1
|
Shen W, Li Y. Gonadoblastoma in Turner syndrome with puberty delay: A case report and literature review. Mol Genet Genomic Med 2023; 11:e2300. [PMID: 37822273 PMCID: PMC10724510 DOI: 10.1002/mgg3.2300] [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: 05/22/2023] [Revised: 09/04/2023] [Accepted: 09/29/2023] [Indexed: 10/13/2023] Open
Abstract
BACKGROUND Y chromosome material stands as an independent risk determinant for the onset of gonadoblastoma (GB) and subsequent gonadal germ cell tumours in individuals with Turner syndrome (TS). However, the delayed and underestimated identification of Y chromosome material through karyotyping within primary care settings exacerbates the intricacies of managing these patients over the long term. METHODS We present a case involving TS accompanied by Y chromosome material, wherein puberty delay and GB were identified during prophylactic gonadectomy. Subsequently, we delve into the literature to explore the GB-related malignancy risk in TS patients with Y chromosome material, the incidence of Y chromosome presence in TS patients using methodologies beyond routine chromosomal testing, and the diagnosis and treatment of puberty delay in TS patients, all based on our case. RESULTS A spectrum of more sensitive molecular techniques, including polymerase chain reaction (PCR) and fluorescence in situ hybridisation, effectively augments the detection of Y chromosome material alongside karyotyping. In addition to gonadectomy, the implementation of appropriate oestrogen therapy and a holistic, multidisciplinary approach to care can enhance the quality of life, while mitigating the long-term morbidity and mortality risks for TS patients harbouring Y chromosome material. CONCLUSIONS Beyond gonadectomy, adopting a multifaceted approach the Y chromosome material detection, prompt initiation of puberty, tailored oestrogen therapy, and coordinated multidisciplinary management significantly contributes to the comprehensive health oversight of TS patients with Y chromosome material.
Collapse
Affiliation(s)
- Wei Shen
- Department of Obstetrics and GynecologyTongji Hospital, Tongji Medical College, Huazhong University of Science and TechnologyWuhanChina
| | - Ya Li
- Department of Obstetrics and GynecologyTongji Hospital, Tongji Medical College, Huazhong University of Science and TechnologyWuhanChina
| |
Collapse
|
2
|
Ossama HM, Kholeif S, Elhady GM. The Use of Fluorescence In situ Hybridisation in the Diagnosis of Hidden Mosaicism in Egyptian Patients with Turner Syndrome. J Hum Reprod Sci 2023; 16:286-298. [PMID: 38322635 PMCID: PMC10841934 DOI: 10.4103/jhrs.jhrs_128_23] [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: 09/27/2023] [Revised: 12/01/2023] [Accepted: 12/01/2023] [Indexed: 02/08/2024] Open
Abstract
Background Turner syndrome (TS) is the most common chromosomal abnormality in females. The diagnosis of TS is based on karyotyping of 30 blood lymphocytes. This technique does not rule out tissue mosaicism or low-grade mosaicism in the blood. Because of the associated risk of gonadoblastoma, mosaicism is especially important in case this involves a Y chromosome. Aims This study was set to determine the value of additional genetic studies such as fluorescent in situ hybridisation and the inclusion of buccal cells in search for mosaicism in TS patients. Settings and Design This cross-sectional, descriptive study was performed in Human Genetics Department, Medical Research Institute, Alexandria University. Materials and Methods Fluorescence in situ hybridisation technique was applied to lymphocyte cultures as well as buccal smears using centromeric probes for X and Y chromosomes. Genotype phenotype correlation was also evaluated. Statistical Analysis Used Descriptive study where categorical variables were described using number and percentage and continuous variables were described using mean and standard deviation. Results Fluorescence in situ hybridisation technique study detected hidden mosaicism in 60% of studied patients; 20% of patients had a cell line containing Y material, while 40% had variable degrees of X, XX mosaicism, and in the remaining 40% no second cell line was detected. Fluorescence in situ hybridisation study helped identify the origin of the marker to be Y in all patients. The introduction of an additional cell line helped in identifying mosaicism in patients with monosomy X. Virilisation signs were only observed among TS patients with Y cell line mosaicism. The clinical manifestations were more severe in patients with monosomy X than other mosaic cases. Conclusions Molecular cytogenetic investigation for all suspected cases of TS should be considered for appropriate treatment plan and genetic counselling.
