Hymie Gordon

The triad of gastric leiomyosarcoma, functioning extra-adrenal paraganglioma and pulmonary chondroma

The association of three uncommon neoplasms — gastric leiomyosarcoma, functioning extra-adrenal paraganglioma and pulmonary chondroma — in two patients and the occurrence of two of these tumors in ...

Dominant Inheritance of the Complex of Myxomas, Spotty Pigmentation, and Endocrine Overactivity

We describe a family in which lentigines were present in the index patient, in three of her seven siblings, in their mother, and in a niece (the daughter of an affected sister). Cutaneous myxomas were present in the index patient, in two of her brothers, and probably in their mother. In addition, the index patient had two cardiac myxomas. multiple myxoid mammary fibroadenomas, and the Cushing syndrome, and an affected brother had acromegaly caused by a growth hormone-secreting tumor of the pituitary gland. Thus, at least one manifestation of the complex of myxomas, spotty pigmentation, and endocrine overactivity has occurred in three successive generations of this family. Both male and female family members were affected, and 5 of the 11 children of affected persons had the disorder. The karyotypes of two affected persons were normal. These observations are consistent with mendelian dominant inheritance of the syndrome.

Chromosomally Abnormal Clones and Nonrandom Telomeric Translocations in Cardiac Myxomas

Cardiac myxomas from eight patients were examined cytogenetically in short-term cultures. Cultures could not be established in two of the eight cases. Chromosomally abnormal clones occurred in two of the myxomas; their karyotypes were 45,X,-Y,+7,-18 and 45,X,-Y. In three other myxomas, we found a rare kind of telomere-to-telomere translocation between chromosomes. The telomeres predominantly involved in these three tumors were the 2qter (the end of the long arm of chromosome 2), the 12pter (the end of the short arm of chromosome 12), and Yqter (the end of the long arm of the Y chromosome), respectively. In one other myxoma, 20% of the cells were tetraploid. These findings support the concept that myxomas are neoplastic; those with an abnormal clone may even have malignant potential. The unusual telomere-to-telomere translocations were not observed in a clonal pattern. They may represent a specific type of chromosomal instability associated with a defect in repair or replication of telomeric DNA.

Hypertrophic obstructive cardiomyopathy and lentiginosis: A little known neural ectodermal syndrome

Eleven patients, 10 male, with classic hypertrophic obstructive cardiomyopathy and lentiginosis are described. Physical examination showed differences from the few previously reported cases in that (1) this condition was not confined to children; (2) mental retardation, sensorineural deafness and gonadal and somatic infantilism were either rare or absent; and (3) detailed family studies provided no evidence that this condition was inherited. Nine patients underwent cardiac catheterization and left ventricular angiography; all had left ventricular outflow obstruction and three had concomitant right ventricular outflow obstruction with a pressure gradient in excess of 100 mm Hg. Ten of the 11 patients were severely symptomatic, and 7, each with a left ventricular pressure gradient of more than 70 mm Hg, underwent successful septal myotomy/myectomy that resulted in marked symptomatic improvement that was maintained after long-term follow-up.

Usefulness of Chromosome Examination in the Diagnosis of Malignant Pleural Effusions

To determine whether chromosome analysis could facilitate the diagnosis of malignant pleural effusions, we examined chromosomes in effusions from 104 unselected patients. An effusion was regarded as malignant if at least three of 30 metaphase cells were hyperdiploid or contained a marker chromosome. Results were compared with standard cytologic diagnoses. All 22 benign effusions were diagnosed correctly by cytologic examination, but one nosed correctly by cytologic examination, but one (acute rheumatoid lung disease) was misclassified as positive by chromosome criteria. Of the 82 malignant effusions, 53 (65 per cent) were diagnosed correctly by cytologic tests, as compared with 58 (71 per cent) by chromosome analysis (P greater than 0.2). Among patients with malignant neoplasms, 13 had leukemia or lymphoma; only four of these (31 per cent) were diagnosed by cytologic tests as compared with 11 (85 per cent) by chromosome analysis (P less than 0.01). The combination of standard cytologic and chromosome analyses correctly identified 83 per cent of the neoplasms, a result significantly better than that with either technic alone (P less than 0.01).

