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Saraiva M, Santos VMF, Ramos L, Ramos F, Serra-Caetano J, Cardoso R, Dinis I, Mirante A. Early Diagnosis of 46,XX Testicular Difference of Sexual Development: Unusual Presentation with Increased Nuchal Translucency. Fetal Pediatr Pathol 2024; 43:176-181. [PMID: 37902221 DOI: 10.1080/15513815.2023.2274831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 10/18/2023] [Indexed: 10/31/2023]
Abstract
INTRODUCTION 46,XX testicular disorder of sexual development (DSD) may present prenatally as a mismatch between phenotype and karyotype. Enlarged nuchal translucency is an abnormal sign of many disorders. We present a first trimester fetus with increased nuchal translucency that was later determined to be a 46,XX testicular DSD. CASE PRESENTATION A first-trimester pregnancy ultrasound revealed enlarged nuchal translucency. Chorionic villous sampling documented a 46,XX karyotype. Subsequent ultrasounds identified male external genitalia. FISH analysis documented a SRY gene translocation. At birth, the infant had normal male internal and external genitalia. CONCLUSIONS 46,XX testicular DSD may present in the first trimester with an enlarged nuchal translucency.
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Affiliation(s)
- Miguel Saraiva
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário de Santo António, Porto, Portugal
| | - Vera M F Santos
- Department of Medical Genetics, Centro Hospitalar Universitário de Coimbra, Coimbra, Portugal
| | - Lina Ramos
- Department of Medical Genetics, Centro Hospitalar Universitário de Coimbra, Coimbra, Portugal
| | - Fabiana Ramos
- Department of Medical Genetics, Centro Hospitalar Universitário de Coimbra, Coimbra, Portugal
| | - Joana Serra-Caetano
- Pediatric Endocrinology, Diabetes and Growth Unit, Centro Hospitalar Universitário de Coimbra, Coimbra, Portugal
| | - Rita Cardoso
- Pediatric Endocrinology, Diabetes and Growth Unit, Centro Hospitalar Universitário de Coimbra, Coimbra, Portugal
| | - Isabel Dinis
- Pediatric Endocrinology, Diabetes and Growth Unit, Centro Hospitalar Universitário de Coimbra, Coimbra, Portugal
| | - Alice Mirante
- Pediatric Endocrinology, Diabetes and Growth Unit, Centro Hospitalar Universitário de Coimbra, Coimbra, Portugal
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Wang C, Du J, Xiang X, Wang Y, Xiang J, Xu Q. 46, XX disorder of sexual development associated with mixed germ cell tumor of the prostate: a rare case report. BMC Urol 2024; 24:36. [PMID: 38347538 PMCID: PMC10860332 DOI: 10.1186/s12894-024-01420-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Accepted: 01/29/2024] [Indexed: 02/15/2024] Open
Abstract
BACKGROUND Extragonadal germ cell tumors originating from the prostate are exceptionally rare. To the best of our knowledge, there have been no reported cases of mixed germ cell tumors in individuals with 46 XX disorder of sex development. In this study, we conducted a comprehensive analysis using whole genome sequencing to investigate the clinicopathological and molecular genetic characteristics of a submitted case, with the objective of elucidating its underlying pathogenesis. CASE PRESENTATION A 40-year-old male patient was diagnosed with a combination of 46, XX disorder of sex development and a primary prostate mixed germ cell tumor with yolk sac tumor and teratoma components. Whole-genome sequencing revealed that the tumor cells had a high somatic mutational load. Analysis of genomic structural variations and copy number variants confirmed the patient's karyotype as 46, XX (SRY +). Additionally, the patient exhibited short stature, small bilateral testes, slightly enlarged breasts, elevated serum alpha-fetoprotein concentrations, elevated follicle-stimulating hormone and luteinizing hormone levels, and low testosterone levels. DISCUSSION A case of 46, XX disorder of sex development, along with a primary prostatic mixed germ cell tumor, was diagnosed. This diagnosis has contributed to advancing our understanding of the genetic and phenotypic profile of the disease and may provide some insights for its treatment.
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Affiliation(s)
- Changrong Wang
- Department of Pathology, Affiliated Hangzhou First People's Hospital, Westlake University School of Medicine, Hangzhou, 310006, China
| | - Jiangli Du
- Hangzhou Buping Medical LaboratoryCo., Ltd, Hangzhou, 310006, China
| | - Xueping Xiang
- Department of Pathology, Affiliated Second Hospital, Zhejiang University School of Medicine, Hangzhou, 310006, China
| | - Yuyong Wang
- Department of Urology, Affiliated Hangzhou First People's Hospital, Westlake University School of Medicine, Hangzhou, 310006, China
| | - Jingjing Xiang
- Department of Pathology, Affiliated Hangzhou First People's Hospital, Westlake University School of Medicine, Hangzhou, 310006, China
| | - Qiaoping Xu
- Department of Clinical Pharmacology, Affiliated Hangzhou First People's Hospital, Westlake University School of Medicine, Hangzhou, 310006, China.
