Molecular and Cytogenetic Analysis of Romanian Patients with Differences in Sex Development
Abstract
:1. Background
2. Materials and Methods
2.1. Strip Assay Technique for the CYP21A2 Gene
2.2. Chromosomal Microarray Technique
2.3. Genes Panel Sequencing
3. Results
4. Discussion
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Karyotype | Number of Patients, n |
---|---|
45,X | 18 |
45,X/46,XY | 2 |
45,X/46,XX | 4 |
45,X/46,XX/47,XXX | 3 |
46,Xi(Xp) | 1 |
46,XX,dup(X)(q22q24) | 1 |
47,XXY | 3 |
46,XY/47,XXY | 1 |
48,XXXY | 1 |
48,XXYY | 1 |
49,XXXXX | 1 |
46,XY,dup(8)(q24.3) | 1 |
46,XY,del(12)(q13) | 1 |
46,XY/47,XY,+mar | 1 |
46,XX | 106 |
46,XY | 122 |
Patient | Isolated/ Syndromic | Clinical Phenotype | Karyotype | CNV/DUP | Size | Main Genes Included | Interpretation |
---|---|---|---|---|---|---|---|
p3 | Syndromic | Primary amenorrhea, clitoridian hypertrophy, short stature, intellectual disability | 46,XX | arr[GRCh37]15q11.2(22753733_23226254)x3 | 472 kb | NIPA1, NIPA2, CYFIP1, TUBGCP5 | VUS |
p4 | Syndromic | Bilateral cryptorchidism, intellectual disability, craniofacial dysmorphism | 46,XY | UPD7 | - | - | Pathogenic |
p6 | Syndromic | Enlarged phallus, urogenital sinus, partial posterior fusion of genital folds (Prader 3), global developmental delay, craniofacial dysmorphism | 46,XY | arr[GRCh37]15q11.2(22652330_23226254)x3 | 573 kb | NIPA1, NIPA2, CYFIP1, TUBGCP5 | VUS |
p10 | Syndromic | Cryptorchidism, micropenia, puberty delay, intellectual disability | 46,XY | arr[GRCh37]16p11.2(29595483_30192561)x1 | 597 kb | PRRT2, KIF22, ALDOA, TBX6, SEZ6L2, TMEM219, MAPK3, SPN, QPRT, MAZ, MVP, and 11 other OMIM genes (proximal 16p11.2 microdeletion syndrome) | Pathogenic |
p14 | Syndromic | Bilateral cryptorchidism, short stature, obesity, deafness | 46,XY | UPD15 | - | - | Pathogenic |
p18 | Syndromic | Cryptorchidism, obesity, macrocrania, micromelia | 46,XY | arr[GRCh37]Xp11.4(38230704_38246882)x1 | 16 kb | OTC (exon 4) | Pathogenic |
p21 | Syndromic | Micro-penis, bilateral, cryptorchidism, hypotonia, craniofacial dysmorphism | 46,XY | UPD15 | - | - | Pathogenic |
p24 | Syndromic | Scrotal hypospadias, cryptorchidism, intellectual disability, language delay, obesity | 46,XY | arr[GRCh37]6p25.1(5256116_ 5391419)x1 | 135 kb | FARS2, LYRM4 | VUS |
p26 | Syndromic | Micro-penis, cryptorchidism, craniofacial dysmorphism, intellectual disability | 46,XY | arr[GRCh37]14q11.2(19401281_20420338)x3 | 1.01 Mb | POTEG | VUS |
p30 | Syndromic | Primary amenorrhea, uterus agenesia, forearm agenesia, ectromelia, epilepsy, intellectual disability | 46,XX | arr[GRCh37]1q21.1(145394955_145755813)x1 | 360 kb | RBM8A, PEX11B, POLR3GL, HJV, HEF2A, and other OMIM genes (BP2-BP3 microdeletion syndrome) | Pathogenic |
