Isocromosoma Filadelfia en dos pacientes con leucemia mieloide crónica / Philadelphia isochromosome in two patients with chronic myeloid leukemia

RESUMEN El cromosoma Filadelfia (Ph por su abreviatura del inglés "Philadelphia") se presenta en más del 90 % de los pacientes con leucemia mieloide crónica. Un cromosoma Ph extra es una de las alteraciones secundarias comúnmente observada como evolución clonal de la enfermedad y se puede presentar como un derivativo adicional o un isocromosoma del 22 derivativo. Es una alteración adquirida durante la progresión de la enfermedad con implicación pronóstica. Se presentan dos casos con diagnóstico de leucemia mieloide crónica, resistentes al tratamiento con mesilato de imatinib. En el estudio cromosómico con técnica de banda G se observaron en ambos pacientes líneas celulares con dos isocromosomas del derivativo del 22, 2ider (22) t (9; 22). El primer caso falleció en crisis blástica y el segundo luego de no responder al tratamiento de primera línea, se le indicó nilotinib pero su evolución fue no satisfactoria. Las alteraciones cromosómicas secundarias están asociadas con un impacto negativo en la supervivencia y progresión a fase acelerada y crisis blástica de la enfermedad.

ABSTRACT The Philadelphia chromosome (Ph) is present in more than 90% of patients with chronic myeloid leukemia. An extra Ph chromosome is one of the secondary alterations commonly observed in clonal evolution and it could be as na additional derivative or anisochromosome of the derivative. It is na alteration acquired during the progression of the disease with prognostic implications. We present two cases with a diagnosis of chronic myeloid leukemia, Who showed resistance to treatment with imatinib mesylate. In both patients,the chromosomal study with G-band technique, show cell lines with two isochromosomes from the derivative of 22, 2ider(22)t(9; 22). The first case died in blast crisis and to the second after not responding to the first line treatment, was precribed nilotinib but the evolution was unsatisfactory. Secondary chromosomal alterations are associated with a negative impact on survival and the progression to accelerated phase and blast crisis of the disease.

Clinical and cytogenetic characterization of a patient with tetrasomy 18p / Caracterización clínica y citogenética de un paciente con tetrasomía 18p

The 18p tetrasomy is a structural chromosomal abnormality with the presence of an extra isochromosome 18p, caused by a nondisjunction failure during maternal meiosis II. This additional i(18p) occurs in 1 of 180,000 live-born children worldwide, affecting males and females equally. It is characterized by craniofacial dysmorphisms; ears, nose and throat (ENT) abnormalities; musculoskeletal alterations; and global development delay. We aim to present the clinical and cytogenetic findings of a 3-year-10-month-old Latin American male with i(18p), to support the gene dosage effects, comparing his features with the ones reported in literature. This patient was product of the second pregnancy of a 39-year-old woman and the first son of a 49-year-old man. His main clinical features were microcephaly, facial dysmorphism, generalized hypotonia, and developmental delay. A blood sample of the patient was required to perform a GTG-banded karyotype and a fluorescence in situ hybridization (FISH) for chromosome 18 short arm. In addition, an SNP microarray analysis was carried out to detect genomic imbalances. Cytogenetic analysis revealed the presence of a metacentric supernumerary marker chromosome. The FISH study confirmed the origin of the marker chromosome by showing two signals for the 18p subtelomere and an intermediate signal for the 18 centromere. The microarray analysis showed a copy number gain of 18,385 Mb within the 18p.Tetrasomy tends to be a result of de novo events. The presence of the patient's isochromosome could be explained by advanced maternal age as it is known that this factor has high influence in isochromosome formation. Despite that there were no genes associated with the i(18p)'s clinical manifestations, these features are negatively correlated with dosage effects of the entire short arm. Physical and language therapy was recommended to the patient; the family received medical orientation, and awareness in family planning was raised.

