1
|
Guess T, Wheeler FC, Yenamandra A, Schilit SLP, Anderson HS, Bone KM, Carstens B, Conlin L, Dulik MC, Dupont BR, Fanning E, Gardner JA, Haag M, Hilton BA, Johnson J, Kogan J, Murry J, Polonis K, Quigley DI, Repnikova EA, Rowsey RA, Spinner N, Stoeker M, Thurston V, Wiley M, Zhang L. A multicenter analysis of individuals with a 47,XXY/46,XX karyotype. Genet Med 2024; 26:101212. [PMID: 39011769 DOI: 10.1016/j.gim.2024.101212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Revised: 07/10/2024] [Accepted: 07/11/2024] [Indexed: 07/17/2024] Open
Abstract
PURPOSE Klinefelter syndrome, a sex chromosome aneuploidy (SCA), is associated with a 47,XXY chromosomal complement and is diagnosed in ∼1:600 live male births. Individuals with a 46,XX cell line, in addition to 47,XXY, are less common with a limited number of published case reports. METHODOLOGY To better understand the implications of a 47,XXY/46,XX karyotype, we conducted a retrospective, multicenter analysis of the cytogenetic findings and associated clinical records of 34 patients diagnosed with this SCA across 14 institutions. RESULTS Presence of the XX cell line ranged from 5% to 98% in patient specimens. Phenotypes also exhibited significant heterogeneity with some reporting a single reason for referral and others presenting with a constellation of symptoms, including ambiguous genitalia and ovotestes. Ovotestes were present in 12% of individuals in this cohort, who had a significantly higher percentage of XX cells. Notably, 2 patients were assigned female sex at birth. CONCLUSION These findings highlight the variability of the clinical phenotypes associated with this SCA, as well as the challenges of clinical management for this population. Karyotype or fluorescence in situ hybridization analysis, which offer single-cell resolution, rather than chromosomal microarray or molecular testing, is the ideal test strategy in these instances as mosaicism can occur at low levels.
Collapse
Affiliation(s)
- Tiffany Guess
- Molecular Pathology Laboratory Network, Maryville, TN; Department of Pathology, Vanderbilt University Medical Center, Nashville, TN.
| | - Ferrin C Wheeler
- Department of Pathology, Vanderbilt University Medical Center, Nashville, TN
| | - Ashwini Yenamandra
- Department of Pathology, Vanderbilt University Medical Center, Nashville, TN
| | - Samantha L P Schilit
- Division of Clinical Cytogenetics, Center for Advanced Molecular Diagnostics, Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Hannah S Anderson
- ARUP Laboratories, Salt Lake City, UT; Department of Human Genetics, University of Utah, Salt Lake City, UT
| | - Kathleen M Bone
- Department of Pathology, Medical College of Wisconsin, Milwaukee, WI
| | - Billie Carstens
- Colorado Genetics Laboratory, Department of Pathology, University of Colorado, Anschutz Medical Center, Aurora, CO
| | - Laura Conlin
- Department of Pathology and Laboratory Medicine, The Children's Hospital of Philadelphia, PA
| | - Matthew C Dulik
- Department of Pathology and Laboratory Medicine, The Children's Hospital of Philadelphia, PA
| | | | - Elizabeth Fanning
- Department of Pathology and Laboratory Medicine, The Children's Hospital of Philadelphia, PA
| | - Juli-Anne Gardner
- Department of Pathology and Laboratory Medicine, University of Vermont Medical Center, Burlington, VT
| | - Mary Haag
- Colorado Genetics Laboratory, Department of Pathology, University of Colorado, Anschutz Medical Center, Aurora, CO
| | | | | | - Jillene Kogan
- Advocate Clinical Laboratories, Advocate Health, Rosemont, IL
| | - Jacyln Murry
- Johns Hopkins University School of Medicine, Baltimore, MD
| | - Katarzyna Polonis
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
| | - Denise I Quigley
- Department of Pathology, Medical College of Wisconsin, Milwaukee, WI
| | - Elena A Repnikova
- Department of Pathology and Laboratory Medicine, Children's Mercy Hospital Kansas City, MO
| | - Ross A Rowsey
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
