The XXXXY Chromosome Anomaly: Report of Three New Cases and Review of 30 Cases from the Literature

The majority of abnormal sex chromosome complexes in the male have been considered to be variants of Klinefelter's syndrome but an exception should probably be made in the case of the XXXXY individual who has distinctive phenotypic features. Clinical, radiological and cytological data on three new cases of XXXXY syndrome are presented and 30 cases from the literature are reviewed. In many cases the published clinical and radiological data were supplemented and re-evaluated. Mental retardation, usually severe, was present in all cases. Typical facies was observed in many; clinodactyly of the fifth finger was seen in nearly all.

Radiological examination revealed abnormalities in the elbows and wrists in all the 19 personally evaluated cases, and other skeletal anomalies were very frequent. Cryptorchism is very common and absence of Leydig's cells may differentiate the XXXXY chromosome anomaly from polysomic variants of Klinefelter's syndrome. The relationship of this syndrome to Klinefelter's syndrome and to Down's syndrome is discussed.

     

Chromosomal Abnormalities and Their Relation to Disease

When human chromosome anomalies were first described in 1959, it appeared that specific abnormalities might be correlated with specific syndromes. Mongolism and the D and E syndromes are examples of specific syndromes associated with the presence of an extra autosome. Klinefelter's syndrome may be associated with a variety of different sex chromosome anomalies including XXY, XXYY, XXXY and XXXXY. The lastnamed variant is the only one that frequently presents features distinguishing it from the others. An XO sex chromosome complex is found in many women with gonadal dysgenesis. However, a variety of mosaicisms have been described in association with this condition, including XO/XX, XO/XXX, XO/XX/XXX, XO/XY and XO/XYY. Extra X chromosomes in phenotypical females do not seem to impair fertility or be consistently associated with congenital anomalies. Two families are described in which chromosome anomalies were found, but the association with defects was irregular. In one family the abnormality involved one of the number 16 chromosomes and in the other it involved one of the small acrocentric chromosomes.     

The Sex Chromosomes in Evolution and in Medicine

The recent emergence of human cytogenetics has a firm foundation in studies on other forms of life. Historical highlights are Mendel's studies on the garden pea (published in 1865 but lost in an obscure journal until 1900); formulation of cytogenic postulates by Sutton and Boveri (1902-1903); Bridges' discovery of chromosome abnormalities in Drosophila (1916), followed by numerous similar studies in plants; and demonstration of the chromosomal basis of the syndromes of Down, Klinefelter and Turner in man (1959).

The sex chromosomes (XX and XY) evolved from a pair of undifferentiated autosomes of a premammalian ancestor, the X chromosome changing less than the Y as they evolved. Eleven numerical abnormalities of the sex chromosomes are known in man, and knowledge of their effects on development is accumulating. The abnormal complexes range in size from the XO error of Turner's syndrome to the XXXXY error of a variant of Klinefelter's syndrome.

     

Human Chromosomes: II. Preparation, Analysis and Diagnostic Implications of Abnormalities

This presentation is designed to show the diagnostic implications of chromosomal abnormalities, and how in some cases chromosome analysis may be helpful in prognosis and counselling. Most males with Klinefelter's syndrome have chromatinpositive nuclei and an abnormal sex chromosome complex (usually XXY). In Turner's syndrome many such females have chromatin-negative nuclei and a deficient sex chromosome complex (usually XO). Multiple-X females have unusual chromatin patterns (two or three masses of sex chromatin) and abnormal sex chromosome complexes (XXX, XXXX, XO/XXX, etc.). One of the parents of a translocation mongol may carry a translocation chromosome and pass it to future children. Cytogenetic data are therefore essential for genetic counselling. Mosaic and deletion mongols may show incomplete manifestations of mongolism, which make diagnosis difficult; chromosome analysis is helpful in diagnosis, and in prognosis concerning mental development. Abnormal chromosome numbers result from non-disjunction, usually during gametogenesis. The error may occur, however, during cleavage, producing cells with different chromosome complements (mosaicism). Visible structural abnormalities of chromosomes result from deletions or translocations of chromosome fragments.     

