Zarate Yuri A, Bosanko Katherine A, Bhoj Elizabeth, Ganetzky Rebecca, Starr Lois J, Zackai Elaine H, Schaefer G Bradley
Section of Genetics and Metabolism, University of Arkansas for Medical Sciences, Little Rock, Arkansas.
Department of Clinical Genetics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
Am J Med Genet A. 2015 Sep;167A(9):2168-75. doi: 10.1002/ajmg.a.37126. Epub 2015 Apr 25.
The coexistence of two or more distinct genetic conditions is known to be a rare phenomenon. Full chromosome aneuploidies can be associated with a broad variety of cytogenetic abnormalities or single gene disorders resulting in phenotypic modifications that confuse the diagnostic process. We present six patients with primary aneuploidies and a suspected or confirmed secondary genetic diagnosis or unusual birth defect. Among the cases included, we report the first patients with concurrent Down syndrome in combination with Prader-Willi, Craniofacial Microsomia, and Stickler syndromes. We also describe only the second reported case of a neonate with Down syndrome and Marfan syndrome. In all cases, the unusual clinical presentations lead to further molecular cytogenetic studies as well as single or multi-gene molecular evaluations. We make emphasis on the importance of entertaining the possibility of coexistent diagnoses when the phenotype is not what is expected for aneuploidies rather than attributing the unusual findings to rare or unreported associations of the primary aneuploidy.
已知两种或更多种不同遗传病症共存是一种罕见现象。全染色体非整倍体可能与多种细胞遗传学异常或单基因疾病相关,从而导致表型改变,这会使诊断过程变得复杂。我们报告了6例原发性非整倍体患者,他们伴有疑似或确诊的继发性遗传诊断或不寻常的出生缺陷。在这些病例中,我们报告了首例同时患有唐氏综合征并伴有普拉德-威利综合征、颅面短小畸形和斯蒂克勒综合征的患者。我们还描述了仅第二例报告的患有唐氏综合征和马凡综合征的新生儿病例。在所有病例中,不寻常的临床表现促使进一步进行分子细胞遗传学研究以及单基因或多基因分子评估。我们强调,当表型与非整倍体预期不符时,考虑共存诊断的可能性很重要,而不是将异常发现归因于原发性非整倍体罕见或未报告的关联。