| | - Nancy Spinner
- Department of Pathology and Laboratory Medicine, The Children's Hospital of Philadelphia, PA
| | - Mikayla Stoeker
- Colorado Genetics Laboratory, Department of Pathology, University of Colorado, Anschutz Medical Center, Aurora, CO
| | | | | | - Lei Zhang
- Department of Pathology and Laboratory Medicine, Children's Mercy Hospital Kansas City, MO
| |
Collapse
|
2
|
A Rare Case of Malignant Ovarian Germ Cell Tumor: Dysgerminoma and Seminoma in the Same Patient. REPORTS 2023. [DOI: 10.3390/reports6010014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2023] Open
Abstract
Ovarian malignant germ cell tumors (OMGCTs) represent a rare type of malignant tumors composed of primitive germ cells that often originate from dysgenetic gonads and are frequently associated with hermaphroditism. Such tumors occur more frequently in adolescents or young adults, and their etiopathogenic mechanism is not well established. We report the case of a 20-year-old female with ovarian dysgenesis and female phenotype. A laparoscopic surgery was performed, and ovotestis was discovered. To achieve a histopathological examination, right oophorectomy was performed, which confirmed the diagnosis of dysgerminoma. In the case of hermaphroditism, mixed germ cell tumors can develop, leading to a more aggressive evolution with bilateral malignancy of the gonads, which requires the removal of both ovotestis. The patient was recalled. A histopathological examination revealed a seminoma, so laparoscopic left oophorectomy was performed. The management of this type of diagnosis primarily involves surgery, minimally invasive interventions being preferred. Not all pathologic conditions are readily identifiable by means of exploratory laparoscopy, as in our patient’s case. We consider that the optimal solution for these patients would be the preservation of fertility via egg donation and embryo transfer; the survival rate of such patients being 97–100%, if the tumor is diagnosed at an early age.
Collapse
|
3
|
Mitranovici MI, Chiorean DM, Mureșan MC, Buicu CF, Moraru R, Moraru L, Cotoi TC, Cotoi OS, Toru HS, Apostol A, Turdean SG, Mărginean C, Petre I, Oală IE, Simon-Szabo Z, Ivan V, Pușcașiu L. Diagnosis and Management of Dysgerminomas with a Brief Summary of Primitive Germ Cell Tumors. Diagnostics (Basel) 2022; 12:diagnostics12123105. [PMID: 36553112 PMCID: PMC9776801 DOI: 10.3390/diagnostics12123105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 11/30/2022] [Accepted: 12/07/2022] [Indexed: 12/14/2022] Open
Abstract
Dysgerminoma represents a rare malignant tumor composed of germ cells, originally from the embryonic gonads. Regarding its incidence, we do not have precise data due to its rarity. Dysgerminoma occurs at a fertile age. The preferred treatment is the surgical removal of the tumor succeeded by the preservation of fertility. Even if a multidisciplinary team, founded in 2009 by a gynecologist, an oncologist, a pediatric oncologist and a pediatric surgeon, under the guidance of the Malignant Germ Cell International Consortium (MaGIC), studies this type of tumor, issues still remain related to the lack of a randomized study and to both the management and understanding of the concept of OMGCTs (ovarian malignant germ cell tumors). The aim of this review is to present from the literature the various approaches for this type of tumor, and, regarding innovative therapies or possible prevention, which can be applied in clinical practice. Multidisciplinarity and treatment in reference centers have proven their usefulness as well.
Collapse
Affiliation(s)
- Melinda-Ildiko Mitranovici
- Department of Obstetrics and Gynecology, Emergency County Hospital Hunedoara, 14 Victoriei Street, 331057 Hunedoara, Romania
- Correspondence: (M.-I.M.); (D.M.C.)
| | - Diana Maria Chiorean
- Department of Pathology, County Clinical Hospital of Targu Mures, 540072 Targu Mures, Romania
- Correspondence: (M.-I.M.); (D.M.C.)
