You are here: Home / Rare Disease Information / Rare Disease Database

Search Rare Diseases

Enter a disease name or synonym to search NORD's database of reports.

0-9 - A - B - C - D - E - F - G - H - I - J - K - L - M - N - O - P - Q - R - S - T - U - V - W - X - Y - Z

Chromosome 9, Trisomy Mosaic

Synonyms of Chromosome 9, Trisomy Mosaic

  • Trisomy 9 (Complete Trisomy 9 Syndrome), Included
  • Trisomy 9 Mosaic
  • Trisomy 9 Mosaicism
  • Trisomy 9 Mosaicism Syndrome

Disorder Subdivisions

  • No subdivisions found.

General Discussion

Chromosome 9, Trisomy Mosaic, also known as Trisomy 9 Mosaicism syndrome, is a rare chromosomal disorder in which the entire 9th chromosome appears three times (trisomy) rather than twice in some cells of the body. The term "mosaic" indicates that some cells contain the extra chromosome 9, while others have the normal chromosomal pair.

Associated symptoms and findings may vary greatly in range and severity, depending on the percentage of cells with the extra chromosome. However, common features include growth deficiency before birth (intrauterine growth retardation); mental retardation; structural malformations of the heart that are present at birth (congenital heart defects); and/or distinctive abnormalities of the skull and facial (craniofacial) region, such as a sloping forehead, a bulbous nose, short eyelid folds (palpebral fissures), deeply set eyes, and/or low-set, malformed ears. The syndrome may also be characterized by musculoskeletal, genital, kidney (renal), and/or additional physical abnormalities. Chromosome 9, Trisomy Mosaic may be caused by errors during the division of a parent's reproductive cells (meiosis) or during the division of body tissue cells (somatic cells) early in the development of the embryo (mitosis).

Symptoms

As noted above, Chromosome 9, Trisomy Mosaic is characterized by an extra 9th chromosome (trisomy 9) in some cells of the body (mosaicism). The range and severity of associated features may be variable, depending on the percentage of trisomic cells. In addition, rare cases have also been reported in which all body cells have appeared to be trisomic for all of chromosome 9; such "nonmosaic" cases are sometimes referred to as Trisomy 9 or Complete Trisomy 9 syndrome. According to investigators, in such patients, characteristic clinical features do not substantially differ from those seen with Trisomy 9 Mosaicism; however, symptoms and findings associated with the latter may tend to be less severe in some cases (e.g., due to percentage of mosaicism).

Chromosome 9, Trisomy Mosaic is commonly characterized by growth deficiency beginning before birth (prenatal onset), failure to grow and gain weight at the expected rate (failure to thrive) during infancy, and low muscle tone (hypotonia). In addition, many affected individuals have severe mental retardation and severe delays in the acquisition of skills requiring the coordination of mental and physical activities (psychomotor retardation). However, there have also been some reports in which individuals with the disorder have normal psychomotor development or are only mildly developmentally delayed.

Chromosome 9, Trisomy Mosaic is also often associated with characteristic malformations of the skull and facial (craniofacial) region. Many affected infants have an abnormally small head (microcephaly); a sloping forehead with narrow temples; a broad nose with a bulbous tip and "slitlike" nostrils; and/or a small jaw (micrognathia). Additional characteristic features may include abnormal wideness of the "soft spots" (fontanels) and the fibrous joints (i.e., cranial sutures) between certain bones of the skull; a prominent upper lip covering a receding lower lip; a highly arched roof of the mouth (palate); low-set, misshapen ears; and/or a short neck. Various eye (ocular) abnormalities may also be present, such as short, upwardly slanting eyelid folds (palpebral fissures); deeply set eyes; abnormal reduction in the size of the eyes (microphthalmia); and/or other ocular defects. Some affected infants may also have an abnormal groove in the upper lip (cleft lip); incomplete closure (clefting) of the palate; abnormal outgrowths of skin and cartilage on or before the ears (preauricular tags); and/or other craniofacial abnormalities.

