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1.
Arch. endocrinol. metab. (Online) ; 65(6): 739-746, Nov.-Dec. 2021. tab, graf
Article in English | LILACS | ID: biblio-1349982

ABSTRACT

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). Materials and 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. Conclusions: 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.


Subject(s)
Humans , Female , Turner Syndrome/genetics , Body Height , Polymerase Chain Reaction , Chromosomes , Mosaicism
2.
Article in Chinese | WPRIM | ID: wpr-888392

ABSTRACT

OBJECTIVE@#To review the clinical data of a fetus with false positive result of non-invasive prenatal testing (NIPT) due to confined placental mosaicism (CPM).@*METHODS@#Amniotic fluid sample was taken from a pregnant women with high risk for chromosome 16 aneuploidy for karyotyping analysis, single nucleotide polymorphism array (SNP array) and interphase fluorescence in situ hybridization (FISH). Genetic testing was also conducted on the fetal and maternal surface of the placenta, root of umbilical cord and fetal skin tissue after induced abortion.@*RESULTS@#Cytogenetic analysis of the amniotic fluid sample yielded a normal karyotype. SNP array revealed mosaicism (20%) of trisomy 16 in the fetus. FISH confirmed the presence of mosaicism (25%) for trisomy 16. After induced labor, all sampled sites of placenta were confirmed to contain trisomy 16 by SNP array, while the analysis of fetal skin tissue yielded a negative result.@*CONCLUSION@#CPM is an important factor for false positive NIPT result. Prenatal identification of CPM and strengthened pregnancy management are important to reduce adverse pregnancy outcomes.


Subject(s)
Amniocentesis , Chromosomes, Human, Pair 16/genetics , Cytogenetic Analysis , Female , Fetus , Humans , In Situ Hybridization, Fluorescence , Molecular Biology , Mosaicism , Placenta , Pregnancy , Prenatal Diagnosis , Trisomy/genetics
3.
Article in Chinese | WPRIM | ID: wpr-922035

ABSTRACT

OBJECTIVE@#To carry out genetic analysis and parental tracing for a fetus with an inconclusive chromosomal karyotype.@*METHODS@#The fetus and its parents were subjected to combined chromosomal karyotyping, chromosomal microarray analysis (CMA), fluorescence in situ hybridization (FISH) and multiplex PCR testing for Y chromosome microdeletions.@*RESULTS@#The fetus was found to have a karyotype of 45,X[18]/46,X,+mar[72]. CMA revealed that the fetus has carried a 2.6 Mb duplication at Yp11.32p11.31 and a 44.5 Mb deletion at Yq11.21q12. Interphase FISH of amniocytes confirmed the chromosomal mosaicism in the fetus, which has derived from Y chromosome. Multiplex PCR revealed deletion of AZFb and AZFc regions on the Y chromosome. No karyotypic abnormality was found with either parent at 400-band level.@*CONCLUSION@#Combined genetic analysis has delineated the aberrant karyotype in the fetus, which has facilitated prediction of its clinical phenotype and genetic counseling.


Subject(s)
Chromosomes, Human, Y/genetics , Female , Fetus , Humans , In Situ Hybridization, Fluorescence , Karyotype , Mosaicism , Pregnancy , Prenatal Diagnosis
4.
Article in Chinese | WPRIM | ID: wpr-922005

ABSTRACT

OBJECTIVE@#To report on a family which has two siblings with SCN2A mutation caused by germline mosaicism suffering from autism spectrum disorder/development delay (ASD/DD).@*METHODS@#Clinical data was collected for the proband and his parents. Next generation sequencing (NGS) was carried out on the proband and his parents. Suspected mutations were verified by Sanger sequencing of the proband, his parents and brother. To detect whether there is a low proportion of somatic mosaicism in the parents, a droplet digital PCR was conducted. The result of ddPCR showed that the father was germline mosaicism (0.233%).@*RESULTS@#NGS has identified a de novo splicing mutation of the SCN2A gene, c.605+1G>A, in the proband and his brother. Combined with its clinical phenotype and inheritance pattern, SCN2A was judged to be the pathogenic gene. Above findings strongly suggested parental germline mosaicism.@*CONCLUSION@#ASD/DD in siblings with SCN2A mutations caused by germline mosaicism. Paternal mosaicism should be considered as one of the important inheritance patterns for counseling parents with a child carrying SCN2A mutation. The ddPCR can help to reveal very low proportion of germline mosaicism.


