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Meenal B, Meenakshi G, Pratibha S, Garima Y, Priyanka K, Poonam E. 46 XY Ovotesticular Disorder: A Rare Case Report with Review of Literature. Gynecol Minim Invasive Ther 2021; 10:171-173. [PMID: 34485063 PMCID: PMC8384022 DOI: 10.4103/gmit.gmit_107_19] [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] [Received: 03/16/2020] [Revised: 05/18/2020] [Accepted: 07/02/2020] [Indexed: 11/04/2022] Open
Abstract
Ovotesticular disorder represents 10% of cases of disorder of sex development characterized by the presence of both ovarian and testicular tissue in the same individual, with karyotype 46 XY being a rare sex chromosomal abnormality. We report the case of a 16-year-old person, who is reared as female, with a complaint of primary amenorrhea along with lack of secondary sexual characteristics, karyotype 46 XY. Prophylactic bilateral gonadectomy was done, and histopathological examination of bilateral gonads revealed ovarian stroma with a few Sertoli cell line tubules suggestive of bilateral ovotestis; hence, we concluded and framed our diagnosis of ovotesticular disorder.
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Affiliation(s)
- Bhati Meenal
- Department of Obstetrics and Gynecology, AIIMS, Jodhpur, Rajasthan, India
| | - Gothwal Meenakshi
- Department of Obstetrics and Gynecology, AIIMS, Jodhpur, Rajasthan, India
| | - Singh Pratibha
- Department of Obstetrics and Gynecology, AIIMS, Jodhpur, Rajasthan, India
| | - Yadav Garima
- Department of Obstetrics and Gynecology, AIIMS, Jodhpur, Rajasthan, India
| | - Kathuria Priyanka
- Department of Obstetrics and Gynecology, AIIMS, Jodhpur, Rajasthan, India
| | - Elhence Poonam
- Department of Pathology, AIIMS, Jodhpur, Rajasthan, India
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Manotas MC, García-Acero M, González DM, Moreno OM, Suárez-Obando F, Céspedes C, Forero C, Pérez J, Fernández N, Rojas A. Clinical and Molecular Cytogenetic Characteristics of Five Cases with Isodicentric Y Chromosome. Sex Dev 2021; 14:12-20. [PMID: 33677455 DOI: 10.1159/000512803] [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: 04/30/2020] [Accepted: 10/01/2020] [Indexed: 11/19/2022] Open
Abstract
Isodicentric Y chromosome [idic(Y)] is one of the most common structural abnormalities of the Y chromosome and has been observed in patients with reproductive disorders and in patients with disorders of sexual development. Most idic(Y) chromosomes are found in mosaic form with a 45,X cell line. These chromosomes are highly unstable during mitosis due to the presence of 2 centromers, which explains their probable loss in early mitosis or mitosis of the embryo and therefore the presence of the 45,X line. It has been hypothesized that the proportion of 45,X cells in various tissues probably influences the phenotypic sex of individuals carrying an idic(Y) chromosome, ranging from infertile men, hypospadias, ambiguous genitalia, and Turner syndrome to sex reversal. In this article we present 5 cases of patients with idic(Y) referred for suspected disorder of sex development (DSD), 3 with a male assignment and 2 with a female assignment. All cases have variable clinical characteristics, which were assessed by the transdisciplinary group of Disorders of Sex Development of the Hospital Universitario San Ignacio, Bogotá, Colombia. Patients were analyzed by conventional and molecular cytogenetics using high-resolution G-band and FISH techniques. Our findings highlight the importance of cytogenetic studies in the diagnosis of DSD patients.