Approximately two-thirds of affected individuals also have congenital heart defects. Such defects may include an abnormal opening in the partition (septum) that separates the two lower or upper chambers (ventricles or atria) of the heart (ventricular or atrial septal defects), patent ductus arteriosus (PDA), and/or other associated defects, allowing some oxygen-rich blood to recirculate through the lungs and potentially leading to rising blood pressure in the lungs (pulmonary hypertension). In PDA, the channel that is present between the pulmonary artery and the aorta during fetal development fails to close after birth. (The pulmonary artery carries oxygen-depleted blood from the right ventricle to the lungs, where the exchange of oxygen and carbon dioxide occurs. The aorta, which is the major artery of the body, arises from the left ventricle and supplies oxygen-rich blood to most arteries.)

In individuals with cardiac defects, associated symptoms and findings may vary, depending upon the size, nature, and/or combination of heart malformations present and other factors. Some individuals may show no apparent symptoms (asymptomatic), while others may develop difficulties feeding, poor growth, difficult or labored breathing (dyspnea), profuse sweating, irritability, an impaired ability of the heart to pump blood efficiently to the lungs and the rest of the body (heart failure), and/or other abnormalities. In severe cases, congenital heart disease may lead to potentially life-threatening complications.

Chromosome 9, Trisomy Mosaic is also often characterized by various musculoskeletal abnormalities. These frequently include congenital dislocation of the hips; abnormal position and/or limited function of other joints, such as those of the elbows, knees, and/or fingers and toes (digits); abnormal curvature of the spine; and/or other defects. Additional abnormalities of the hands and feet may also be present, such as underdevelopment (hypoplasia) of certain bones of the digits (phalanges); hypoplasia of the nails; and/or a single crease across the palms (simian crease). Other skeletal malformations have also been reported in association with the disorder, including a narrow chest, rib defects, additional malformations of certain bones of the spine (vertebral anomalies), and/or other abnormalities.

Affected males may also have genital abnormalities, including undescended testes (cryptorchidism); a small penis (micropenis); and/or abnormal placement of the urinary opening (hypospadias), such as on the underside of the penis. Kidney (renal) abnormalities may also be present, including renal cysts; swelling (distension) of the kidneys with urine (hydronephrosis) due to narrowing or blockage of the tubes (i.e., ureters) that carry urine from the kidneys into the bladder; and/or other renal defects.

In some cases, Chromosome 9, Trisomy Mosaic may also be associated with certain abnormalities of the brain, such as hydrocephalus, Dandy-Walker malformation, and/or other features. Hydrocephalus is characterized by obstructed flow or impaired absorption of cerebrospinal fluid (CSF), resulting in abnormal accumulation of CSF in the skull, usually under increased pressure, and widening of cavities (ventricles) of the brain. CSF is the watery protective fluid that circulates through the four ventricles of the brain, the canal containing the spinal cord (spinal canal), and the space between layers of the protective membranes (meninges) surrounding the brain and spinal cord (i.e., subarachnoid space). Depending on the age at symptom onset and other factors, associated symptoms may include rapid enlargement of the head, sudden episodes of uncontrolled electrical activity in the brain (seizures), feeding difficulties, vomiting, irritability, headache, loss of coordination, deteriorating mental functioning, and/or other findings. In severe cases, potentially life-threatening complications may result. In those with Dandy-Walker malformation, cystic malformation of the fourth ventricle of the brain may lead to hydrocephalus, a rapid increase in head size, abnormal prominence of the back region of the head (occiput), and/or additional associated abnormalities.

In some instances, additional physical features have been reported in association with Chromosome 9, Trisomy Mosaic. Such abnormalities have included clouding of the dome-shaped, normally transparent region forming the front of the eyeball (corneal opacities); the presence of cysts on the eyeballs (epibulbar dermoids); underdevelopment of the lungs (pulmonary hypoplasia); diaphragmatic hernia; gastroesophageal reflux; and/or other abnormalities. In those with a diaphragmatic hernia, there is protrusion of abdominal structures into the chest cavity through an abnormal opening in the diaphragm. Gastroesophageal reflux is characterized by abnormal backflow (reflux) of stomach acid into the esophagus, causing inflammation of and possible damage to the esophageal lining.

