TY - JOUR
T1 - Multiparameter Investigation of a 46,XX/46,XY Tetragametic Chimeric Phenotypical Male Patient with Bilateral Scrotal Ovotestes and Ovulatory Activity
AU - Van Bever, Yolande
AU - Wolffenbuttel, Katja P.
AU - Brüggenwirth, Hennie T.
AU - Blom, Eric
AU - De Klein, Annelies
AU - Eussen, Bert H.J.
AU - Van Der Windt, Florijn
AU - Hannema, Sabine E.
AU - Dessens, Arianne B.
AU - Dorssers, Lambert C.J.
AU - Biermann, Katharina
AU - Hersmus, Remko
AU - De Rijke, Yolanda B.
AU - Looijenga, Leendert H.J.
PY - 2018/2/1
Y1 - 2018/2/1
N2 - We report on an adult male initially presenting with gynecomastia and a painless scrotal mass without additional genital anomalies. Hyperpigmentation of the skin following the Blaschko's lines was identified. He underwent gonadectomy because of suspected cancer. Histological analyses revealed an ovotestis with ovulatory activity confirmed by immunohistochemistry with multiple markers. Karyotyping of cultured peripheral blood lymphocytes and a buccal smear revealed a 46,XX/46,XY chimeric constitution with different percentages. Multiple molecular analyses as well as blood typing implied a tetragametic origin. After the unilateral gonadectomy, the patient developed recurrent painful cystic swellings of the remaining gonad. Because of the wish to preserve hormonal activity as well as future fertility, the patient underwent surgical resection of a cystic gonadal area. The removed tissue showed ovulation-related features in addition to both testicular and ovarian tissue, diagnosed as an ovotestis. Testosterone therapy was initiated to suppress the persistently elevated gonadotropins and thereby suppress ovarian activity. During treatment, the recurrent pain complaints and cystic swellings ceased, although gonadotropin levels were not fully suppressed. Based on these observations, the importance of a detailed genetic and pathological diagnosis and the clinical dilemmas including the pros and cons of personalized treatment with gonadal preservative surgery are discussed.
AB - We report on an adult male initially presenting with gynecomastia and a painless scrotal mass without additional genital anomalies. Hyperpigmentation of the skin following the Blaschko's lines was identified. He underwent gonadectomy because of suspected cancer. Histological analyses revealed an ovotestis with ovulatory activity confirmed by immunohistochemistry with multiple markers. Karyotyping of cultured peripheral blood lymphocytes and a buccal smear revealed a 46,XX/46,XY chimeric constitution with different percentages. Multiple molecular analyses as well as blood typing implied a tetragametic origin. After the unilateral gonadectomy, the patient developed recurrent painful cystic swellings of the remaining gonad. Because of the wish to preserve hormonal activity as well as future fertility, the patient underwent surgical resection of a cystic gonadal area. The removed tissue showed ovulation-related features in addition to both testicular and ovarian tissue, diagnosed as an ovotestis. Testosterone therapy was initiated to suppress the persistently elevated gonadotropins and thereby suppress ovarian activity. During treatment, the recurrent pain complaints and cystic swellings ceased, although gonadotropin levels were not fully suppressed. Based on these observations, the importance of a detailed genetic and pathological diagnosis and the clinical dilemmas including the pros and cons of personalized treatment with gonadal preservative surgery are discussed.
KW - (Partial) gonadectomy
KW - Blood typing
KW - DNA polymorphisms
KW - Hormonal treatment
KW - Mosaicism
KW - Next-generation sequencing
KW - Ovotestis
KW - Ovulatory activity
KW - SNP array
KW - XX/XY chimerism
UR - http://www.scopus.com/inward/record.url?scp=85029754994&partnerID=8YFLogxK
U2 - https://doi.org/10.1159/000479946
DO - https://doi.org/10.1159/000479946
M3 - Review article
C2 - 28926831
SN - 1661-5425
VL - 12
SP - 145
EP - 154
JO - Sexual development
JF - Sexual development
IS - 1-3
ER -