¿Qué puede esconder el retraso global del desarrollo? A propósito de un caso de causa genética / What can Global Developmental Delay Conceal? Apropos of a Case with a Genetic Cause

Se presenta un niño de 6 años con antecedente de retraso del lenguaje que llevó a sus padres a realizar múltiples consultas. En un primer momento, su cuadro fue interpretado como parte de un retraso global del desarrollo. Posteriormente, el paciente presentó convulsiones y episodios de descompensación metabólica, comenzando desde entonces su seguimiento por los Servicios de neurología, genética y metabolismo. Finalmente, tras varios estudios complementarios, por medio de un exoma trío se arribó al diagnóstico de síndrome de microduplicación del cromosoma 7q11.23, lo que justifica tanto el retraso global de desarrollo del paciente como su clínica neurológica. (AU)

A six-year-old boy presents with a history of language delay that led his parents to make multiple consultations. At first, we interpreted his condition as part of a global developmental delay. Subsequently, the patient presented seizures and episodes of metabolic decompensation, and since then, he had to be followed up by neurology, genetics, and metabolism services. Finally, after several complementary studies, following a trio exome analysis, we diagnosed chromosome 7q11.23 microduplication syndrome, which explains his global developmental delay and neurological symptoms. (AU)

Translocación cromosómica no balanceada t(5; 7)(q22; p15) en un niño con anomalías congénitas: reporte de caso clínico / Unbalanced chromosomal translocation t(5; 7)(q22; p15) in a child with congenital anomalies: clinical case report

Resumen Introducción: La incidencia de las anomalías congénitas es de 0,5% dentro de los cuales el 0,1-0,3% corresponden a anomalías cromosómicas estructurales, entre ellas están las translocaciones no balanceadas en las que hay pérdida o ganancia de información genética que da como resultado manifestaciones fenotípicas con compromiso en la salud de quienes las padecen. Reporte de caso: Se describe un paciente escolar con una translocación no balanceada t(5;7) (q22;p15) de origen paterno y sus repercusiones. Discusión: Cuando existen reordenamientos en el material genético, las manifestaciones clínicas están ligadas a la localización de los puntos de ruptura y como consecuencia a los genes que estén incluidos en estos segmentos, tal como se presentó en nuestro caso índice. Conclusiones: Es importante el estudio de estos pacientes ya que deben permanecer en vigilancia médica por el riesgo de desarrollar patologías relacionadas con alteraciones en los genes implicados en el reordenamiento genético.

Abstract Introduction: The incidence of congenital anomalies is 0,5%, wich 0,1 to 0,3% belong to structural chromosomic anomalies, between these are unbalanced translocations in which there are loss or gain of genetic information that results in phenotypic manifestations with health compromise of whom suffer it. Case report: A scholar patient with an unbalanced translocation t(5;7) (q22;p15) of paternal origin and its repercussions is described. Discussion: When there are rearrangements in genetic material, the clinical manifestations are linked to breakpoints localizations and as consequence to the genes included in this segments, as presented in our index case. Conclusions: The study of these patients is important because they must remain under medical surveillance due the risk of developing pathologies related with gene alterations implicated in the genetic rearrangement.

Diabetes insipidus como manifestação inicial de leucemia mieloide aguda em paciente com monossomia do cromossomo 7 / Diabetes insipidus as initial manifestation of acute myeloid leukemia in a patient with monosomy of chromosome 7

O diabetes insipidus (DI) central é uma síndrome caracterizada pela incapacidade de concentração urinária devido à deficiência do hormônio antidiurético. O envolvimento do sistema nervoso central é frequente nas leucemias, mas a ocorrência de DI é rara e confere pior prognóstico. A patogênese do DI na leucemia não é totalmente conhecida, mas a infiltração do eixo hipotálamo-hipofisário por células leucêmicas parece ser um fator responsável. O presente relato descreve o caso de um paciente que apresentou DI como primeira manifestação de leucemia mieloide aguda e que evoluiu com dificuldades de ajustes do sódio sérico, da poliúria e da reposição volêmica, necessitando de permanência prolongada em unidade de cuidados intensivos(AU)

Central diabetes insipidus (DI) is a syndrome characterized by the inability to concentrate urine due to a lack of antidiuretic hormone. Involvement of the central nervous system is common in acute leukemia, but the occurrence of DI is rare and determines a worse prognosis. The pathogenesis of DI in leukemia has not been fully understood yet, but infiltration of the hypothalamic-pituitary axis by leukemic cells seems to be involved. This report describes a case of a patient who presented with DI as the first manifestation of acute myeloid leukemia. Difficulties in the management of serum sodium, fluid replacement and polyuria led to prolonged length of stay in an intensive care unit(AU)

