Twin delivery of a 46,XY gonadal dysgenetic woman following vitrified oocytes donation

A 46,XY gonadal dysgenetic woman gave birth to two healthy girls following vitrified oocytes donation. The loss of SRY gene was considered as the cause of this patient. Although similar cases have been reported about pregnancies of 46,XY pure gonadal dysgenetic women, successful delivery from vitrified oocytes has been hardly reported yet. Oocytes vitrification technique provides a beneficial way by saving superfluous oocytes from the pregnancy patients to these women who need.     

SRY基因突变和性腺肿瘤发生的研究Ⅰ．家族性46，XY女性SRY基因检测

近年证明ＳＲＹ男性性基因是性别决定关键。ＳＲＹ突变能引起男性性异常。４６，ＸＹ性腺发育不全（或ＸＹ女性）系ＳＲＹ基因突变所致，并有高发性腺肿瘤特点。ＳＲＹ突变有多种类型；本研究检测一家庭集聚性ＸＹ女性高发肿瘤成员有个ＳＲＹ基因缺失。结合细胞遗传学和病理学检查结果，对ＸＹ女性性腺癌变机理提出了推测。     

单纯性XY性腺发育不全

本文报道5例单纯性性晚发育不全(Swyer综合征)。基因型为46,XY,表现型为女性伴性腺发育不全。3例为家族性,2例为散发性。临床特征为女性表现型,原发闭经,无青春期变化。所有患者均有幼稚子宫、正常输卵管、条索状性腺和女性外生殖器。2例有性母细胞瘤。讨论了发病机理、性腺肿瘤和处理等问题。     

OPS玻璃化冷冻小鼠MII期卵效果观察

目的　以小鼠为研究模型 ,探讨MII期卵母细胞冷冻后纺锤体和染色体改变的有效观察方法。研究OPS玻璃化冻存成熟卵的可行性。　方法　运用激光扫描共聚焦显微镜 (LSCM)的光学切片和三维图像重建技术 ,系统研究了OPS玻璃化冷冻对小鼠MII期卵纺锤体和染色体的影响。　结果　冷冻组卵复苏后存活率达 5 8% ,纺锤体和染色体形态正常率分别为 46%和 5 2 % ,与对照组 ( 76%和 70 % )相比 ,差异具显著性 (P <0 0 5 )。暴露组卵纺锤体和染色体结构正常率较对照组略有下降 ,但无统计学差异。　结论　LSCM能够清晰有效地观察冷冻对卵母细胞纺锤体和染色体影响。应用OPS玻璃化方法能够有效冻存卵母细胞     

46,XY单纯性性腺发育不全的临床分析

 目的 探讨染色体核型为46,XY单纯性性腺发育不全患者(合并或不合并卵巢肿瘤)的诊断和治疗。方法 分析1991年7月至2011年8月我院收治的6例染色体核型为46,XY单纯性性腺发育不全病例。所有病例均行剖腹探查术或腹腔镜手术。结果 所有患者的临床表现为原发闭经或继发闭经;乳房不发育或发育欠佳;阴毛、腋毛无或稀少;内外生殖器幼稚,有输卵管、卵巢、子宫及阴道。实验室检查FSH,LH均明显高于正常水平;染色体检查为46,XY。手术切除双侧性腺,病理提示6名患者中有4例发生卵巢肿瘤,肿瘤发生率高达66.7%。结论 及时确诊46,XY单纯性性腺发育不全十分重要,确诊后需立即切除双侧性腺以避免肿瘤的发生。     

46,XY单纯性腺发育不全的治疗(附2例报告)

目的 探讨46,XY单纯性腺发育不全病人的病因、临床表现及治疗方法 .方法 对2例染色体核型为46,XY单纯性腺发育不全病人的临床资料进行分析.结果 2例病人的生长和智力发育均正常,两臂与地平行伸展开两手中指的距离等于身高.原发闭经,青春期有女性第二性征发育,有阴毛、腋毛,乳房发育可.病人均有阴道, 行人工周期月经治疗有效.2例行腹腔探查术,术中均可见到发育不良的子宫、发育欠佳的输卵管、条索状性腺组织以及实性包块.手术切除包块及条索状性腺组织,病理诊断均为无性细胞瘤.结论 对生殖器官发育不良病人应常规行染色体检查;对46,XY单纯性腺发育不全病人应尽早切除性腺,通过性激素替代治疗提高病人生活质量.     