A diploid‐triploid human mosaic with cytogenetic evidence of double fertilization

The karyotype 46,XX/69,XXY was found in a 13‐year‐old, mentally subnormal patient with club feet, strabismus, eunuchoid habitus, small penis, midscrotal urethrovaginal opening, small descended left testis, and small undescended right testis; no ovarian tissue could be found at laparotomy. Triploid:diploid cell ratios were 60:40 and 4:96 in skin fibroblasts and circulating lymphocytes, respectively. In the triploid line, two of the no. 13 chromosomes had unusually large satellites and one of the no. 22 chromosomes had a brightly fluorescent zone on its short arms. The patients father was heterozygous for both these autosomal markers; the mother carried neither marker. This, together with the single Y, indicated that the extra haploid set was derived from the father. Of several possible mechanisms, we favor the suggestion that double fertilization occurred; one sperm nucleus immediately fused with the egg nucleus producing the diploid line; the second sperm nucleus was incorporated later into one of the two cells resulting from the first division of the zygote, producing the triploid line.

Chromosomal Studies in Cryptorchidism

The chromosomes of undescended tests from 13 boys were analyzed. In 12 of these patients the peripheral blood chromosomes were examined and in 7 the chromosomes of normal skin cultures were examined. In addition to standard techniques the chromosomes also were analyzed by G and Q-banding methods. We were unable to detect any significant abnormalities of either chromosome number of structure in the undescended testes. Thus, our investigation failed to demonstrate a chromosomal lesions that may be responsible for maldescent of the testes. Our investigation did not reveal any changes in the chromosomes of these undescended testes that could be interpreted as indicating a potentially malignant state.

Marfan Syndrome Diagnosed in Patients 32 Years of Age or Older

The Marfan syndrome, a generalized inherited disorder, is usually diagnosed in young patients and is associated with a poor prognosis. With use of our diagnostic-retrieval system, we identified 28 patients with the Marfan syndrome who were 32 years of age or older at the time of diagnosis. These patients had at least two of four major diagnostic criteria for the Marfan syndrome--a confirmed family history, a long-limbed habitus, dislocated lenses, and disease of the aortic root. In these relatively older patients, some clinical findings (the ocular disorder and the family history) corresponded to the expected findings in younger patients with the Marfan syndrome; however, the proportion of those with cardiovascular disease was greater. Echocardiography has improved the potential for detection of the cardiac lesions, the most frequent cause of death in these patients. Early diagnosis of the Marfan syndrome is important so that complications of the cardiac lesions can be prevented or delayed and so that genetic counseling can be done at an appropriate time.

Familial pericentric and paracentric inversions of chromosome 1

SummaryWe investigated 33 individuals (21 carriers) from one family with a pericentric inversion involving a large part of chromosome 1 (1p36.1→1q32). In addition, we investigated 15 individuals (10 carriers) from another family with a paracentric inversion of a small part of chromosome 1(1p32→1p36.1). In each family, the index patient was ascertained because three miscarriages had occurred. Each carrier of these inversions was phenotypically normal. If the miscarriages of the index patients are excluded, the frequency of recognized miscarriages among the carriers of childbearing age was 9% (4 of 46) for the family with pericentric inversion and 17% (4 of 23) for the family with paracentric inversion. One of the pericentric inv(1) carriers had had a stillborn daughter. The carriers of the pericentric inversion who were of childbearing age had 41 children; carriers of the paracentric inversion who were of childbearing age had 19 children. No live-born children with birth defects were observed in either family. This evidence, together with the low frequency of miscarriages, suggests that crossover within the inversion loop occurs much less frequently than might be expected from the large size of this inversion. Our investigation suggests that the risk of recognized miscarriages, stillbirths, and live-born children with recombinant chromosomes who have birth defects may be much lower for inv(1) carriers than previously reported. The risk of having a malformed child because of a recombinant chromosome is probably less than 3% for carriers of the pericentric inversion and less than 6% for the carriers of the paracentric inversion.

The Family History and the Pedigree Chart

In investigating the etiology of a familial disease, it is important to obtain a detailed family history and to construct a pedigree chart. The chart not only aids in recognizing genetic factors in the disease but also provides important information for genetic counseling. Suggestions are given here for constructing a pedigree chart using conventional symbols.