La tetrasomía 18p es una anormalidad cromosómica estructural con la presencia de un isocromosoma extra 18p, causado por una no disyunción durante la meiosis materna II. Este adicional i(18p) ocurre en 1 de 180.000 niños nacidos vivos en todo el mundo, y afecta a hombres y mujeres por igual. Se caracteriza por dismorfias craneofaciales; anomalías en oídos, nariz y garganta (ENT); alteraciones musculoesqueléticas y del desarrollo global. Nuestro objetivo es presentar los hallazgos clínicos y citogenéticos de un varón latinoamericano de 3 años y 10 meses de edad con i(18p), para explicar los efectos de dosificación génica, comparando sus características con las reportadas en la literatura. Este paciente es producto del segundo embarazo de una mujer de 39 años y el primer hijo de un hombre de 49 años. Sus principales características clínicas fueron microcefalia, dismorfia facial, hipotonía generalizada y retraso global en el desarrollo. Se requirió una muestra de sangre del paciente para realizar un cariotipo con bandas GTG y una hibridación fluorescente in situ (FISH) para el análisis del brazo corto del cromosoma 18. Además, se llevó a cabo un análisis de microarreglos para detectar desequilibrios genómicos. El análisis citogenético reveló la presencia de un cromosoma supernumerario metacéntrico. Mientras que el estudio FISH confirma el origen del cromosoma marcador al mostrar dos señales para subtelómeros 18p y una señal intermedia para el centrómero 18. El análisis de microarreglos mostró una ganancia en el número de copias de 18,385 Mb dentro de la región 18p.La tetrasomía tiende a ser el resultado de eventos de novo. El isocromosoma del paciente podría explicarse por la edad materna avanzada, ya que se sabe que tiene una gran influencia en su formación. A pesar de que no hay genes asociados con las manifestaciones clínicas de i(18p), estas características están negativamente correlacionadas con los efectos de dosificación de todo el brazo corto. Se le recomendó terapia física y de lenguaje al paciente, la familia recibió orientación médica y se concientiza sobre la planificación familiar.

Primary mediastinal germ cell tumors: the clinicopathologic analysis of 56 cases / 临床与实验病理学杂志

Purpose To investigate the clinicopathologic features of primary mediastinal germ cell tumors and to improve the diagnosis and treatment guidance. Methods The clinical features, histologic findings, molecular detection and biological behaviors of 56 PMGCT cases were analyzed retrospectively. Results The age of patients ranged from 9 to 48 years (median age 29.1 years), and mature teratoma(76.8％, 43/56) were the most common type.3 cases of mature teratoma were prepubertal patients.53 cases of postpubertal patients included 40 cases of mature teratoma, 2 cases of nonmature teratoma, 2 cases of yolk sac tumor, 5 cases of seminoma, 4 cases of mixed germ cell tumor. All malignant PMGCTs were male, and mature teratoma was found in the female. Histopathologic morphology and immune phenotype of primary mediastinal germ cell tumors were consistent with those of sexual gland. The isochromosome 12p was detected in various component of malignant GCTs, not in mature teratoma. All patients underwent surgical resection, with additional chemotherapy for malignant germ cell tumor cases. The prognosis of mature teratoma regardless of prepubertal or postpubertal patients was benign, but PMGCTs (except mature teratoma) of postpubertal type were malignant. Conclusion Primary mediastinal germ cell tumors are rare and mature teratoma is most common. The malignant PMGCTs mostly occur in young men. The abnormal 12p detected by FISH is helpful to differential diagnosis and guide the treatment.

A rare case of an Isochromosome Mosaic Turner Syndrome

@#Turner syndrome is characterized by a complete or partial absence of one X chromosome. The most common karyotype is 45,X0. A variant of Turner syndrome is Isochromosome Mosaic Turner syndrome which presents with an abnormality of the chromosome structure. This is a case of a 22 year old female who presented with short neck, widely spaced nipples, low posterior hairline, absence of nose bridge, minimal axillary hair and underdeveloped breasts. Ultrasound examination showed an infantile uterus with small ovaries. Her karyotype showed an isochromosome of the long arm of the X chromosome and the remaining eight cells showed a loss of one X chromosome, resulting in monosomy X (ISCN: 46,X,i(X)(q10)[42]/45,X[8]). Hormonal evaluation showed a hypergonadotropic and hypogonadism state. Test results for auditory, ophthalmologic, cardiac and renal functions were all within normal limits. The patient was diagnosed with isochromosome mosaic Turner syndrome and started on hormonal therapy.

