Histogenesis of retinal dysplasia in trisomy 13

Ada Chan, Satyanarayana Lakshminrusimha, Reid Heffner, Federico Gonzalez-Fernandez

Research output: Contribution to journalArticle

18 Citations (Scopus)

Abstract

Background. Although often associated with holoprosencephaly, little detail of the histopathology of cyclopia is available. Here, we describe the ocular findings in a case of trisomy 13 to better understand the histogenesis of the rosettes, or tubules, characteristic of the retinal dysplasia associated with this condition. Methods. A full pediatric autopsy was performed of a near term infant who died shortly after birth from multiple congenital anomalies including fused facial-midline structures. A detailed histopathological study of the ocular structures was performed. The expression of interphotoreceptor retinoid-binding protein (IRBP), cellular retinal-binding protein (CRALBP), rod opsin, and Sonic Hedgehog (Shh) were studied by immunohistochemistry. Results. Holoprosencephaly, and a spectrum of anatomical findings characteristic of Patau's syndrome, were found. Cytogenetic studies demonstrated trisomy 13 [47, XY, +13]. The eyes were fused but contained two developed separate lenses. In contrast, the cornea, and angle structures were hypoplastic, and the anterior chamber had failed to form. The retina showed areas of normally laminated neural retina, whereas in other areas it was replaced by numerous neuronal rosettes. Histological and immunohistochemical studies revealed that the rosettes were composed of differentiated retinal neurons and Müller cell glia. In normally laminated retina, Shh expression was restricted to retinal-ganglion cells, and to a population of neurons in the inner zone of the outer nuclear layer. In contrast, Shh could not be detected in the dysplastic rosettes. Conclusion. The histopathology of cyclopia appears to be more complex than what may have been previously appreciated. In fact, the terms "cyclopia" and "synophthalmia" are misnomers as the underlying mechanism is a failure of the eyes to form separately during development. The rosettes found in the dysplastic retina are fundamentally different than those of retinoblastoma, being composed of a variety of differentiated cell types. The dysplastic rosettes are essentially laminated retina failing to establish a polarized orientation, resulting in the formation of tubules. Finally, our findings suggest that defective ganglion cell Shh expression may contribute to the ocular pathology of cyclopia.

Original languageEnglish (US)
Article number48
JournalDiagnostic Pathology
Volume2
Issue number1
DOIs
StatePublished - Dec 1 2007
Externally publishedYes

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Retinal Dysplasia
Retina
Holoprosencephaly
Rod Opsins
Multiple Birth Offspring
Retinal Neurons
Retinoblastoma
Retinal Ganglion Cells
Anterior Chamber
Cytogenetics
Neuroglia
Ganglia
Cornea
Lenses
Autopsy
Carrier Proteins
Immunohistochemistry
Trisomy 13 syndrome
Pediatrics
Pathology

ASJC Scopus subject areas

  • Pathology and Forensic Medicine
  • Histology

Cite this

Histogenesis of retinal dysplasia in trisomy 13. / Chan, Ada; Lakshminrusimha, Satyanarayana; Heffner, Reid; Gonzalez-Fernandez, Federico.

In: Diagnostic Pathology, Vol. 2, No. 1, 48, 01.12.2007.

Research output: Contribution to journalArticle

Chan, Ada ; Lakshminrusimha, Satyanarayana ; Heffner, Reid ; Gonzalez-Fernandez, Federico. / Histogenesis of retinal dysplasia in trisomy 13. In: Diagnostic Pathology. 2007 ; Vol. 2, No. 1.
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abstract = "Background. Although often associated with holoprosencephaly, little detail of the histopathology of cyclopia is available. Here, we describe the ocular findings in a case of trisomy 13 to better understand the histogenesis of the rosettes, or tubules, characteristic of the retinal dysplasia associated with this condition. Methods. A full pediatric autopsy was performed of a near term infant who died shortly after birth from multiple congenital anomalies including fused facial-midline structures. A detailed histopathological study of the ocular structures was performed. The expression of interphotoreceptor retinoid-binding protein (IRBP), cellular retinal-binding protein (CRALBP), rod opsin, and Sonic Hedgehog (Shh) were studied by immunohistochemistry. Results. Holoprosencephaly, and a spectrum of anatomical findings characteristic of Patau's syndrome, were found. Cytogenetic studies demonstrated trisomy 13 [47, XY, +13]. The eyes were fused but contained two developed separate lenses. In contrast, the cornea, and angle structures were hypoplastic, and the anterior chamber had failed to form. The retina showed areas of normally laminated neural retina, whereas in other areas it was replaced by numerous neuronal rosettes. Histological and immunohistochemical studies revealed that the rosettes were composed of differentiated retinal neurons and M{\"u}ller cell glia. In normally laminated retina, Shh expression was restricted to retinal-ganglion cells, and to a population of neurons in the inner zone of the outer nuclear layer. In contrast, Shh could not be detected in the dysplastic rosettes. Conclusion. The histopathology of cyclopia appears to be more complex than what may have been previously appreciated. In fact, the terms {"}cyclopia{"} and {"}synophthalmia{"} are misnomers as the underlying mechanism is a failure of the eyes to form separately during development. The rosettes found in the dysplastic retina are fundamentally different than those of retinoblastoma, being composed of a variety of differentiated cell types. The dysplastic rosettes are essentially laminated retina failing to establish a polarized orientation, resulting in the formation of tubules. Finally, our findings suggest that defective ganglion cell Shh expression may contribute to the ocular pathology of cyclopia.",
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