| | - Maria Cezara Mureșan
- Department of Obstetrics and Gynecology, “Victor Babes” University of Medicine and Pharmacy, 2 Eftimie Murgu Sq., 300041 Timisoara, Romania
| | - Corneliu-Florin Buicu
- Public Health and Management Department, “George Emil Palade” University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 540139 Targu Mures, Romania
| | - Raluca Moraru
- Faculty of Medicine, “George Emil Palade” University of Medicine, Pharmacy, Sciences and Technology, 540142 Targu Mures, Romania
| | - Liviu Moraru
- Department of Anatomy, “George Emil Palade” University of Medicine, Pharmacy, Sciences and Technology, 540142 Targu Mures, Romania
| | - Titiana Cornelia Cotoi
- Department of Pharmaceutical Technology, “George Emil Palade” University of Medicine, Pharmacy, Sciences and Technology, 540142 Targu Mures, Romania
- Close Circuit Pharmacy of County Clinical Hospital of Targu Mures, 540072 Targu Mures, Romania
| | - Ovidiu Simion Cotoi
- Department of Pathology, County Clinical Hospital of Targu Mures, 540072 Targu Mures, Romania
- Department of Pathophysiology, “George Emil Palade” University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 38 Gheorghe Marinescu Street, 540142 Targu Mures, Romania
| | - Havva Serap Toru
- Department of Pathology, Akdeniz University School of Medicine, Antalya Pınarbaşı, Konyaaltı, 07070 Antalya, Turkey
| | - Adrian Apostol
- Department of Cardiology, “Victor Babes” University of Medicine and Pharmacy, 2 Eftimie Murgu Sq., 300041 Timisoara, Romania
| | - Sabin Gligore Turdean
- Department of Pathology, County Clinical Hospital of Targu Mures, 540072 Targu Mures, Romania
| | - Claudiu Mărginean
- Department of Obstetrics and Gynecology, “George Emil Palade” University of Medicine, Pharmacy, Sciences and Technology, 540142 Targu Mures, Romania
| | - Ion Petre
- Department of Medical Informatics and Biostatistics, “Victor Babes” University of Medicine and Pharmacy, 2 Eftimie Murgu Sq., 300041 Timisoara, Romania
| | - Ioan Emilian Oală
- Department of Obstetrics and Gynecology, Emergency County Hospital Hunedoara, 14 Victoriei Street, 331057 Hunedoara, Romania
| | - Zsuzsanna Simon-Szabo
- Department of Pathophysiology, “George Emil Palade” University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 38 Gheorghe Marinescu Street, 540142 Targu Mures, Romania
| | - Viviana Ivan
- Department of Obstetrics and Gynecology, “Victor Babes” University of Medicine and Pharmacy, 2 Eftimie Murgu Sq., 300041 Timisoara, Romania
| | - Lucian Pușcașiu
- Department of Obstetrics and Gynecology, “George Emil Palade” University of Medicine, Pharmacy, Sciences and Technology, 540142 Targu Mures, Romania
| |
Collapse
|
4
|
De Clercq E, Starke G, Rost M. "Waking up" the sleeping metaphor of normality in connection to intersex or DSD: a scoping review of medical literature. HISTORY AND PHILOSOPHY OF THE LIFE SCIENCES 2022; 44:50. [PMID: 36282442 PMCID: PMC9596528 DOI: 10.1007/s40656-022-00533-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Accepted: 08/31/2022] [Indexed: 06/16/2023]
Abstract
The aim of the study is to encourage a critical debate on the use of normality in the medical literature on DSD or intersex. For this purpose, a scoping review was conducted to identify and map the various ways in which "normal" is used in the medical literature on DSD between 2016 and 2020. We identified 75 studies, many of which were case studies highlighting rare cases of DSD, others, mainly retrospective observational studies, focused on improving diagnosis or treatment. The most common use of the adjective normal was in association with phenotypic sex. Overall, appearance was the most commonly cited criteria to evaluate the normality of sex organs. More than 1/3 of the studies included also medical photographs of sex organs. This persistent use of normality in reference to phenotypic sex is worrisome given the long-term medicalization of intersex bodies in the name of a "normal" appearance or leading a "normal" life. Healthcare professionals should be more careful about the ethical implications of using photographs in publications given that many intersex persons describe their experience with medical photography as dehumanizing.