Collapse
Affiliation(s)
- Heba Mohamed Ossama
- Department of Human Genetics, Medical Research Institute, Alexandria University, Alexandria, Egypt
| | - Soha Kholeif
- Department of Human Genetics, Medical Research Institute, Alexandria University, Alexandria, Egypt
| | - Ghada Mohamed Elhady
- Department of Human Genetics, Medical Research Institute, Alexandria University, Alexandria, Egypt
| |
Collapse
|
3
|
Karila D, Donadille B, Léger J, Bouvattier C, Bachelot A, Kerlan V, Catteau-Jonard S, Salenave S, Albarel F, Briet C, Coutant R, Brac De La Perriere A, Valent A, Siffroi JP, Christin-Maitre S. Prevalence and characteristics of gonadoblastoma in a retrospective multi-center study with follow-up investigations of 70 patients with Turner syndrome and a 45,X/46,XY karyotype. Eur J Endocrinol 2022; 187:873-881. [PMID: 36305565 DOI: 10.1530/eje-22-0593] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 10/27/2022] [Indexed: 11/08/2022]
Abstract
INTRODUCTION A gonadectomy is currently recommended in patients with Turner syndrome (TS) and a 45,X/46,XY karyotype, due to a potential risk of gonadoblastoma (GB). However, the quality of evidence behind this recommendation is low. OBJECTIVE This study aimed to evaluate the prevalence of GB, its characteristics, as well as its risk factors, according to the type of Y chromosomal material in the karyotype. METHODS Our study within French rare disease centers included patients with TS and a 45,X/46,XY karyotype, without ambiguity of external genitalia. Clinical characteristics of the patients, their age at gonadectomy, and gonadal histology were recorded. The regions of the Y chromosome, the presence of TSPY regions, and the percentage of 45,X/46,XY mosaicism were evaluated. RESULTS A total of 70 patients were recruited, with a median age of 29.5 years (21.0-36.0) at the end of follow-up. Fifty-eight patients had a gonadectomy, at a mean age of 15 ± 8 years. GB was present in nine cases. Two were malignant, which were discovered at the age of 14 and 32 years, without metastases. Neither the percentage of XY cells within the 45,X/46,XY mosaicism nor the number of TSPY copies was statistically different in patients with or without GB (P = 0.37). However, the entire Y chromosome was frequent in patients with GB (6/9). CONCLUSIONS In our study, including a large number of patients with 45,X/46,XY TS, the prevalence of gonadoblastoma is 12.8%. An entire Y chromosome appears as the main risk factor of GB and should favor early gonadectomy. SIGNIFICANT STATEMENT About 10% of patients with TS have a karyotype containing Y chromosomal material: 45,X/46,XY. Its presence is related to the risk of GB. Therefore, a prophylactic gonadectomy is currently recommended in such patients. However, the quality of evidence is low. Our objective was to evaluate the prevalence of GB according to the type of Y-chromosomal material. We found a prevalence of GB of 12.8% in a cohort of 70 TS patients. No sign of hyperandrogenism was observed. The entire Y chromosome was the most frequent type of Y-material in patients with GB. As the prognosis of these tumors was good, a delay of surgery might be discussed.
Collapse
Affiliation(s)
- Daphné Karila
- Sorbonne University, Endocrine Unit, Reproductive Medicine, Centre de Référence des Maladies Endocriniennes Rares de la Croissance et du Développement (CRMERC), Endo-ERN (id 739527), Saint-Antoine Hospital, AP-HP, Paris, France
| | - Bruno Donadille
- Sorbonne University, Endocrine Unit, Reproductive Medicine, Centre de Référence des Maladies Endocriniennes Rares de la Croissance et du Développement (CRMERC), Endo-ERN (id 739527), Saint-Antoine Hospital, AP-HP, Paris, France
| | - Juliane Léger
- Pediatric Endocrinology and Diabetology, Robert-Debré Hospital, Centre de Référence des Maladies Endocriniennes Rares de la Croissance et du Développement (CRMERC), Endo-ERN Paris, France
