Chimerism 46,XX/46,XY in a phenotypic female

Summary A female patient is reported with lymphocyte chromosome chimerism (46,XX/46,XY). Her whole-body chimerism was confirmed in the AB0 blood group system by the presence of two different erythrycyte populations, A₁0 and 00. Normal findings were recorded at physical and gynecological examination, except for mammary hypoplasia and sterility of 7 years duration, the latter complaint being the cause for genetic examination of the patient.     

Down syndrome in two siblings with 47,XY,+21 and 46,XY/46,XY,-21,+t(21q;21q)

Summary This is the first report in the literature of siblings affected with Down syndrome; one sibling had a nondisjunction of chromosome 21 and the other a (21q;21q) translocation.     

Permanent tooth sizes in 46,XY females.

The teeth of seven Finnish patients with complete testicular-feminization syndrome (46,XY females) were studied to obtain further information about their growth and possible somatic determinants on the Y chromosome. The sizes of the permanent teeth of the 46,XY females were found to be as large as those of control males and definitely larger than those of control females. Testicular feminization is caused by androgen insensitivity, and persons affected are phenotypically females. Hence, these results also indicate the influence of the Y chromosome on dental determination.     

Translocation of c-abl oncogene and PDGFB (c-sis) gene in a case of CML with 46,XY, t(22;22)

In a case of CML with a variant Philadelphia translocation (Ph1 or Ph) t(22;22) (q11;q13) in bone marrow cells and unstimulated peripheral blood cells, no cytogenetically detectable involvement of chromosome 9 was observed. Southern blot experiments using probes specific for bcr and c-sis however revealed rearrangement of the bcr, but not of PDGFB (c-sis) gene. Northern blot analysis of bone marrow RNA showed a very weak signal with the c-sis probe, while in a lymph-node biopsy PDGFB m-RNA could not be detected. Chromosomal in situ hybridization gave evidence for translocation of c-abl from chromosome 9 to Ph and of PDGFB from chromosome 22 to chromosome 9, as the result of a threefold translocation t(9;22;22).     

Karyotype 46,XY,22p+ in a male patient (author's transl)

The authors report the case of a 2-month-old infant with psychomotor retardation and several physical stigmata. Cytogenetic studies of the patient using the normal technique show in all the cells a karyotype 46,XY with a G group chromosome substituted by an F-like mediocentric element with satellites. The R, G and C-banding methods reveal that it is the 22 with too developed short arms (22p+). This element was found in the mother's and maternal grandfather's karyotypes although they both present normal phenotypes. The authors advance two hypotheses concerning the origin of the alteration but cannot exclude a possible connection between this particular chromosome and the proband's anomalies. The difficulties of genetic counselling in this case are evident.     

Molecular analysis of 46,XY females and regional assignment of a new Y-chromosome-specific probe

Summary The relationship between Y-chromosome abnormalities and gonadal differentiation was investigated in six phenotypic females with a 46,XY karyotype and one patient with ambiguous genitalia secondary to apparently nonmosaic 46,XY mixed gonadal dysgenesis. No alterations were found in the Y chromosomes of six of these individuals by the use of either cytogenetic or molecular techniques. Cytogenetic analysis with high-resolution G-banding and Q-banding revealed a small deletion in the short arm of the Y chromosome in one female patient with some features of Turner syndrome. Southern hybridization with Y-specific probes showed a loss of DNA within deletion intervals 1, 2, and 3 of the Y chromosome. A new Y-chromosome-specific DNA probe that hybridizes to deletion interval 3 is described.     

