Mosaicism
Mosaicism • Two different genotypes that developed from a single fertilized egg • Why? • Event during cell division • Chromosomal mutation during development • Gene mutation during development (somatic) • X-inactivation (females)
Rudolf Happle, M.D. • Well-renowned pediatric dermatologist • Professor in Marburg and Freiburg • Defined several inherited dermatologic conditions • Helped us understand concepts in dermatology
The term mosaicism (somatic segregation) • 1901 Rediscovery of Mendelian inheritance • 1904 Valentin Häcker • Mosaikbastarde: animals showing traits from both of their parents in a mosaic pattern. • 1913 Collins • Variegated pattern in seeds of maize
Jumping Genes • Investigated mosaic patterns in maize • Jumping genes • Epigenetic mosaicism Barbara McClintock
Happle R. Mosaicism in Human Skin
Incontinentia pigmenti The pattern of lesions follows the lines of Blaschko. Also the areas of normal skin alternating with normal skin represent areas of random inactivation of x or X. Widukind Lenz described the alternating lines as an example of X inactivation
Somatic mosaicism • A postzygotic mutation CAN affect gonads, therefore, an individual with type 1 segmental disease may have offsprings with non- segmental involvement! Happle R. Mosaicism in Human Skin
Type 1 segmental involvement • Tuberous sclerosis Trauner MA. J Am Acad Dermatol 2003;49:S164-6
Type 2 segmental involvement Pronounced manifestation in the background of milder diffuse manifestation Heterozygous embryo featuring loss of heterozygosity Ø in the affected area Examples include PTEN hamartoma syndrome
Genomic X-chromosome mosaicism in male patients Incontinentia pigmenti in males • 46,XY males present with incontinentia pigmenti (Bloch-Sulzberger syndrome) because of postzygotic X chromosome NEMO deletions • The other explanation for males affected is 47,XXY karyotype
Patterns of skin involvement • Lines of Blaschko • Checkerboard pattern • Phylloid pattern • Patchy pattern without midline separation • Lateralization pattern • Sash-like pattern
Patterns of skin involvement Happle R. Mosaicism in Human Ski
Epidermal nevus syndromes
Ep Epiderma rmal n nevu vus s s syndrome ome • Sporadic patients • Cutaneous manifestations • Skeletal manifestations • Central nervous system manifestations
Ep Epiderma rmal n nevu vus s s syndrome ome • A syndrome that does not really exist! • Schimmelpenning • Sebaceous gland nevi, CNS anomalies, eye problems • Νevus comedonicus • Cataracts • Pigmented and hairy nevus syndrome • Becker nevus, chest hypoplasia, scoliosis • Proteus syndrome • Hamartomas • CHILD syndrome • Females, congenital hemidysplasia, ichthyosiform erythroderma, limb defects
McCune-Albright syndrome
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