A case of partial deletion of the long arm of chromosome 7 / 中南大学学报(医学版)

Partial deletion of the long arm of chromosome 7 is a rare disease and is prone to missing the diagnosis or being misdiagnosed.Here we present a case of a 13-year-old boy that showed symptoms such as growth-retardation,moderate intellectual disability,hypotelorism,microcephaly,epicanthal folds,genu varum and lumbar vertebral cleft,but it did not show serious symptoms like cleft lip,urogenital malformation and hypotonia.He was eventually diagnosed as partial deletion of the long arm of chromosome 7 syndrome through gene analysis.Considering the rare incidence of this disease and more rarely for being hospitalized to endocrine ward due to growth retardation,this case report can provide more information for clinic diagnosis and differential diagnosis for growth retardation.

Síndrome de duplicación 7q11. 23: Primer caso descrito en América Latina / Chromosome 7q11. 23 duplication syndrome: First reported case in Latin America

El síndrome de duplicación 7q11.23 es una patología causada por la duplicación de una región del cromosoma 7 que comprende 26 genes. El primer caso descrito en la literatura fue reportado por Somerville et al., en el año 2005, quienes describieron un paciente con dolicocefalia, frente alta y estrecha, pestanas largas, nariz alta y ancha, filtrum corto, paladar ojival, maloclusión dental, retrognatia y retardo grave en el lenguaje. Presentamos una paciente colombiana con hallazgo de duplicación 7q11.23 mediante técnicas de hibridación genómica comparativa y hallazgos clínicos clásicos. Este es el primer caso comunicado en Colombia y en América Latina.

7q11.23 duplication syndrome is a disease caused by duplication of a region of chromosome 7 comprising 26 genes. The first case described in the literature was reported by Somerville et al. in 2005, who described a patient with dolichocephaly, high and narrow forehead, long eyelashes, high and wide nose, short philtrum, high arched palate, dental malocclusion, retrognathia, and severe language delay. We report the case of a Colombian patient with 7q11.23 duplication by comparative genomic hybridization techniques, and classical clinical findings, this being the first reported case in Colombia and Latin America.

Síndrome de deleción 7Q terminal / 7q35 terminal deletion syndrome

El síndrome de deleción terminal 7q se presenta por una pérdida de un fragmento distal del brazo largo del cromosoma 7, siendo variable dependiendo del tamaño de la región comprometida. Su espectro clínico es amplio con alteración en varios sistemas. Reporte del caso: Paciente de 8 años quien presenta retardo del desarrollo psicomotor, lenguaje verbal ausente, pabellones auriculares en copa, sobreplegamiento del hélix, retrognatia, incisivos prominentes, hiperplasia gingival, mal oclusión dental, hernia umbilical y pie equinovaro. El cariotipo bandeo G (25 metafases analizadas, 550-600 bandas) reporta: 46, XX, del (7) (q35); 46, XX, del (7) (pter → q35:). Las alteraciones fenotípicas varían según el punto de corte cromosómico. Se comparan los hallazgos de la paciente con lo descrito en la literatura. Se establece la importancia de la caracterización clínica y realizar estudio citogenético y molecular para poder tener un diagnóstico oportuno y con esto indicar manejo preventivo y asesoría genética.

7q terminal deletion syndrome is due to a loss of the distal portion of the long arm of chromosome 7; it is variable and depends on the size of the compromised region. Its clinical spectrum is wide and includes several anatomic systems. Case report: The patient is an eightyear- old girl who shows neurodevelopmental delay, absence of speech, cupped ears with overfolding helix, retrognathia, prominent incisors with gingival hyperplasia, dental malocclusion, umbilical hernia and clubfoot. The G-banding karyotype (25 metafases analyzed, 550-600 bands) reported: 46, XX, del (7) (q35), 46, XX, del (7) (pter → q35:). Phenotypic alterations differ due to chromosomal breakpoints. We compare clinical findings of the patient with case reports published in the worldwide literature. It is important to establish a clinical characterization and to perform molecular and cytogenetic studies in order to have a well-timed diagnosis and prescribe preventive management and genetic counseling.

Chromosome 7 aneuploidy in clear cell and papillary renal cell carcinoma: Detection using silver in situ hybridization technique.