A novel mutation in the SRY gene of a Chinese 46,XY female patient with unilateral mixed germ cell tumor

Objective To determine the nosogenetic factors of a 46,XY female with primary amenorrhea and unilateral mixed germ cell tumor.Methods Eight genes associated with 46,XY gonadal dysgenesis were detected in the patient and her parents by target region captured-next generation sequencing.Results An insertion of a single nucleotide(adenine) at the coding site 230(c.230_231insA) located in the high mobility group(HMG) domain of SRY was revealed,which led to a truncated protein(p.Lys77 fsX 27). This mutation was at position 2655414 of the Y chromosome, supported with 127 unique mapped reads, however, this mutation was not found in the in-house dataset of 1 092 controls. Additionally, none of the candidate gene was detected in the patient's parents, which indicated that it is a de novo mutation.Conclusion A novel SRY sporadic mutation due to a single nucleotide insertion at position 230(c.230_231insA) was identified as the cause of the disease in this patient.Target region captured-next generation sequencing was found to be an effective method for the molecular genetic testing of 46,XY complete gonadal dysgenesis(46,XY CGD).     

Mixed gonadal dysgenesis. Report of 11 cases

Eleven cases of Mixed Gonadal Dysgenesis are reported. The disease is characterized by gonadal asymmetry, as well as retained Mullerian duct structures. These individuals exhibit varying degrees of masculinization of the external genitalia, the spectrum of phenotypic expression extending from the normal male to the normal female. 45,/46, XY is the typical karyotype. The etiology, the role of H-Y antigen, pathogenesis and management are discussed. The risk of neoplastic transformation in gonads is a significant threat and must be considered at all the stages of management.     

The role of sexual related Y gene detection in the diagnosis of patients with gonadal dysgenesis

Objective To clarify the role of sexual related Y (SRY) gene detection in the diagnosis of gonadal dysgenesis.Methods Sixteen cases of gonadal dysgenesis were included in this study: 5 with androgen insensitivity syndrome, 1 with 17-α-hydroxylase deficiency, 4 with true herm aphrodite, 2 with 45,X/46,XY gonadal dysgenesis, 1 with 45,X gonadal dysgenesis, 1 with XY pure gonadal dysgenesis, 1 with testicular regression, and 1 XY fema le who gave birth to a normal baby. SRY gene was detected by using polymerase c hain reaction (PCR) in blood and gonad samples and by direct sequencing of the S RY motif. Results Among the 16 cases, 15 were blood SRY positive, among which 13 (86.7%) showed t he presence of testicular tissue, and 2 showed ovaries without testicular tissue . One SRY negative case showed the presence of testicular tissue. In 3 cases, SRY detection in gonadal tissue correlated with pathological findings but not wi th blood karyotype. The correlation between peripheral blood SRY and the pathol ogy of the gonads was 81.25% and the correlation between the presence of periph eral blood Y chromosome and pathology of the gonads was 68.75%. Sequencing of the SRY motif in an XY female who gave birth to a normal baby showed no mutatio n.Conclusions SRY detection is more sensitive and specific than blood karyotype in the predic tion of the presence of testicular tissue. Peripheral blood karyotype does not necessarily reflect gonadal type. There may be testicular related factors other than the SRY gene.     

10例性分化异常患者的SRY基因检测

目的：研究性分化异常患者的染色体核型和SRY基因在性分化异常中的作用。方法：采用常规G显带方法分析10例性分化异常患者的染色体核型并通过应用PCR技术扩增SRY基因。结果：10例性分化异常患者中,有5例男性患者染色体核型为46,XX,其SRY基因为阴性,2例男性患者染色体核型为46,XX,其SRY基因为阳性,2例女性患者染色体核型为46,XY,其SRY基因为阳性,1例女性患者染色体核型为46,XY／45,X,其SRY基因为阳性。结论：性分化异常患者的染色体核型与其性腺性别不相符,SRY基因是在性分化异常中睾丸分化和发育的关键基因。     