Causes

In individuals with Chromosome 9, Trisomy Mosaic, the entire 9th chromosome appears three times (trisomy) rather than twice in some cells of the body (mosaicism). Chromosomes are found in the nucleus of all body cells. They carry the genetic characteristics of each individual. Pairs of human chromosomes are numbered from 1 through 22, with an unequal 23rd pair of X and Y chromosomes for males and two X chromosomes for females. Each chromosome has a short arm designated as "p," a long arm identified by the letter "q," and a narrowed region at which the two arms are joined (centromere). Chromosomes are further subdivided into bands that are numbered outward from the centromere. For example, the short arm of chromosome 9 includes bands 9p11 to 9p24, and the long arm includes bands 9q11 to 9q34.

The same chromosomal makeup is usually present in all body cells. However, those with a mosaicism have two or more cell lines that are karyotypically distinct. In individuals with Chromosome 9, Trisomy Mosaic, there is trisomy (duplication) of chromosome 9 in a percentage of cells, while other cells have a normal chromosomal makeup. The additional chromosome is responsible for the symptoms and physical findings that characterize the disorder. Individuals with a low percentage of affected cells (low mosaicism) may have fewer, less severe symptoms than those with a high percentage of affected cells (high mosaicism).

Chromosome 9, Trisomy Mosaic appears to result from errors of chromosomal separation (nondisjunction) during the division of reproductive cells in one of the parents (meiosis) or during cellular division after fertilization (mitosis). There have been some reports in which the disorder has appeared to occur due to a balanced chromosomal rearrangement known as a "pericentric inversion" in one of the parents; in such cases, affected individuals have had the variant chromosome 9 in duplicate within trisomic cells. A pericentric inversion is characterized by breakage of a chromosome in two places including the centromere and reunion of the segment in the reverse order. If a chromosomal rearrangement is balanced, meaning that it consists of an altered but balanced set of chromosomes, it is usually harmless to the carrier. However, such a chromosomal rearrangement may be associated with an increased risk of abnormal chromosomal development in the carrier's offspring.

Chromosomal analysis and genetic counseling are typically recommended for parents of an affected child to help confirm or exclude the presence of a pericentric inversion or other chromosomal rearrangement involving chromosome 9 in one of the parents.

Affected Populations

Chromosome 9, Trisomy Mosaic appears to affect males and females in relatively equal numbers. Since the disorder was originally described in 1973 (Haslam RH), over 30 cases have been reported in the medical literature.

Related Disorders

Certain symptoms and findings associated with the following disorders may be similar to those of Chromosome 9, Trisomy Mosaic. Comparisons may be useful for a differential diagnosis:

Goldenhar syndrome, a term that is often used synonymously with "oculo-auriculo-vertebral (OAV) spectrum" is a rare disorder characterized by a spectrum of clinical features that may be extremely variable from case to case. However, primary features tend to include abnormalities of the cheekbones, jaws, mouth, ears, eyes, and/or bones of the spinal column (vertebrae). Although such malformations often are restricted to one side of the body (unilateral), both sides may sometimes be involved (bilateral), with one side more affected than the other (asymmetry). Associated craniofacial abnormalities may include underdevelopment (hypoplasia) of the cheekbones, the jaw bones, and the bones forming a portion of the lower skull (temporal hypoplasia); incomplete development of certain facial muscles; a wide mouth (macrostomia); cleft lip and cleft palate; and/or abnormalities of the teeth. Affected individuals may also have hypoplastic and/or absent external ears (pinnae) and narrow, blind ending, or absent external ear canals (microtia); abnormal outgrowths of skin and cartilage on or in front of the ears (preauricular tags); and/or abnormalities affecting the middle and/or inner ears, contributing to or resulting in hearing impairment (i.e., conductive and/or sensorineural hearing loss). Eye abnormalities may include partial absence of tissue from the upper eyelids (colobomas); cysts on the eyeballs (epibulbar dermoids and lipodermoids); abnormal smallness of the eyes (microphthalmia); narrowing of the eyelid folds (palpebral fissures); and/or abnormal deviation of one eye in relation to the other (strabismus). Some affected individuals also have incomplete development, absence, and/or fusion of certain vertebrae. The disorder may also be characterized by additional skeletal, cardiac, neurologic, lung (pulmonary), renal, and/or gastrointestinal (GI) abnormalities. Goldenhar syndrome (OAV spectrum) usually appears to occur sporadically in the absence of a family history. However, in some cases, more than one family member has been affected, suggesting autosomal dominant or autosomal recessive inheritance. Some researchers indicate that the disorder may be caused by the interaction of multiple genes, possibly in association with environmental factors (multifactorial inheritance). (For further information, choose "Goldenhar" as your search term in the Rare Disease Database.)