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Politi C, Grillone K, Nocera D, Colao E, Bellisario ML, Loddo S, Catino G, Novelli A, Perrotti N, Rodolfo I, Malatesta P. Non-Invasive Prenatal Test Analysis Opens a Pandora's Box: Identification of Very Rare Cases of SRY-Positive Healthy Females, Segregating for Three Generations Thanks to Preferential Inactivation of the XqYp Translocated Chromosome. Genes (Basel) 2024; 15:103. [PMID: 38254992 PMCID: PMC10815901 DOI: 10.3390/genes15010103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 01/03/2024] [Accepted: 01/12/2024] [Indexed: 01/24/2024] Open
Abstract
The translocation of the testis-determining factor, the SRY gene, from the Y to the X chromosome is a rare event that causes abnormalities in gonadal development. In all cases of males and females carrying this translocation, disorder of sex development is reported. In our study, we described a peculiar pedigree with the first evidence of four healthy females from three generations who are carriers of the newly identified t(X;Y)(q28;p11.2)(SRY+) translocation with no evidence of ambiguous genitalia or other SRY-dependent alterations. Our study was a consequence of a Non-Invasive Prenatal Test (NIPT) showing a sexual chromosomal abnormality (XXY) followed by a chorionic villus analysis suggesting a normal karyotype 46,XX and t(X;Y) translocation detected by FISH. Here, we (i) demonstrated the inheritance of the translocation in the maternal lineage via karyotyping and FISH analysis; (ii) characterised the structural rearrangement via chromosomal microarray; and (iii) demonstrated, via Click-iT® EdU Imaging assay, that there was an absolute preferential inactivation of the der(X) chromosome responsible for the lack of SRY expression. Overall, our study provides valuable genetic and molecular information that may lead personal and medical decisions.
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Affiliation(s)
- Cristina Politi
- Medical Genetics, Renato Dulbecco University Hospital, Viale T. Campanella 115, 88100 Catanzaro, Italy; (C.P.); (K.G.); (D.N.); (E.C.); (M.L.B.); (N.P.); (P.M.)
| | - Katia Grillone
- Medical Genetics, Renato Dulbecco University Hospital, Viale T. Campanella 115, 88100 Catanzaro, Italy; (C.P.); (K.G.); (D.N.); (E.C.); (M.L.B.); (N.P.); (P.M.)
| | - Donatella Nocera
- Medical Genetics, Renato Dulbecco University Hospital, Viale T. Campanella 115, 88100 Catanzaro, Italy; (C.P.); (K.G.); (D.N.); (E.C.); (M.L.B.); (N.P.); (P.M.)
| | - Emma Colao
- Medical Genetics, Renato Dulbecco University Hospital, Viale T. Campanella 115, 88100 Catanzaro, Italy; (C.P.); (K.G.); (D.N.); (E.C.); (M.L.B.); (N.P.); (P.M.)
| | - Michelle Li Bellisario
- Medical Genetics, Renato Dulbecco University Hospital, Viale T. Campanella 115, 88100 Catanzaro, Italy; (C.P.); (K.G.); (D.N.); (E.C.); (M.L.B.); (N.P.); (P.M.)
| | - Sara Loddo
- Laboratory of Medical Genetics, Translational Cytogenomics Research Unit, Bambino Gesù Children Hospital, Scientific Institute for Research, Hospitalization and Healthcare (IRCCS), 00146 Rome, Italy; (S.L.); (G.C.); (A.N.)
| | - Giorgia Catino
- Laboratory of Medical Genetics, Translational Cytogenomics Research Unit, Bambino Gesù Children Hospital, Scientific Institute for Research, Hospitalization and Healthcare (IRCCS), 00146 Rome, Italy; (S.L.); (G.C.); (A.N.)
| | - Antonio Novelli
- Laboratory of Medical Genetics, Translational Cytogenomics Research Unit, Bambino Gesù Children Hospital, Scientific Institute for Research, Hospitalization and Healthcare (IRCCS), 00146 Rome, Italy; (S.L.); (G.C.); (A.N.)
| | - Nicola Perrotti
- Medical Genetics, Renato Dulbecco University Hospital, Viale T. Campanella 115, 88100 Catanzaro, Italy; (C.P.); (K.G.); (D.N.); (E.C.); (M.L.B.); (N.P.); (P.M.)