PATHOLOGICAL CHARACTERISTICS OF GONADS IN NINE PATIENTS WITH TRUE HERMAPHRODITISM

The gonadal histopathology, and its correlation with the clinical features has been investigated in 9 true hermaphroditism patients, aged 5-21 yr. Seven of 9 patients had been raised as females, of which the chromosomal karyotype was 46XX in 5 cases, 46XX/46XY and 46XX/47XXY in 2 cases. Two of 9 patients were raised as males, the chromosomal karyotypes being 46XX and 46XX/46XY. All 9 patients had testieular tissue excised, and biopsies of the conserved ovaxian tissue were performed. Ovotestis was the most common form of the abnormal gonads; two of 9 patients had bilateral ovotestes, seven had unilsteral ovotestes (5 in right side, 2 in left side). In seven patients with a unilateral ovotestis, 6 had a contralateral ovary and one had a contralateral testis. Microscopically, the ovarian tissue of 11 ovotestes, including 6 biopsies from contealateral ovaris, were normal, with many primordal follicles and a few growing follicles.In two of the patients, aged over 15 years, evidence of ovulation was observed. In comparison, the testicular tissue of the ovotestis and the one left inguinal testis was histologically abnormal, with immature seminiferous tubbers, most of which filled with Sertoli cells only, Three of 9 patients married after surgical treatment. Two of these subsequently conceived and delivered of normal infants by cesarean section.     

小鼠卵母细胞玻璃化冷冻的研究

目的　对小鼠卵母细胞玻璃化的方法和冷冻液进行研究。方法　用两种玻璃化冷冻液EFS4 0 (高钠 )、DEFS4 0 (低钠 )对ICR、C57BL 6J小鼠卵母细胞进行冷冻 ,0 5mol L蔗糖液解冻 ,体外授精前对部分解冻后的C57BL 6J小鼠卵母细胞进行透明带切割。结果　DEFS4 0冷冻液冷冻效果明显高于EFS4 0冷冻液 ,ICR小鼠卵母细胞解冻后成活率达 75 2 %、体外授精率 (2 4 6 % )与对照组相比差异无显著性 ,C57BL 6J小鼠卵母细胞解冻后成活率为 87 1%、卵母细胞切割后体外受精率 (36 0 % )与对照组相比差异也无显著性。结论　冷冻液中钠离子浓度影响小鼠卵母细胞冷冻效果 ,用DEFS4 0 (低钠 )冷冻液进行玻璃化冷冻可以取得理想的冷冻效果。     

圆头精子受精能力、胚胎发育潜能及遗传风险的研究

目的 探讨圆头精子的受精能力、胚胎发育潜能及其遗传风险.方法 通过精子形态染色和透射电镜证实一例圆头精子症患者,其女方共获卵26颗,赠卵6颗,将20颗卵子(19颗为MII卵)行卵细胞质内单个圆头精子的显微注射,6颗赠卵行常规体外授精.测定该患者的染色体核型,同时针对Y染色体AZFa、AZFb、AZFc的sY84、sY86、sY127、sY134、sY254、sY255等6个序列标签位点(STS)进行Y染色体微缺失测定.结果 19颗MII卵子行圆头精子显微注射后有4颗正常受精并卵裂,其余均未受精和卵裂.6颗赠卵常规体外授精后全部正常受精并卵裂,受精率显著高于圆头精子(100%vs 21.1%,P＜0.01),卵裂率两者差异无统计学意义(100%vs 100%,P＞0.05).患者染色体核型正常(46,XY),未发现微缺失.女方行冻胚移植后妊娠,足月剖宫产一男孩,染色体核型正常(46,XY).受者行冻胚移植后妊娠,足月剖宫产一男孩,体健.结论 尽管受精率低下,卵细胞质内单精子注射(ICSI)仍不失为治疗圆头精子症患者不育的一种有效方法.     