The XXYY Variant of Klinefelter's Syndrome

Three males with an XXYY sex chromosome complex are described. These patients, together with five XXYY subjects recorded in the literature, show the clinical features of Klinefelter's syndrome. Taking into consideration the findings in XYY and XXXYY individuals, it appears that the addition of a Y chromosome to XY, XXY and XXXY complexes has a variable and as yet not clearly delineated harmful effect. For example, a 44 + XXYY complement of chromosomes may prove to have significant manifestations in skeletal maturation and predispose to vascular and cutaneous abnormalities of the lower extremities in older patients. But when two Y chromosomes are present, the phenotype does not differ markedly from that resulting from the presence of a single Y chromosome in the sex chromosome complex. This finding is compatible with the view that the Y chromosome of man is relatively inert, compared with the autosomes, except for genes that function in male sex determination.     

Sex Chromosomal Analysis of Fifty Cases with Azoospermia

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Chromosome Abnormalities in Patients with Syndactyly

Chromosome studies on 105 patients with syndactyly included two trisomy-21 mongols, a chromatin-positive boy with 47, XXY, a chromatin-negative short girl with 45,X0 and a boy with a familial D/D translocation. Chromosome patterns were normal in the other cases which included three patients with acrocephalosyndactyly and one patient with oro-facial-digital syndrome.

The incidence of chromosome abnormalies was greater than expected since syndactyly of the fingers is uncommon in the chromosome disorders.

This incidence may be related to the increased maternal age (mean: 29.4 years) of the syndactyly group compared to maternal age (mean: 26.64 years) of the control group although, paradoxically, four mothers of the five patients with chromosome abnormalities were young.

     

A rare case of ambiguous genitalia

Genes on the Y chromosome are essential for normal sex determination and sex differentiation of male genitalia. However, genes on the X chromosome and other autosomes have been shown to be anti-testes and have a detrimental effect on this process. Addition of X chromosomes to the 46,XY karyotype results in seminiferous tubules dysgenesis, hypogonadism and malformed genitalia. We report a term male newborn with 49,XXXXY syndrome presenting with ambiguous genitalia, multiple extra-gonadal anomalies, facial dysmorphism, and radioulnar synostosis.     

原发性无精子症病人的细胞遗传学分析

①目的 探讨无精子症病人的细胞遗传学效应。②方法 采用外周血培养方法对57例原发性无精子症病人进行染色体核型分析。③结果 检出染色体核型异常病人23例．均涉及性染色体。最多的为47．XXY共17例，检出率为29．83％,占异常核型的73．91％。其次为大Y染色体4例．检出率为7．02％,占异常核型的17．39％。46，XY／47，XXY和47，XYY各1例，检出率为1．75％，占异常核型的4．35％。④结论 性染色体异常是原发性无精子症发生的根本原因之一。     

Y-chromosomal genes in a phenotypic male with a 46XX karyotype.

A number of patients with a male phenotype and a female (46XX) karyotype have been described. Although there is little or no evidence for the presence of a Y chromosome in their cells, these individuals resemble patients with Klinefelter syndrome (47XXY). Using a new serological assay for the presence of H-Y antigen, a cell surface component associated with the Y chromosome, we have demonstrated the presence of Y-chromosomal genes in a 46-year-old man with an XX karyotype. In addition, using standard cytological technique, we have located a minor population of XXY cells as well as cells bearing and abnormal chromosome 17 among the blood leukocytes of this individual.     

