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CASE REPORT
Year : 2019  |  Volume : 10  |  Issue : 1  |  Page : 1-4

A child with partial trisomy 4 (q26 – qterminal) resulting from paternally inherited translocation (4:18) associated with multiple congenital anomalies and death


1 Molecular Stress and Stem Cell Biology Group, School of Biotechnology, KIIT University, Bhubaneswar, Odisha, India
2 Department of Paediatrics, Kalinga Institute of Medical Sciences, KIIT University, Bhubaneswar, Odisha, India
3 Division of Cytogenetics, inDNA Life Sciences Private Limited, Bhubaneswar, Odisha, India
4 Department of Physiology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
5 Molecular Stress and Stem Cell Biology Group, School of Biotechnology, KIIT University; Division of Cytogenetics, inDNA Life Sciences Private Limited, Bhubaneswar, Odisha, India

Date of Web Publication24-May-2019

Correspondence Address:
Birendranath Banerjee
Molecular Stress and Stem Cell Biology Group, KIIT School of Biotechnology, KIIT University, Bhubaneshwar - 751 024, Odisha
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/genint.genint_4_18

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  Abstract 


Parental balanced reciprocal translocations can result in partial aneuploidy in the offspring due to unbalanced meiotic segregation during gametogenesis. Herein, we report the phenotypic and cytogenetic characterization in a 9-day-old male child with partial trisomy of chromosome 4. Karyotyping of the proband and parents was performed along with multicolor fluorescence in situ hybridization (mFISH) of paternal chromosomes. Conventional cytogenetic analysis by karyotyping showed 47,XY,der(18),t(4;18)(q26;q22),+4 in proband, and the paternal karyotype was found as 47,XY,der(18),t(4;18)(q26;q22). mFISH analysis on paternal chromosomal preparations confirmed both region and origin of the balanced translocation. In this study, karyotyping helped us to identify both numerical and structural anomalies in the proband, and mFISH helped us to confirm our cytogenetic findings. Therefore, cytogenetic screening of both partners is recommended before pregnancy to rule out or confirm the presence of any numerical or structural anomaly in one, both, or none of the partners.

Keywords: Balanced translocation, karyotyping, multicolor fluorescence in situ hybridization, omphalocele


How to cite this article:
Chakraborty A, Panda SK, Mohakud NK, Roy D, Padhi S, Koh SW, Hande MP, Banerjee B. A child with partial trisomy 4 (q26 – qterminal) resulting from paternally inherited translocation (4:18) associated with multiple congenital anomalies and death. Genome Integr 2019;10:1-4

How to cite this URL:
Chakraborty A, Panda SK, Mohakud NK, Roy D, Padhi S, Koh SW, Hande MP, Banerjee B. A child with partial trisomy 4 (q26 – qterminal) resulting from paternally inherited translocation (4:18) associated with multiple congenital anomalies and death. Genome Integr [serial online] 2019 [cited 2019 Jun 17];10:1-4. Available from: http://www.genome-integrity.org/text.asp?2019/10/1/1/259099




  Introduction Top


When any two different chromosomes undergo the adjacent-1 type of segregation, it leads to balanced translocations which typically present with no significant phenotypic effects unless there is involvement of an important functional gene at one or both the chromosomal breakpoint(s). Balanced translocation results in a combination of partial trisomy and/or partial monosomy in the zygote.[1] Few reports have highlighted the occurrence of partial trisomy of chromosome 4 and associated phenotypical characteristics. de novo translocation t(4;7)(q27;q22) in a girl aged 13 years was previously reported to have severe mental retardation, growth retardation, and hearing impairment, along with minor foot, thumb, and facial abnormalities.[2] Chen et al.[3] reported a case of a 23-year-old female with trisomy 4q32.3–4q35.2 and trisomy of 21q11.2–21q22.11, suffering from recurrent pregnancy losses along with mental retardation and unusual facial characteristics.[3] In this manuscript, we report the case of a male child (9 days old), diagnosed with omphalocele and facial dysmorphic features. To the best of our knowledge, the occurrence of partial trisomy of chromosome 4q26-qter due to the inheritance of paternal balanced translocation involving long arms of chromosome 4 and chromosome 18 has been reported in less than ten cases worldwide.[4] From India, translocation 4;18 associated with omphalocele along with other morphological abnormalities has not been reported yet.


