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从一名45,X/46,XY嵌合体患者成功进行手术取精并随后实现体外受精妊娠:一例报告。

Successful surgical sperm retrieval from a patient with 45,X/46,XY mosaicism followed by in vitro fertilization pregnancy: A case report.

作者信息

Zhang Yu, Liu Zheng, Ou Jian, Zhang Ling-Xiao, Lu Wei-Ying, Li Qi, Ma Yanlin

机构信息

Hainan Provincial Key Laboratory for Human Reproductive Medicine and Genetic Research.

Hainan Provincial Clinical Research Center for Thalassemia, The First Affiliated Hospital of Hainan Medical University.

出版信息

Medicine (Baltimore). 2020 Oct 2;99(40):e22223. doi: 10.1097/MD.0000000000022223.

Abstract

RATIONALE

Mixed gonadal dysgenesis is a rare disorder of sex development, and typically contains a mosaic 45,X/46,XY karyotype.

PATIENT CONCERNS

We reported here a case of a 42-year-old man with infertility for 6 years and inability to ejaculate during intercourse.

DIAGNOSIS

Physical examination confirmed that the external genitalia was male. The right testis of this patient was resected and the left testis had intrascrotal calcification. Hormone test showed that the level of follicle-stimulating hormone was 20.14 IU/L (normal range, 1.27-19.26 IU/L). No deletion or mutation was found on the sex-determining region Y. H&E staining revealed seminiferous tubule dysgenesis. The karyotyping in peripheral blood and testicular tissue was 45,X/46,XY and 45,X/47,XYY/46,XY, respectively. Based on these results, the patient was diagnosed with 45,X/46,XY or 45,X/47,XYY/46,XY mosaicism and gonadal dysgenesis.

INTERVENTIONS

In vitro fertilization and embryo transfer technology were used to help his wife to achieve pregnancy.

OUTCOMES

A normal baby boy was born at 36 weeks of gestation with a karyotype 46, XY.

LESSONS

We reported a rare case of a karyotype 45,X/46,XY in blood cells and 45,X/47, XYY/46,XY in testicular tissue. In vitro fertilization and embryo transfer technology can help to achieve pregnancy.

摘要

理论依据

混合性性腺发育不全是一种罕见的性发育障碍,通常具有45,X/46,XY嵌合核型。

患者情况

我们在此报告一例42岁男性,患有6年不育症且性交时无法射精。

诊断

体格检查证实外生殖器为男性。该患者右侧睾丸被切除,左侧睾丸有阴囊内钙化。激素检测显示促卵泡激素水平为20.14 IU/L(正常范围,1.27 - 19.26 IU/L)。在Y染色体性别决定区未发现缺失或突变。苏木精 - 伊红染色显示生精小管发育不全。外周血和睾丸组织的核型分析分别为45,X/46,XY和45,X/47,XYY/46,XY。基于这些结果,该患者被诊断为45,X/46,XY或45,X/47,XYY/46,XY嵌合以及性腺发育不全。

干预措施

采用体外受精和胚胎移植技术帮助其妻子受孕。

结果

孕36周时产下一名核型为46,XY的正常男婴。

经验教训

我们报告了一例血细胞核型为45,X/46,XY且睾丸组织核型为45,X/47,XYY/46,XY的罕见病例。体外受精和胚胎移植技术有助于实现受孕。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1f08/7535675/e9bd9769eb7a/medi-99-e22223-g001.jpg

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