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Bbs K, Ad A, Djiwa T, B T, M K, Ke K, Na A. Ovotesticular disorder of sex development in a 46 XY adolescent: a rare case report with review of the literature. BMC Womens Health 2023; 23:549. [PMID: 37875919 PMCID: PMC10594775 DOI: 10.1186/s12905-023-02698-1] [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: 03/29/2023] [Accepted: 10/09/2023] [Indexed: 10/26/2023] Open
Abstract
INTRODUCTION Ovotestis is a rare cause of sexual ambiguity characterized by the presence in a patient of both testicular and ovarian tissue, leading to the development of both male and female structures. We report a case of ovotestis diagnosed in an adolescent, with a review of the literature. CASE REPORT A 15-year-old patient presented with a right scrotal swelling associated with gynecomastia. Histology showed a juxtaposition of ovarian stroma with ovarian follicle and seminiferous tubules. Karyotype revealed a male subject (XY). We have therefore retained the diagnosis of ovotesticular disorders of sex development. CONCLUSION Ovotestis is a rare finding, heterogeneous in its genetic etiology and clinical presentation. While many patients are diagnosed during infancy or childhood, we presented a case diagnosed in a 15-year-old adolescent.
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Affiliation(s)
- Koui Bbs
- Department of Pathological Anatomy, Teaching Hospital of Treichville, Treichville, Côte d'Ivoire
| | - Abouna Ad
- Department of Pathological Anatomy, Teaching Hospital of Treichville, Treichville, Côte d'Ivoire
| | - Toukilnan Djiwa
- Department of Pathological Anatomy, Teaching Hospital of Lomé, University of Lomé, Lomé, BP 1515, Togo.
| | - Traore B
- Department of Pathological Anatomy, Teaching Hospital of Treichville, Treichville, Côte d'Ivoire
| | - Kouyate M
- Department of Pathological Anatomy, Teaching Hospital of Treichville, Treichville, Côte d'Ivoire
| | - Kouame Ke
- Department of Pathological Anatomy, Teaching Hospital of Treichville, Treichville, Côte d'Ivoire
| | - Aman Na
- Department of Pathological Anatomy, Teaching Hospital of Bouaké, Bouaké, Côte d'Ivoire
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Hovnik T, Zitnik E, Avbelj Stefanija M, Bertok S, Sedej K, Bancic Silva V, Battelino T, Groselj U. An Adolescent Boy with Klinefelter Syndrome and 47,XXY/46,XX Mosaicism: Case Report and Review of Literature. Genes (Basel) 2022; 13:genes13050744. [PMID: 35627128 PMCID: PMC9141365 DOI: 10.3390/genes13050744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 04/21/2022] [Accepted: 04/22/2022] [Indexed: 02/01/2023] Open
Abstract
Klinefelter syndrome is the most commonly reported sex chromosome abnormality. It is heavily underdiagnosed due to the substantial variability of clinical presentations but is generally characterized by small, firm testes, hypergonadotropic hypogonadism, and the absence of spermatogenesis. Most patients with Klinefelter syndrome have a 47,XXY genotype. If they present with mosaicism, two different cell lines are usually identified, an aneuploid 47,XXY cell line and a normal male 46,XY cell line. There are very few cases of 47,XXY mosaicism with the additional female cell line 46,XX described in the literature. We report a case of an adolescent with the male phenotype and a rare variant mosaic 47,XXY/46,XX karyotype who presented with painless bilateral gynaecomastia. 47,XXY and 46,XX mosaic cell lines were identified with GTG-banding and further characterized using fluorescent in situ hybridization. We summarized the available clinical presentations of reported male patients with 47,XXY/46,XX mosaicism. To improve the clinical management and quality of life in individuals with rare and cryptic genomic imbalances, the genetic diagnosis would need to be extended to atypical cases.
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Affiliation(s)
- Tinka Hovnik
- Clinical Institute for Special Laboratory Diagnostics, University Children’s Hospital, UMC, 1000 Ljubljana, Slovenia;
- Institute of Biochemistry and Molecular Genetics, Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia
| | - Eva Zitnik
- Department of Pediatric Endocrinology, Diabetes and Metabolic Diseases, University Children’s Hospital, UMC, 1000 Ljubljana, Slovenia; (E.Z.); (M.A.S.); (S.B.); (K.S.); (V.B.S.); (T.B.)
| | - Magdalena Avbelj Stefanija
- Department of Pediatric Endocrinology, Diabetes and Metabolic Diseases, University Children’s Hospital, UMC, 1000 Ljubljana, Slovenia; (E.Z.); (M.A.S.); (S.B.); (K.S.); (V.B.S.); (T.B.)
- Department of Pediatrics, Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia
| | - Sara Bertok
- Department of Pediatric Endocrinology, Diabetes and Metabolic Diseases, University Children’s Hospital, UMC, 1000 Ljubljana, Slovenia; (E.Z.); (M.A.S.); (S.B.); (K.S.); (V.B.S.); (T.B.)
- Department of Pediatrics, Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia
| | - Katarina Sedej
- Department of Pediatric Endocrinology, Diabetes and Metabolic Diseases, University Children’s Hospital, UMC, 1000 Ljubljana, Slovenia; (E.Z.); (M.A.S.); (S.B.); (K.S.); (V.B.S.); (T.B.)
| | - Vesna Bancic Silva
- Department of Pediatric Endocrinology, Diabetes and Metabolic Diseases, University Children’s Hospital, UMC, 1000 Ljubljana, Slovenia; (E.Z.); (M.A.S.); (S.B.); (K.S.); (V.B.S.); (T.B.)
| | - Tadej Battelino
- Department of Pediatric Endocrinology, Diabetes and Metabolic Diseases, University Children’s Hospital, UMC, 1000 Ljubljana, Slovenia; (E.Z.); (M.A.S.); (S.B.); (K.S.); (V.B.S.); (T.B.)