| | - Claire Bouvattier
- Pediatric Endocrinology and Diabetology, Bicêtre Hospital, Centre de référence des maladies rares du développement (DEVGEN), Endo-ERN Le Kremlin Bicêtre, France
| | - Anne Bachelot
- Sorbonne University, Department of Endocrinology and Reproductive Medicine, Centre de Référence des Maladies Endocriniennes Rares de la Croissance et du Développement, CRMERC, Endo-ERN, Pitié-Salpêtrière Hospital, AP-HP, Paris, France
| | | | | | - Sylvie Salenave
- Endocrinology and metabolism, Bicêtre Hospital, Le Kremlin Bicetre, APHP, France
| | - Frédérique Albarel
- Department of Endocrinology, Assistance Publique-Hôpitaux de Marseille (AP-HM), Hôpital de la Conception, Centre de référence des Maladies Rares de l'hypophyse HYPO, 13005 Marseille, FRANCE
| | - Claire Briet
- Endocrinology, Diabetology, and Nutrition, Centre de référence des maladies rares de la Thyroïde et des Récepteurs Hormonaux, ENDO ERN CHU Angers, Angers, France
| | - Regis Coutant
- Pediatric Endocrinology and Diabetology, Centre de référence des maladies rares de la Thyroïde et des Récepteurs Hormonaux Endo-ERN CHU Angers, Angers, France
| | | | - Alexander Valent
- Department of Molecular Pathology, Cytogenetics and Medical Biology, Institut Gustave Roussy, Villejuif, France
| | - Jean-Pierre Siffroi
- Sorbonne University, Genetic unit, Trousseau Hospital, Paris, APHP, France
- INSERM UMR-833, Trousseau Hospital, Paris, France
| | - Sophie Christin-Maitre
- Sorbonne University, Endocrine Unit, Reproductive Medicine, Centre de Référence des Maladies Endocriniennes Rares de la Croissance et du Développement (CRMERC), Endo-ERN (id 739527), Saint-Antoine Hospital, AP-HP, Paris, France
- INSERM UMR-833, Trousseau Hospital, Paris, France
| |
Collapse
|
4
|
Dejonckheere C, Moyson C, de Zegher F, Antonio L, Van Buggenhout G, Decallonne B. Neoplasia in Turner syndrome: a retrospective cohort study in a tertiary referral centre in Belgium. Acta Clin Belg 2022; 77:86-92. [PMID: 32780684 DOI: 10.1080/17843286.2020.1805237] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVES Patients with Turner syndrome (TS), the most common sex chromosome abnormality in women, can suffer from a variety of well-researched reproductive, cardiovascular, metabolic, and autoimmune comorbidities. Few studies investigate the neoplasia risk. We assessed the general neoplasia risk in TS women, and more specifically, the gonadoblastoma/dysgerminoma risk in the subgroup with Y chromosome mosaicism, and evaluated potential risk factors for neoplasia development, such as karyotype, metabolic and autoimmune comorbidity, and treatment with growth hormone and/or estrogen replacement. DESIGN 10-year retrospective cohort study in a tertiary referral centre in Belgium. RESULTS 105 TS women were included (median age 29; range 2-69). Six malignant tumours were detected in 5 (4.8%) patients (SIR = 0.6, 95% CI 0.2-1.0). In addition, 2 benign meningiomas were observed, resulting in 3 (2.9%) tumours of the central nervous system (CNS; SIR = 19.9, 95% CI 4.0-35.8). No breast cancer was noted. Benign neoplasms occurred in 22 women (21.0%), with skin lesions being the most frequent. All patients with Y chromosome mosaicism (n = 9; 8.6%) underwent prophylactic gonadectomy, but gonadoblastoma/dysgerminoma was not detected. A weak association was found between any tumour type and autoimmune comorbidity (r = 0.24; p = 0.02). CONCLUSION The overall malignancy risk was not increased, but a different pattern of occurrence is apparent, with an increased risk of CNS and skin tumours and a decreased breast cancer risk. Gonadoblastoma/dysgerminoma was not reported. There is a need for centralised multidisciplinary care and prospective research to unravel and predict the neoplasia risk.