Chromosome 9, Trisomy 9p is a rare chromosomal disorder in which a portion of the 9th chromosome appears three times (trisomy) rather than twice in cells of the body. The trisomy may involve a portion of the short arm (9p), the entire short arm, or the short arm and a portion of the long arm (9q) of chromosome 9. (As noted above [see "Causes"], each chromosome contains a short arm known as "p" and a long arm designated as "q," with both arms further subdivided into bands that are numbered.) Evidence suggests that, in many cases, associated symptoms and findings may be relatively similar among affected infants despite differing lengths of the trisomic (duplicated) segment of 9p. However, in individuals with larger trisomies, such as those that extend through bands 9q22 or 9q32, additional clinical findings may also be present that appear to correlate with the extent of the duplication.

Generally, according to investigators, trisomies involving part or all of 9p and, in some cases, extending to band 9q11-13 may be characterized by moderate to severe mental retardation; psychomotor retardation; short stature; and distinctive craniofacial malformations. Such craniofacial defects may include a small head (microcephaly); a wide mouth with downturned corners; a relatively bulbous nose; low-set, "cup-shaped" ears; deeply set, widely spaced eyes; downwardly slanting eyelid folds (palpebral fissures); and/or an unusually short vertical groove in the center of the upper lip (philtrum). However, in addition to such features, congenital heart defects, other skeletal abnormalities (e.g., congenital hip dislocation), intrauterine growth retardation, and additional craniofacial malformations (e.g., micrognathia, cleft lip and cleft palate) are more common with trisomies extending to band 9q22-q32. In addition, evidence indicates that, in individuals with larger trisomies involving more of 9q, clinical features resemble those associated with Chromosome 9, Trisomy Mosaic. In some cases, Chromosome 9, Trisomy 9p appears to result from a balanced chromosomal rearrangement in one of the parents. In others, it is thought to arise from spontaneous (de novo) errors very early in embryonic development that occur for unknown reasons (sporadically). (For further information, please choose "trisomy 9p" as your search term in the Rare Disease Database.)

Chromosome 9, Tetrasomy 9p is a rare chromosomal disorder in which the short arm of chromosome 9 (9p) is present four times (tetrasomy) rather than twice in all or some cells of the body. Although many associated symptoms and findings may be similar to those seen in individuals with Trisomy 9p, researchers suggest that such features may be more variable or severe in some cases. Characteristic abnormalities associated with Tetrasomy 9p may include growth deficiency; psychomotor retardation; moderate to severe mental retardation; and various craniofacial, skeletal, heart (cardiac), kidney (renal), and/or other physical defects. Craniofacial abnormalities may include an unusually small head (microcephaly); a bulbous nose; low-set, malformed ears; a downslanted mouth; deeply set, widely spaced eyes; a short neck; and/or other features. Chromosome 9, Tetrasomy 9p appears to result from spontaneous (de novo) errors very early in embryonic development. (For more information, choose "Tetrasomy 9p" as your search term in the Rare Disease Database.)

Additional chromosomal disorders may be characterized by symptoms and findings similar to those associated with Chromosome 9, Trisomy Mosaic. Chromosomal testing is necessary to confirm the specific chromosomal abnormality present. (For further information on such disorders, choose the name of the specific chromosomal disorder in question or use "chromosome" as your search term in the Rare Disease Database.)