p31 | Syndromic | Cryptorchidism, micro-penis intellectual disability, craniofacial dysmorphism | 46,XY | arr[GRCh37]18p11.32p11.31 (13034_4390081)x1 | 4.3 Mb | SMCHD1, LPIN2, TGIF1, and other OMIM genes included in 18p11.3 region (18p11.3 deletion syndrome) | Pathogenic |
p32 | Isolated | Enlarged phallus, partial fusion of genital folds, Prader 2 | 46,XX | arr[GRCh37]6p21.33(32005904_32006896)x0 | 0.99 kb | CYP21A2 (exons 1-3) | Pathogenic |
p35 | Syndromic | Scrotal hypospadias, cryptorchidism, palatine cleft, skeletal dysplasia | 46,XY | arr[GRCh37]Xp11.4 (41665315_41684603)x1 | 19 kb | CASK (intron 2) | VUS |
Patient | Age | Gender | Gonads | Muller Derivatives | External genitalia | Puberty | FSH LH | Hormonal | Other | Karyotype | SRY | Variant (HGVS) | Zigosity | Variant Interpretation (ACMG Criteria) |
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
p1 | 4 | F | Bilateral testicular ectopia | Yes, uterus, Vagina | Female N | Tanner 1 | Prepuberty level | N | craniofacial dysmorphism, diaphragmatic hernia, calos body hypoplasia | 46,XY | + | WT1(NM_024426.5): | Heterozygous | VUS |
c.437C>A (p.Trp151Cys) | (PM2, PP2, PP3) | |||||||||||||
MAF = 0 | ||||||||||||||
p2 | 11 | M | Bilateral cryptorchidism | No | Micropenis, cryptorchidism | Tanner 1 | Prepuberty level | N | Craniofacial dysmorphism | 46,XY | + | CHD7 (NM_017780.3): | Heterozygous | Likely pathogenic |
c.5405-7G>A, MAF = 0 | (PP5, PM2) | |||||||||||||
rs398124321, MAF = 0 | ||||||||||||||
p5 | 1 | F | Bilateral cryptorchidism | No | Female N | Tanner 1 | Prepuberty level | N | No | 46,XY | + | AR(NM_000044.6): | Heterozygous | Likely pathogenic |
c.2071_2073del (p.Asp691del), MAF = 0 | (PM1, PM2, PM4, PP3) | |||||||||||||
p7 | 1.6 | M | Anorhidia | No | Micro-penis | Tanner 1 | ↑↑↑ | N | craniofacial | 46,XY | + | NIPBL(NM_133433.4): | Heterozygous | Pathogenic |
dysmorphism, GDD/ID | c.1808del (p.Lys603SerfsTer11) | (PVS1, PM2, PP3, PP5) | ||||||||||||
rs727503767, MAF = 0 | ||||||||||||||
p8 | 0.3 | F | Bilateral testicular ectopia | No | Clitoridian hypertrophy, 2 orifices, right inguinal hernia | Tanner 1 | Prepuberty level | N | Hypercalcemia | 46,XY | + | AR(NM_000044): | Heterozygous | VUS |
c.167T>A (p.Leu56Gln) | (PM2, PP2) | |||||||||||||
rs868709351, MAF = 0 | ||||||||||||||
AR(NM_000044): | Heterozygous | VUS | ||||||||||||
c.170_171insGCAGCAGCA (p.L57insGlnGlnGln) | (PM2,PP3) | |||||||||||||
rs3032358, MAF = 0 | ||||||||||||||
p9 | 3.1 | M | Scrotal testes | No | Penoscrotal hypospadias, micro-penis, bifidus scrotum | Tanner 1 | Prepuberty level | T, DHT ↓ | no | 46,XX | - | RSPO1(NM_001242908.2): | Heterozygous | VUS |
c.286+1G>A | (PM2, PP3, PP5) | |||||||||||||