Using Array-Based Comparative Genomic Hybridization to Diagnose Pallister-Killian Syndrome

Pallister-Killian syndrome (PKS) is a rare multisystem disorder characterized by isochromosome 12p and tissue-limited mosaic tetrasomy 12p. In this study, we diagnosed three pediatric patients who were suspicious of having PKS using array-based comparative genomic hybridization (array CGH) and FISH analyses performed on peripheral lymphocytes. Patients 1 and 2 presented with craniofacial dysmorphic features, hypotonia, and a developmental delay. Array CGH revealed two to three copies of 12p in patient 1 and three copies in patient 2. FISH analysis showed trisomy or tetrasomy 12p. Patient 3, who had clinical features comparable to those of patients 1 and 2, was diagnosed by using FISH analysis alone. Here, we report three patients with mosaic tetrasomy 12p. There have been only reported cases diagnosed by chromosome analysis and FISH analysis on skin fibroblast or amniotic fluid. To our knowledge, patient 1 was the first case diagnosed by using array CGH performed on peripheral lymphocytes in Korea.

Diagnostic value of immunohistochemistry and FISH for chromosome 12p in type Ⅱ testicular germ cell tumors / 中华男科学杂志

<p><b>Objective</b>To study the pathological morphology, immunohistochemical characteristics, and molecular changes of type Ⅱ testicular germ cell tumors (TGCT) and investigate the possible value of immunohistochemistry and fluorescence in situ hybridization (FISH) in the diagnosis of TGCT.</p><p><b>METHODS</b>We collected for this study 97 cases of TGCT, including 75 cases of seminoma, 17 cases of embryonal carcinoma, 11 cases of yolk sac tumor, 16 cases of mature teratoma, 3 cases of immature teratoma, and 1 case of epidermoid cyst, in which normal testicular tissue was found in 20 and non-TGCT in 6. We detected the expressions of different antibodies in various subtypes of TGCT by immunohistochemistry and determined the rate of chromosome 12p abnormality using FISH.</p><p><b>RESULTS</b>The immunophenotypes varied with different subtypes of TGCT. SALL4 and PLAP exhibited high sensitivity in all histological subtypes. CD117 and OCT4 showed strongly positive expressions in invasive seminoma and germ cell neoplasia in situ (GCNIS) but not in normal seminiferous tubules. GPC3 was significantly expressed in the yolk sac tumor, superior to GATA3 and AFP in both range and intensity. CKpan, OCT4, and CD30 were extensively expressed in embryonal carcinoma, while HCG expressed in choriocarcinoma. The positivity rate of isochromosome 12p and 12p amplification in TGCT was 96.7% (29/30).</p><p><b>CONCLUSIONS</b>The majority of TGCT can be diagnosed by histological observation, but immunohistochemical staining is crucial for more accurate subtypes and valuable for selection of individualized treatment options and evaluation of prognosis. Chromosome 12p abnormality is a specific molecular alteration in type Ⅱ TGCT, which is useful for ruling out other lesions.</p>

Isocromosoma Xq en mosaico y microduplicación 17pl3. 3pl3. 2 en una paciente con síndrome de Turner y catarata congénita / Mosaic isochromosome Xq and microduplication 17p13. 3p13. 2 in a patient with Turner syndrome and congenital cataract