Collapse
Affiliation(s)
- Cas Dejonckheere
- Faculty of Medicine, Catholic University Leuven, Leuven, Belgium
| | - Carolien Moyson
- Department of Adult Endocrinology, University Hospitals Leuven, Leuven, Belgium
| | - Francis de Zegher
- Department of Paediatrics, University Hospitals Leuven, Leuven, Belgium
| | - Leen Antonio
- Department of Adult Endocrinology, University Hospitals Leuven, Leuven, Belgium
| | | | - Brigitte Decallonne
- Department of Adult Endocrinology, University Hospitals Leuven, Leuven, Belgium
| |
Collapse
|
5
|
Soares JS, da Silva Lago RMR, Toralles MBP, Mota LR, Alves ES, de Carvalho AFL. Searching chromosome mosaicisms in 45,X Turner syndrome: how relevant is it? ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2021; 65:739-746. [PMID: 34762780 PMCID: PMC10065388 DOI: 10.20945/2359-3997000000403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Objective To investigate the presence of chromosome mosaicism, especially for the presence of Y derived material in 45,X women with Turner syndrome (TS). Methods FISH and PCR were performed for the presence of chromosome mosaicism and Y-derived-material and genetic findings were correlated to clinical data. Results Thirty-one participants were enrolled: 18 (58%) had chromosome mosaicisms (FISH), Y-derived material was found in 2. Yet, SRY primer was found with PCR in only one of them and DYZ3 was not found. The most frequent clinical findings were short or webbed neck (81,82%), high-arched palate (78%), breast hypertelorism, e cubitus valgus and genu valgus (57.6%, both), short fourth metacarpals (46.9%), epicanthic folds (43.8%), shield chest (43.8%), lymphedema (37.5%), and low set ears (34.4%). Both patients with Y-derived-material had primary amenorrhea, dyslipidemia and reached the height of 150 cm despite not treated with recombinant growth hormone (GHr). One of them showed 26% of leukocytes with Y-derived material and few clinical findings. Conclusion FISH techniques proved efficient in detecting chromosome mosaicisms and Y-derived material and searching in different tissues such as mouth cells is critical due to the possibility of tissue-specific mosaicism. Phenotypical variance in TS may be a signal of chromosome mosaicisms, especially with the presence of Y-derived material.
Collapse
Affiliation(s)
- Jéssica Silva Soares
- Laboratório de Genética Humana e Mutagênese, Instituto de Biologia, Universidade Federal da Bahia, Salvador, BA, Brasil
| | | | - Maria Betânia Pereira Toralles
- Departamento de Genética Médica, Hospital Universitário Edgard Santos, Universidade Federal da Bahia, Salvador, BA, Brasil
| | - Laís Ribeiro Mota
- Laboratório de Genética Humana e Mutagênese, Instituto de Biologia, Universidade Federal da Bahia, Salvador, BA, Brasil
| | - Esmeralda Santos Alves
- Departamento de Genética Médica, Hospital Universitário Edgard Santos, Universidade Federal da Bahia, Salvador, BA, Brasil
| | | |
Collapse
|
6
|
Significance of Y Chromosome in a Turner Mosaic Girl with Dysgerminoma: Case Report with Literature Review. INDIAN JOURNAL OF GYNECOLOGIC ONCOLOGY 2021. [DOI: 10.1007/s40944-021-00563-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
7
|
Akcan AB, Boduroğlu OK. Y Chromosome Material in Turner Syndrome. Cureus 2021; 13:e19977. [PMID: 34868795 PMCID: PMC8628189 DOI: 10.7759/cureus.19977] [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] [Accepted: 11/28/2021] [Indexed: 11/05/2022] Open
Abstract
Background Turner Syndrome (TS) is a frequently identified chromosomal disease in humans characterized by short stature, sexual infantilism, streak gonads, primary amenorrhea, and a number of somatic anomalies. Approximately 55% of TS individuals have a nonmosaic 45,X karyotype. In addition, a cell line with a Y chromosome is present in 5% of patients, which is undetectable by the standard cytogenetic analysis. The identification of Y chromatin in some TS individuals has been associated with the development of gonadoblastoma. Therefore, it is important to exclude the presence of Y chromatin in TS individuals. In this study, it was planned to detect cases with mosaicism in terms of Y chromatin with the help of Y whole chromosome probes (WCP) from individuals with TS by fluorescence in situ hybridization (FISH) analysis. Methodology Forty-four patients with Turner syndrome, who were being followed up in the Genetics Unit, were contacted and invited for the study. Of the 44 invited patients, 28 responded to the invitation. In this study, it was planned to detect TS patients with mosaicism in terms of Y chromatin with the help of the Y whole chromosome probe. Results The majority of the cases (71.42%) included in the study carried pure X monosomy, which is the classical Turner syndrome karyotype. Other structural X chromosome aberrations, in isolated or mosaic forms, were less frequently represented. Y chromosome sequences were searched in 28 cases with Turner syndrome by the FISH method using Y whole chromosome probe. Y chromosome sequence was detected in one (3.5%) case of 28 cases. Conclusions It is recommended that individuals with Turner syndrome be screened for Y chromatin. Detection of this will provide information and guidance to individuals with Turner syndrome, especially in terms of the risk of developing gonadoblastoma, with advanced clinical consultation. This study was conducted to emphasize the importance of this.