  Case Report Top


The proband was a male born to a nonconsanguineous couple, a 35-year-old father and a 25-year-old mother, with a history of one previous first-trimester abortion. Clinical history of the previous abortion was not available. The second pregnancy resulted in the birth of the proband, diagnosed with omphalocele along with various craniofacial anomalies, including cleft lip, wide forehead, flat nasal bridge, hypertelorism, and low set of ears [Figure 1]a,[Figure 1]b, [Figure 1]c[Figure 1]d. Blood sample from the proband was sent on the day he was born, from the Neonatal Intensive Care Unit of Kalinga Institute of Medical Sciences to our laboratory for routine genetic analysis by karyotyping, accounting to all the above-mentioned phenotypical anomalies. Conventional G-banding by trypsin and Giemsa stain (GTG banding) was performed on the metaphase chromosome spreads of the proband. The proband was viable carrying one extra copy of chromosome 4(q26-qter) which was found to be consistent with every metaphase spread scored. The proband passed away on the 9th day of his birth. We retrospectively approached the parents of the proband to know the status of their chromosomes, as it was speculated that extra copy of chromosome 4 must have come from either of the parents. They were counseled, and written consent was obtained from both parents for being active participants in this study. Family history was obtained from each of them for three generations, followed by peripheral blood collection for our further research interest. Pedigree analysis and GTG banding were performed on the metaphase chromosome spreads from both the partners.
Figure 1: Facial dysmorphic features: Images of the proband showing wide forehead, cleft lip pallet, hypertelorism, flat nasal bridge (a), clubbed foot (b), along with omphalocele (c), and low set of ears (d)

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According to the pedigree analysis [Figure 2], none of the individuals in the previous generation had any history of recurrent spontaneous abortions or any history of neonatal death; therefore, it became quite clear to us that the origin of the balanced translocation was de novo in nature. As per the ISCN 2016 guidelines, we report the proband karyotype as 47, XY, der(18), t(4;18)(q26-qter),+4 [Figure 3]a, [Figure 3]b; the paternal karyotype was reported as 46, XY, der(18), t(4;18)(q26;q22) [Figure 3] and [Figure 4]; and the maternal karyotype was reported as 46, XX (data not shown). Multicolor fluorescence in situ hybridization was performed as described previously[5] on freshly casted slides of metaphase chromosome of the father to confirm our karyotype finding on another molecular cytogenetic platform and also to rule out the presence of any other cryptic translocations which may not have been detected by general karyotyping [Figure 3]b. Due to neonatal demise of the proband, further molecular cytogenetic studies were not performed. The male partner was found to harbor a balanced translocation involving chromosomes 4 and 18, which was inherited by the proband as an extra copy of chromosome 4(q26-qter), thus leading to partial trisomy of chromosome 4 and also resulted in neonatal demise of the proband. On the other hand, karyotype of the female partner was found to be normal.
Figure 2: Pedigree analysis: Pedigree analysis of the proband up to the previous three generations. White symbol (square or circle) - a healthy person, white symbol (square or circle stroked through diagonally) - death of that individual, triangle - miscarriage, white symbol (blue colored and stroked diagonally) - proband

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Figure 3: G-banding by trypsin and Giemsa stain banding chromosomal analysis: Both proband (a) and his father (b), karyotyping analysis reveals the presence of a balanced translocation of chromosomes 4 and 18 in the father, which has been inherited by the proband as an unbalanced partial trisomy 4(q-ter)

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Figure 4: Multicolor fluorescence in situ hybridization: A stable balanced chromosomal translocation in the father of proband, detected by multicolor fluorescence in situ hybridization. Chromosomes involved in this translocation are indicated by arrows; a balanced chromosomal translocation is shown involving two chromosomes: 4 and 18

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  Discussion Top


Balanced reciprocal translocations are known to be the most common structural chromosomal anomaly. They result from breakage and reunion of two or more chromosomes and subsequent transfer of the nucleated derivative chromosome in following cell divisions. Carriers with balanced reciprocal chromosomal translocation are not presented with phenotypic manifestations unless the translocations result in gene disruption(s).[6] Trisomy 4q is a very rare finding. Common clinical features associated with trisomy 4q include phenotypic malformations such as low set of ears, microcephaly, psychomotor retardation, malformed limbs, hypotonia, antimongoloid slant, short neck, epicanthal folds, heart defects, simian crease, wide nasal bridge, micrognathia, malformation of the urinary system, and sloping forehead.[4] Moreover, there are reports where trisomy 4q has resulted in endocrinal abnormalities.[7] Few facial morphologic features of the proband resemble with that of de novo trisomy of the long arm of chromosome 4, which is also known as trisomy 4q syndrome,[2] but none of the previously reported cases presented with omphalocele followed by neonatal death. Previous reports suggested that individuals with trisomy 4q can survive for few years, but in our case, the proband deceased early probably due to cardiac failure. According to a previous literature, partial trisomy 4q presents with intellectual disability, speech delay, tall stature, seizures, and facial dysmorphism. Incidences of partial trisomy 4p are quite common as compared to 4q.[8] Inherited paternal balanced chromosomal translocation t(4;18) resulting in partial trisomy of chromosome 4(q26-ter) in offspring is a rare finding. Bands within the chromosomal location of 4q26 and 4q31 have been previously reported as the region for most constant trisomy/duplication for chromosome 4,[9],[10],[11] which was consistent in paternal karyotype in our study. Due to adjacent-1 meiotic segregation of paternal balanced chromosomal translocation, the proband was trisomic for a large segment of chromosome 4(q26-qter), with minimal loss of genetic material from chromosome 18.[12] Parental balanced reciprocal translocations can result in partial aneuploidy in the offspring due to unbalanced meiotic segregation during gametogenesis. However, the carriers are known to experience recurrent spontaneous abortion, stillbirth, infertility, nonimplantation, and developmental delay in children after birth.[13]