La combinación del síndrome de Turner con otros trastornos genéticos, como la catarata congénita, ha sido reportada. Sin embargo, su asociación con una forma de catarata nuclear congénita con herencia autosómica dominante y penetrancia incompleta no ha sido reportada previamente en la literatura. Tampoco existen reportes de su presentación junto con rearreglos en el cromosoma 17. A continuación, presentamos el excepcional caso de una paciente con una constelación de anomalías mayores y menores, diagnosticada con síndrome de Turner en mosaico por isocromosoma Xq, asociado a una microduplicación 17p13.3p13.2, quien además presenta catarata nuclear congénita bilateral de herencia autosómica dominante con penetrancia incompleta. Se realiza una revisión acerca del origen y la causa de estas alteraciones genéticas y una aproximación a la hipótesis de la patogénesis de la asociación de dos de estos trastornos genéticos en una misma paciente.

The combination of Turner syndrome with other genetic disorders such as congenital cataract has been reported, but its association with a congenital form with autosomal dominant inheritance and incomplete penetrance has not been previously reported in the literature. There are no reports on its presentations with rearrangements on chromosome 17. We report the exceptional case of a 20 months old girl with a constellation of major and minor anomalies, diagnosed with mosaic Turner syndrome by isochromosome Xq associated with a microduplication 17p13.3p13.2, who also had bilateral congenital nuclear cataract autosomal dominant with incomplete penetrance. We reviewed in the literature the origin and cause of these genetic alterations and we provided an approach to the hypothesis of the pathogenesis of the association of two of these genetic disorders in the same patient.

A case report of prenatally diagnosed tetrasomy 18p

Tetrasomy 18p, one of the most commonly observed isochromosomes, consists of two copies of the p arms on chromosome 18[i(18p)]. It is known as a de novo occurrence of non-disjunction or centromeric mis-division during meiosis II in the vast majority of cases. It has a prevalence of 1/140,000-180,000 live births and affects both genders equally. A 28-year-old woman was referred at 33+2 weeks gestation to rule out fetal congenital heart disease. Her prenatal ultrasonography showed intrauterine growth retardation, cardiomegaly, and imperforate anus. Doppler ultrasonographic finding showed fetal anemia. Tetrasomy 18p was confirmed by conventional karyotyping and fluorescence in situ hybridization. Because of its very low prevalence rate, only several cases of tetrasomy 18p has been reported worldwide and it has not yet been reported in Korea before. Therefore, we report a case of prenatally diagnosed tetrasomy 18p.

Cytogenetic investigation of patients with primary amenorrhea.

Primary amenorrhea refers to absence of spontaneous menarche even after the age of 16. Cytogenetic analysis in two cases with primary amenorrhea, short stature, poorly developed secondary sexual characteristics, and growth retardation were studied. Routine GTG-band analysis of metaphases from peripheral blood leucocytes revealed female karyotype with a 15(ps+) and an isochromosome of X, i(Xq), in one patient and 46,X, i(Xq), in another patient. Ascertainment of the karyotype aided in confirmation of the provisional diagnosis, a better phenotype–genotype correlation to understand clinical heterogeneity in genetic counseling.

A Case of Acute Myeloid Leukemia with Bone Marrow Basophilia and Dysmegakaryocytic Hyperplasia with Isochromosome 17q as a Sole Cytogenetic Abnormality: A Clinical Study with Literature Review

A new clinico-pathological entity in which isochromosome 17q is the sole abnormality has been reported in myelodysplastic syndrome and in myeloproliferative neoplasm with an aggressive course; In particular, myelodysplastic syndrome with the isolated i(17)(q10) chromosome has the unique features of male sex, severe anemia, dysmegakaryocytic hyperplasia, increased micromegakaryocytes, basophilia, eosinophila and high risk for progression to acute myeloid leukemia (AML). However, the isolated i(17)(q10) is occurring at a relatively low frequency in de novo AML, and only a few reports are available in the literature about the clinical features and molecular characteristics of the isolated i(17)(q10) in AML. Herein, we report both the clinico-pathological features and the results of high resolution single nucleotide polymorphism (SNP) array analysis in a case of AML with i(17)(q10) as the sole cytogenetic abnormality. This case showed marrow findings of basophilia and dysmegakaryocytic hyperplasia and aggressive clinical outcome and these findings were suggestive of the presence of underlying myelodysplastic syndrome. The breakpoint of i(17)(q10) was located within 17p11.2 sub-band, which is known as a genetically highly unstable region presenting a unique genomic architectural features of low copy repeats (LCRs); thus, LCRs within 17p11.2 might lead to genomic instability and facilitate somatic genetic rearrangements such as i(17) (q10) and could play an important pathogenetic role in presenting unique clinico-pathologic features as well as in tumor development and disease progression.