rs1570099690, MAF = 0 | ||||||||||||||
RSPO1(NM_001242908.2): | Heterozygous | VUS | ||||||||||||
c.484A>G (p.Lys162Glu) | (PM2) | |||||||||||||
rs36043533, MAF = 0.0000464 | ||||||||||||||
p11 | 0.3 | F | Bilateral testicular ectopia | Yes, uterus, vagina | Penoclitoridian organ, one orifice at the base of the gland, labioscrotal folds posteriorly fusioned, not palpable gonads, Prader 4 | Tanner 1 | Prepuberty level | N | no | 46,XY | + | AMHR2(NM_020547.3): | Heterozygous | Pathogenic |
c.233-2A>G, MAF = 0 | (PVS1, PM2, PP3) | |||||||||||||
AMHR2(NM_020547.3): | Heterozygous | Likely pathogenic | ||||||||||||
c.133delA (p.Thr45GlnfsTer23), MAF = 0 | (PVS1, PM2) | |||||||||||||
AMHR2(NM_020547.3): | Heterozygous | VUS | ||||||||||||
c.137G>T (p.Gly46Val) | (PM2, PP2, PP3) | |||||||||||||
p12 | 17 | F | Not evidenced | Yes, hypoplasic uterus | Female N | Tanner 1 | ↑ | N | no | 46,XX | + | FGFR1(NM_001174067.1): | Heterozygous | pathogenic |
c.914A>G (p.Glu305Gly) | (PS3, PM1, PM2, PP2, PP3, PP5) | |||||||||||||
rs727505369, MAF = 0 | ||||||||||||||
FGFR1(NM_001174067.1): | Heterozygous | VUS | ||||||||||||
c.2440A>C (p.Thr814Pro) | (PM2, PP2, PP3) | |||||||||||||
MAF = 0 | ||||||||||||||
p13 | 22 | M | Bilateral cryptorchidism | No | Masculine Prader 5 | Tanner 5 | N | N | no | 46,XY | + | AR(NM_000044.6): | Heterozygous | VUS |
c.1097A>C (p.Asn366Thr) | (PM2, PP2, PP3) | |||||||||||||
MAF = 0 | ||||||||||||||
p15 | 0.1 | M | Bilateral cryptorchidism | No | Micro-penis, hypospadias, one orifice at the base, scrotal folds, inguinal hernia | Tanner 1 | Prepuberty level | N | no | 46,XY | + | NR0B1(NM_000475.5):c.512G>A (p.Trp171Ter); MAF = 0 | Heterozygous | Likely pathogenic (PVS1, PM2) |
p16 | 1.2 | M | Scrotal testes | No | Micro-penis, pensoscrotal hypospadias | Tanner 1 | Prepuberty level | N | no | 46,XY | + | AR(NM_000044.6): c.2415C>G | Heterozygous | Likely pathogenic |
(p.Phe805Leu) | (PM1, PM2, PP2, PP3) | |||||||||||||
MAF = 0 | ||||||||||||||
p17 | 4 | M | Scrotal testes | No | Hypospadias | Tanner 1 | Prepuberty level | N | Pierre Robin sequence, | 46,XY | + | EMX2(NM_004098): | Heterozygous | VUS |
calos body hypoplasia, hydrocephaly, GDD/ID | c.614G>A(p.Arg205Gln) MAF = 0 | (PM2, PP3) | ||||||||||||
p19 | 48 | F | Bilateral cryptorchidism | no | Female, upper region of vagina without external orifice | Tanner 1 | ↑↑↑ | Adrenal insuficiency | adrenal insuficiency, | 46,XY | + | CYP17A1(NM_000102.4): | Heterozygous | Likely pathogenic |
arterial hypertension | c.1318C>T (p.Arg440Cys) | (PM2, PM5, PP2, PP3) | ||||||||||||
rs868228603, MAF = 0.0000119 | ||||||||||||||
CYP17A1(NM_000102.4):c.1214A>G(p.Glu405Gly) | Heterozygous | VUS | ||||||||||||
MAF = 0 | (PM2, PP2, PP3) | |||||||||||||