Standard Therapies

Diagnosis
In some cases, the diagnosis of Chromosome 9, Trisomy Mosaic may be suggested before birth (prenatally) by ultrasound and various specialized tests that enable analysis of fluid or tissue samples extracted from the fetus or the uterus (e.g., amniocentesis, chorionic villus sampling [CVS], and/or fetal blood sampling). During fetal ultrasonography, reflected sound waves create an image of the developing fetus, potentially revealing certain characteristic findings that suggest a chromosomal disorder or other developmental abnormalities. During amniocentesis, a sample of fluid that surrounds the developing fetus is removed and analyzed, while CVS involves the removal of tissue samples from a portion of the placenta. Fetal blood samples may be obtained with a needle guided via ultrasound into a blood vessel in the umbilical cord. Chromosomal studies performed on such fluid or tissue samples may reveal Trisomy 9 Mosaicism. Experts indicate that the nature of mosaicism may complicate prenatal diagnosis for this chromosomal disorder, as test samples may not be representative of the entire cell population of the fetus and may not accurately reflect the distribution of abnormal and normal cell lines. In addition, there have been cases reported in the medical literature in which prenatal testing detected mosaicism, but the infant was born with normal chromosomes.

Chromosome 9, Trisomy Mosaic may be diagnosed and/or confirmed after birth (postnatally) by a thorough clinical evaluation, identification of characteristic physical findings, chromosomal analysis, and other specialized tests. In addition, diagnostic evaluation may include various studies, including advanced imaging techniques, to help detect and/or characterize certain abnormalities that may be associated with the disorder (e.g., particular craniofacial defects, other skeletal malformations, brain abnormalities, etc.). In addition, a thorough cardiac evaluation may be advised to detect any heart abnormalities that may be present. Such evaluation may include a thorough clinical examination; evaluation of heart and lung sounds with a stethoscope; x-ray studies; tests that record the electrical activities of the heart muscle (electrocardiography [EKG]); a technique in which sound waves are directed toward the heart, enabling evaluations of cardiac motion and structure (echocardiogram); or other measures.

Treatment
The treatment of Chromosome 9, Trisomy Mosaic is directed toward the specific symptoms that are apparent in each individual. Such treatment may require the coordinated efforts of a team of medical professionals, such as pediatricians; surgeons; heart specialists (cardiologists); physicians who diagnose and treat abnormalities of the skeleton, joints, muscles, and related tissues (orthopedists); neurologists; and/or other health care professionals.

In affected individuals with congenital heart defects, treatment with certain medications, surgical intervention, and/or other measures may be required. For those with hydrocephalus, disease management may include administration of particular medications to help reduce the rate of cerebrospinal fluid (CSF) production, shunting, or other measures. (Shunts are specialized devices that drain excess CSF away from the brain to another part of the body for absorption into the bloodstream.) In addition, in some cases, physicians may recommend surgical repair or correction of other craniofacial, musculoskeletal, genital, and/or other malformations associated with the disorder. The specific surgical procedures performed will depend upon the nature and severity of the anatomical abnormalities, their associated symptoms, and other factors.

Early intervention services may also be important in ensuring that affected children reach their potential. Special services that may be beneficial include special remedial education, physical therapy, and/or other medical, social, and/or vocational services. Genetic counseling will also be of benefit for families of affected children. Other treatment for this disorder is symptomatic and supportive.

Investigational Therapies

Information on current clinical trials is posted on the Internet at www.clinicaltrials.gov. All studies receiving U.S. government funding, and some supported by private industry, are posted on this government web site.

For information about clinical trials being conducted at the NIH Clinical Center in Bethesda, MD, contact the NIH Patient Recruitment Office:

Tollfree: (800) 411-1222
TTY: (866) 411-1010
Email: prpl@cc.nih.gov

For information about clinical trials sponsored by private sources, contact:
www.centerwatch.com.

Organizations related to Chromosome 9, Trisomy Mosaic

(Please note that some of these organizations may provide information concerning certain conditions potentially associated with this disorder [e.g., mental retardation, craniofacial abnormalities, congenital heart defects, etc.].)

References

TEXTBOOKS
Behrman RE, et al., eds. Nelson Textbook of Pediatrics. 16th ed. Philadelphia, Pa: W.B. Saunders Company; 2000:1811.

Jones KL. Smith's Recognizable Patterns of Human Malformation. 5th ed. Philadelphia, PA: W.B. Saunders Company; 1997:28-29, 50-54.

Gorlin RJ, et al., eds. Syndromes of the Head and Neck. 3rd ed. New York, NY: Oxford University Press; 1990:82-84.

Buyse ML. Birth Defects Encyclopedia. Dover, Mass: Blackwell Scientific Publications, Inc; 1990:354-56.

