Case Report | | Peer-Reviewed

Klinefelter Mosaicism 46, XX/47, XXY with Ovotestis- DSD

Received: 15 October 2024     Accepted: 4 November 2024     Published: 26 November 2024
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Abstract

Klinefelter syndrome is a relatively common chromosomal condition affecting approximately 1 in 500-1,000 males. 46, XX /47 XXY Klinefelter Syndrome mosaicism is rare enough, resulting in a few cases described in literature. Variable phenotypes and clinical presentations such as gynecomastia, infertility, cryptorchidism, and disorders of sexual development (DSD) are associated with this karyotype presentation. The association of Klinefelter syndrome mosaicism 46 XX/47 XXY and OT DSD is a rare feature. We report the case of a 34-year-old man who presented for semen analysis and karyotyping in our unit. The patient had bilateral gynecomastia and absence of facial hair. Penile length was 4,5 cm with an external meatus located on the posterior face of the phallus, characterizing a posterior hypospadias. Testis was palpable in the right hemiscrotum, but the left hemiscrotum was empty. Ultrasonography revealed the presence of the left gonad located in the left iliac fossa, while the right gonad in the scrotum had testicular morphology according to ultrasound exam. Chromosomal analysis revealed 46, XX/47, XXY mosaicism, and semen analysis an azoospermia. Our patient underwent surgery because of the risk of malignancy, and histopathologic examination of the left excised gonad confirmed the structure to be an ovotestis. The biopsy of the right gonad, realized for eventual cryopreservation, revealed atrophic seminiferous tubules and a pseudo tumoral aspect of Leydig cells with hyperplasia without atypia. Personalized approach and multidisciplinary care are needed to get a diagnosis, resolve sex reassignment, and improve the quality of life of the patient. In that feature, the percentage of XX cells could play a role on phenotype, particularly on Müllerrian structure persistence, but also on a relative increased risk of malignancy degenerescence compared to other cases of OT-DSD.

Published in International Journal of Genetics and Genomics (Volume 12, Issue 4)
DOI 10.11648/j.ijgg.20241204.13
Page(s) 86-92
Creative Commons

This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2024. Published by Science Publishing Group

Keywords

KS Mosaicism, Ovo testis (OT)-DSD, Percentage of 46, XX Clone Cells, Germ Cell Tumor

References
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Cite This Article
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    SY, M., Dial, C. M., Diallo, A. D., Ibondou, R. K., Diallo, A. S., et al. (2024). Klinefelter Mosaicism 46, XX/47, XXY with Ovotestis- DSD. International Journal of Genetics and Genomics, 12(4), 86-92. https://doi.org/10.11648/j.ijgg.20241204.13

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    ACS Style

    SY, M.; Dial, C. M.; Diallo, A. D.; Ibondou, R. K.; Diallo, A. S., et al. Klinefelter Mosaicism 46, XX/47, XXY with Ovotestis- DSD. Int. J. Genet. Genomics 2024, 12(4), 86-92. doi: 10.11648/j.ijgg.20241204.13

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    AMA Style

    SY M, Dial CM, Diallo AD, Ibondou RK, Diallo AS, et al. Klinefelter Mosaicism 46, XX/47, XXY with Ovotestis- DSD. Int J Genet Genomics. 2024;12(4):86-92. doi: 10.11648/j.ijgg.20241204.13

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  • @article{10.11648/j.ijgg.20241204.13,
      author = {Mama SY and Chérif Mouhamed Dial and Adji Djeynaba Diallo and Racha Kamenda Ibondou and Abdoulaye Séga Diallo and Oumar Faye},
      title = {Klinefelter Mosaicism 46, XX/47, XXY with Ovotestis- DSD
    },
      journal = {International Journal of Genetics and Genomics},
      volume = {12},
      number = {4},
      pages = {86-92},
      doi = {10.11648/j.ijgg.20241204.13},
      url = {https://doi.org/10.11648/j.ijgg.20241204.13},
      eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijgg.20241204.13},
      abstract = {Klinefelter syndrome is a relatively common chromosomal condition affecting approximately 1 in 500-1,000 males. 46, XX /47 XXY Klinefelter Syndrome mosaicism is rare enough, resulting in a few cases described in literature. Variable phenotypes and clinical presentations such as gynecomastia, infertility, cryptorchidism, and disorders of sexual development (DSD) are associated with this karyotype presentation. The association of Klinefelter syndrome mosaicism 46 XX/47 XXY and OT DSD is a rare feature. We report the case of a 34-year-old man who presented for semen analysis and karyotyping in our unit. The patient had bilateral gynecomastia and absence of facial hair. Penile length was 4,5 cm with an external meatus located on the posterior face of the phallus, characterizing a posterior hypospadias. Testis was palpable in the right hemiscrotum, but the left hemiscrotum was empty. Ultrasonography revealed the presence of the left gonad located in the left iliac fossa, while the right gonad in the scrotum had testicular morphology according to ultrasound exam. Chromosomal analysis revealed 46, XX/47, XXY mosaicism, and semen analysis an azoospermia. Our patient underwent surgery because of the risk of malignancy, and histopathologic examination of the left excised gonad confirmed the structure to be an ovotestis. The biopsy of the right gonad, realized for eventual cryopreservation, revealed atrophic seminiferous tubules and a pseudo tumoral aspect of Leydig cells with hyperplasia without atypia. Personalized approach and multidisciplinary care are needed to get a diagnosis, resolve sex reassignment, and improve the quality of life of the patient. In that feature, the percentage of XX cells could play a role on phenotype, particularly on Müllerrian structure persistence, but also on a relative increased risk of malignancy degenerescence compared to other cases of OT-DSD.
    },
     year = {2024}
    }
    