Collapse
Affiliation(s)
- Abdullah Baris Akcan
- Department of Pediatrics, Division of Neonatology, Aydın Adnan Menderes University Faculty of Medicine, Aydın, TUR
| | - Osman K Boduroğlu
- Department of Pediatrics, Division of Pediatric Genetics, Hacettepe University Faculty of Medicine, Ankara, TUR
| |
Collapse
|
8
|
Santi M, Graf S, Zeino M, Cools M, Van De Vijver K, Trippel M, Aliu N, Flück CE. Approach to the Virilizing Girl at Puberty. J Clin Endocrinol Metab 2021; 106:1530-1539. [PMID: 33367768 PMCID: PMC8063244 DOI: 10.1210/clinem/dgaa948] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Indexed: 11/19/2022]
Abstract
UNLABELLED Virilization is the medical term for describing a female who develops characteristics associated with male hormones (androgens) at any age, or when a newborn girl shows signs of prenatal male hormone exposure at birth. In girls, androgen levels are low during pregnancy and childhood. A first physiologic rise of adrenal androgens is observed at the age of 6 to 8 years and reflects functional activation of the zona reticularis of the adrenal cortex at adrenarche, manifesting clinically with first pubic and axillary hairs. Early adrenarche is known as "premature adrenarche." It is mostly idiopathic and of uncertain pathologic relevance but requires the exclusion of other causes of androgen excess (eg, nonclassic congenital adrenal hyperplasia) that might exacerbate clinically into virilization. The second modest physiologic increase of circulating androgens occurs then during pubertal development, which reflects the activation of ovarian steroidogenesis contributing to the peripheral androgen pool. However, at puberty initiation (and beyond), ovarian steroidogenesis is normally devoted to estrogen production for the development of secondary female bodily characteristics (eg, breast development). Serum total testosterone in a young adult woman is therefore about 10- to 20-fold lower than in a young man, whereas midcycle estradiol is about 10- to 20-fold higher. But if androgen production starts too early, progresses rapidly, and in marked excess (usually more than 3 to 5 times above normal), females will manifest with signs of virilization such as masculine habitus, deepening of the voice, severe acne, excessive facial and (male typical) body hair, clitoromegaly, and increased muscle development. Several medical conditions may cause virilization in girls and women, including androgen-producing tumors of the ovaries or adrenal cortex, (non)classical congenital adrenal hyperplasia and, more rarely, other disorders (also referred to as differences) of sex development (DSD). The purpose of this article is to describe the clinical approach to the girl with virilization at puberty, focusing on diagnostic challenges. The review is written from the perspective of the case of an 11.5-year-old girl who was referred to our clinic for progressive, rapid onset clitoromegaly, and was then diagnosed with a complex genetic form of DSD that led to abnormal testosterone production from a dysgenetic gonad at onset of puberty. Her genetic workup revealed a unique translocation of an abnormal duplicated Y-chromosome to a deleted chromosome 9, including the Doublesex and Mab-3 Related Transcription factor 1 (DMRT1) gene. LEARNING OBJECTIVES Identify the precise pathophysiologic mechanisms leading to virilization in girls at puberty considering that virilization at puberty may be the first manifestation of an endocrine active tumor or a disorder/difference of sex development (DSD) that remained undiagnosed before and may be life-threatening. Of the DSDs, nonclassical congenital adrenal hyperplasia occurs most often.Provide a step-by-step diagnostic workup plan including repeated and expanded biochemical and genetic tests to solve complex cases.Manage clinical care of a girl virilizing at puberty using an interdisciplinary team approach.Care for complex cases of DSD manifesting at puberty, such as the presented girl with a Turner syndrome-like phenotype and virilization resulting from a complex genetic variation.
