partial hydatidiform mole, the chief criteria being focal syncytiotrophoblastic hyperplasia, focal villous edema leading to cistern formation, scalloped outline of villi, and frequent "trophoblastic inclusion" formation. The minority (14 per cent) of the conceptuses were nonmolar with a normal or hypoplastic trophoblast. The triploid fetuses in both groups tended to die at about eight weeks' menstrual age. Intrauterine retention was generally prolonged in the partial moles, whereas nonmolar conceptuses tended to abort within the first trimester, often with live or recently dead fetuses. The problem of two distinct morphologic entities within triploidy remains to be further investigated, especially with respect to the etiologic factors responsible for the division.

Triploidy in human abortions

Seven triploid embryos and fetuses, six spontaneously aborted and one resulting from pregnancy interruption are described. A wide range of malformations, from amorphous, nodular embryos, to apparently normal phenotypes were observed. The degree of hydatid degeneration in the placentae ranged from minimal to severe. In several cases large, atypical cells were present in the villous stroma. There was no apparent correlation between the degree of placental lesion and fetal malformations. It is suggested that termination of triploid pregnancies is determined more by the degree of placental damage rather than the severity and type of fetal anomalies.

Ocular findings in triploidy

We studied the abnormal ocular and systemic findings in one case of true triploidy and two cases of triploid mosaicism. A liveborn triploid child 69,XXY, had abnormalities including cebocephaly, a single midline nostril, incomplete cleft palate, transverse palmar creases, partial syndactyly, and ambiguous genitalia. Ocular abnormalities included hypotelorism, blepharophimosis, microcornia, iris coloboma, cataract, persistent hyaloid vasculature, retinal dysplasia, and optic atrophy. A 16-year-old girl with triploid mosaicism had congenital left facial and body hemiatrophy, both growth and mental retardation, left-sided grand mal seizures, incontinentia pigmenti of both legs, partial syndactyly, and generalized weakness. Results of her ocular examination were within normal limits. A 13-year-old boy with triploid mosaicism exhibited both growth and mental retardation, truncal obesity, and required a brace to support his back. Ocular findings included synophrys, bilateral blepharoptosis, and abnormal results of Schirmer tear test. Studies indicate a wide spectrum of ocular and systemic abnormalities occur that are presumably associated with the chromosome error.

Unusually long survival in a case of full triploidy of maternal origin

A female newborn with full triploidy and multiple malformations, who survived for 2 months, is presented. In all examined lymphocytes and fibroblasts a 69,XXX karyotype was found. Banding studies showed the presence of one 9qh in the mother and two 9qh chromosomes in the child, indicating that the triploidy arose from the failure to expel the second polar body.

Clinical details, cytogenic studies,and cellular physiology of a 69, XXX fetus, with comments on the biological effect of triploidy in man

A triploid fetus, 69, XXX, aborted spontaneously at 26 weeks' gestation. It had multiple abnormalities including syndactyly of the hands and feet single palmar creases, hypoplasia of the adrenals and ovaries, hypertrophy of thigh muscles, and abnormalities of the brain. The placenta was large and showed hydatidiform degeneration. The pregnancy had been complicated by acute dyspnoea, pre-eclampsia, and postpartum haemorrhage. Detailed cytogenetic studies, using banding and fluorescence techniques, were performed on fetus and parents. Meiotic studies were made on the fetal ovaries. Muscle cell differentiation and electrophysiological relationships of cultured skin fibriblasts were examined in an attempt to study the way in which the extra haploid set of chromosomes exerts its effect on the phenotype. The antenatal diagnosis of late triploidy is discussed. The finding that 25 per cent of late triploids have spina bifida is further evidence that meningomyelocele has a genetic component and strongly suggests that this results from chromosomal imbalance or a regulatory gene disturbance.

Pathomorphological changes in an early spontaneous abortus with triploidy (69, XXX)

Triploid (69,XXX) spontaneous abortus with a gestational age of 14--15 weeks (anatomical age of the embryo was 6 weeks) was analyzed macro- and microscopically. There were hydatidiform swelling and cystic degeneration of the villi, without proliferatio of the trophoblast of cells, aplasia of one umbilical artery. The embryo had the following anomalies: cranial and caudal hypoplasia; aplasia of the facial structures (aprosopia), ocular vesicles, nasal stalk, extremity buds, somites, upper jaw, hyoid and pharyngeal arches, esophagus; trachea, Rathke's pouch and oropharyngeal cavity; encephalocele, focal anomalous rudiments of cartilage in the chordamesoderm, atresia of the stomodeal foramen and persistance of the lenticular placode.

A diploid-triploid human mosaic with cytogenetic evidence of double fertilization

The karyotype 46,XX/69,XXY was found in a 13-year-old mentally subnormal patient with club feet, strabismus, eunuchoid habitus, small penis, midscrotal urethrovaginal opening, small descended left testis, and small undescended right testis; no ovarian tissue could be found at laparotomy. Triploid:diploid cell ratios were 60:40 and 4:96 in skin fibroblasts and curculating lymphocytes, respectively. In the triploid line, two of the no. 13 chromosomes had unusually large satellites and one of the no. 22 chromosomes had a brightly fluorescent zone on its short arms. The patient's father was heterozygous for both these autosomal markers; the mother carried neither marker. This, together with the single Y, indicated that the extra haploid set was derived from the father. Of several possible mechanisms, we favor the suggestion that double fertilization occurred; one sperm nucleus immediately fused with the egg nucleus producing the diploid line; the second sperm nucleus was incorporated later into one of the two cells resulting from the first division of the zygote, producing the triploid line.

[Triploidy as a cause of midtrimester gestosis(author's transl)]

The authors report a case of triploidy in a prematurely born child. The pregnancy was complicated by severe toxemia beginning during the second trimester and terminating in preeclampsia leading to cesarian section in the 33th week of gestation. The externally female child was underweight, hypotonic and asphyctic and died shortly after birth. She exhibited a complex brain malformation including excessive hydrocephaly, cebocephaly and aplasia of the piturary gland, and multiple dysmorphic signs. Autopsy revealed hypoplasia and dysplasia of the adrenal glands; no uterus, tubes and ovaries were present, but no testes were found. The placenta showed localized hydatidiform degeneration and was relatively large. The karyotype was 69,XXY, and with the aid of fluorescence markers, paternal origin of the additional haploid chromosome set was demonstrated. Typical findings in pregnancies with fetal triploidy are discussed and the possibility of prenatal diagnosis of triploidy by chromosome analysis in cultivated amniotic fluid cells is pointed out.