Clinical and genetic heterogeneity in Meckel syndrome

Meckel syndrome (MKS) is a lethal malformation syndrome characterised by posterior meningoencephalocele, polycystic kidneys, fibrotic changes of the liver, and polydactyly. We have previously shown a linkage to chromosome 17q in 17 Finnish Meckel families. In this study we have analysed one Italian, one Austrian (of Turkish origin) and three British MKS families (Caucasian, Pakistani, and Bangladeshi families) for linkage to the MKS locus on chromosome 17q22–q24. We did not observe co-segregation of the disease and marker haplotypes in the Austrian family or in the three British families, of which two represented classical MKS and one a slightly atypical MKS phenotype with longer survival of the patient. In the Italian family the affected and non-affected children did not share the same maternal chromosome and thus this family could represent the same allelic disease as the Finnish MKS families. These results suggest locus heterogeneity in Meckel syndrome – a feature previously suspected based on the highly variable clinical phenotype. Received: 2 June 1997 / Accepted: 12 June 1997     

Visceral anomalies in the Meckel syndrome

The visceral abnormalities of 32 autopsied Meckel's syndrome cases were analysed macroscopically and histologically in order to observe the distribution and spectrum of internal abnormalities in this hereditary malformation syndrome. All cases showed the classical triad of central nervous system anomaly, postaxial polydactyly, and cystic kidneys. Five cases were midterm fetuses and 27 cases were perinatal deaths. The kidneys were grossly enlarged in almost all of the cases (29) and showed a uniform histological pattern of fibrocystic proliferation, which is considered characteristic of MS. Fibrosis and proliferation of the bile ducts in the hepatic portal tracts were found in each case. Severe hypoplasia of the male genitalia associated with cryptorchidism was the third consistent anomaly. Derivatives of the müllerian ducts were present in four males, and the initial sex determination of the male infants was sometimes difficult. Epididymal cysts (39%) and ductal dilatation as well as fibrosis of the pancreas (31%) were further common anomalies. This series showed that a number of gross and microscopic abnormalities are consistently present in MS and that histological investigation is invaluable in defining the syndrome in doubtful cases.     

The isochromosome 18p syndrome: confirmation of cytogenetic diagnosis in nine cases by in situ hybridization.

Nine cases are described of tetrasomy 18p resulting from the presence of an isochromosome 18p [i(18p)]. The initial diagnosis of i(18p) was by standard cytogenetic techniques and was confirmed by in situ hybridization with a biotinylated alphoid probe (L1.84) specific for the pericentric region of chromosome 18 and with a tritium-labeled chromosome 18 probe (B74) which hybridizes to the D18S3 locus situated at 18p11.3. The clinical features of the cases are summarized and shown to constitute a distinct and recognizable syndrome. Common features were low birth weight, a characteristic facies, neonatal hypotonia with subsequent limb spasticity, short stature, microcephaly, mental retardation, and seizure disorders. On the basis of size and cytogenetic banding a marker chromosome can be suspected to be an i(18p). In situ hybridization with the alphoid probe L1.84 provides confirmation of chromosome 18 origin. This more precise diagnosis will be an advantage in situations of pre- and postnatal diagnosis, since parents can be provided with a more confident prognosis for their child.     

Fertilization and embryonic development in vitro in cattle. Morphological and cytogenetic observations.

The presented ichonography provides a documentation of the changes occurring during maturation, fertilization of oocytes and embryonic development in vitro; it points out the correlations between morphological features and the stage of nuclear chromatin and gives the possibility to observe some abnormalities that frequently occur during these processes.     

Wiedemann-Beckwith syndrome: clinical, cytogenetical and radiological observations in 39 new cases.