性母细胞瘤与45,XO/47,XYY嵌合体(1例报道及5例文献复习)

本文报道1例核型为45,XO/47,XYY的性母细胞瘤,结合近30年文献中该类核型7例报道中发生性母细胞瘤的5例。性母细胞瘤在该类核型的发生率为75％(6/8)。本院1例性腺组织培养的核型分析显示肿瘤侧XYY细胞系占优势(80％),而非肿瘤侧仅占11％。6例肿瘤的性腺组织学来源,除1例发生于发育不全的睾丸外,均来自条索状性腺。这些病例的临床表现与性腺组织学及肿瘤分泌的性激素有关。具Turner体征的患者,伴或不伴性征发育均应做核型分析,如果有Y染色体存在,应尽早切除性腺以免发生肿瘤。     

Male pseudohermaphrodite reared as a female

A 31-year-old male pseudohermaphrodite has been brought up as a female. The parents had told their child not to discuss the problem of ambiguous genitalia with anyone. As a teenager masculinization had occurred. Chromosome analysis of both peripheral blood and gonadal tissue was 46XY. The internal gonads were testes surrounded by a rim of ovarian stroma. A rudimentary cervix opened into a small vagina, as did the urethra in a valve-like fashion. The phallus was amputated during surgical reconstruction of the external genitalia to create a phenotypic female and the vagina was enlarged. Oestrogen therapy resulted in breast development.     

世界首报7例染色体异常核型

本文首报7例世界人类染色体异常核型如下: 46,XX,t(1;7)(p32;p22);46,XY,t(5;11)(q31;q23); 46,XY,t(3;6)(q21;q25);47,XY, 21,t(5;11)(q31;q23); 46,XX,t(X;14)(q13;q11);47,XY, 21,inv(6)(p21;q21); 46,XY,t(3;4)(q12;p11); 并就染色体平衡易位患者的表型效应及平衡易位染色体对染色体复合畸变的影响做了初步探讨。     

Fertility preservation in children and young adults undergoing treatment for malignancy

Advances in cancer therapy have improved the long-term survival of young patients suffering from malignancies. However, the adverse effects of the treatment are sterility and loss of gonadal function especially in females. Preservation of fertility in males by sperm freezing is more practical and already established. For young women undergoing cancer treatment, the availability of preserving the gonadal function and fertility has just begun. Today, we can cryopreserve the oocytes, the embryos or the ovarian tissue and in those undergoing pelvic irradiation, laparoscopic lateral ovarian suspension can be considered. Because women with non-gynecological malignancies seek advice from a general surgeon or a medical oncologist, increasing the awareness of the physicians and general public is recommended.     

改良Hemi straw与Cryoleaf法对人卵和胚胎玻璃化保存效果的比较

目的比较改良的Hemi straw与Cryoleaf法对人卵子和胚胎的玻璃化保存效果。方法 将接受体外受精-胚胎移植周期中剩余的98枚未受精卵和76枚废弃胚胎，分别采用Cryoleaf(A组)与改良的Hemi straw（B组）为载体进行玻璃化冷冻，复苏后观察并计算两种玻璃化载体的卵子存活率，24?h继续存活率与卵裂率；胚胎存活率，24?h继续存活率及囊胚形成率。结果Cryoleaf与改良的Hemi straw法保存人未受精卵分别为43、55枚，复苏存活分别为29（67.4%）、31（56.4%）枚，24?h继续存活分别为23（53.5%）、25（45.5%）枚，卵裂分别为3（7.0%）、1（1.8%）枚，两种载体差异不明显（P＞0.05）。Cryoleaf与改良的Hemi straw法保存废弃胚胎分别为39、37枚，复苏存活分别为29（74.4%）、33（89.2%）枚，24?h继续存活分别为28（71.8%）、33（89.2%）枚，形成囊胚分别为5（12.8%）、1（2.7%）枚，两种载体差异不明显（P＞0.05）。结     

PVP对人卵母细胞玻璃化冻融效果的影响

目的 探讨在玻璃化冷冻液中添加大分子物质PVP(polyvinyl pyrrolidone)对人卵母细胞冻融效果的影响.方法 玻璃化液中添加6% PVP者为A组,不添加者B组,未冻融者为对照组(C组),冻融后存活及对照组卵母细胞固定后进行免疫荧光染色,然后用Nikon CISI激光扫描共聚焦显微镜观察纺锤体、染色体形态...     

80例男性不育患者的细胞遗传学研究

本文对80例男性不育患者行进行了染色体分析,发现Klinefelter综台征21例,其中核型为47,xxy13例;46,xy/47,xxy8例;罗伯逊易位(21/22)1例;46,xy/92,xxyy4例;46,xy/46,xy~(-2)例。总的染色体异常发生率为35％。本文还讨论了不育男性染色体异常类型及发生率,分析了表现型与核型的关系