p20 | 4 | M | Bilateral cryptorchidism | No | Male, Prader 5 | Tanner 1 | Prepuberty level | Adrenal insuficiency | Adrenal insuficiency | 46,XY | + | - | - | - |
p22 | 15 | M | Scrotal testes | No | Male N | Tanner 3, Ginecomastia | N | T↑ estradiol↑ | no | 46,XY | + | - | - | - |
p23 | 40 | F | Not evidenced | Yes, uterus, vagina | Female N | Tanner 3 | N | N | no | 46,XX | - | - | - | - |
p25 | 1 | M | Bilateral cryptorchidism | No | micro-penis | Tanner 1 | ↓ | N | no | 46,XY | + | GNRHR(NM_000406.3): | Heterozygous | Likely pathogenic |
c.236T>C (p.Leu79Pro) | (PM1, PM2, PP2, PP3) | |||||||||||||
MAF = 0 | ||||||||||||||
p27 | 14 | M | Bilateral cryptorchidism | No | Micro-penis, penoscrotal hypospadias | Tanner 4, Ginecomastia | N | N | Obesity, short stature, astigmatism, hypermetropia | 46,XY | + | - | - | |
p28 | 6 | M | Bilateral cryptorchidism | No | penoscrotal hypospadias | Tanner 1 | Prepuberty level | N | Dysmorphism, aortic bicuspidia, ventricular septal defect, GDD/ID | 46,XY | + | GATA4(NM_002052.5): | Heterozygous | Likely pathogenic (PM1, PM2, PP2, PP3) |
c.698C>A (p.Thr233Lys) | ||||||||||||||
MAF = 0 | ||||||||||||||
p29 | 0.8 | M | Unilateral cryptorchidism | No | Penoclitoridian glans, one orifice at the base, labioscrotal folds, one gonad at the left fold, Prader 3 | Tanner 1 | Prepuberty level | N | no | 46,XY | + | - | - | - |
p33 | 20 | F | Ovarian agenesia | Yes, uterus, vagina | Female N | Tanner 3 | ↑↑↑ | N | no | 46,XX | - | - | - | - |
p34 | 32 | F | Ovarian agenesia | Yes, uterus, vagina | Female N | Tanner 3 | ↑↑↑ | N | no | 46,XX | - | ATM(NM_000051.4):c.1075G>T (p.Glu359Ter) | Heterozygous | Pathogenic |
MAF = 0 | (PVS1, PM2, PP3) |
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Miclea, D.; Alkhzouz, C.; Bucerzan, S.; Grigorescu-Sido, P.; Popp, R.A.; Pascanu, I.M.; Cret, V.; Ghervan, C.; Blaga, L.; Zaharie, G. Molecular and Cytogenetic Analysis of Romanian Patients with Differences in Sex Development. Diagnostics 2021, 11, 2107. https://doi.org/10.3390/diagnostics11112107
Miclea D, Alkhzouz C, Bucerzan S, Grigorescu-Sido P, Popp RA, Pascanu IM, Cret V, Ghervan C, Blaga L, Zaharie G. Molecular and Cytogenetic Analysis of Romanian Patients with Differences in Sex Development. Diagnostics. 2021; 11(11):2107. https://doi.org/10.3390/diagnostics11112107
Chicago/Turabian StyleMiclea, Diana, Camelia Alkhzouz, Simona Bucerzan, Paula Grigorescu-Sido, Radu Anghel Popp, Ionela Maria Pascanu, Victoria Cret, Cristina Ghervan, Ligia Blaga, and Gabriela Zaharie. 2021. "Molecular and Cytogenetic Analysis of Romanian Patients with Differences in Sex Development" Diagnostics 11, no. 11: 2107. https://doi.org/10.3390/diagnostics11112107