JOURNAL ARTICLES
Dereser-Dennl M, et al. Hypomelanosis Ito in translocation trisomy 9/mosaicism (46,XX/46,XX,t(9;9)(p24;p24)). Spontaneous remission in childhood. Hautarzt. 2000;51:688-92.

Okumura A, et al. Two patients with trisomy 9 mosaicism. Pediatr Int. 2000;42:89-91.

Saneto RP, et al. Atypical manifestations of two cases of trisomy 9 syndrome: rethinking development delay. Am J Med Genet. 1998;80:42-45.

Wooldridge J, et al. Trisomy 9 syndrome: report of a case with Crohn disease and review of the literature. Am J Med Genet. 1995;10:258-64.

McDuffie RS Jr. Complete trisomy 9: case report with ultrasound findings. Am J Perinatol. 1994;11:80-84.

Zelante L, et al. Cytogenetic and molecular analysis of trisomy 9. Case report and review. Ann Genet. 1994;37:21-25.

Tarani L, et al. Trisomy 9 mosaicism syndrome. A case report and review of the literature. Ann Genet. 1994;37:14-20.

Bureau YA, et al. Prenatal diagnosis of trisomy 9 mosaic presenting as a case of Dandy-Walker malformation. Prenat Diagn. 1993;13:79-85.

Willatt LR, et al. A male with trisomy 9 mosaicism and maternal uniparental disomy for chromosome 9 in the euploid cell line. J Med Genet. 1992;29:742-44.

Levy I, et al. Gastrointestinal abnormalities in the syndrome of mosaic trisomy 9. J Med Genet. 1989;26:280-81.

Herranz JL, et al. Mosaic trisomy 9. Report of a new case and delimitation of the clinical syndrome. An Esp Pediatr. 1987;26:191-96.

Delicado A, et al. Complete trisomy 9. Two additional cases. Ann Genet. 1985;28:63-66.

Kaminker CP, et al. Mosaic trisomy 9 syndrome with unusual phenotype. Am J Med Genet. 1985;22:237-41.

Wilson GN, et al. Trisomy 9 mosaicism: another etiology for the manifestations of Goldenhar syndrome. J Craniofac Genet Dev Biol. 1983;3:313-16.

Sanchez JM, et al. Report of a new case and clinical delineation of mosaic trisomy 9 syndrome. J Med Genet. 1982;19:384-87.

Ginsberg J, et al. Pathologic features of the eye in trisomy 9. J Pediatr Ophthalmol Strabismus. 1982;19:37-41.

Frydman M, et al. Normal psychomotor development in a child with mosaic trisomy and pericentric inversion of chromosome 9. J Med Genet. 1981;18:390-92.

Katayama KP, et al. Clinical delineation of trisomy 9 syndrome. Obstet Gynecol. 1980;56:665-68.

Akatsuka A, et al. Trisomy 9 mosaicism with punctate mineralization in developing cartilages. Eur J Pediatr. 1979;131:271-75.

Qazi QH, et al. Trisomy 9 syndrome. Clin Genet. 1977;12:221-26.

Bowen P, et al. Trisomy 9 mosaicism in a newborn infant with multiple malformations. J Pediatr. 1974;85:95-97.

Feingold M, et al. A case of trisomy 9. J Med Genet. 1973;10:184-87.

Haslam RH, et al. Trisomy 9 mosaicism with multiple congenital anomalies. J Med Genet. 1973;10:180-84.

The information in NORD’s Rare Disease Database is for educational purposes only. It should never be used for diagnostic or treatment purposes. If you have questions regarding a medical condition, always seek the advice of your physician or other qualified health professional. NORD’s reports provide a brief overview of rare diseases. For more specific information, we encourage you to contact your personal physician or the agencies listed as “Resources” on this report.

Report last updated: 2008/05/10 00:00:00 GMT+0

0-9 - A - B - C - D - E - F - G - H - I - J - K - L - M - N - O - P - Q - R - S - T - U - V - W - X - Y - Z

NORD's Rare Disease Information Database is copyrighted and may not be published without the written consent of NORD.

 
Copyright ©2014 NORD - National Organization for Rare Disorders, Inc. All rights reserved.
The following trademarks/registered service marks are owned by NORD: NORD, National Organization for Rare Disorders, the NORD logo, RareConnect. .