Subject(s)
Autism Spectrum Disorder , Germ Cells , Humans , Male , Mosaicism , Mutation , /genetics , Siblings
5.
Article in Chinese | WPRIM | ID: wpr-879592

ABSTRACT

OBJECTIVE@#To analyze a patient with infertility and a fragile site found at 16q22 by using cytogenetic methods.@*METHODS@#Peripheral blood sample was taken from the patient and subjected to chromosomal karyotyping and single nucleotide polymorphism microarray (SNP-array) analysis.@*RESULTS@#The patient was found to be a mosaicism for a fragile site at 16q22, which has a variable morphology and cannot be induced by folic acid treatment. No abnormality was found by SNP-array analysis.@*CONCLUSION@#A rare fragile site, which can be induced without folic acid treatment, has been identified at 16q22. The strategy of assisted reproduction for such individuals is yet to be explored.


Subject(s)
Chromosome Fragile Sites , Chromosome Fragility , Chromosomes, Human, Pair 16 , Genetic Testing , Humans , Karyotyping , Mosaicism
6.
Article in Chinese | WPRIM | ID: wpr-879580

ABSTRACT

OBJECTIVE@#To assess the impact of confined placental mosaicism (CPM) on non-invasive prenatal testing (NIPT) and pregnancy outcomes.@*METHODS@#Copy number variation sequencing (CNV-seq) and single nucleotide polymorphism array (SNP-array) were carried out on placental specimen sampled from eight pregnancies with confirmed false-positive NIPT results. The impact of CPM on NIPT and pregnancy outcomes were analyzed based on the laboratory tests and clinical characteristics.@*RESULTS@#Five of the eight cases with false-positive NIPT results were proven to be CPM involving trisomy 9, 13, 21, 22, and X, respectively. The mosaic ratios for different placental regions have varied from 4% to 80%. Two fetuses with confirmed CPM showed fetal growth restriction (FGR) and additional ultrasound abnormalities, 1 fetus showed only FGR. The remaining two fetuses showed normal growth.@*CONCLUSION@#NIPT is highly sensitive to CPM, whilst CPM is an important cause for false-positive NIPT result. CPM may be associated with FGR. Investigation of the presence of CPM is important for both pre- and post-test genetic counseling and management of the pregnancy.


Subject(s)
DNA Copy Number Variations , Female , Humans , Mosaicism , Pregnancy , Pregnancy Outcome , Prenatal Diagnosis , Trisomy
7.
Article in Chinese | WPRIM | ID: wpr-879916

ABSTRACT

OBJECTIVE@#To perform gene mutation analysis in a patient with atypical clinical manifestations of tuberous sclerosis (TSC) for definite diagnosis.@*METHODS@#Peripheral blood DNA was obtained from a patient with clinically suspected TSC and her parents, and all exons and their flanking sequences of @*RESULTS@#A heterozygous nonsense mutation c.1096G>T (p.E366*) was identified in the exon 11 of the @*CONCLUSIONS@#The somatic mosaic mutation c.1096G>T (p.e366*) may be responsible for the phenotype of TSC in this patient. And the drop digital PCR is expected to be a diagnostic method for somatic cells mosaicism.


Subject(s)
Female , Humans , Male , Mosaicism , Mutation , Tuberous Sclerosis/genetics , Tuberous Sclerosis Complex 2 Protein/genetics , Whole Exome Sequencing
8.
Article in Chinese | WPRIM | ID: wpr-826549

ABSTRACT

OBJECTIVE@#To explore the genetic basis for a female with a peripheral lymphocyte karyotype of trisomy 18 but normal intelligence.@*METHODS@#G-banding karyotype analysis, fluorescence in situ hybridization (FISH) and single nucleotide polymorphism microarray (SNP array) were employed to analyze the peripheral blood sample and buccal cells from the patient.@*RESULTS@#Chromosomal karyotyping, SNP array and FISH analysis of the patient's peripheral blood all suggested 47,XX,+18. Interphase FISH analysis of buccal cells, however, revealed presence of 45,X and low percentage of trisomy 18 and monosomy 18.@*CONCLUSION@#The clinical manifestation of germ layer chromosomal mosaicism is complex. The impact of the genetic disorder on the individual will depend on the structure and function derived from the affected germ layer.


