Kurnaz Erdal, Çetinkaya Semra, Savaş-Erdeve Şenay, Aycan Zehra
Pediatric Endocrinology Clinic, Dr. Sami Ulus Obstetrics and Gynecology and Pediatrics Training and Research Hospital, Ankara, Turkey.
Pediatric Endocrinology Clinic, Dr. Sami Ulus Obstetrics and Gynecology and Pediatrics Training and Research Hospital, Ankara, Turkey.
J Gynecol Obstet Hum Reprod. 2019 Apr;48(4):265-267. doi: 10.1016/j.jogoh.2019.01.012. Epub 2019 Jan 24.
If turner syndrome (TS) patients have a Y-containing cell line, they have an increased risk for gonadal tumors. TS patients are therefore screened for Y-chromosome and Y-specific sequences, such as SRY, DYZ1, DYZ3, DYS132, ZFY, TSPY, etc. In addition, since the dysgenetic gonad may include the stroma and granulosa/sertoli cells, which produce androgens, virilization can seen in girls with Y-chromosomal material. Prophylactic gonadectomy may therefore be required for optimal management in such patients. Our aim is to discuss our observations in the follow-up of TS patients.
SRY was investigated in 71 out of 85 TS cases (aged 3 months-27 years) between 2005 and 2017. Fluorescent in situ hybridization (FISH) was used until 2014, after which SRY analysis was performed using the polymerase chain reaction (PCR) method. SRY analysis was performed a second time using PCR in 25 cases previously investigated with FISH.
We identified no positive cases. No pathological findings in terms of virilization, clitoromegaly, or posterior labial adhesions were also determined in our TS cases. Further studies were not required since no pathological findings also were detected at ultrasonography.
If Y-chromosome material has not been detected by conventional cytogenetic methods in TS patients with masculine features, further techniques should be applied to prevent the risk of invasive tumors, such as multiple sequences beside the Y centromere. This approach will prevent overtreatment.
如果特纳综合征(TS)患者存在含Y染色体的细胞系,那么他们患性腺肿瘤的风险会增加。因此,需要对TS患者进行Y染色体及Y特异性序列筛查,如SRY、DYZ1、DYZ3、DYS132、ZFY、TSPY等。此外,由于发育不全的性腺可能包括产生雄激素的基质及颗粒/支持细胞,所以患有Y染色体物质的女孩可能会出现男性化表现。因此,对于此类患者,可能需要进行预防性性腺切除术以实现最佳治疗。我们的目的是讨论TS患者随访中的观察结果。
2005年至2017年间,对85例TS病例(年龄3个月至27岁)中的71例进行了SRY检测。2014年之前采用荧光原位杂交(FISH)技术,之后采用聚合酶链反应(PCR)方法进行SRY分析。对25例先前用FISH检测过的病例再次采用PCR进行SRY分析。
我们未发现阳性病例。在我们的TS病例中,也未发现男性化、阴蒂肥大或阴唇后粘连方面的病理表现。由于超声检查也未发现病理表现,所以无需进一步检查。
对于具有男性特征的TS患者,如果常规细胞遗传学方法未检测到Y染色体物质,应采用进一步技术来预防侵袭性肿瘤风险,如Y着丝粒旁的多个序列。这种方法可避免过度治疗。