Collapse
Affiliation(s)
- Maristella Santi
- Pediatric Endocrinology, Diabetology, and Metabolism, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Stefanie Graf
- Pediatric Endocrinology, Diabetology, and Metabolism, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Mazen Zeino
- Department of Pediatric Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Martine Cools
- Department of Internal Medicine and Pediatrics, Ghent University, Ghent, Belgium
| | | | - Mafalda Trippel
- Institute of Pathology, Inselspital, University of Bern, Bern, Switzerland
| | - Nijas Aliu
- University Clinic for Pediatrics, Human Genetics, Inselspital, University of Bern, Bern, Switzerland
| | - Christa E Flück
- Pediatric Endocrinology, Diabetology, and Metabolism, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Department of BioMedical Research, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Correspondence: Christa E. Flück, Pediatric Endocrinology and Diabetology, University Children’s Hospital, Freiburgstrasse 15 / C845, 3010 Bern, Switzerland. E-mail:
| |
Collapse
|
9
|
Gawrychowska A, Iżycka-Świeszewska E, Lipska-Ziętkiewicz BS, Kuleszo D, Bautembach-Minkowska J, Łosin M, Stefanowicz J. Dysgerminoma with a Somatic Exon 17 KIT Mutation and SHH Pathway Activation in a Girl with Turner Syndrome. Diagnostics (Basel) 2020; 10:diagnostics10121067. [PMID: 33321690 PMCID: PMC7763800 DOI: 10.3390/diagnostics10121067] [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: 10/16/2020] [Revised: 11/29/2020] [Accepted: 12/04/2020] [Indexed: 11/23/2022] Open
Abstract
This article reports a case of a 7-year-old girl with Turner syndrome, treated with growth hormone (GH), who developed ovarian dysgerminoma. The patient karyotype was mosaic for chromosome Xq deletion: 46,X,del(X)(q22)/45,X. No Y chromosome sequences were present. Molecular studies revealed the presence of a driving mutation in exon 17 of the KIT gene in the neoplastic tissue, as well as Sonic-hedgehog (SHH) pathway activation at the protein level. The patient responded well to chemotherapy and remained in complete remission. This is the first case of dysgerminoma in a Turner syndrome patient with such oncogenic pathway.
Collapse
Affiliation(s)
- Ada Gawrychowska
- Department of Paediatrics, Haematology and Oncology, Clinical University Centre, 7 Debinki Street, 80-952 Gdansk, Poland;
| | - Ewa Iżycka-Świeszewska
- Department of Pathology and Neuropathology, Faculty of Health Sciences, Medical University of Gdansk, 3a Maria Sklodowska-Curie Street, 80-210 Gdansk, Poland;
| | - Beata S. Lipska-Ziętkiewicz
- Centre for Rare Diseases, Medical University of Gdansk, 7 Debinki Street, 80-952 Gdansk, Poland;
- Clinical Genetics Unit, Department of Biology and Medical Genetics, Faculty of Medicine, Medical University of Gdansk, 1 Debinki Street, 80-211 Gdansk, Poland
| | - Dominika Kuleszo
- Department of Biology and Medical Genetics, Faculty of Medicine, Medical University of Gdansk, 1 Debinki Street, 80-211 Gdansk, Poland;
| | - Joanna Bautembach-Minkowska
- Department of Paediatrics, Diabetology and Endocrinology, Clinical University Centre, 7 Debinki Street, 80-952 Gdansk, Poland;
| | - Marcin Łosin
- Department of Surgery and Urology for Children and Adolescents, Faculty of Medicine, Medical University of Gdansk, 1-6 Nowe Ogrody Street, 80-803 Gdansk, Poland;
| | - Joanna Stefanowicz
- Department of Paediatrics, Haematology and Oncology, Clinical University Centre, 7 Debinki Street, 80-952 Gdansk, Poland;
- Department of Paediatrics, Haematology and Oncology, Faculty of Medicine, Medical University of Gdansk, 7 Debinki Street, 80-210 Gdansk, Poland
- Faculty of Health Sciences, Medical University of Gdansk, 3a Maria Sklodowska-Curie Street, 80-210 Gdansk, Poland
- Correspondence: ; Tel.: +48-58-349-2808
| |
Collapse
|
10
|
Leng XF, Lei K, Li Y, Tian F, Yao Q, Zheng QM, Chen ZH. Gonadal dysgenesis in Turner syndrome with Y-chromosome mosaicism: Two case reports. World J Clin Cases 2020; 8:5737-5743. [PMID: 33344568 PMCID: PMC7716306 DOI: 10.12998/wjcc.v8.i22.5737] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 09/04/2020] [Accepted: 09/17/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Turner syndrome (TS) has a variety of different karyotypes, with a wide range of phenotypic features, but the specific karyotype may not always predict the phenotype. TS with Y chromosome mosaicism may have mixed gonadal dysgenesis, and the mosaicism is related to the potential for gonadoblastoma.
CASE SUMMARY In this case report, we report two cases of TS with different karyotypes and gonadal dysgenesis. Patient 1 had obvious virilization, and was positive for the SRY gene, but her karyotype in peripheral blood lymphocytes was 45X. Patient 2 had a mosaic karyotype, 45X/46X, dic (Y:Y) (p11.3:p11.2), and the proportion of Y-bearing cells was 50% in peripheral blood lymphocytes, but the patient had normal female external genitalia and streaky gonads, with no genital virilism. Different tissues in the same TS individual may exhibit different ratios of mosaicism. The gonadal determination and differentiation of mosaic TS are primarily dependent on the predominant cell line in the gonads.