Klinefelter's syndrome, mosaic 46,XX/46,XY/47,XXY/48,XXXY/48,XXYY: a case report

A 35-year-old male was investigated for primary infertility. Clinical examination showed an intelligent man with normal facial appearance and moustache and small firm testes. Testicular histopathology revealed marked atrophy of the testes with no spermatogenesis and absence of germ cells. Hormonal profile showed elevated levels of FSH,LH and low levels of testosterone. Chromosome analysis from whole blood culture showed cells with 46,XX/46,XY/47,XXY/48,XXXY/48,XXYY mosaicism. The predominant cell line was 47,XXY (87.86%). 46,XY/47,XXY mosaicism is not uncommon. However, mosaicism of multiple sex chromosome aneuploidy is rarely observed. This is the first report of mosaicism in Klinefelter's syndrome variant with five cell lines.     

Ovarian development in 46,XY gonadal dysgenesis

Summary In human the XY ovary is degenerative, there being scant evidence of persistence of that organ beyond the perinatal period. Here we describe indications of functional ovarian tissue in a 17-year-old female with male karyotype, H-Y⁺ cellular phenotype, and some signs of the Turner syndrome. Her gonads were removed after the onset of secondary amenorrhea. Histological examination revealed a degenerative right ovary devoid of germ cells and follicles, and a left streak gonad. There was no trace of testicular development in either side.     

46,XX/46,XY chimerism in a phenotypically normal man

Summary Some twenty cases of dispermic chimeras with the karyotype 46,XX/46,XY, discovered because of gonadal dysplasias or a true hermaphroditism, have been reported. This is a report of a phenotypically normal man with 46,XX/46,XY chimerism in whom a prepubertal finding of positive X-chromatin was interpreted as Klinefelter syndrome. The diagnosis was revised 11 years later when the family doctor, who doubted the earlier diagnosis because of the patient's normal-sized testes, sent him to an outpatient clinic. The young man was 23 years old, athletic (74kg, 180cm), with normal body proportions, normal sexual hair distribution, normal libido and potency, normal endocrine parameters, and a normal spermiogram. The karyotype revealed an XX/XY mosaic in a proportion of 1:2. An identical set of maternal markers (Q- and C-banding) was present in male and female cells. Differences were found with respect to two paternal markers. Furthermore, blood, serum, and red cell enzyme groups in five systems showed two phenotypes, again with duality of paternal origin. It is concluded that a positive X-chromatin in prepuperty, especially in the absence of supporting clinical features, must be followed by a karyotype study.     

Synaptonemal complex studies in a mosaic 46,XY/47,XXY male

Summary We describe the results of synaptonemal complex (SCs) studies by light (LM) and electron microscopy (EM) in a sterile 46,XY/47,XXY male mosaic. Meiotic studies showed an arrest at the first spermatocyte level. Pachytene figures showed three types of cells: (1) cells with normal SCs, normal sex vesicle, and a 23,XY constitution; (2) cells with no sex vesicle, normal pairing of SCs, and a 24, (?) constitution; and (3) cells with a normal sex vesicle and fragmented SCs.     

New cytogenetic variant of Orbeli's syndrome (46,XY/45,XY,-D/46,XY,Dq+)

Summary A newborn child with multiple congenital abnormalities, including severe hypoplastic thumb and atresia recti, is described. The cytogenetic analysis revealed a mosaicism 46,XY/45,XY,-D/46,XY,Dq+. The combination of mosaic D-monosomy and two cardinal features of 13q-syndrome give the possibility to consider this case as new cytogenetical variant of the Orbeli's syndrome.

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Zusammenfassung Ein Neugeborenes mit multiplen kongenitalen Abnormitäten einschließ-lich erheblicher Hypoplasie der Daumen und Atresia recti wird beschrieben. Die cytogenetische Analyse ergab ein Mosaik 46,XY/45,XY,-D/46,XY,Dq+ Die Kombination von Mosaik D-Monosomie und den zwei Hauptsymptomen des 13q-Syndroms läßt in diesem Falle eine neue cytogenetische Variante des Orbeli-Syndroms vermuten.