Background: Chromosome 7 aberrations in renal cell carcinoma (RCC) have been reported in papillary renal cell carcinoma (pRCC) and clear cell renal cell carcinoma (ccRCC). However, the implication of these anomalies on prognosis and survival is still unclear. RCC Chromosome 7 aberrations have commonly been detected by fl uorescent in situ hybridization and chromogenic in situ hybridization but not silver in situ hybridization (SISH). Aim: The purpose was to report chromosome 7 aberrations in ccRCC and pRCC using SISH in paraffi nembedded tissues and determine the association between the anomalies with clinical and pathological features. Materials and Methods: Cases of ccRCC and pRCC from University Malaya Medical Centre (2001-2009) were analyzed. Chromosome 7 staining was performed using an automated SISH method and association tests between chromosomal anomalies, clinical features and survival were performed. Results: SISH is a feasible technique to detect chromosome 7 aberration in RCC. Chromosome 7 aberrations with nuclear grading, staging and survival yielded no signifi cant correlation. Surprisingly, there was a signifi cant association between gender and chromosome 7 expressions. Though grade did not reach statistical signifi cance for survival in our RCC cases, there was a signifi cant correlation between overall survival with race and stage. Conclusion: Chromosome 7 aberrations in ccRCC showed no prognostic signifi cance. Nevertheless, staging and grading systems that include prognostic variables could hold better promise.

Síndrome de Williams-Beuren: uma revisão da literatura / Williams-Beuren sydrome: an updated review

Introdução: A síndrome de Williams-Beuren (SWB) é uma rara síndrome de deleção de genes contíguos, sua incidência estimada é de 1: 13.000 a 1: 25.000 nativivos. A ocorrência, na maioria das famílias, é esporádica, podendo porta-se de forma autossômica dominante. Objetivo: Revisão da literatura sobre a SWB. Métodos: Foram realizadas buscas nos bancos de dados científicos eletrônicos (MEDLINE, SciELO, Lilacs, Bireme), capítulos de livros e sites de organizações voltadas para o tema SWB. Neste estudo foram examinados artigos publicados no período entre 2000 e 2011. Foram selecionados 43 artigos, dos quais 34 foram usados como base para esta revisão. Critérios de exclusão: Os artigos excluídos não tinham como tema central a SWB ou não traziam atualização relevante sobre o tema. Critérios de inclusão: Artigos e teses que tivessem como tema central a SWB, abordando os mais diversos aspectos da patologia. A coleta de dados ocorreu entre janeiro e abril 2011. As alterações físicas mais comuns são as cardiovasculares (estenose aórtica supravalvular e pulmonar periférica), fácies característica, atraso de crescimento, além das alterações comportamentais e atraso mental que, pelas suas peculiaridades, motivam especial atenção. Não se conhecem as interações gene-gene ou gene-ambiente. O diagnóstico é clínico, tendo como exame padrão-ouro o teste de Fish. É necessário o encaminhamento desses pacientes para equipes multiprofissionais. Conclusões: Conclui-se que a SWB necessita ser mais conhecida e diagnosticada pelos médicos, em especial pelos pediatras, para fins terapêuticos e de manejo adequado do paciente portador.

Un caso de síndrome de Williams-Beuren o facies de gnomo o duendecillo / A Case of Williams-Beuren Syndrome

En este artículo se presenta el caso de una enfermedad considerada rara, el síndrome de Williams-Beuren. Éste se caracteriza clínicamente por la tétrada de retraso mental leve o moderado, estenosis aórtica supravalvular, hipercalcemia y rasgos faciales dismórficos característicos, denominados de gnomo o duendecillo. El síndrome se debe a una alteración genética, a una eliminación en el brazo largo del cromosoma 7 (7q11.23), que hace que se pierda el gen que codifica para la elastina. Prácticamente todos los casos se producen de novo, por lo tanto, cuando se hereda lo hace como un rasgo autosómico dominante.

Williams-Beuren syndromeis a rare disease. Characterización by clinical mild or moderate mental retardation, aortic supravalvular stenosis, hipercalcemia and typically dismorphic elfinlike faces. The syndrome is due to a genetic disorder, generally deletion of the long arm of chromosome 7 (7q11.23), producing loss of gene codification for elastin. Every case is produced of new , when it is inherited it does so as an autosomic dominant character.