孕妇年龄影响胎儿性染色体非整倍体风险

目的: 分析孕妇年龄对胎儿性染色体非整倍体发生风险的影响。方法: 以2014年1月至2018年7月在浙江大学医学院附属妇产科医院行羊水染色体核型分析的孕妇为研究对象,分为非高龄组（≤28岁、>28~34岁）和高龄组（>34~ < 38岁和≥38岁）,比较各组间胎儿性染色体非整倍体的发生率。结果: > 34~ < 38岁组胎儿45,X的发生率低于≤28岁组（P < 0.05）;高龄组两个亚组胎儿总的性染色体三体的发生率高于非高龄组的两个亚组（P < 0.05或P < 0.01）;≥38岁组47,XXX发生率高于>28~34岁组（P < 0.05）;高龄两组47,XXY发生率高于非高龄组的两个亚组（P < 0.01）;各组间胎儿47,XYY发生率差异无统计学意义（P>0.05）。排除无创产前检测提示性染色体异常高风险孕妇后,高龄组两个亚组胎儿45,X发生率均低于≤28岁组（P < 0.05或P < 0.01）,且>34~ < 38岁组45,X发生率低于>28~34岁组（P < 0.05）;其余结果均与全部孕妇结果一致。结论: 孕妇年龄越大,胎儿45,X发生风险降低,但47,XXX和47,XXY的发生风险升高。     

精神障碍患者性染色体异常的研究

目的本研究旨在探讨精神障碍患者性染色质和性染色体的异常.方法应用随机、双盲的方法对2 784名精神障碍患者口腔黏膜细胞的性染色质.异常者进一步检查外周血染色体核型.对照组为1 069名正常人.结果男性患者Y染色质[(28.0±6.6)%]和女性患者X 染色质[(22.3±8.0)%]频率明显高于对照组;分裂症亚组和情感障碍亚组中 X 染色质频率高于神经症亚组和心因性精神障碍亚组.8例男性患者X染色质为阳性,染色体核型3例为47,XXY,5例为47,XXY/46,XY,47,XXY 型发生率为0.77%,明显高于对照组.2例女性患者X 染色质阴性,染色体核型为45,X/46,XX, 45,X 型发生率为0.12%;1例女性患者具有双X染色质,染色体核型为 47,XXX/46,XX,对照组未发现性染色质和性染色体核型异常者.结论结果提示性染色质频率增高与精神障碍遗传倾向密切相关,精神障碍患者中女性少1条X染色体和男性多1条X染色体的比率升高.     

Chromosome studies in a neonatal population

The results of chromosome studies on 6809 consecutive newborn infants are presented. One hundred and one (1.48%) were heterozygous for a marker chromosome, the significance of which is not at present clear. Twenty-two infants (0.32%) had a major chromosome abnormality. Only six of these infants (0.09%) had a clinically recognizable abnormal phenotype (Down's syndrome). The occult chromosome abnormalities included five sex chromosome abnormalities (one 47,XYY; two 47,XXY; two 47,XXX) and 11 balanced translocations. Seven of these were t(DqDq) and four were reciprocal translocations. The results of the present survey are combined with four other similar neonatal surveys in which a total of 23,328 newborns have been screened. Of these, 117 (0.5%; range 0.65-0.32%) had major chromosome abnormalities. The majority of these (72.7%) would not have been detected at birth without chromosome studies, an important fact in the context of prenatal diagnosis of chromosome disease and the early ascertainment of high-risk families.     

应用荧光原位杂交技术检测性染色体异常

探讨荧光原位杂交技术在性染色体异常诊断中的价值。方法：应用Ｘ、Ｙ染色体着丝粒探针,对１９例女性性腺发育不全及５例男性不育患者的外周血染色体或间期细胞进行杂交。结果发现的异常核型有：４６,Ｘ,ｒ（Ｘ）,４５,Ｘ／４６,Ｘ,ｒ（Ｘ）、４５,Ｘ／４６,Ｘ,ｄｉｃｉ（Ｙｑ）、４５,Ｘ／４６,ＸＹ、４５,Ｘ／４７,ＸＸＸ、４５,Ｘ／４６,ＸＸ／４７,ＸＸＸ、４５,Ｘ及４７,ＸＸＹ等类型。结论应用ＦＩＳＨ技术     