- Department of Pediatrics, Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia
| | - Urh Groselj
- Department of Pediatric Endocrinology, Diabetes and Metabolic Diseases, University Children’s Hospital, UMC, 1000 Ljubljana, Slovenia; (E.Z.); (M.A.S.); (S.B.); (K.S.); (V.B.S.); (T.B.)
- Department of Pediatrics, Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia
- Correspondence: ; Tel.: +386-1-522-9235
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Tangshewinsirikul C, Dulyaphat W, Tim-Aroon T, Parinayok R, Chareonsirisuthigul T, Korkiatsakul V, Waisayarat J, Sirisreetreerux P, Tingthanatikul Y, Wattanasirichaigoon D. Klinefelter Syndrome Mosaicism 46,XX/47,XXY: A New Case and Literature Review. J Pediatr Genet 2020; 9:221-226. [PMID: 32733741 DOI: 10.1055/s-0040-1713002] [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: 03/02/2020] [Accepted: 04/21/2020] [Indexed: 10/24/2022]
Abstract
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.
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Affiliation(s)
- Chayada Tangshewinsirikul
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Wirada Dulyaphat
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Thipwimol Tim-Aroon
- Division of Medical Genetics, Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Rachanee Parinayok
- Department of Pathology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Takol Chareonsirisuthigul
- Department of Pathology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Veerawat Korkiatsakul
- Department of Pathology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Jariya Waisayarat
- Department of Pathology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Pokket Sirisreetreerux
- Division of Urology, Department of Surgery, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Yada Tingthanatikul
- Division of Reproductive Medicine, Department of Obstetrics and Gynecology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailands
| | - Duangrurdee Wattanasirichaigoon
- Division of Medical Genetics, Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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Pattamshetty P, Mantri H, Mohan V. Rare Disorder of Sexual Differentiation with a Mosaic 46,XX/47,XXY in a Klinefelter Syndrome Individual. J Reprod Infertil 2020; 21:222-224. [PMID: 32685420 PMCID: PMC7362088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Klinefelter syndrome (KS) mosaicism 46,XX/47,XXY is an extremely rare disorder of sex development characterized by the presence of both ovarian and testicular tissues in the same individual. Both elements can be present in the same gonad (ovotestis) or separately in the same individual or as a unilateral ovotestis and the other side with testis or ovary. A mosaic with 46,XY would present with problems related to male infertility and in general, testicular insufficiency, but with a 46,XX mosaic, it is a completely rare presentation. As adolescents, these boys may experience severe emotional and behavioral issues; it is up to the parents to identify these conditions early and get them physician evaluated for possible abnormalities so that they can get the benefit of treatment. CASE PRESENTATION A case of a rare disorder of sexual differentiation with a mosaic 46,XX/47,XXY in a KS individual is reported for whom karyotyping and SRY-FISH work-up was done. CONCLUSION Early cytogenetic testing is essential to identify these individuals and testosterone replacement therapy and breast reduction for case management are helpful. Assisted reproductive technology (ART) may assist these individuals father children in some cases.
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Affiliation(s)
- Preethi Pattamshetty
- Department of Genetics and Molecular Medicine, Vasavi Medical and Research Centre, Hyderabad, India,Corresponding Author: Preethi Pattamshetty, Department of Genetics and Molecular Medicine, Vasavi Medical and Research Centre, Hyderabad, India, E-mail:
| | - Harika Mantri
- Department of Genetics and Molecular Medicine, Vasavi Medical and Research Centre, Hyderabad, India
| | - Vasavi Mohan
- Department of Genetics and Molecular Medicine, Vasavi Medical and Research Centre, Hyderabad, India, Department of Genetics, Apollo Health and lifestyle Ltd, Hyderabad, India
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Chouhan JD, Chu DI, Birs A, Pyle LC, Van Batavia JP, Linn RL, Back SJ, Russo P, Darge K, Kolon TF, Srinivasan AK. Ovotestis in Adolescence: 2 Case Reports. Urology 2017; 105:171-174. [PMID: 28412334 DOI: 10.1016/j.urology.2017.04.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Revised: 04/03/2017] [Accepted: 04/06/2017] [Indexed: 10/19/2022]
Abstract
We present 2 patients found to have ovotesticular disorder of sexual development (otDSD) in late adolescence. Two 15-year-old phenotypically male patients presented to a large pediatric hospital with different complaints: 1 with concern for testicular rupture after a straddle injury; 1 with gynecomastia. Further workup, including imaging and laboratory tests, was performed before surgical exploration. The first patient had unilateral ovotestis, contralateral testis, and SRY-negative 46,XX karyotype. The second patient with gynecomastia had unilateral ovotestis with hemi-uterus and fallopian tube, contralateral ovarian tissue, and 46,XX/47,XXY Klinefelter mosaic karyotype. Although rare, phenotypically normal male patients may present later with ovotesticular disorder of sexual development.
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Affiliation(s)
- Jyoti D Chouhan
- Department of Urology, SUNY Downstate Medical Center, Brooklyn, NY
| | - David I Chu
- Division of Urology, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Antoinette Birs
- University of Central Florida College of Medicine, Orlando, FL
| | - Louise C Pyle
- Division of Human Genetics, Children's Hospital of Philadelphia, Philadelphia, PA
| | | | - Rebecca L Linn
- Division of Anatomic Pathology, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Susan J Back
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Pierre Russo
- Division of Anatomic Pathology, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Kassa Darge
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Thomas F Kolon
- Division of Urology, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Arun K Srinivasan
- Division of Urology, Children's Hospital of Philadelphia, Philadelphia, PA.
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