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The Principles of Clinical Cytogenetics - Extra Materials - Springer

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Sex Chromosomes and Sex Chromosome Abnormalities 211<br />

Turner Syndrome Variants<br />

Approximately half <strong>of</strong> all patients with Turner syndrome have a 45,X karyotype. <strong>The</strong> remainder<br />

exhibit mosaicism and other structural abnormalities <strong>of</strong> the X chromosome. In a study <strong>of</strong> cytogenetic<br />

and cryptic mosaicism in 211 patients with Turner syndrome, Jacobs et al. (45) reported pure 45,X in<br />

46%, 47% had a structurally abnormal sex chromosome (41% with abnormal X and 6% with abnormal<br />

Y), and 7% had a 46,XX or 47,XXX cell line. Two patients were found to have cryptic X mosaicism<br />

and none had cryptic Y mosaicism.<br />

MOSAICISM<br />

Fig. 2. A 45,X fetus with large cystic hygroma and hydrops.<br />

Mosaicism for 45,X and another cell line is found in the lymphocytes <strong>of</strong> 15–20% <strong>of</strong> patients with<br />

Turner syndrome. A 46,XX cell line might modify the phenotypic features <strong>of</strong> the syndrome. As<br />

mentioned earlier, in order to explain why 99% <strong>of</strong> 45,X conceptions terminate in miscarriage, it has<br />

been proposed that most surviving 45,X fetuses have some degree <strong>of</strong> mosaicism. In a study <strong>of</strong> both<br />

lymphocytes and fibroblast cultures in 87 patients with Turner syndrome, mosaicism was found in<br />

66.7% (46). In a patient with several typical features <strong>of</strong> Turner syndrome but normal lymphocyte<br />

chromosome analysis, analysis <strong>of</strong> another tissue such as skin should be considered (46).

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