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Journal of Medical Genetics logoLink to Journal of Medical Genetics
. 1994 Sep;31(9):694–701. doi: 10.1136/jmg.31.9.694

Asymmetry and skin pigmentary anomalies in chromosome mosaicism.

C G Woods 1, A Bankier 1, J Curry 1, L J Sheffield 1, S F Slaney 1, K Smith 1, L Voullaire 1, D Wellesley 1
PMCID: PMC1050079  PMID: 7815438

Abstract

We report six persons mosaic for a chromosome anomaly. All were mentally retarded and dysmorphic. Unilateral or asymmetrical features were found in all cases, in one an unusual transverse terminal limb anomaly, and in the others various degrees of hemiatrophy of the left side of the body. Five of the subjects had skin pigmentary anomalies which were distributed in the lines of Blaschko. The abnormal cell lines found were ring chromosome 22, trisomy 22, a large acrocentric marker, a deletion of 18q, a deletion of 8q, and triploidy. In four cases the clinical diagnosis was only confirmed by skin biopsy. In one case low level mosaicism in blood was fortuitously detected because of cytogenetic fragile X screening and confirmed in a skin biopsy. The sixth case was of dynamic mosaicism of a non-mosaic deletion 18q with a chromosome 18 derived marker present in a proportion of cells. Chromosome mosaicisn may cause subtle and asymmetrical clinical features and can require repeated cytogenetic investigations. The diagnosis should be actively sought as it enables accurate genetic counselling to be given.