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Affiliation(s)
- María C Manotas
- Institute of Human Genetics, School of Medicine, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Mary García-Acero
- Institute of Human Genetics, School of Medicine, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Daniel M González
- Institute of Human Genetics, School of Medicine, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Olga M Moreno
- Institute of Human Genetics, School of Medicine, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Fernando Suárez-Obando
- Institute of Human Genetics, School of Medicine, Pontificia Universidad Javeriana, Bogotá, Colombia.,Clinical Genetics, Hospital Universitario San Ignacio, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Camila Céspedes
- School of Medicine, Pontificia Universidad Javeriana, Bogotá, Colombia.,Pediactric Endocrinology, Hospital Universitario San Ignacio, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Catalina Forero
- School of Medicine, Pontificia Universidad Javeriana, Bogotá, Colombia.,Pediactric Endocrinology, Hospital Universitario San Ignacio, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Jaime Pérez
- School of Medicine, Pontificia Universidad Javeriana, Bogotá, Colombia.,Division of Urology, Hospital Universitario San Ignacio, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Nicolás Fernández
- School of Medicine, Pontificia Universidad Javeriana, Bogotá, Colombia.,Division of Urology, Hospital Universitario San Ignacio, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Adriana Rojas
- Institute of Human Genetics, School of Medicine, Pontificia Universidad Javeriana, Bogotá, Colombia,
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Chen CQ, Liu Z, Lu YS, Pan M, Huang H. True hermaphroditism with dysgerminoma: A case report. Medicine (Baltimore) 2020; 99:e20472. [PMID: 32481455 DOI: 10.1097/md.0000000000020472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION True hermaphroditism is a rare and usually sporadic disorder. It is defined by the presence of both ovarian and testicular tissues together as ovotestis. PATIENT CONCERNS In this study, we reported a rare true hermaphroditism case with dysgerminoma. A 49-year-old woman developed masses in both inguinal regions for 30 years. Recently 3 months, the patient found that the size of mass in her left inguinal region was significantly increased. DIAGNOSIS After surgical resection, the results of immunohistochemical examination in left mass revealed a dysgerminoma with positive expression of placental alkaline phosphatase and octamer-binding transcription factor 3/4, and right mass was a cryptorchidism. Chromosomal analysis revealed the karyotype 46, XY. Combined immunohistochemical and karyotype analysis, a diagnosis of true hermaphroditism with dysgerminoma was made. INTERVENTIONS Radiotherapy combined with chemotherapy after tumor resection was used to improve her prognosis. Hormone replacement therapy with conjugated estrogen and medroxyprogesterone acetate were used to maintain her female characteristics. OUTCOMES The patient underwent hormonal replacement and has been well for 6 months. CONCLUSION The positive expression of placental alkaline phosphatase and octamer-binding transcription factor 3/4 could be 2 diagnosis markers of dysgerminoma. Surgery combined with radiotherapy and chemotherapy could improve the prognosis of dysgerminoma. Moreover, hormone replacement therapy with conjugated estrogen and medroxyprogesterone acetate was very helpful to maintain the female characteristic of patients with true hermaphroditism.
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Affiliation(s)
- Chun-Qiao Chen
- The Department of Oncology, People's Hospital of Guilin
- The Department of Oncology, Fifth Clinical Medical College
| | - Zheng Liu
- College of Medical Laboratory Science, Guilin Medical University, Guilin, Guangxi, China
| | - Yu-Song Lu
- The Department of Oncology, People's Hospital of Guilin
| | - Min Pan
- The Department of Oncology, People's Hospital of Guilin
| | - Hui Huang
- The Department of Oncology, People's Hospital of Guilin
- The Department of Oncology, Fifth Clinical Medical College
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Caputo M, Mele C, Zavattaro M, Samà MT, Giordano M, Umari P, Volpe A, Aimaretti G, Prodam F. Ovotesticular Disorder of Sex Development: A Rare Case of Lateral Subtype 45X/46XY kariotype Diagnosed in Adulthood. Urology 2019; 129:68-70. [DOI: 10.1016/j.urology.2019.04.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2019] [Revised: 03/23/2019] [Accepted: 04/06/2019] [Indexed: 11/30/2022]
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Zheng J, Yang X, Lu H, Guan Y, Yang F, Xu M, Li M, Ji X, Wang Y, Hu P, Zhou Y. Prenatal diagnosis of sex chromosome mosaicism with two marker chromosomes in three cell lines and a review of the literature. Mol Med Rep 2018; 19:1791-1796. [PMID: 30592288 DOI: 10.3892/mmr.2018.9798] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2018] [Accepted: 11/21/2018] [Indexed: 11/06/2022] Open
Abstract
The present study described the diagnosis of a fetus with sex chromosome mosaicism in three cell lines and two marker chromosomes. A 24‑year‑old woman underwent amniocentesis at 21 weeks and 4 days of gestation due to noninvasive prenatal testing identifying that the fetus had sex chromosome abnormalities. Amniotic cell culture revealed a karyotype of 45,X[13]/46,X,+mar1[6]/46,X,+mar2[9], and prenatal ultrasound was unremarkable. The woman underwent repeat amniocentesis at 23 weeks and 4 days of gestation for molecular detection. Single nucleotide polymorphism (SNP) microarray analysis on uncultured amniocytes revealed that the fetus had two Y chromosomes and 7.8‑Mb deletions in Yq11.222q12. The deletion regions included DAZ, RBMY and PRY genes, which could cause spermatogenesis obstacle and sterility. Interphase fluorescence in situ hybridization (FISH) using centromeric probes DXZ1/DYZ3/D18Z1 was performed on uncultured amniocytes to verify the two marker chromosomes to be Y chromosome derivatives. According to these examinations, the mar1 was identified as a derivative of the Y chromosome with a deletion in Yq11.222q12, and the mar2 was identified as a dicentric derivative of the Y chromosome. The molecular karyotype was therefore 45,X,ish(DXZ1+, DYZ3‑,D18Z1++)[5]/46,X,del(Y)(q11.222),ish(DXZ1+,DYZ3+,D18Z1++)[11]/46, X,idic(Y)(q11.222),ish(DXZ1+,DYZ3++,D18Z1++)[14]. The comprehensive use of cytogenetic, SNP array and FISH detections was advantageous for accurately identifying the karyotype, identifying the origin of the marker chromosome and preparing effective genetic counseling.