     

H-Y antigen in 46,XY gonadal dysgenesis

Summary Presence of H-Y antigen has been correlated with testicular differentiation, and absence of H-Y with failure of testicular differentiation, in a variety of mammalian species. To determine more precisely the relationship between expression of H-Y antigen and development of the testis, we studied the cells of phenotypic females with the 46,XY male karyotype. Blood leukocytes were typed H-Y⁺ in five XY females with gonadal dysgenesis, although in other studies blood leukocytes from XY females with gonadal dysgenesis were typed H-Y^-. Thus mere presence of H-Y antigen is not sufficient to guarantee normal differentiation of the testis. In the present paper we review evidence for an additional factor in gonadal organogenesis, the H-Y antigen receptor. We infer that testicular development requires engagement of H-Y and its receptor. It follows that XY gonadal dysgenesis is the consequence of functional absence of the H-Y testis inducer as in the following conditions: failure of synthesis of H-Y or failure of specific binding of H-Y.     

Meiotic association between the XY chromosomes and the autosomal quadrivalent of a reciprocal translocation in two infertile men, 46,XY,t(19;22) and 46,XY,t(17;21)

An electron microscopy study of synaptonemal complexes in two men carrying reciprocal translocations, a t(19;22) and a t(17;21), is reported. It is shown that a delay in synapsis affects the segments corresponding to the short arms of the acrocentrics involved in the formation of quadrivalents. This appears to provoke an interaction with the sex bivalent which could lead to a failure of spermatogenesis. A study of the literature comparing reciprocal translocations that do and do not involve acrocentrics in sterile and fertile men shows the existence of a significant association between the presence of an acrocentric in the rearrangement and sterility. These results on reciprocal translocations involving at least one acrocentric chromosome correspond to those obtained in cases of Robertsonian translocations.     

Etude d'une observation de chromosome du groupe 13–15 en anneau (46,XY,15r)

Résumé Observation d'un garçon de 8 ans et demi de petite taille, microcéphalique avec retard mental mais sans dysmorphie faciale ou autre malformation. Le caryotype fait à partir de cultures de leucocytes met en évidence la présence d'un anneau remplaçant un chromosome 13–15 absent. L'autoradiographie démontre que l'anneau provient d'un N^o 15.

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A ring D chromosome (46,XY,15r)

Summary A male infant, 8 and half years old, of short stature, is microcephalic with mental retardation but no facial dysmorphy or other malformation. The caryotype in peripherical leucocyte cultures revealed a chromosome complement with a ring replacing a missing 13–15 chromosome. This ring was identified as a chromosome n^o 15 by autoradiography.

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Zusammenfassung Die Autoren berichten über einen 81/2 Jahre alten Jungen mit Kleinwuchs, Mitrocephalie und Schwachsinn. Es fand sich jedoch weder eine Dysmorphie des Gesichtes noch eine andere Mißbildung. Der Karyotyp in peripheren Leukocytenkulturen zeigte ein Ringchromosom an Stelle eines Chromosoms de Gruppe 13–15. Mit Autoradiographie ließ sich dieser Ring als Chromosom Nr. 15 identifizieren.

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Clinique des Maladies des enfants et Hygiène du premier âge (Professeur R. Jean)     

A successful second delivery outcome using refrozen thawed testicular sperm from an infertile male true hermaphrodite with a 46, XX/46, XY karyotype: case report

We report a successful second delivery of a healthy infant fathered using refrozen thawed testicular sperm from an infertile male chimera. We also examined sex chromosome distribution of the seminiferous tubule. Intracytoplasmic sperm injection (ICSI) was performed using the remaining refrozen testicular sperm, which had been stored during the first treatment. Biopsied testicular cells were examined by fluorescence in situ hybridization (FISH) and the peripheral lymphocyte karyotype was tested using a G-band. Following ICSI, a second pregnancy was established, and a healthy girl was successfully delivered at 40 gestational weeks without complications. Although the husband’s lymphocyte chromosomal analysis revealed a 46, XX [28]/46, XY [2] karyotype, the seminiferous tubule cells on histological examination by FISH were chimeric sex chromosome type XX [18]/XY [82]. In conclusion, this is a very rare case report of a successful subsequent delivery of a healthy infant (46, XX) from an infertile true hermaphrodite (46, XX/46, XY) using refrozen thawed testicular sperm. The seminiferous tubule cells’ karyotype ratio differed from that of the lymphocytes.     