CONCLUSION In TS patients with virilization, it is necessary to test at least two to three tissues to search for cryptic Y material.
Collapse
Affiliation(s)
- Xue-Fei Leng
- Department of Pediatric Endocrinology, Affiliated Hospital of Medical College Qingdao University, Qingdao 266001, Shandong Province, China
| | - Ke Lei
- Department of Laboratory Medicine, Affiliated Hospital of Medical College Qingdao University, Qingdao 266001, Shandong Province, China
| | - Yi Li
- Department of Gastrointestinal Surgery, Affiliated Hospital of Medical College Qingdao University, Qingdao 266001, Shandong Province, China
| | - Fei Tian
- Department of Pediatric Endocrinology, Affiliated Hospital of Medical College Qingdao University, Qingdao 266001, Shandong Province, China
| | - Qin Yao
- Department of Gynecology, Affiliated Hospital of Medical College Qingdao University, Qingdao 266001, Shandong Province, China
| | - Qing-Mei Zheng
- Department of Gynecology, Affiliated Hospital of Medical College Qingdao University, Qingdao 266001, Shandong Province, China
| | - Zhi-Hong Chen
- Department of Pediatric Endocrinology, Affiliated Hospital of Medical College Qingdao University, Qingdao 266001, Shandong Province, China
| |
Collapse
|
11
|
Abstract
This review describes the germ cell neoplasms that are malignant and most commonly associated with several types of gonadal dysgenesis. The most common neoplasm is gonadoblastoma, while others including dysgerminomas, yolk-sac tumors and teratomas are rare but can occur. The purpose of this review is to evaluate the incidences of these abnormalities and the circumstances surrounding these specific tumors.According to well-established methods, a PubMed systematic review was performed, to obtain relevant studies published in English and select those with the highest-quality data.Initially, the first search was performed using gonadal dysgenesis as the search term, resulting in 12,887 PubMed papers, published, from 1945 to 2017. A second search using ovarian germ cell tumors as the search term resulted in 10,473 papers, published from 1960 to 2017. Another search was performed in Medline, using germ cell neoplasia as the search term, and this search resulted in 7,560 papers that were published between 2003 to 2016, with 245 new papers assessing gonadoblastomas.The higher incidence of germ cell tumors in gonadal dysgenesis is associated with a chromosomal anomaly that leads to the absence of germ cells in these gonads and, consequently, a higher incidence of neoplasms when these tumors are located inside the abdomen. Several hypotheses suggest that increased incidence of germ cell tumors involves all or part of the Y chromosome or different genes.
Collapse
Affiliation(s)
- Mauri José Piazza
- Departamento de TocoGinecologia, Universidade Federal do Parana, Curitiba, PR, BR
- Corresponding author. E-mail:
| | | |
Collapse
|
12
|
Farooqui A, Tazyeen S, Ahmed MM, Alam A, Ali S, Malik MZ, Ali S, Ishrat R. Assessment of the key regulatory genes and their Interologs for Turner Syndrome employing network approach. Sci Rep 2018; 8:10091. [PMID: 29973620 PMCID: PMC6031616 DOI: 10.1038/s41598-018-28375-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Accepted: 06/15/2018] [Indexed: 12/13/2022] Open
Abstract
Turner Syndrome (TS) is a condition where several genes are affected but the molecular mechanism remains unknown. Identifying the genes that regulate the TS network is one of the main challenges in understanding its aetiology. Here, we studied the regulatory network from manually curated genes reported in the literature and identified essential proteins involved in TS. The power-law distribution analysis showed that TS network carries scale-free hierarchical fractal attributes. This organization of the network maintained the self-ruled constitution of nodes at various levels without having centrality-lethality control systems. Out of twenty-seven genes culminating into leading hubs in the network, we identified two key regulators (KRs) i.e. KDM6A and BDNF. These KRs serve as the backbone for all the network activities. Removal of KRs does not cause its breakdown, rather a change in the topological properties was observed. Since essential proteins are evolutionarily conserved, the orthologs of selected interacting proteins in C. elegans, cat and macaque monkey (lower to higher level organisms) were identified. We deciphered three important interologs i.e. KDM6A-WDR5, KDM6A-ASH2L and WDR5-ASH2L that form a triangular motif. In conclusion, these KRs and identified interologs are expected to regulate the TS network signifying their biological importance.