Subject(s)
Female , Humans , In Situ Hybridization, Fluorescence , Intelligence , Karyotype , Karyotyping , Lymphocytes , Mosaicism , Mouth Mucosa , Polymorphism, Single Nucleotide , Trisomy 18 Syndrome , Genetics
9.
Article in Chinese | WPRIM | ID: wpr-826542

ABSTRACT

OBJECTIVE@#To explore the genetic basis for a couple with normal phenotype but repeated pregnancies with fetuses affected by osteogenesis imperfecta.@*METHODS@#Whole exome sequencing (WES) was carried out on fetal specimens and parental DNA to detect potential pathologic variants. Suspected variants were verified by Sanger sequencing. Semen sample of the husband was collected for the extraction of genome DNA, and whole genome amplification (WGA) was performed for single sperms isolated from the sample.@*RESULTS@#WES has identified a heterozygous c.1378G>A (p.G460S) variant of the COL1A2 gene in the fetus, which was predicted to be pathogenic but not detected in peripheral blood samples of both husband and wife. The heterozygotic variant was detected in semen DNA from the husband. Among 15 spermatozoa, 4 were found to harbor the variant.@*CONCLUSION@#The fetus was diagnosed with osteogenesis imperfecta, and the gonadal mosaicism probably accounted for the repeated abnormal pregnancies. Possibility of gonadal mosaicism should be considered when counseling couples with normal phenotype and genotype but recurrent abnormal pregnancies and/or births of children with similar phenotypes and genetic variants.


Subject(s)
Adult , Child , Collagen Type I , Genetics , Female , Fetus , Gonadal Disorders , Genetics , Humans , Male , Mosaicism , Mutation , Osteogenesis Imperfecta , Diagnosis , Genetics , Pregnancy , Prenatal Diagnosis , Whole Exome Sequencing
10.
Article in Chinese | WPRIM | ID: wpr-879485

ABSTRACT

OBJECTIVE@#To carry out prenatal diagnosis for a fetus with Pallister-killian syndrome (PKS).@*METHODS@#The fetus was found to have limb malformations at 23rd gestational week. With informed consent from its parents, amniotic fluid sample was taken from the fetus and subjected to chromosomal karyotyping, chromosomal microarray analysis (CMA) and fluorescence in situ hybridization (FISH) assay.@*RESULTS@#G-banding analysis suggested the fetus has a mos47,XY,+mar[55]/46,XY[10] karyotype. CMA analysis of the cultured amniocytes with CytoScan 750K microarray revealed a segmental tetrasomy duplication of 12p13.33p11.1. FISH confirmed a 70% mosaicism of tetrasomy 12p in the metaphase amniocytes with 12pter/12qter probes.@*CONCLUSION@#Combined use of G-banding karyotyping, CMA and FISH analysis has enabled diagnosis of PKS in the fetus. Although short limb is a common feature of PKS, unequal femur length has not been reported previously, which has expanded the spectrum of PKS-associated limb abnormalities.


Subject(s)
Chromosome Disorders/genetics , Chromosomes, Human, Pair 12/genetics , Female , Fetus , Humans , In Situ Hybridization, Fluorescence , Mosaicism , Pregnancy , Prenatal Diagnosis
11.
Article in Chinese | WPRIM | ID: wpr-879482