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Affiliation(s)
- Jianli Zheng
- Department of Prenatal Diagnosis, Laboratory of Clinical Genetics, Maternity and Child Health Care Hospital, Yancheng, Jiangsu 224001, P.R. China
| | - Xiaoyu Yang
- Department of Clinical Reproductive Medicine, State Key Laboratory of Reproductive Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, P.R. China
| | - Haiyan Lu
- Department of Prenatal Diagnosis, Laboratory of Clinical Genetics, Maternity and Child Health Care Hospital, Yancheng, Jiangsu 224001, P.R. China
| | - Yongjuan Guan
- Department of Prenatal Diagnosis, Laboratory of Clinical Genetics, Maternity and Child Health Care Hospital, Yancheng, Jiangsu 224001, P.R. China
| | - Fangfang Yang
- Department of Prenatal Diagnosis, Laboratory of Clinical Genetics, Maternity and Child Health Care Hospital, Yancheng, Jiangsu 224001, P.R. China
| | - Mengjun Xu
- Department of Prenatal Diagnosis, Laboratory of Clinical Genetics, Maternity and Child Health Care Hospital, Yancheng, Jiangsu 224001, P.R. China
| | - Min Li
- Department of Prenatal Diagnosis, Laboratory of Clinical Genetics, Maternity and Child Health Care Hospital, Yancheng, Jiangsu 224001, P.R. China
| | - Xiuqing Ji
- Department of Prenatal Diagnosis, State Key Laboratory of Reproductive Medicine, Obstetrics and Gynecology Hospital Affiliated to Nanjing Medical University, Nanjing, Jiangsu 210004, P.R. China
| | - Yan Wang
- Department of Prenatal Diagnosis, State Key Laboratory of Reproductive Medicine, Obstetrics and Gynecology Hospital Affiliated to Nanjing Medical University, Nanjing, Jiangsu 210004, P.R. China
| | - Ping Hu
- Department of Prenatal Diagnosis, State Key Laboratory of Reproductive Medicine, Obstetrics and Gynecology Hospital Affiliated to Nanjing Medical University, Nanjing, Jiangsu 210004, P.R. China
| | - Yun Zhou
- Department of Prenatal Diagnosis, Laboratory of Clinical Genetics, Maternity and Child Health Care Hospital, Yancheng, Jiangsu 224001, P.R. China
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Andrade JGRD, Andrade LALDA, Guerra-Junior G, Maciel-Guerra AT. 45,X/46,XY ovotesticular disorder of sex development revisited: undifferentiated gonadal tissue may be mistaken as ovarian tissue. J Pediatr Endocrinol Metab 2017; 30:899-904. [PMID: 28742519 DOI: 10.1515/jpem-2017-0039] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Accepted: 06/12/2017] [Indexed: 11/15/2022]
Abstract
BACKGROUND The 45,X/46,XY karyotype has been associated with mixed gonadal dysgenesis (MGD) and ovotesticular disorder of sex development (DSD). Our aim was to revise the diagnosis of ovotesticular DSD in two patients in the context of a retrospective study of 45,X/46,XY subjects with genital ambiguity. CASE PRESENTATION Patient 1 had a left streak gonad; the right one was considered an ovotestis. Patient 2 had a right testis; the left gonad was considered an ovary. Revision of the histological sections was performed. Both the "ovarian" part of the right gonad of patient 1 and the left "ovary" of patient 2 contained ovarian-type stroma with clusters of sex-cordlike structures and rare germ cells, compatible with undifferentiated gonadal tissue (UGT). Misdiagnosis of ovarian tissue in patients with 45,X/46,XY mosaicism or its variants could also be found in six published case reports. CONCLUSIONS A distinction between 45,X/46,XY ovotesticular DSD and MGD should be made on past and future cases keeping in mind that UGT may be mistaken as ovarian tissue.
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