无精子症患者的遗传学诊断

目的 :了解精子发生障碍的遗传学原因。　方法 :对 1 0 7例无精子症患者进行染色体核型分析及Y染色体微缺失的检测。　结果 :检出染色体异常核型 1 3例 (1 2 .1 % ) ,均涉及性染色体数目、结构畸变 ,其中 1 0例为 4 7,XXY ,1例为 4 7,XXY ,t(4 ;1 2 ) ,1例为 4 6X ,del(Y) ,1例为 4 6 ,XX。 4 6X ,del(Y)和 4 6 ,XX除检出SRY外 ,未检出Y染色体上与精子发生相关的其他DNA片段。检出 8例患者有Y染色体微缺失 ,AZFb AZFc缺失 2例 ,AZFc缺失 6例 ,共占 7.5 % (8/ 1 0 7)。 1例AZFb AZFc缺失患者 ,睾丸活检病理显示唯支持细胞综合征 ,1例生精阻滞在初级精母细胞阶段。 6例AZFc缺失患者精液细胞学检测 ,1例见初级精母细胞 ,5例见各级生精细胞。　结论 :染色体核型分析和Y染色体微缺失的检测有助于无精子症的遗传学病因诊断。     

多重定量荧光PCR在21-三体及性染色体多倍体畸变诊断中的应用

目的探讨多重定量荧光PCR(QF-PCR)技术在染色体非整倍体畸变诊断中的应用价值。方法抽取脐血样本16份,羊水样本73份,21、X、Y染色体数目异常患者及其父母外周静脉血71份,针对21号染色体和X、Y染色体上7个基因位点21S1435、D21S11、D21S1411、AMXY、DXS981、DXS6809和X22应用QF-PCR方法进行多重扩增,毛细管电泳法检测并分析结果。所有样本同时进行染色体核型分析。结果染色体核型分析中有129例为正常核型46,XX(XY);26例21-三体(其中1例为易位型,余为标准型);1例45,XO/46,XX;2例47,XXX;1例47,XXY;1例45,XX,der(13,21)。QF-PCR结果中,确诊1例47,XXY,26例21-三体征中23例确诊,2例47,XXX被提示可能存在性染色体数目异常,其余为阴性结果。结论多重定量荧光技术可用于染色体非整倍体畸变的快速诊断。     

49, XXXXY syndrome

49, XXXXY syndrome is a rare sex chromosomal disorder. A 5-month-old boy had failure to thrive and multiple congenital anomalies including microcephaly, facial dysmorphism (hypertelorism, megacornea, cleft palate, and micrognathia), obvious heart murmur, umbilical hernia, microphallus, and mild clenched hands. Chromosomal studies via techniques of G-banding and fluorescence in situ hybridization showed the constitution to be 47, XXXXY in all cells. Ventriculomegaly and congenital cardiac defects (patent ductus arteriosus, atrial septal defect, and peripheral pulmonary stenosis) were noted. He has severe atopic dermatitis with high IgE levels and psychomotor retardation. After heart surgery and nutritional support, he has better growth and the rehabilitation program is continuing.     

28例原发性闭经患者细胞遗传学研究

28例原发闭经患者经GTG核型分析,其中46,XX者10例,45,XO者9例,45,XO/46,XY者2例,45,X/47,XYY者1例,46,X,i(Xq)者3例,45,X/46,X,i(Xq)者1例,45,X/46,XXr者1例及46,XY睾丸女性化1例。染色体数目及结构异常皆属于Turner综合征,她们大多数有体矮,外阴幼稚型,第二性征发育差等体征。一例45,X/47,XYY已剖腹探查具两种性服亦属两性畸形。一例环状染色体为Xp~-,部分枝型分析为45,X/46,X,r(X)(p~(11)q~(28))。此外,本文对X染色体异常导致原闭及其对临床表型影响作了讨论。     

无精少精不育症的染色体分析

排除诸多其它原因引起的男性不育，就５０例无精子和少精子患者进行染色体分析，结果发现１８例染色体的数目与结构异常。其中２例经湖南医科大学国家医学遗传中心鉴别系世界首报核型。１８例中，性染色体异常１３例，又以４７，ＸＸＹ纯合型为最高，达１０例之多。常染色体异常者有５例，其中各种易位３例，缺失和标记染色体各１例。本文并讨论了无精子、少精子不育患者与染色体之间的关系。