ABSTRACT

OBJECTIVE@#To explore the genetic cause of a patient suspected for congenital ectodermal dysplasia with repeated hyperthermia and to assess the reproductive risk for his family.@*METHODS@#Medical whole-exome sequencing (WES) were used to detect single-nucleotide variations and low-coverage massively parallel copy number variation sequencing (CNV-seq) were employed to verify suspected CNVs. PCR and real-time quantitative PCR were applied to confirm the deletion of EDA gene.@*RESULTS@#The results of WES suggested that the patient carried a hemizygous deletion for chrX:69 243 016-69 395 730. CNV-seq indicated that the patient carried a deletion of approximately 0.12 Mb on Xq13.1, which encompassed the EDA gene. The PCR results confirmed that there was a hemizygous deletion of exons 3 to 8 of the EDA gene. The same deletion was not found in his mother.@*CONCLUSION@#The congenital ectodermal dysplasia of the patient may be attributed to deletion of exons 3 to 8 of the EDA gene, which could be de novo or derive from germline mosaicism of his mother. The WES and CNV-seq are of great value for the diagnosis of rare diseases.


Subject(s)
DNA Copy Number Variations , Ectodermal Dysplasia/genetics , Ectodysplasins/genetics , Exons , Genetic Testing , High-Throughput Nucleotide Sequencing , Humans , Mosaicism , Sequence Deletion , Whole Exome Sequencing
12.
Med. lab ; 24(4): 317-324, 2020. ilus
Article in Spanish | LILACS | ID: biblio-1283807

ABSTRACT

El síndrome de Cri du chat es una alteración cromosómica causada por deleciones en el brazo corto de cromosoma 5, las cuales varían en tamaño, desde muy pequeñas que comprometen solo el locus 5p15.2, hasta la pérdida de todo el brazo corto. Las mutaciones se originan de novo en el 80% a 90% de los casos. Existen dos regiones críticas para el síndrome de Cri du chat; una ubicada en 5p15.3, cuya deleción se manifiesta con el llanto de maullido de gato y retraso en el habla, y otra ubicada en 5p15.2, cuya deleción se manifiesta como microcefalia, hipertelorismo, retraso psicomotor y mental severo. Se han descrito varios genes implicados localizados en estas regiones críticas; entre ellos, TERT, SEMA5A, CTNND2 y MARCHF6, cuya haploinsuficiencia se asocia con los diferentes fenotipos del Cri du chat. En este artículo se describe el caso clínico de una paciente femenina de 8 meses de vida, con características clínicas y un análisis citogenético en mosaico que confirmaron el síndrome de Cri du chat. Este caso es el primero reportado de esta variante en el suroccidente colombiano.


Cri du chat syndrome is a chromosomal disorder caused by deletions in the short arm of chromosome 5, which vary in size, from very small and involving only the 5p15.2 locus, to the loss of the entire short arm. Mutations originate de novo in 80% to 90% of cases. There are two critical regions for Cri du chat syndrome; one located at 5p15.3 with a deletion that is manifested as a cat's cry and speech delay, and another located at 5p15.2 with a deletion that manifests as microcephaly, hypertelorism, severe psychomotor and mental retardation. Several involved genes located in these critical regions have been described; among them, TERT, SEMA5A, CTNND2 and MARCHF6, and whose haploinsufficiency is associated with the different phenotypes of Cri du chat. This article describes the clinical case of an 8-monthold female patient, with clinical characteristics and a mosaic cytogenetic analysis that confirmed Cri du chat syndrome. This case is the first reported of this variant in southwestern Colombia.


Subject(s)
Humans , Chromosomes, Human, Pair 5 , Chromosome Deletion , Cri-du-Chat Syndrome , Mosaicism
13.
Braz. j. med. biol. res ; 53(3): e8980, 2020. tab
Article in English | LILACS | ID: biblio-1089344

ABSTRACT

The mosaic 45,X/46,XY karyotype is a common sex chromosomal abnormality in infertile men. Males with this mosaic karyotype can benefit from assisted reproductive therapies, but the transmitted abnormalities contain 45,X aneuploidy as well as Y chromosome microdeletions. The aim of this study was to investigate the clinical and genetic characteristics of infertile men diagnosed with 45,X/46,XY mosaicism in China. Of the 734 infertile men found to carry chromosomal abnormalities, 14 patients were carriers of 45,X/46,XY mosaicism or its variants, giving a prevalence of 0.27% (14/5269) and accounting for 1.91% (14/734) of patients with a chromosomal abnormality. There were ten cases (71.43%, 10/14) of 45,X mosaicism exhibiting AZF microdeletions. Case 1 and Case 4 had AZFc deletions, and the other eight cases had AZFb+c deletions. A high frequency of Y chromosome microdeletions were detected in male patients with 45,X/46,XY mosaicism. Preimplantation genetic diagnosis should be offered to men having intracytoplasmic sperm injection for hypospermatogenesis caused by 45,X/46,XY mosaicism, to avoid the risk of transfering AZF microdeletions in addition to X monosomy in male offspring.