Thirty-nine patients (82% under 1 year of age) with Wiedemann-Beckwith syndrome (WBS) were prospectively studied. To evaluate the somatometric data the normal range was set out at mean +/- 2 SD. The relevant physical findings were a characteristic face, non increased mean height and weight, normal head circumference, defective abdominal wall, a predominance of the upper segment, and tibial bowing. Mental retardation was documented in 5 cases but in only 1 it was related to hypoglycemia. The 32 cases karyotyped were normal. Since neonatal hypoglycemia is frequent (34.3% in our series) and potentially deleterious for the CNS we propose to monitor the glycemia every 6 h during the first 3 days in WBS newborns in order to correct glycemia below of 2.6 mmol/l (46.8 mg/dl) according to recent studies. The comparison with previous large series enabled us to precise the frequency, onset and evolution of the main stigmata.     

A prospective cytogenetic study of 36 cases of DiGeorge syndrome

Cytogenetic analysis was carried out in a prospective series of 36 children with DiGeorge syndrome. High-resolution banding (> 850 bands/haploid set) was achieved in 30 cases. Monosomy 22q11.21-->q11.23 was found in 9 of these 30 cases. In each of these cases monosomy 22q11.21-->q11.23 resulted from an interstitial deletion and not from a translocation. No other chromosome abnormalities were seen.     

The r(14) syndrome. 3 new observations

Three observations of r(14) are reported. Constant features of r(14) syndrome are the following: moderate but typical craniofacial dysmorphism, seizures and other neurological abnormalities, abnormal retinal pigmentation, and recurrent respiratory infections. The value of gene dosage evaluation for genes mapped to the distal segment of 14q, particularly the Ig heavy chain genes, is emphasized.     

Fibromatosis colli in infants. A cytologic study of eight cases

OBJECTIVE: To review eight cases of fibromatosis colli and assess their cytomorphologic features. STUDY DESIGN: Cytologic smears from eight patients diagnosed as having fibromatosis colli on fine needle aspiration cytology were reviewed. RESULTS: Cytologic features of fibromatosis colli are bland-appearing fibroblasts and degenerative atrophic skeletal muscle in a clean background. Besides these, we found a large number of muscle giant cells; numerous bland, bare nuclei; and parallel clusters of fibroblasts. Collagen was seen in all cases. CONCLUSION: A confirmatory, noninvasive diagnosis of fibromatosis colli can be made by fine needle aspiration cytology alone; invasive diagnostic and therapeutic measures are best avoided. Excision biopsy may not be necessary and should be reserved for cases with a strong clinicopathologic suspicion of malignancy.     

The peculiarities of cytogenetic changes in different types of myelodysplastic syndrome

A cytogenetic study of bone marrow aspirate from 32 patients with different types of myelodysplastic syndrome (MDS) has been carried out. The patients were from eight regions of Ukraine. Chromosome deletions prevailed in the spectrum of karyotype changes. The largest number of chromosome abnormalities was revealed in patients with a refractory anemia with an excess of blasts (66.6% of cases). Chromosomal changes that involved three or more chromosomes occurred among 27% of all karyotype changes examined by us. Transformation of myelodysplastic syndrome to acute myeloid leukemia (AML) was found in 5 patients (45.4% of the cases) among 11 patients with abnormal karyotypes. We propose that cytogenetic confirmation of increased apoptosis in the bone marrow from the myelodysplastic syndrome patients is a phenomenon of chromosome fragmentation. The risk of transformation of myelodysplastic syndrome to acute myeloid leukemia was measured with the use of a new international score system, IPSS.     

Roberts syndrome: study of 4 new Rgyptian cases with comparison of clinical and cytogenetic findings

Roberts syndrome is a rare autosomal recessive genetic disorder (MIM 268300). It is characterized by pre and postnatal growth retardation, severe shortening of limbs with radial defects, oligodactyly and characteristic facial features. The present study reports 4 new cases of Roberts syndrome from 3 families presenting variable phenotypes. Patients were thoroughly investigated clinically and cytogenetically. By reviewing literature, we compared our cases to those previously reported. The rating severity system proposed by Van den Berg and Francke (30) was applied to correlate the phenotypic and cytogenetics changes. We observed more severe reduction defects in the upper limbs than in the lower limbs. While the main reduction defects in the upper limbs involved the thumb and radius ranging to phocomelia, absent or severely hypoplastic fibula was the main lower limb involvement. We emphasize this finding in the present investigation. Heterochromatin repulsion of chromosomes derived from Roberts syndrome patients is a characteristic cytogenetic abnormality. It was a constant finding in our studied patients demonstrated by DABI stain which supports the possibility that mutations in Roberts syndrome lie in centromere related proteins which may also play a role in body patterning. This was proved recently by Vega et al. (31). Application of the clinical rating score and its correlation with cytogenetic changes showed negative results. Cytogenetic studies in normal obligatory heterozygotes parents showed no changes. Phenotypic variability within the same family as well as between different families was observed. The ascertainment of 4 cases with Roberts syndrome from 3 Egyptian consanguineous families during one year in our department may indicate a high frequency of the Roberts syndrome allele among Egyptians. This confirms the need for molecular studies for early and accurate prenatal diagnosis to prevent such dramatic malformation syndrome.     