Isochromosome X mosaicism in a child with Kabuki syndrome phenotype: A rare cytogenetic association.

Isochromosome is a structurally unbalanced chromosome consisting of two short arms or two long arms, which are derived by abnormal centromere division or sister-chromatid exchange. Most autosomal isochromosomes are unusual, while those involving sex chromosomes are common. Kabuki syndrome (KS, OMIM 147920) is a multiple malformation/mental retardation syndrome of unknown etiology. A conventional cytogenetic study on lymphocytes from a 4-year-old girl with physical features suggestive of KS was found to have mosaicism for isochromosome for the long arm of the X. Although most manifestations present in this patient have been described before, this report is a rare association of clinical and cytogenetic findings in this syndrome. A genome-wide analysis and a larger number of patient groups studied could improve our understanding of the genetic basis of KS.

Development of Acute Megakaryoblastic Leukemia with Isochromosome (12p) after a Primary Mediastinal Germ Cell Tumor in Korea

The association of hematological malignancies with a mediastinal germ cell tumor (GCT) is very rare. We report one case of a young adult male with primary mediastinal GCT who subsequently developed acute megakaryoblastic leukemia involving isochromosome (12p). A 25-yr-old man had been diagnosed with a mediastinal GCT and underwent surgical resection and adjuvant chemotherapy. At 1 week after the last cycle of chemotherapy, his peripheral blood showed leukocytosis with blasts. A bone marrow study confirmed the acute megakaryoblastic leukemia. A cytogenetic study revealed a complex karyotype with i(12p). Although additional chemotherapy was administered, the patient could not attain remission and died of septic shock. This case was definitely distinct from therapy-related secondary leukemia in terms of clinical, morphologic, and cytogenetic features. To our knowledge, this is the first case report of a patient with mediastinal GCT subsequently developing acute megakaryoblastic leukemia involving i(12p) in Korea.

A case of isochromosome Xq Turner syndrome associated with metabolic syndrome and autoimmune thyroiditis / 대한내과학회지

Autoimmune thyroiditis in Turner syndrome is more prevalent in women with the X isochromosome karyotype, compared with other karyotypes. The cause of obesity in Turner syndrome is not to be sure, it may be related to metabolic syndrome inducing insulin resistance, hyperlipidemia, and cardiovascular diseases. Also the influence of each karyotypes on degree of obesity is unclear in Turner syndrome. We experienced a case of X isochromosome Turner syndrome with metabolic syndrome and autoimmune thyroiditis and report it with reviews of literatures.

A case of isochromosome Xq Turner syndrome associated with metabolic syndrome and autoimmune thyroiditis / 대한내과학회지

Autoimmune thyroiditis in Turner syndrome is more prevalent in women with the X isochromosome karyotype, compared with other karyotypes. The cause of obesity in Turner syndrome is not to be sure, it may be related to metabolic syndrome inducing insulin resistance, hyperlipidemia, and cardiovascular diseases. Also the influence of each karyotypes on degree of obesity is unclear in Turner syndrome. We experienced a case of X isochromosome Turner syndrome with metabolic syndrome and autoimmune thyroiditis and report it with reviews of literatures.

Down syndrome with fragment X - A case report.