Chromosome 7q Deletion Syndrome 46, XX, del(7)(q34) with Hydronephrosis

Chromosome 7q deletion, relatively rare syndrome, was first described by de Grouchy in 1969. The most frequent clinical manifestations of a "7q deletion syndrome" include; low birth weight, postnatal growth retardation, mental retardation, developmental delay, microcephaly, congenital heart disease, hypotonia, bulbous nasal tip and abnormal ears. We report a case of 7q deletion syndrome with microcephaly, upslanting palpabral fissure, micrognathia, bulbous nasal tip, developmental delay and hydronephrosis.

A Case of Partial Inverted Duplication of Chromosome 7q

Duplication of chromosome 7q has been reported as either partial or complete. Partial 7q duplication was first described by Carpentier in 1972. Pure partial duplication of the long arm of chromosome 7 is extremely rare and only 16 cases with a pure partial duplication of different 7q segment have been described in the literature. Pure partial duplication of the long arm of chromosome 7 is characterized by growth and developmental retardation, muscular hypotonia, distinct craniofacial dysmorphic features, a short neck and skeletal abnormalities. A 3 month-old male was referred to our department of Pediatrics because of dyspnea, hypotonia and delayed development. He shows growth and developmental delay, hypertelorism, a depressed nasal bridge, low set ears, a short neck and muscular hypotonia. Karyotype revealed 46, XY, dup(7)(q36q33) by GTC-banding. We report a case of a partial inverted duplication of chromosome 7q.

Unbalanced Translocations of Chromosome 2 and Chromosome 20 in a Two-Generation Family

An unbalanced translocation is frequently the result of inheritance of an unbalanced haploid set from a parent with a balanced translocation. Families in which one parent is a balanced translocation carrier fall into the following classes : Those in which none of the possible abnormal offsprings is viable; Those in which one type of offspring, usually the one with the smaller deletion, is born alive; Those in which two types of abnormal offspring are viable. We report a neonate whose karyotype was 46,XX,der(2)t(2;7)(q21;p21.2),der(20)t(2;20)(q21;p13). She was small for her gestational age and had multiple anomalies such as exophthalmos, corneal opacity, short neck, tongue tie, clinodactyly, atrial septal defect, patent ductus arteriosus and ventriculomegaly. Moreover, her mother's karyotype was 46,XX,der(2)t(2;7)(q21;p21.2),del(16)(q22.1),der(20)t(2;20)(q21;p13) but her father had normal karyotype. The same derivative chrosomes were found between mother and her infant, except for del(16)(q22.1) in her mother and these same unbalanced translocations in a two-generation family are extremely rare.

A Case of Multicystic Renal Dysplasia with Chromosomal Abnormality / 대한주산의학회잡지

Holoprosencephaly is a rare and complex malformation affecting the cleavage of the developing forebrain and is usually associated with defects of the mid Face. We have experienced a case of holoprosencephaly, diagnosed prenatally by ultrasound examination at 31 weeks of pregnancy in a 31-year-old primigravida woman. This case is characterized by holoprosencephaly, cleft palate, cleft lip, left renal aplasia and right renal hypertrophy. The chromosomal study showed a deletion of the long arm of chromosome 7, 46, XX, del(7)(q32), We report with a terminal deletion of chromosome 7q associated with atypical clinical picture and holoprosencephaly.

A Case of Holoprosencephaly Associated with Chromosomal Deletion Diagnosed by Prenatal Ultreasound / 대한주산의학회잡지

Holoprosencephaly is a rare and complex malformation affecting the cleavage of the developing forebrain and is usually associated with defects of the mid Face. We have experienced a case of holoprosencephaly, diagnosed prenatally by ultrasound examination at 31 weeks of pregnancy in a 31-year-old primigravida woman. This case is characterized by holoprosencephaly, cleft palate, cleft lip, left renal aplasia and right renal hypertrophy. The chromosomal study showed a deletion of the long arm of chromosome 7, 46, XX, del(7)(q32), We report with a terminal deletion of chromosome 7q associated with atypical clinical picture and holoprosencephaly.

A Case of Bilateral Split Hand and Foot Malformation with Inversion of Chromosome 7

Split hand and split foot(SHSF) is a human developmental defect characterized by missing digits, fusion of remaining digits, and a deep median cleft resulting in a clawlike appearance of the hands and feets. SHSF is usually inherited in an autosomer dominant fashion. The incidence of SHSF is between 1/10,000 and 1/90,000. Thirteen cases of SHSF and chromosomal aberrations involving 7q21-22 have been described so far in the world. We experienced a case of typical tetramelic SHSF in neonate. Chromosome studies showed a pericentric inversion of chromosome 7:46,XY,inv(7) (p22q22). Inspection of the extremities and chromosome studies in the parents were normal.