Journal List > Korean J Lab Med > v.29(4) > 1011567

Park, Shin, Kwon, Koo, Kim, Lim, Kim, and Han: Prenatal Diagnosis of Pallister-Killian Syndrome Associated with Pulmonary Stenosis and Right Ventricular Dilatation

Abstract

Pallister-Killian syndrome (PKS) is a rare disorder characterized cytogenetically by tetrasomy 12p for isochromosome of the short arm of chromosome 12. PKS is diagnosed by prenatal genetic analysis through chorionic villous sampling, genetic amniocentesis, and cordocentesis, or by chromosomal analysis of skin fibroblasts, but is not usually detected by chromosomal analysis of peripheral blood cells. Herein, we report a case of a gravida at 23 weeks gestation with pulmonary stenosis and right ventricular dilation of the heart which were detected by sonography. Fluorescence in situ hybridization and a multicolor banding technique were performed to verify the diagnosis as 47,XX, +mar.ish i(12)(p10)(TEL++)[16]/46,XX[4], and an autopsy confirmed the cardiac anomalies detected on antenatal sonography.

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Fig. 1.
Conventional cytogenetic analysis on GTG-banded chromosomes from amniotic fluid of the fetus showed 47,XX,+mar in 16 cells and 46,XX in 4 cells.
kjlm-29-366f1.tif
Fig. 2.
Fluorescence in situ hybridization (FISH) analysis using a TEL/AML1 (LSI TEL/AML1 Dual Color, Extra Signal Fusion Translocation Probe, Abbot Molecular/Vysis, Des Plaines, IL, USA) probe showed two green (TEL) signals located symmetrically on both arms of the marker chromosome (arrows).
kjlm-29-366f2.tif
Fig. 3.
The chromosome 12-specific mBAND probe kit, XCyte 12 (MetaSystems, Altlussheim, Germany), was hybridized to metaphase cells. Each fluorochrome was detected by adequate filter and the signals were analyzed by Isis/mFISH imaging software (MetaSystems). This analysis refined chromosome regions involved in isochromosome 12. The multiple band pattern confirmed that i(12) contained all regions of 12p.
kjlm-29-366f3.tif
Table 1.
Prenatally diagnosed Pallister-Killian syndromes presenting with cardiac defects
Reference Cardiac defects Extracardiac abnormalities G-wks Degree of mosaicism Molecular cytogenetic method
Gilgenkrantz et al. [4] Ebstein's anomaly Polyhydroamnios, rhizomelic micromelia, edema (neck, trunk), facial dysmorphia with macrocephaly, Club feet, sacral dimple 26 100% of amniocytes -
Wilson et al. [17] Tetralogy of Fallot Polyhydroamnios, diaphragmatic hermia, micromelia, facial dysmorphia, pleural effusion, anal stenosis, rectovaginal fistula 26 16/18 amniocytes FISH
Turleau et al. [18] Right hypertrophy, abnormal tricuspid valve Polyhydroamnios, micromelia, craniofacial abnormalities, clinodactyly, hypoplastic lung, sacrococcygeal pit 30 100% of amniocytes -
Lalatta et al. [19] Atrio-ventricular septal defect Diaphragmatic hernia, macrocephaly, facial abnormalites, abscent testicles 19 0% of 20 clones of amniocytes -
Langford et al. [3] Hypoplastic left heart Increased nuchal translucency, hydrops, diaphragmatic hernia, micromelia, postaxial polydactyly, talipes∗ camptodactyly,∗ imperforate anus 15 6% of Chorionic villi ISH
Doray et al. [7] Tetralogy of fallot Dandy walker malformatrion, rhizomelic micromelia, diaphragmatic hernia, club hand, craniofacial dysmorphism, flexed toes, various deformity, adrenal hypertrophy 16 9/100 Cord blood Lymphocytes -
Abad et al. [16] Right ventricular hypertrophy, VSD, severe TR Increased nuchal translucency, facial abnormalities 13 100% of amniocytes  
Present case Right ventricular dilatation, PS Dolicocephaly, low set ear 23 16/20 of amniocytes FISH, mBAND

Autopsy finding.

Abbreviations: G-wks, gestational week at cytogenetic diagnosis; VSD, ventricular septal defect; TR, tricuspid regurgitation; PS, pulmonary stenosis; ISH, in situ hybridization; mBAND, multicolor banding.

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