This article reports a case of four-month-old female infant referred to Division of Human Genetics, St. Johns' Medical College, for karyotyping with suspicion of Down syndrome. On karyotyping all analysed spreads showed trisomy 21 but a few spreads (6.66%) showed fragment X. X was broken at the centromere and both short and long arms were present in the spread. GTG bands of the two fragments correlated with the normal X counter parts. The mechanism behind isochromosome formation is discussed. Thus, this case is free trisomy 21 for Down syndrome and a mosaic for the X structural anomaly.

A Case of Bone Marrow Involvement of Hepatosplenic gamma delta-Cell Lymphoma / 대한혈액학회지

Hepatosplenic gamma delta-cell lymphoma is a rare histologic type of peripheral T-cell lymphomas, clinically characterized by predominant involvement of liver and spleen, no or little adenopathy, and an often aggressive course. We report a case of bone marrow involvement of hepatosplenicgamma delta-cell lymphoma in a 21- year-old woman who presented with fever, anemia, thrombocytopenia, and hepatosplenomegaly. A lymphoma was found subsequently by bone marrow biopsy and computed tomography scan of the abdomen and pelvis. Immunologic characterization of lymphoma cells in bone marrow revealed positivity for CD2, CD3, and CD16/56, and negativity for CD4, CD5, CD7, CD8, CD34, and terminal deoxynucleotidyl transferase (TdT). Conventional cytogenetic studies revealed the presence of isochromosome 7q. Using the PCR-SSCP technique, monoclonal gene rearrangement of the T-cell receptor gamma chain was demonstrated. Thus, we could make a confirmatory diagnosis as hepatosplenic gamma delta-cell lymphoma.

Two Cases of Kabuki Make-up Syndrome Including One Case Associated with Xq Isochromosome

Kabuki make-up syndrome(KMS) is characterized by mental and developmental retardation and peculiar facial features including long palpebral fissures with eversion of the lateral portion of lower eyelid and arching of eyebrows, resembling the actors in Japanese Kabuki. In addition, dermatoglyphic and skeletal abnormalities are commonly associated. Although most karyotypes of KMS are shown to be normal, there have been some reports suggesting the involvement of X chrornosome in KMS. We report here two children showing the main features of KMS, one of whom has a mosaic Turner karyotype of 45,X/46,Xi(Xq). We reviewed KMS and its association with abnormalities of X chromosome.

Medulloblastoma: Does the Isochromosome 17q Influence on the Long Term Survival?

OBJECTIVE: An isochromosome for the long arm of 17, i(17q), is the most frequent chromosomal abnormality in medulloblastoma, occurring in 30-60% of cases by karyotype analysis and this abnormality has been reported to be present in cases with a shorter survival time by some authors. Moleculogenetic analysis for i(17q) was performed to identify its influence on the long term survival. PATIENTS AND METHODS:The authors reviewed 17 children and divided them into two groups(favorable and poor outcomes) to elucidate the influence of the i(17q) on the long term survival. Eight children with favorable outcome are in disease-free status during the follow-up period (range: 52-87 months, median: 66 months). The other nine children with poor outcome died of disease progression or recurrence and their median survival time was 13 months (range: 1-28 months). Fluorescent in situ hybridization(FISH) was used for the detection of i(17q) in 17 children. RESULTS: The i(17q) was detected in nine of 17 children. There was no difference in the positive rates of i(17q) between two groups. CONCLUSION: The i(17q) was detected by FISH in 53% of medulloblastoma patients. Presence of the i(17q) was not a prognostic factor on the long term survival.

A Case of Tetrasomy 9P

Supernumerary isochromosome resulting in autosomal tetrasomy are rare and have been described only for 12P, 18P, and 9P. Tetrasomy 9P, initially described by Ghymer et al, is a rare chromosomal aberration that has been described in 20 patients. Affected subjects show both cytogenetic and ohenotypic variability. Some patients have the abnormal cell line in all cells, but many display tissue limited mosaicism. The phenotype varies in severity from prenatal death to mild developmental delay and minor anomalies. We reported a infant with mild manifestations of tetrasomy 9p with brief review of related literatures.