Cytological observations on genome homology in eight interspecific hybrids ofPhalaenopsis

Cytological analysis of eight interspecific hybrids ofPhalaenopsis, (2n=38), intra-as well as intersectional, involving eight species, revealed various degrees of genome homology. The species can be divided into two groups. Within each of the groups a strong genome homology occurs. The first group comprises the speciesP. amabilis, P. stuartiana, P. sanderiana, P. aphrodite andP. equestris, all having similar genomes of small chromosomes. The second group includesP. lueddemanniana, P. mannii andP. amboinensis, having genomes comprising larger chromosomes. In addition, the genomes of the latter three species have a different average chromosome size. Cytological evidence for differences in length at somatic metaphase as well as in metaphase I configurations in hybrids of species of the second group is presented. Hybrids between representative species of the first and the second group show poor to fair genome homology. The implications of the cytological observations for the classification ofPhalaenopsis are discussed.This research was supported by grants toDr. Y. Sagawa and forms part of a thesis submitted by the author in partial fulfillment of the requirements for a MS degree at the University of Hawaii (1968).Journal Series No. 1161 of the Hawaiian Agricultural Experiment Station.     

Molecular, cytogenetic, and clinical investigations of Prader-Willi syndrome patients.

Thirty-seven patients presenting features of the Prader-Willi syndrome (PWS) have been examined using cytogenetic and molecular techniques. Clinical evaluation showed that 29 of these patients fulfilled diagnostic criteria for PWS. A deletion of the 15q11.2-q12 region could be identified molecularly in 21 of these cases, including several cases where the cytogenetics results were inconclusive. One clinically typical patient is deleted at only two of five loci normally included in a PWS deletion. A patient carrying a de novo 13;X translocation was not deleted for the molecular markers tested but was clinically considered to be "atypical" PWS. In addition, five cases of maternal heterodisomy and two of isodisomy for 15q11-q13 were observed. All of the eight patients who did not fulfill clinical diagnosis of PWS showed normal maternal and paternal inheritance of chromosome 15 markers; however, one of these carried a ring-15 chromosome. A comparison of clinical features between deletion patients and disomy patients shows no significant differences between the two groups. The parental ages at birth of disomic patients were significantly higher than those for deletion patients. As all typical PWS cases showed either a deletion or disomy of 15q11.2-q12, molecular examination should provide a reliable diagnostic tool. As the disomy patients do not show either any additional or more severe features than typical deletion patients do, it is likely that there is only one imprinted region on chromosome 15 (within 15q11.2-q12).     

Roberts syndrome: phenotypic variation, cytogenetic definition and heterozygote detection.

Five cases of Roberts syndrome (RS) in four nuclear families are reported and the wide range of phenotypic variation among them is described. This is in contrast with the remarkable uniformity of the cytogenetic findings. Indirect immunofluorescence with seric antibodies from patients with CREST, revealed that the centromeric structures are normal in RS thus confirming J. German's assumption that the chromatid repulsion is confined to the heterochromatin. The authors quantified the phenomenon of centromeric heterochromatin separation (as occasionally revealed by C-bands in normal subjects) in obligate heterozygotes and possible heterozygotes for RS. The results are indicative of the possibility to screen for heterozygotes. The nosology of RS and related syndromes is discussed in view of the cytogenetic findings and the natural history of the disease.