Collapse
Affiliation(s)
- Eva De Clercq
- Institute for Biomedical Ethics, University of Basel, Bernoullistrasse 28, 4056 Basel, Switzerland
- Institute of Biomedical Ethics and History of Medicine, University of Zürich, Winterthurerstrasse 30, 8006 Zurich, Switzerland
| | - Georg Starke
- Institute for Biomedical Ethics, University of Basel, Bernoullistrasse 28, 4056 Basel, Switzerland
- College of Humanities, École Polytechnique Fédérale de Lausanne, Rte Cantonale, 1015 Lausanne, Switzerland
| | - Michael Rost
- Institute for Biomedical Ethics, University of Basel, Bernoullistrasse 28, 4056 Basel, Switzerland
| |
Collapse
|
5
|
Guerrero-Fernández J, González-Peramato P, Rodríguez Estévez A, Alcázar Villar MJ, Audí Parera L, Azcona San Julián MC, Carcavilla Urquí A, Castaño González LA, Martos Tello JM, Mora Palma C, Moreno Macián MF, Yeste Fernández D, Nistal M. Guía de consenso sobre la gonadectomía profiláctica en el desarrollo sexual diferente. ENDOCRINOL DIAB NUTR 2022. [DOI: 10.1016/j.endinu.2021.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
6
|
Guerrero-Fernández J, González-Peramato P, Rodríguez Estévez A, Alcázar Villar MJ, Audí Parera L, Azcona San Julián MC, Carcavilla Urquí A, Castaño González LA, Martos Tello JM, Mora Palma C, Moreno Macián MF, Yeste Fernández D, Nistal M. Consensus guide on prophylactic gonadectomy in different sex development. ENDOCRINOL DIAB NUTR 2022; 69:629-645. [PMID: 36369235 DOI: 10.1016/j.endien.2022.10.002] [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: 05/06/2021] [Accepted: 11/06/2021] [Indexed: 06/16/2023]
Abstract
The risk of suffering from gonadal germ cell tumors (GCT) is increased in some patients with different sexual development (DSD), mainly in those with Y chromosome material. This risk, however, varies considerably depending on a multitude of factors that make the decision for prophylactic gonadectomy extremely difficult. In order to make informed recommendations on the convenience of this procedure in cases where there is potential for malignancy, this consensus guide evaluates the latest clinical evidence, which is generally low, and updates the existing knowledge in this field.
Collapse
Affiliation(s)
- Julio Guerrero-Fernández
- Grupo de Trabajo Sobre ADS/DSD de la Sociedad Española de Endocrinología Pediátrica (SEEP), Spain; Servicio de Endocrinología Pediátrica, Hospital Infantil La Paz, Madrid, Spain.
| | - Pilar González-Peramato
- Departamento de Anatomía Patológica, Hospital Universitario La Paz, Universidad Autónoma de Madrid, Madrid, Spain
| | | | - María José Alcázar Villar
- Grupo de Trabajo Sobre ADS/DSD de la Sociedad Española de Endocrinología Pediátrica (SEEP), Spain; Unidad de Endocrinología Pediátrica, Hospital de Fuenlabrada, Fuenlabrada, Spain
| | - Laura Audí Parera
- Grupo de Trabajo Sobre ADS/DSD de la Sociedad Española de Endocrinología Pediátrica (SEEP), Spain; Vall d'Hebron Institut de Recerca (VHIR), CIBER de Enfermedades Raras (CIBERER), Hospital Vall d'Hebron, Barcelona, Spain
| | - María Cristina Azcona San Julián
- Grupo de Trabajo Sobre ADS/DSD de la Sociedad Española de Endocrinología Pediátrica (SEEP), Spain; Unidad de Endocrinología Pediátrica, Departamento de Pediatría, Clínica Universidad de Navarra, Pamplona, Spain
| | - Atilano Carcavilla Urquí
- Grupo de Trabajo Sobre ADS/DSD de la Sociedad Española de Endocrinología Pediátrica (SEEP), Spain; Servicio de Endocrinología Pediátrica, Hospital Infantil La Paz, Madrid, Spain
| | - Luis Antonio Castaño González
- Grupo de Trabajo Sobre ADS/DSD de la Sociedad Española de Endocrinología Pediátrica (SEEP), Spain; Instituto BioCruces - Endocrinología Pediátrica, Hospital Universitario Cruces, Barakaldo, Spain