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Selected References

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  1. Akefeldt A., Gillberg C. Hypomelanosis of Ito in three cases with autism and autistic-like conditions. Dev Med Child Neurol. 1991 Aug;33(8):737–743. doi: 10.1111/j.1469-8749.1991.tb14953.x. [DOI] [PubMed] [Google Scholar]
  2. Antonarakis S. E. Human chromosome 21: genome mapping and exploration, circa 1993. Trends Genet. 1993 Apr;9(4):142–148. doi: 10.1016/0168-9525(93)90210-9. [DOI] [PubMed] [Google Scholar]
  3. Bui T. H., Iselius L., Lindsten J. European collaborative study on prenatal diagnosis: mosaicism, pseudomosaicism and single abnormal cells in amniotic fluid cell cultures. Prenat Diagn. 1984 Spring;4(Spec No):145–162. doi: 10.1002/pd.1970040710. [DOI] [PubMed] [Google Scholar]
  4. Bühler E. M., Bühler U. K., Beutler C., Fessler R. A final word on the tricho-rhino-phalangeal syndromes. Clin Genet. 1987 Apr;31(4):273–275. doi: 10.1111/j.1399-0004.1987.tb02806.x. [DOI] [PubMed] [Google Scholar]
  5. Chitayat D., Friedman J. M., Johnston M. M. Hypomelanosis of Ito--a nonspecific marker of somatic mosaicism: report of case with trisomy 18 mosaicism. Am J Med Genet. 1990 Mar;35(3):422–424. doi: 10.1002/ajmg.1320350320. [DOI] [PubMed] [Google Scholar]
  6. Dennis N. R., Collins A. L., Crolla J. A., Cockwell A. E., Fisher A. M., Jacobs P. A. Three patients with ring (X) chromosomes and a severe phenotype. J Med Genet. 1993 Jun;30(6):482–486. doi: 10.1136/jmg.30.6.482. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Donnai D., McKeown C., Andrews T., Read A. P. Diploid/triploid mixoploidy and hypomelanosis of Ito. Lancet. 1986 Jun 21;1(8495):1443–1444. doi: 10.1016/s0140-6736(86)91588-6. [DOI] [PubMed] [Google Scholar]
  8. Glover M. T., Brett E. M., Atherton D. J. Hypomelanosis of Ito: spectrum of the disease. J Pediatr. 1989 Jul;115(1):75–80. doi: 10.1016/s0022-3476(89)80332-4. [DOI] [PubMed] [Google Scholar]
  9. Gorlin R. J. Second Robert J Gorlin Conference on Human Dysmorphology, Minneapolis, USA. 7-9 November 1992. Clin Dysmorphol. 1993 Jul;2(3):278–282. [PubMed] [Google Scholar]
  10. Graham J. M., Jr, Hoehn H., Lin M. S., Smith D. W. Diploid-triploid mixoploidy: clinical and cytogenetic aspects. Pediatrics. 1981 Jul;68(1):23–28. [PubMed] [Google Scholar]
  11. Grazia R., Tullini A., Rossi P. G., Neri I., Patrizi A., Croci G., Manenti E., Gobbi G. Hypomelanosis of Ito with trisomy 18 mosaicism. Am J Med Genet. 1993 Jan 1;45(1):120–121. doi: 10.1002/ajmg.1320450134. [DOI] [PubMed] [Google Scholar]
  12. Happle R. Lyonization and the lines of Blaschko. Hum Genet. 1985;70(3):200–206. doi: 10.1007/BF00273442. [DOI] [PubMed] [Google Scholar]
  13. Hsu L. Y., Perlis T. E. United States survey on chromosome mosaicism and pseudomosaicism in prenatal diagnosis. Prenat Diagn. 1984 Spring;4(Spec No):97–130. doi: 10.1002/pd.1970040708. [DOI] [PubMed] [Google Scholar]
  14. Hunter A. G., Clifford B., Cox D. M. The characteristic physiognomy and tissue specific karyotype distribution in the Pallister-Killian syndrome. Clin Genet. 1985 Jul;28(1):47–53. doi: 10.1111/j.1399-0004.1985.tb01217.x. [DOI] [PubMed] [Google Scholar]
  15. Iancu T., Komlos L., Shabtay F., Elian E., Halbrecht L., Bök J. A. Incontinentia pigmenti. Clin Genet. 1975 Feb;7(2):103–110. doi: 10.1111/j.1399-0004.1975.tb00305.x. [DOI] [PubMed] [Google Scholar]
  16. Jackson R. The lines of Blaschko: a review and reconsideration: Observations of the cause of certain unusual linear conditions of the skin. Br J Dermatol. 1976 Oct;95(4):349–360. doi: 10.1111/j.1365-2133.1976.tb00835.x. [DOI] [PubMed] [Google Scholar]
  17. Jenkins D., Martin K., Young I. D. Hypomelanosis of Ito associated with mosaicism for trisomy 7 and apparent 'pseudomosaicism' at amniocentesis. J Med Genet. 1993 Sep;30(9):783–784. doi: 10.1136/jmg.30.9.783. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Johnson V. P., Aceto T., Jr, Likness C. Trisomy 14 mosaicism: case report and review. Am J Med Genet. 1979;3(4):331–339. doi: 10.1002/ajmg.1320030404. [DOI] [PubMed] [Google Scholar]
  19. Kelly T. E., Rary J. M. Mosaic tetraploidy in a two-year-old female. Clin Genet. 1974;6(3):221–224. doi: 10.1111/j.1399-0004.1974.tb00655.x. [DOI] [PubMed] [Google Scholar]
  20. Kingston H. M., Nicolini U., Haslam J., Andrews T. 46,XY/47,XY, + 17p + mosaicism in amniocytes associated with fetal abnormalities despite normal fetal blood karyotype. Prenat Diagn. 1993 Jul;13(7):637–642. doi: 10.1002/pd.1970130715. [DOI] [PubMed] [Google Scholar]