- Department of Human Health, University Magna Graecia of Catanzaro, Campus S. Venuta, Viale Europa, Località Germaneto, 88100 Catanzaro, Italy
| | - Iuliano Rodolfo
- Medical Genetics, Renato Dulbecco University Hospital, Viale T. Campanella 115, 88100 Catanzaro, Italy; (C.P.); (K.G.); (D.N.); (E.C.); (M.L.B.); (N.P.); (P.M.)
- Department of Human Health, University Magna Graecia of Catanzaro, Campus S. Venuta, Viale Europa, Località Germaneto, 88100 Catanzaro, Italy
| | - Paola Malatesta
- Medical Genetics, Renato Dulbecco University Hospital, Viale T. Campanella 115, 88100 Catanzaro, Italy; (C.P.); (K.G.); (D.N.); (E.C.); (M.L.B.); (N.P.); (P.M.)
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Leydig Cell Tumor in a Patient with 46,XX Disorder of Sex Development (DSD), Ovotesticular: A Case Report and a Review of the Literature. Case Rep Pathol 2021; 2021:5552305. [PMID: 33859857 PMCID: PMC8024097 DOI: 10.1155/2021/5552305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 03/16/2021] [Accepted: 03/18/2021] [Indexed: 11/17/2022] Open
Abstract
Disorder of sex development (DSD) is a rare condition with atypical development of chromosomal, gonadal, or anatomical sex. It is classified in different subgroups based on the patient's karyotype, gonadal dysgenesis, and the appearance of the internal and external genitalia. Within the subgroups, the risk for developing neoplasms varies a lot. Here, we report the case of a 41-year-old patient with disorder of sex development, showing a 46,XX karyotype with an ovotestis and the simultaneous manifestation of a Leydig cell tumor in the ovotestis. The patient initially presented with infertility, and a suspicious lesion of the left testicle was noted on MRI-Scan. Upon resection, a Leydig cell tumor and an ovotestis were diagnosed. Nongerm call tumors are rare in patients with DSD. We report a nongerm cell tumor in a patient with 46,XX DSD, ovotesticular. This shows that although 46,XX DSD, ovotesticular is known to have a low potential for germ cell neoplasia, nongerm cell tumors can develop and should be into account for the management of those patients.
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Ashfaq S, Siddiqui A, Shafiq W, Azmat U. A Rare Presentation of Disorder of Sex Development. Cureus 2021; 13:e12782. [PMID: 33628654 PMCID: PMC7890592 DOI: 10.7759/cureus.12782] [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] [Indexed: 11/05/2022] Open
Abstract
Disorder of sex development (DSD) is the term ascribed to a wide group of disorders presenting with congenital discord between chromosomal sex and phenotypic manifestation. Its incidence is 1 in 4500 births. 46 XX testicular DSD is a rare disorder characterized by the discordance between female karyotype and male phenotype. Its incidence is 1:20,000 to 25,000 male infants. It is further classified into SRY positive and SRY negative individuals, depending on the presence or absence of sex-determining region Y gene (SRY) on the X chromosome as a result of translocation. We are hereby reporting a rare case of de la Chapelle syndrome (SRY negative). A 30-year-old phenotypical male presented to us with complaints of primary infertility. He had had hypospadias during his childhood and underwent corrective surgery at the age of 18 years. For the previous 1.5 years, he had been complaining of decreased libido, difficulty in micturition, and presence of watery ejaculate. On examination, he had bilateral palpable testis with the testicular volume of 7 mL each, curved micropenis with chordee, and eccentric meatus with fistula. Semen analysis revealed azoospermia and hormonal profile was consistent with hypergonadotropic hypogonadism. His karyotyping turned out to be 46 XX chromosome without the SRY gene on polymerase chain reaction (PCR) array. He was medically treated with testosterone and underwent surgical correction of chordee. The SRY negative testicular 46 XX disorder is a rare expression and can be diagnosed at the time of birth with the presence of severe hypospadias, cryptorchidism, or ambiguous genitalia. All new-borns with these findings should undergo evaluation for the disorder of sexual development. Such individuals can never father a child and genetic counseling should be offered. Infertility is the main concern for such individuals which can be addressed by in vitro fertilization (IVF) with a sperm donor or adoption.
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Affiliation(s)
- Sara Ashfaq
- Endocrinology, Diabetes and Metabolism, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, PAK
| | - Ahmed Siddiqui
- Diabetes & Endocrinology and Internal Medicine, Jersey General Hospital, Jersey, JEY.,Endocrinology and Diabetes, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, PAK
| | - Waqas Shafiq
- Endocrinology and Diabetes Mellitus , General (Internal) Medicine, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, PAK
| | - Umal Azmat
- Diabetes, Endocrinology and Metabolism, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, PAK
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