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  • TY  - JOUR
    T1  - Klinefelter Mosaicism 46, XX/47, XXY with Ovotestis- DSD
    
    AU  - Mama SY
    AU  - Chérif Mouhamed Dial
    AU  - Adji Djeynaba Diallo
    AU  - Racha Kamenda Ibondou
    AU  - Abdoulaye Séga Diallo
    AU  - Oumar Faye
    Y1  - 2024/11/26
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    N1  - https://doi.org/10.11648/j.ijgg.20241204.13
    DO  - 10.11648/j.ijgg.20241204.13
    T2  - International Journal of Genetics and Genomics
    JF  - International Journal of Genetics and Genomics
    JO  - International Journal of Genetics and Genomics
    SP  - 86
    EP  - 92
    PB  - Science Publishing Group
    SN  - 2376-7359
    UR  - https://doi.org/10.11648/j.ijgg.20241204.13
    AB  - Klinefelter syndrome is a relatively common chromosomal condition affecting approximately 1 in 500-1,000 males. 46, XX /47 XXY Klinefelter Syndrome mosaicism is rare enough, resulting in a few cases described in literature. Variable phenotypes and clinical presentations such as gynecomastia, infertility, cryptorchidism, and disorders of sexual development (DSD) are associated with this karyotype presentation. The association of Klinefelter syndrome mosaicism 46 XX/47 XXY and OT DSD is a rare feature. We report the case of a 34-year-old man who presented for semen analysis and karyotyping in our unit. The patient had bilateral gynecomastia and absence of facial hair. Penile length was 4,5 cm with an external meatus located on the posterior face of the phallus, characterizing a posterior hypospadias. Testis was palpable in the right hemiscrotum, but the left hemiscrotum was empty. Ultrasonography revealed the presence of the left gonad located in the left iliac fossa, while the right gonad in the scrotum had testicular morphology according to ultrasound exam. Chromosomal analysis revealed 46, XX/47, XXY mosaicism, and semen analysis an azoospermia. Our patient underwent surgery because of the risk of malignancy, and histopathologic examination of the left excised gonad confirmed the structure to be an ovotestis. The biopsy of the right gonad, realized for eventual cryopreservation, revealed atrophic seminiferous tubules and a pseudo tumoral aspect of Leydig cells with hyperplasia without atypia. Personalized approach and multidisciplinary care are needed to get a diagnosis, resolve sex reassignment, and improve the quality of life of the patient. In that feature, the percentage of XX cells could play a role on phenotype, particularly on Müllerrian structure persistence, but also on a relative increased risk of malignancy degenerescence compared to other cases of OT-DSD.
    
    VL  - 12
    IS  - 4
    ER  - 

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Author Information
  • Laboratory of Histology Embryology and Cytogenetics, Faculty of Medicine, Cheikh Anta Diop University, Dakar, Senegal

  • Laboratory of Pathology, Faculty of Medicine, Cheikh Anta Diop University, Dakar, Senegal

  • Laboratory of Histology Embryology and Cytogenetics, Faculty of Medicine, Cheikh Anta Diop University, Dakar, Senegal

  • Laboratory of Histology Embryology and Cytogenetics, Faculty of Medicine, Cheikh Anta Diop University, Dakar, Senegal

  • Laboratory of Histology Embryology and Cytogenetics, Faculty of Medicine, Cheikh Anta Diop University, Dakar, Senegal

  • Laboratory of Histology Embryology and Cytogenetics, Faculty of Medicine, Cheikh Anta Diop University, Dakar, Senegal

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