A cryptic duplication 22q13.31 to qter leads to a distinct phenotype with mental retardation, microcephaly and mild facial dysmorphism.

We present a girl with a terminal 22q duplication due to an unbalanced chromosomal translocation: 46, XX, der(22)(qter --> q13.31::p11 --> qter). She presented with mild to moderate mental retardation, autism spectrum disorder, microcephaly and mild dysmorphic facial features. Because of nasal speech and mental retardation, FISH analysis for the DiGeorge/VCFS region was performed. In this analysis, an extra signal for the control probe LSI ARSA (22q13) on the short arm of one of the chromosomes 22 revealed the terminal duplication 22qter. The duplication was confirmed by means of 1Mb array-CGH and further delineated as a 5.5 Mb region: 46, XX, dup(22)(q13.31qter)(CTA-268H5 --> CTB-99K24)x3. Important phenotypic variability has been described among patients with terminal 22q duplications. However, by considering the present patient and a careful selection of literature reports describing pure trisomy 22qter and comparably small duplicated regions 22q13.3 to qter, we find evidence for a consistent clinical presentation: mild to moderate mental retardation, microcephaly and similar mild dysmorphic features. Furthermore we conclude that small terminal duplications of chromosome 22q may be more common than generally assumed but may remain undetected by high resolution karyotyping. The application of array-CGH in patients with mental retardation and only very mild dysmorphism may allow to detect small 22qter duplications more frequently.