  21. Landy S. J., Donnai D. Incontinentia pigmenti (Bloch-Sulzberger syndrome). J Med Genet. 1993 Jan;30(1):53–59. doi: 10.1136/jmg.30.1.53. [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. Miller C. A., Parker W. D., Jr Hypomelanosis of Ito: association with a chromosomal abnormality. Neurology. 1985 Apr;35(4):607–610. doi: 10.1212/wnl.35.4.607. [DOI] [PubMed] [Google Scholar]
  23. Miller C. A., Parker W. D., Jr Hypomelanosis of Ito: association with a chromosomal abnormality. Neurology. 1985 Apr;35(4):607–610. doi: 10.1212/wnl.35.4.607. [DOI] [PubMed] [Google Scholar]
  24. Miller K., Müller W., Winkler L., Hadam M. R., Ehrich J. H., Flatz S. D. Mitotic disturbance associated with mosaic aneuploidies. Hum Genet. 1990 Mar;84(4):361–364. doi: 10.1007/BF00196235. [DOI] [PubMed] [Google Scholar]
  25. Moss C., Larkins S., Stacey M., Blight A., Farndon P. A., Davison E. V. Epidermal mosaicism and Blaschko's lines. J Med Genet. 1993 Sep;30(9):752–755. doi: 10.1136/jmg.30.9.752. [DOI] [PMC free article] [PubMed] [Google Scholar]
  26. Papenhausen P. R., Mueller O. T., Bercu B., Salazar J., Tedesco T. A. Cell line segregation in a 45,X/46,XY mosaic child with asymmetric leg growth. Clin Genet. 1991 Sep;40(3):237–241. doi: 10.1111/j.1399-0004.1991.tb03084.x. [DOI] [PubMed] [Google Scholar]
  27. Ritter C. L., Steele M. W., Wenger S. L., Cohen B. A. Chromosome mosaicism in hypomelanosis of Ito. Am J Med Genet. 1990 Jan;35(1):14–17. doi: 10.1002/ajmg.1320350104. [DOI] [PubMed] [Google Scholar]
  28. Ritter C. L., Steele M. W., Wenger S. L., Cohen B. A. Chromosome mosaicism in hypomelanosis of Ito. Am J Med Genet. 1990 Jan;35(1):14–17. doi: 10.1002/ajmg.1320350104. [DOI] [PubMed] [Google Scholar]
  29. Schwartz M. F., Jr, Esterly N. B., Fretzin D. F., Pergament E., Rozenfeld I. H. Hypomelanosis of Ito (incontinentia pigmenti achromians): a neurocutaneous syndrome. J Pediatr. 1977 Feb;90(2):236–240. doi: 10.1016/s0022-3476(77)80636-7. [DOI] [PubMed] [Google Scholar]
  30. Stanley W. S., Powell C. M., Devine G. C., Ellingham T., Samango-Sprouse C. A., Vaught D. R., Murphy B. A., Rosenbaum K. N. Mosaic 5p tetrasomy. Am J Med Genet. 1993 Mar 15;45(6):774–776. doi: 10.1002/ajmg.1320450623. [DOI] [PubMed] [Google Scholar]
  31. Sybert V. P., Pagon R. A., Donlan M., Bradley C. M. Pigmentary abnormalities and mosaicism for chromosomal aberration: association with clinical features similar to hypomelanosis of Ito. J Pediatr. 1990 Apr;116(4):581–586. doi: 10.1016/s0022-3476(05)81606-3. [DOI] [PubMed] [Google Scholar]
  32. Takematsu H., Sato S., Igarashi M., Seiji M. Incontinentia pigmenti achromians (Ito). Arch Dermatol. 1983 May;119(5):391–395. [PubMed] [Google Scholar]
  33. Thomas I. T., Frias J. L., Cantu E. S., Lafer C. Z., Flannery D. B., Graham J. G., Jr Association of pigmentary anomalies with chromosomal and genetic mosaicism and chimerism. Am J Hum Genet. 1989 Aug;45(2):193–205. [PMC free article] [PubMed] [Google Scholar]
  34. Tolmie J. L., Boyd E., Batstone P., Ferguson-Smith M. E., al Roomi L., Connor J. M. Siblings with chromosome mosaicism, microcephaly, and growth retardation: the phenotypic expression of a human mitotic mutant? Hum Genet. 1988 Oct;80(2):197–200. doi: 10.1007/BF00702872. [DOI] [PubMed] [Google Scholar]
  35. Turleau C., Taillard F., Doussau de Bazignan M., Delépine N., Desbois J. C., de Grouchy J. Hypomelanosis of Ito (incontinentia pigmenti achromians) and mosaicism for a microdeletion of 15q1. Hum Genet. 1986 Oct;74(2):185–187. doi: 10.1007/BF00282090. [DOI] [PubMed] [Google Scholar]
  36. Vormittag W., Ensinger C., Raff M. Cytogenetic and dermatoglyphic findings in a familial case of hypomelanosis of Ito (incontinentia pigmenti achromians). Clin Genet. 1992 Jun;41(6):309–314. doi: 10.1111/j.1399-0004.1992.tb03404.x. [DOI] [PubMed] [Google Scholar]
  37. Worton R. G., Stern R. A Canadian collaborative study of mosaicism in amniotic fluid cell cultures. Prenat Diagn. 1984 Spring;4(Spec No):131–144. doi: 10.1002/pd.1970040709. [DOI] [PubMed] [Google Scholar]
  38. Wulfsberg E. A., Wassel W. C., Polo C. A. Monozygotic twin girls with diploid/triploid chromosome mosaicism and cutaneous pigmentary dysplasia. Clin Genet. 1991 May;39(5):370–375. doi: 10.1111/j.1399-0004.1991.tb03044.x. [DOI] [PubMed] [Google Scholar]

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