Collapse
Affiliation(s)
- Anam Farooqui
- Centre for Interdisciplinary Research in Basic Sciences, Jamia Millia Islamia, New Delhi, 110025, India
| | - Safia Tazyeen
- Centre for Interdisciplinary Research in Basic Sciences, Jamia Millia Islamia, New Delhi, 110025, India
| | - Mohd Murshad Ahmed
- Centre for Interdisciplinary Research in Basic Sciences, Jamia Millia Islamia, New Delhi, 110025, India
| | - Aftab Alam
- Centre for Interdisciplinary Research in Basic Sciences, Jamia Millia Islamia, New Delhi, 110025, India
| | - Shahnawaz Ali
- Centre for Interdisciplinary Research in Basic Sciences, Jamia Millia Islamia, New Delhi, 110025, India
| | - Md Zubbair Malik
- Centre for Interdisciplinary Research in Basic Sciences, Jamia Millia Islamia, New Delhi, 110025, India
| | - Sher Ali
- Centre for Interdisciplinary Research in Basic Sciences, Jamia Millia Islamia, New Delhi, 110025, India
| | - Romana Ishrat
- Centre for Interdisciplinary Research in Basic Sciences, Jamia Millia Islamia, New Delhi, 110025, India.
| |
Collapse
|
13
|
Recurrent Unilateral Gonadoblastoma - A rare histopathological presentation. JOURNAL OF SURGERY AND MEDICINE 2018. [DOI: 10.28982/josam.407263] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
14
|
Baer TG, Freeman CE, Cujar C, Mansukhani M, Singh B, Chen X, Abellar R, Oberfield SE, Levy B. Prevalence and Physical Distribution of SRY in the Gonads of a Woman with Turner Syndrome: Phenotypic Presentation, Tubal Formation, and Malignancy Risk. Horm Res Paediatr 2017; 88:291-297. [PMID: 28618411 PMCID: PMC5832898 DOI: 10.1159/000477240] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Accepted: 05/01/2017] [Indexed: 12/15/2022] Open
Abstract
Although monosomy X is the most common karyotype in patients with Turner syndrome, the presence of Y chromosome material has been observed in about 10% of patients. Y chromosome material in patients with Turner syndrome poses an increased risk of gonadoblastoma and malignant transformation. We report a woman with a diagnosis of Turner syndrome at 12 years of age, without signs of virilization, and karyotype reported as 46,X,del(X)(q13). At 26 years, cytogenetic studies indicated the patient to be mosaic for monosomy X and a cell line that contained a du-plicated Yq chromosome. Bilateral gonadectomy was performed and revealed streak gonads, without evidence of gonadoblastoma. Histological analysis showed ovarian stromal cells with few primordial tubal structures. FISH performed on streak gonadal tissue showed a heterogeneous distribution of SRY, with exclusive localization to the primordial tubal structures. DNA extraction from the gonadal tissue showed a 6.5% prevalence of SRY by microarray analysis, contrasting the 86% prevalence in the peripheral blood sample. This indicates that the overall gonadal sex appears to be determined by the majority gonosome complement in gonadal tissue in cases of sex chromosome mosaicism. This case also raises questions regarding malignancy risk associated with Y prevalence and tubal structures in gonadal tissue.
Collapse
Affiliation(s)
- Tamar G. Baer
- Division of Pediatric Endocrinology, Diabetes and Metabolism, Columbia University Medical Center, New York, NY
| | - Christopher E. Freeman
- Department of Pathology and Cell Biology, Columbia University Medical Center, New York, NY
| | - Claudia Cujar
- Department of Pathology and Cell Biology, Columbia University Medical Center, New York, NY
| | - Mahesh Mansukhani
- Department of Pathology and Cell Biology, Columbia University Medical Center, New York, NY
| | - Bahadur Singh
- Department of Pathology and Cell Biology, Columbia University Medical Center, New York, NY
| | - Xiaowei Chen
- Department of Pathology and Cell Biology, Columbia University Medical Center, New York, NY
| | - Rosanna Abellar
- Department of Pathology and Cell Biology, Columbia University Medical Center, New York, NY
| | - Sharon E Oberfield
- Division of Pediatric Endocrinology, Diabetes and Metabolism, Columbia University Medical Center, New York, NY
| | - Brynn Levy
- Department of Pathology and Cell Biology, Columbia University Medical Center, New York, NY
| |
Collapse
|