To the best of our knowledge, ths is the first case from eastern part of India that describes a reciprocal balanced translocation of chromosomes 4 and 18 of paternal origin, resulting in a partial trisomy of chromosome 4 in the offspring. Therefore, cytogenetic screening of both partners is recommended before pregnancy to rule out or confirm the presence of any numerical or structural anomaly in one, both, or none of the partners. The cytogenetic screening will also reduce the burden of recurrent miscarriage by ruling out the inheritance of any chromosomal anomaly in the offspring.

Informed consent

All participants signed written informed consent for the publication of their clinical data. For the proband, written consent for publication was obtained by the parents/legal guardians.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the legal guardian has given his consent for images and other clinical information to be reported in the journal. The guardian understands that name and initials of the child will not be published and due efforts will be made to conceal identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

This study has been supported by INSPIRE fellowship IF/150135 and BRNS Grant No.:35/14/06/2015-BRNS/35081.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Paththinige CS, Sirisena ND, Kariyawasam UG, Ediriweera RC, Kruszka P, Muenke M, et al. Achild with multiple congenital anomalies due to partial trisomy 7q22.1 → qter resulting from a maternally inherited balanced translocation: A case report and review of literature. BMC Med Genomics 2018;11:44.  Back to cited text no. 1
    
2.
Lundin C, Zech L, Sjörs K, Wadelius C, Annerén G. Trisomy 4q syndrome: Presentation of a new case and review of the literature. Ann Genet 2002;45:53-7.  Back to cited text no. 2
    
3.
Chen LS, Xue D, Xi ZM, Liu DN, Zou PS, Ma M, et al. Avery rare case of trisomy 4q32.3-4q35.2 and trisomy 21q11.2-21q22.11 in a patient with recombinant chromosomes 4 and 21. Gene 2015;563:72-5.  Back to cited text no. 3
    
4.
Bonfante A, Stella M, Rossi G. Partial trisomy 4q: Two cases resulting from a familial translocation t (4;18)(q27;p11). Hum Genet 1979;52:85-90.  Back to cited text no. 4
    
5.
Hande MP, Azizova TV, Burak LE, Khokhryakov VF, Geard CR, Brenner DJ. Complex chromosome aberrations persist in individuals many years after occupational exposure to densely ionizing radiation: An mFISH study. Genes Chromosomes Cancer 2005;44:1-9.  Back to cited text no. 5
    
6.
Wu T, Yin B, Zhu Y, Li G, Ye L, Chen C, et al. Molecular cytogenetic analysis of early spontaneous abortions conceived from varying assisted reproductive technology procedures. Mol Cytogenet 2016;9:79.  Back to cited text no. 6
    
7.
Angulo MA, Castro-Magana M, Sherman J, Collipp PJ, Milson J, Trunca C, et al. Endocrine abnormalities in a patient with partial trisomy 4q. J Med Genet 1984;21:303-7.  Back to cited text no. 7
    
8.
Wu D, Zhang H, Hou Q, Wang H, Wang T, Liao S. Genotype/phenotype analysis in a male patient with partial trisomy 4p and monosomy 20q due to maternal reciprocal translocation (4;20): A case report. Mol Med Rep 2017;16:6222-7.  Back to cited text no. 8
    
9.
Goodman BK, Capone GT, Hennessey J, Thomas GH. Familial tandem duplication of bands q31.1 to q32.3 on chromosome 4 with mild phenotypic effect. Am J Med Genet 1997;73:119-24.  Back to cited text no. 9
    
10.
Maltby EL, Barnes IC, Bennett CP. Duplication involving band 4q32 with minimal clinical effect. Am J Med Genet 1999;83:431.  Back to cited text no. 10
    
11.
Shashi V, Berry MN, Santos C, Pettenati MJ. Partial duplication of 4q12q13 leads to a mild phenotype. Am J Med Genet 1999;86:51-3.  Back to cited text no. 11
    
12.
Schubert I, Lysak MA. Interpretation of karyotype evolution should consider chromosome structural constraints. Trends Genet 2011;27:207-16.  Back to cited text no. 12
    
13.
De Krom G, Arens YH, Coonen E, Van Ravenswaaij-Arts CM, Meijer-Hoogeveen M, Evers JL, et al. Recurrent miscarriage in translocation carriers: No differences in clinical characteristics between couples who accept and couples who decline PGD. Hum Reprod 2015;30:484-9.  Back to cited text no. 13
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]



 

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