Subject(s)
Humans , Male , Adult , Middle Aged , Sex Chromosome Disorders of Sex Development/genetics , Infertility, Male/genetics , Mosaicism , Sex Chromosome Aberrations , China , Polymerase Chain Reaction , Chromosome Deletion , Chromosomes, Human, Y/genetics , Karyotyping
14.
Rev. cuba. endocrinol ; 30(3): e176, sept.-dic. 2019. graf
Article in Spanish | LILACS, CUMED | ID: biblio-1126444

ABSTRACT

RESUMEN Los trastornos del desarrollo sexual son estados congénitos en los cuales el desarrollo del sexo cromosómico, gonadal o anatómico es atípico. Por tratarse de un caso sumamente raro consideramos de interés su presentación. Se presenta adolescente masculino de 15 años, con antecedentes de genitales atípicos al nacer, desarrollo de baja talla y estigmas turnerianos, pubertad espontánea y normal. Los estudios genéticos determinaron como sexo cromosómico un mosaico 45,X/46,XY/47XYY, y sexo molecular varón. Se inscribió socialmente como varón, se le realizó cirugía de reconstrucción genital y utilizó tratamiento con hormona de crecimiento biosintética que mantiene actualmente. La evolución clínica ha sido favorable con adecuada integración social. Ante la presencia de genitales atípicos al nacer se necesita de un manejo multidisciplinario. El diagnóstico etiológico de los trastornos de la diferenciación sexual requiere de una alta pericia médica. Un tratamiento integral en estos pacientes les garantiza una buena calidad de vida(AU)


ABSTRACT Sexual development´s disorders are congenital states in which the development of the chromosomal, anatomic or gonadal sex is atypical. Since this is a very rare case, we consider it as of interests for presentation. It is presented a teenager, 15-years-old male, with a history of atypical genitalia at birth, development of short height and Turner's stigmas, and spontaneous and normal puberty. The genetic studies identified as chromosomal sex a mosaic 45,X/46,XY/47XYY and male as molecular sex. He was socially registered as a male, he had a genital reconstruction surgery and he was under treatment with biosynthetic growth hormone that he currently maintains. The clinical evolution has been favourable with adequate social integration. In the presence of atypical genitalia at birth, it is needed a multidisciplinary management. The etiological diagnosis of disorders of sexual differentiation requires a high level of medical expertise. A comprehensive treatment in these patients guarantees them a good quality of life(AU)


Subject(s)
Humans , Male , Adolescent , Quality of Life , Disorders of Sex Development/etiology , Sex Reassignment Surgery/methods , Mosaicism , Sex Differentiation , Clinical Evolution
17.
Article in Chinese | WPRIM | ID: wpr-781312

ABSTRACT

OBJECTIVE@#To analyze the clinical phenotype and genomic abnormality of an adult featuring congenital heart defect and multiple developmental disorders.@*METHODS@#The patient was subjected to conventional G-banding chromosomal karyotyping and single nucleotide polymorphism microarray (SNP-array) analysis.@*RESULTS@#The patient showed a normal karyotype, while SNP-array revealed a 42.7 Mb mosaic uniparental disomy (UPD) in the 11p15.5p12 region ([hg19] chr11: 491 333-43 189 376).@*CONCLUSION@#The mosaicism of UPD of 11p15.5p12 region probably underlies the congenital heart defect and developmental disorders in the patient.