| | - José María Martos Tello
- Grupo de Trabajo Sobre ADS/DSD de la Sociedad Española de Endocrinología Pediátrica (SEEP), Spain; Unidad de Endocrinología Pediátrica, Hospital Universitario Virgen de La Arrixaca, Murcia, Spain
| | - Cristina Mora Palma
- Grupo de Trabajo Sobre ADS/DSD de la Sociedad Española de Endocrinología Pediátrica (SEEP), Spain; Servicio de Endocrinología Pediátrica, Hospital Infantil La Paz, Madrid, Spain
| | - Maria Francisca Moreno Macián
- Grupo de Trabajo Sobre ADS/DSD de la Sociedad Española de Endocrinología Pediátrica (SEEP), Spain; Servicio de Endocrinología Pediátrica, Hospital La Fe, Valencia, Spain
| | - Diego Yeste Fernández
- Grupo de Trabajo Sobre ADS/DSD de la Sociedad Española de Endocrinología Pediátrica (SEEP), Spain; Servicio de Endocrinología Pediátrica, Hospital Materno Infantil Vall d'Hebron, CIBER de Enfermedades Raras (CIBERER), EndoERN, Barcelona, Spain
| | - Manuel Nistal
- Departamento de Anatomía, Histología y Neurociencias. Universidad Autónoma de Madrid, Madrid, Spain
| |
Collapse
|
7
|
Mahmoudzadeh L, Abbasi A, Ayatollahi H, Rahimi S, Ilkhanizadeh B. First Report of Concurrent Germ Cell and Epithelial Tumors in Ovotestes of a 46,XY Female Patient. J Oncol Pract 2019; 15:410-412. [PMID: 31219736 DOI: 10.1200/jop.18.00778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - Ata Abbasi
- 1 Urmia University of Medical Sciences, Urmia, Iran
| | | | | | | |
Collapse
|
8
|
Pyle LC, Nathanson KL. A practical guide for evaluating gonadal germ cell tumor predisposition in differences of sex development. AMERICAN JOURNAL OF MEDICAL GENETICS PART C-SEMINARS IN MEDICAL GENETICS 2017; 175:304-314. [PMID: 28544305 DOI: 10.1002/ajmg.c.31562] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/12/2017] [Revised: 04/12/2017] [Accepted: 04/13/2017] [Indexed: 01/16/2023]
Abstract
Differences of Sex Development (DSD) includes a wide spectrum of etiologies and phenotypes. A subset of individuals with DSDs are predisposed to gonadal germ cell tumor (GCT). In this setting, GCT risk varies widely, depending on the DSD molecular etiology and penetrance. Prognostication based on molecular diagnosis remains challenging, as natural history data specific to recently identified molecular causes of DSD is lacking. In this review, we provide a framework for the clinical geneticist to consider GCT tumor risk in the patient with DSD. We discuss germ cell development and etiology of GCT growth, along with parameters to consider when recommending prophylactic gonadectomy including fertility, hormonal output, and malignant GTC treatment outcomes. Shortly after the 2006 reorganization of DSD nomenclature, literature reviews of natural history publications stratified GCT risk by a chromosomal, pathological, and hormonal taxonomy. Our 2017 literature review reveals a larger body of publications. However, the broad DSD GCT risk stratification within the 2006 taxonomy remains stable. We discuss precise GCT risk assessment for specific diagnoses, including androgen insensitivity, Smith-Lemli-Opitz, and 46,XY with MAP3K1 mutations and gonadal dysgenesis, as examples. We also examine the GCT risk in non-DSD syndromes, in addition to the cancer risks in DSD patients with dimorphic gonads and genitalia. This review is intended to provide a nuanced assessment of relative germ cell tumor risk in the DSD patient, including modern precise molecular diagnosis, for use by the clinical geneticist.
Collapse
Affiliation(s)
- Louise C Pyle
- Translational Medicine/Human Genetics, Children's Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Katherine L Nathanson
- Translational Medicine/Human Genetics, Children's Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| |
Collapse
|