Trisomy 16 is the most common type of autosomal trisomy associated with spontaneous abortion and is incompatible with life [1]. Among previously reported cases of partial chromosome 16q duplication, the majority presented complex chromosomal abnormalities due to parental balanced chromosomal translocation carriage [2]. The clinical presentation of very rare pure partial trisomy 16q cases was associated with congenital anomalies, facial dysmorphic findings and intellectual disability [3]. To the best of our knowledge, 22 pure partial trisomy 16q cases have been described in the literature so far (Table 1).
Clinical features of previously reported pure partial trisomy 16q cases in the literature and in our patient.
Partial 16q trisomy region | Prx. D. 16q11.1-q13 | Prx. D. 16q11.2-q12.2 | Prx. D. 16q11.2-q12.1 | Prx. D. 16q11.2-q13 | Prx.D. 16q 12.1-q13 | Prx-Inter. D. 16q11.2-q22.1 | Prx-Inter. D. 16q11.2-q22.3 | Prx-Inter. D. 16q12.1-q21 | Prx-Inter. D. 16q13-q22.3 | Prx-Inter. D. 16q12.1-q22.1 | Inter-Dis. D. 16q22.1-q23.1 | Inter-Dis. D. 16q13-q24 | Prx-Dis. D. 16q12.1-q23.3 |
---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Methodology for genetic analysis | Conv. Cyto./ FISH | Conv. Cyto./ FISH | Conv. Cyto./ FISH | Conv. Cyto./ FISH | Conv. Cyto./ FISH | SNP-aCHG (45,086,927- 71,261,259) 26.17 Mb | Oligonu-cleotide aCGH 22.5 Mb | Oligonucleo-tide aCGH (50,843,158-60,770,795) 9.92 Mb | Conv. Cyto. | aCGH 19.8 Mb | Conv. Cyto./ FISH | Conv. Cyto. | aCGH (52,459,169- 82,285,105) 29.8 Mb |
References | [5] | [6] | [6] | [6] | [7] | [1] | [8] | [2] | [9] | [3] | [10] | [11] | this study |
Gender | F | M | M;M;M;M | M;M;F | M | F | F | F | F | F | M | F | F |
Age (years) | 3 | 5 | 5.3;3;32;32 | 9.5;5;39 | NR | 2 | 5 | 3.5 | 26 | 7 | 10 | 0 | 0 |
Growth retardation | [–] | [–] | NR | 2/3 | NR | [–] | [–] | [–] | [+] | [+] | [+] | NR | [+] |
Intellectual disability | [+] | [+] | 3/2 | 3/3 | RN | [+] | [+] | [+] | [+] | [+] | [+] | NR | [+] |
Micro-cephaly | [–] | NR | NR | [–] | NR | [–] | [+] | [–] | [–] | [–] | [–] | NR | [+] |
Behavioral problems | [+] | [+] | NR | 2/3 | NR | NR | [+] | [+] | [+] | NR | [+] | NR | NR |
Epilepsy | [-] | NR | NR | NR | NR | [–] | [–] | [–] | NR | [+] | [+] | NR | [–] |
Speech delay | [+] | [+] | 2/4 | 2/3 | NR | [+] | [–] | [+] | [+] | NR | [+] | NR | [+] |
Obesity | [-] | [+] | NR | 3/3 | NR | [–] | [+] | [+] | NR | NR | NR | NR | [–] |
Dysmorphic features | [+] | [+] | NR | [–] | NR | [+] | [+] | [+] | [+] | [+] | NR | [+] | [+] |
Ear anomalies | [+] | NR | NR | NR | NR | [+] | NR | [+] | [–] | [–] | [+] | NR | [+] |
Eye anomalies | [-] | [+] | NR | 2/3 | NR | [+] | [+] | [+] | [–] | [+] | [–] | NR | [+] |
Skeletal anomalies | [+] | [+] | NR | 3/3 | NR | [+] | [–] | [+] | [+] | NR | [+] | [+] | [–] |
Heart defects | [-] | [+] | [–] | [–] | NR | [+] | [–] | [–] | NR | [–] | [–] | [+] | [–] |
Urogenital anomalies | [-] | NR | NR | NR | NR | [–] | [–] | [–] | NR | [–] | [–] | [+] | [–] |
CNV anomalies | [-] | NR | NR | NR | NR | [–] | [–] | [–] | NR | [+] | [+] | NR | [–] |
Prx. D.: proximal duplication; Prx-Inter. D.: proximal intermediate duplication; Inter-Dis. D.: intermediate distal duplication;
Prx-Dis. D.: proximal-distal duplication; Conv. Cyto.: conventional cytogenetic; FISH: fluorescence
SNP: single nucleotide polymorphism; aCGH: array comparative genomic hybridization; F: female; M: male; NR: not reported;
CNV: central nervous system.
Chromosome analysis was conducted from peripheral blood lymphocytes derived from the patient, and the analysis of GTG-banded chromosomes was performed according to standard procedures. To identify the extension of the duplicated section, array comparative genomic hybridisation (aCGH) analysis was performed. First, 400 μL of peripheral venous blood was drawn into EDNA vacutainers. Then, genomic DNA was extracted from the peripheral venous blood using the QIAamp® DNA Mini Kit (Qiagen GmbH, Hilden, Germany). The detection of genomic copy number variations (CNVs) was performed with Affymetrix CytoScan Optima 315 K arrays (Thermo Fisher Scientific, Waltham, MA, USA), following the manufacturer’s instructions. Array results were visualized and evaluated using the Chromosome Analysis Suite version 3.2.0 software program (Thermo Fisher Scientific).
The patient’s routine hematological, biochemical and blood gas analysis results were normal. Outcomes of metabolic tests including tandem mass spectrometry (MS/ MS) together with plasma amino acid, urine organic acid, lysosomal enzyme panel and very-long-chain fatty acid findings, were all normal. Her karyotype (450-band level) was 46,XX,add(16)(q24) (Figure 2). The aCGH analysis showed a29.8 Mb duplication [arr[hgl9]16ql2.1q23.3(52, 459, 169-82,285,105) x 3] (Figure 3), interpreted to be pathogenic.
There were 343 genes in the duplication region, 211 of which were Online Mendelian Inheritance in Man (OMIM) genes and 62 (including 18 autosomal dominant genes and 44 autosomal recessive genes) of which were associated with the OMIM phenotype. Her parents’ karyotype (450-band level) and aCGH analysis findings were normal, suggesting a
The human chromosome 16 contains highly segmental duplication regions
To investigate genotype-phenotype correlation, pure partial trisomy 16q cases can be stratified into three groups (proximal, proximal-intermediate, intermediate-distal) according to the location of chromosomal anomaly [2]. Most cases fall into the proximal 16q duplication group but many reports provide insufficient information about clinical findings and the sizes of duplicated segments characterized by aCGH analysis [5, 6, 7]. Almost all patients display intellectual disabilities, speech delays and behavioral problems
In the Decipher database, nine partial 16q duplication cases (similar duplications as seen in our case), where the duplications were considered pathogenic, have been reported (Decipher identification #s. 362109, 368652, 294549, 389723, 400900, 401664, 331631, 398404 and 400834). In four of these cases, the duplications were
The 29.8 Mb duplication in the present case involves 343 genes (including 62 genes associated with the OMIM phenotype). Although genotype-phenotype correlation is difficult, some of these genes are candidates for explaining our patient’s phenotype. The