Subject(s)
Adult , Chromosome Banding , Developmental Disabilities , Genetics , Genetic Testing , Heart Defects, Congenital , Genetics , Humans , Karyotyping , Mosaicism , Phenotype , Polymorphism, Single Nucleotide , Uniparental Disomy
18.
Article in Chinese | WPRIM | ID: wpr-772029

ABSTRACT

OBJECTIVE@#To explore the prenatal screening and diagnosis for a pair of monochorionic-diamniotic (MCDA) twins discordant for 45,X/46,XX mosaicism.@*METHODS@#Amniotic fluid samples were taken from both twins for whom non-invasive prenatal testing has signaled a high risk for sex chromosomal abnormality. Uncultured amniotic fluid was analyzed by fluorescence in situ hybridization (FISH) and single nucleotide polymorphism array (SNP-array). Conventional G-banded karyotyping analysis was performed on the cultured amniotic fluid.@*RESULTS@#Metaphase chromosome analysis showed that one of the twins had a mos 45,X[11]/46,XX[26] karyotype, while the other had a normal karyotype. FISH and SNP-array applied on uncultured amniotic fluid revealed about 30% mosaicism in one of the twins. The twins were confirmed to be monozygotic by SNP-array analysis.@*CONCLUSION@#To avoid confusion arising from discordant karyotypes in MCDA twins with abnormal non-invasive prenatal testing (NIPT) results, dual amniocentesis should be carried out to obtain amniotic fluid samples for chromosomal as well as molecular analysis. To determine the ratio of 45,X and 46,XX cells in Turner syndrome can provide valuable information for prenatal genetic counseling.


Subject(s)
Amniocentesis , Chromosomes, Human, X , Female , Humans , In Situ Hybridization, Fluorescence , Karyotyping , Mosaicism , Pregnancy , Prenatal Diagnosis
19.
Article in Chinese | WPRIM | ID: wpr-771967

ABSTRACT

OBJECTIVE@#To carry out prenatal diagnosis for two cases of Pallister-Killian syndrome (PKS) using combined chromosomal microarray analysis (CMA) and fluorescence in situ hybridization (FISH).@*METHODS@#Umbilical cord blood was sampled from the two fetuses and subjected to G-banding chromosomal karyotyping, CMA and FISH assay.@*RESULTS@#Chromosomal karyotyping showed that the two fetuses were mos 47,XX,+i(12)(p10)[3]/46,XX[197] and mos 47,XY,+i(12)(p10)[5]/46,XY[95], respectively. CMA showed that both had carried duplication of 12p. The results of interphase FISH confirmed mosaicism of 12p tetrasomy. Combined with ultrasonographic findings, both fetuses were diagnosed as PKS.@*CONCLUSION@#Prenatal ultrasound examination, karyotype analysis of umbilical cord blood, G-banded chromosomal analysis, CMA and FISH may be used in conjunct for the prenatal diagnosis of PKS.


Subject(s)
Chromosome Disorders , Diagnosis , Chromosomes, Human, Pair 12 , Female , Humans , In Situ Hybridization, Fluorescence , Microarray Analysis , Mosaicism , Pregnancy , Prenatal Diagnosis
20.
Annals of Dermatology ; : 576-580, 2019.
Article in English | WPRIM | ID: wpr-762368

ABSTRACT

Hypomelanosis of Ito (HI) is a neurocutaneous disorder, also known as incontinentia pigmenti achromians. HI has been associated with chromosomal abnormalities, especially mosaicism. Herein, we report a case of HI with multiple congenital anomalies. A 2-month-old girl presented with multiple linear and whorling hypopigmentation on the face, trunk, and both extremities and patch alopecia on the scalp. Moreover, she had conical teeth, aniridia of the both eyes, and multiple musculoskeletal problems, including syndactyly and coccyx deviation. Cytogenetic analysis on peripheral blood was normal 46, XX, and no mutation was found in IKBKG gene test.


Subject(s)
Alopecia , Aniridia , Chromosome Aberrations , Coccyx , Cytogenetic Analysis , Extremities , Female , Humans , Hypopigmentation , Infant , Karyotype , Mosaicism , Neurocutaneous Syndromes , Pigmentation Disorders , Scalp , Syndactyly , Tooth
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