True hermaphroditism with 46,X,+22p/46,XY and gonadal mosaicism detected by fluorescence in situ hybridization

A Japanese girl was diagnosed as true hermaphroditism with 46,X,+mar/46,XY and the marker chromosome was determined on the short arm of chromosome 22 without alpha-satellite by fluorescence in situ hybridization (FISH) and spectral karyotyping (SKY) methods. At birth, she showed intersexual external genitalia, urethral-vaginal fistula and right inguinal hernia. The right gonad was revealed as an ovotestis, and the left was as an undifferentiated testis. The gonadal mosaicism was demonstrated directly in gonadal tissue by interphase FISH.     

Mutations in MAP3K1 cause 46,XY disorders of sex development and implicate a common signal transduction pathway in human testis determination

Investigations of humans with disorders of sex development (DSDs) resulted in the discovery of many of the now-known mammalian sex-determining genes, including SRY, RSPO1, SOX9, NR5A1, WT1, NR0B1, and WNT4. Here, the locus for an autosomal sex-determining gene was mapped via linkage analysis in two families with 46,XY DSD to the long arm of chromosome 5 with a combined, multipoint parametric LOD score of 6.21. A splice-acceptor mutation (c.634-8T>A) in MAP3K1 segregated with the phenotype in the first family and disrupted RNA splicing. Mutations were demonstrated in the second family (p.Gly616Arg) and in two of 11 sporadic cases (p.Leu189Pro, p.Leu189Arg)-18% prevalence in this cohort of sporadic cases. In cultured primary lymphoblastoid cells from family 1 and the two sporadic cases, these mutations altered the phosphorylation of the downstream targets, p38 and ERK1/2, and enhanced binding of RHOA to the MAP3K1 complex. Map3k1 within the syntenic region was expressed in the embryonic mouse gonad prior to, and after, sex determination. Thus, mutations in MAP3K1 that result in 46,XY DSD with partial or complete gonadal dysgenesis implicate this pathway in normal human sex determination.     

Aberrations of the synaptonemal complexes in a male 46,XY,-14,+der(14)t(Y;14)

An unbalanced translocation 46,XY,-14,+der(14)t(Y;14)(q11;p11) was observed in an azoospermic male, with reduced spermatogenesis and absent spermiogenesis. At the pachytene stage of spermatocyte 1, the segments of the 2 Y chromosomes, fluorescent with quinacrine mustard, were always found close together. This proximity was also demonstrated by the study of synaptonemal complexes, which showed, in addition, an unusual hypercondensation of the proximal segment of bivalent 14, adjacent to the translocated Y chromosome. This allows us to propose that this hypercondensation might correspond to an inactivation of the translocated autosome, which could be responsible of the degeneration of the germ cells.     

Clinical and endocrine spectrum in patients with the 45,X/46,XY karyotype

Summary Cytogenetic and endocrine studies were performed in five unrelated 45,X/46,XY individuals in an attempt to correlate them with their clinical expression and gonadal morphology. A lack of a consistent pattern between cytogenetic findings and phenotype was observed.Endocrine studies revealed a wide spectrum of hypothalamic, pituitary, and gonadal hormone production as assessed by the base line levels of LH, FSH, T, and ⁴-A and their responses to appropriate exogenous stimulation (LH-RH and HCG). An adequate correlation between endocrine findings with gonadal morphology and phenotype could be established; thus demonstrating that patients with this particular chromosome complement have a functional integrity of the gonadotropin hypothalamic pituitary activity modulated accordingly with the gonadal function of each particular case.