Ring chromosome 21 syndrome: report of 2 cases
DOI:
https://doi.org/10.5281/zenodo.13381482Keywords:
Ring Chromosomes, Neurodevelopmental Disorders, Chromosome Disorders, Rare DiseasesAbstract
Background: When a chromosome undergoes 2 distal breaks and the broken ends join together, they form a ring chromosome. Ring 21 syndrome is described with a phenotype with minor dysmorphisms, thrombocytopenia, psychomotor and language delay. The objective of this work is to display 2 cases of male patients with ring chromosome 21.
Clinical cases: The first case was a 5-year-old male patient, with psychomotor and language delay. Broad forehead with prominent metopic suture, bilateral epicanthic fold, hypotelorism, left esotropia, low-set asymmetrical pinnae, micrognathia, lower extremities with deep plantar folds. Karyotype 46,XY,r(21)(p11.2q21)[25]. The second case was an 8-year-old male patient with psychomotor and language delay. Skull with flattened occiput, triangular facies, midfacial flattening, palpebral fissures directed downwards, bilateral epicanthic fold, low-set and asymmetrical pinnae, micrognathia, prominent asymmetrical thorax on the right side, hands with irregular palmar folds. Karyotype: 46,XY,r(21) (p11q22)[25].
Conclusion: Craniofacial dysmorphisms with psychomotor and language delay were the most relevant clinical data in both cases.
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References
Kuroda S, Usui K, Sanjo H, et al. Genetic disorders and male infertility. Reprod Med Biol. 2020;19(4):314-22. doi: 10.1002/ rmb2.12336
Arroyo Carrera I. Genética básica para el pediatra. Pediatr Integr. 2019;23(5):262.
Viotti M. Preimplantation Genetic Testing for Chromosomal Abnormalities: Aneuploidy, Mosaicism, and Structural Rearrangements. Genes (Basel). 2020;11(6):602. doi: 10.3390/ genes11060602
Nikitina TV, Kashevarova AA, Gridina MM, et al. Complex biology of constitutional ring chromosomes structure and (in)stability revealed by somatic cell reprogramming. Sci Rep. 2021; 11(1):1-15. doi: 10.1038/s41598-021-83399-3
Kushwaha S, Stinnett V, Zou YS, et al. Live-born autosomal ring chromosomes at the Johns Hopkins Hospital Cytogenomics Laboratory: Case series-Spanning 52 years of experience in a single center. Am J Med Genet A. 2024;194(2):253- 67. doi: 10.1002/ajmg.a.63429
Li P, Dupont B, Hu Q, et al. The past, present, and future for constitutional ring chromosomes: A report of the international consortium for human ring chromosomes. Hum Genet Genomics Adv. 2022;3(4):100139. doi: 10.1016/j.xhgg.2022.100139
Norman M, Wainstein B, Anazodo A, et al. Combined Immunodeficiency with Ring Chromosome 21. J Clin Immunol. 2018;38(3):251-6. doi: 10.1007/s10875-018-0493-z
Baloda V, Aggarwal N, Rosado FG, et al. B-Cell Acute Lymphoblastic Leukemia with iAMP21 in a Patient with Constitutional Ring Chromosome 21. Cytogenet Genome Res. 2022;5 (162):231-6. doi: 10.1159/000527025
Berkay EG, Karaman B, Başaran S. A rare ring chromosome 21 abnormality is associated with azoospermia in two different phenotypically normal cases. Syst Biol Reprod Med. 2023;0 (0):1-7. doi: 10.1080/19396368.2023.2225682
Muroya K, Yamamoto K, Fukushima Y, et al. Ring chromosome 21 in a boy and a derivative chromosome 21 in the mother: Implication for ring chromosome formation. Am J Med Genet. 2002;110(4):332-7. doi: 10.1002/ajmg.10466
Ambulkar PS, Liehr T, Jain M, et al. Molecular characterization of de novo ring chromosome 21 in a child with seizures, growth retardation, and multiple congenital anomalies. J Genet. 2023;102(2). doi: 10.1007/s12041-023-01439-5
Verhoeven WMA, Van Bon B, Egger JIM, et al. An adult female patient with ring chromosome 21: Behavioural phenotype and results of high-resolution molecular characterisation. Acta Neuropsychiatr. 2010;22(4):188-94. doi: 10.1111/ j.1601-5215.2010.00455.x
Sullivan W. Remarkable chromosomes and karyotypes: A top 10 list. Mol Biol Cell. 2024;35(4):1-10. doi: 10.1091/mbc. E23-12-0498
Mathew MT, Babcock M, Hou YC, et al. Clinical Cytogenetics: Current Practices and Beyond. J Appl Lab Med. 2024;9(1):61- 75. doi: 10.1093/jalm/jfad086
Gibbs RA. The Human Genome Project changed everything. Nat Rev Genet. 2020;21(10):575–6. doi: 10.1038/s41576 -020-0275-3
Karkera S. A Current Knowledge of “Down Syndrome: A Review.” Int J Dent Med Sci Res. 2021;3(1):805-10. doi: 10.35629/ 5252-0301805810
Smith CIE, Bergman P, Hagey DW. Estimating the number of diseases – the concept of rare, ultra-rare, and hyper-rare. iScience. 2022;25(8):104698. doi: 10.1016/j.isci.2022.104698
Michetti F, Clementi ME, Di Liddo R, et al. The S100B Protein: A Multifaceted Pathogenic Factor More Than a Biomarker. Int J Mol Sci. 2023;24(11). doi: 10.3390/ijms24119605
Tan TY, Sedmík J, Fitzgerald MP, et al. Bi-allelic ADARB1 Variants Associated with Microcephaly, Intellectual Disability, and Seizures. Am J Hum Genet. 2020;106(4):467-83. doi: 10.1016/j. ajhg.2020.02.015
Specchio N, Carotenuto A, Trivisano M, et al. Ring 21 chromosome presenting with epilepsy and intellectual disability: Clinical report and review of the literature. Am J Med Genet Part A. 2011;155(4):911-4. doi: 10.1002/ajmg.a.33899
Pritzl SL, Gurney M, Badar T, et al. Clinical and molecular spectrum and prognostic outcomes of U2AF1 mutant clonal hematopoiesis- a prospective mayo clinic cohort study. Leuk Res. 2023;125(2022):107. doi: 10.1016/j.leukres.2022.107007
Pardal Fernández JM, Jerez García P, Carrascosa Romero MC, et al. Cromosomopatía con anillación del 21 (r21) y epilepsia. An Pediatr (Barc). 2004;60:379-81. doi: 10.1016/ S1695-4033(04)78290-9
Ceyhan Y, Zhang M, Sandoval CG, et al. Expression patterns and the roles of phosphatidylinositol phosphatases in testis. Biol Reprod. 2022;107(4):902-15. doi: 10.1093/biolre/ioac132
Mohiuddin M, Kooy RF, Pearson CE. De novo mutations, genetic mosaicism and human disease. Front Genet. 2022;13:1- 20. doi: 10.3389/fgene.2022.983668
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