Table 1 Clinical and autopsy abnormalities in XP-A (XP12BE) and XP-D (XP18BE) patients compared to two XP-C patients
| Â | Case 1 | Case 2 | Case 3 | Case 4 |
|---|---|---|---|---|
| Â | XP-A (XP12BE) (GM05509)* | XP-D (XP18BE) (CRL1275)**(XPKABE) | XP-C (XP24BE) (GM11638)* | XP-C (XP1BE) (GM10881)* |
| Â | late onset juvenile form XP | XP with neurological degeneration | no neurological disease | subclinical neurodegeneration |
Age at death/Gender/DOB | d44 yr/F b1965 | d45 yr/F b1964 | d35 yr/F b1972 | d49 yr/F b1944 |
XP complementation group | XP-A | XP-D | XP-C | XP-C |
Mutations (see text for details) | compound heterozygote | compound heterozygote | compound heterozygote | homozygous |
CLINICAL FINDINGS | Â | Â | Â | Â |
Height | 145.5 cm (<3 %ile) | 165 cm (50–75 %ile) | 153.3 cm - 34 yr (10 %ile) | 160 cm (25–50 %ile) |
Weight | 32 kg (<3 %ile) | 60.6 kg (50 %ile) | 56.7 kg - 35 yr (50 %ile) | 76.6 kg (50–75 %ile) |
Cachexia? | yes | no | no | no |
Acute skin sunburning on minimal exposure? | yes | yes | no | no |
Freckle-like skin lesions on sun exposed skin? | yes | yes | yes | yes |
Skin cancer?1 | >200 BCC and 1 SCC | 7 SCC and 2 BCC | >200 (190-BCC,3 SCC and ~50 MIS) | >200 (>35 BCC, >37 SCC, 2 soft tissue sarcoma, 28 MIS and 6 Mel) |
Microcephaly? | yes (2%ile) | no | no | no |
Hearing | progressive high frequency sensorineural hearing loss | progressive high frequency sensorineural hearing loss | normal | subclinical high frequency sensorineural hearing loss at 48 yr |
Deep tendon reflexes | absent | absent (1995) | normal | normal at 37 yr, ankle hyporeflexia at 43 yr |
Able to walk? | no | no | yes | yes |
Able to talk? | no | no | yes | yes |
Able to care for self? | no | no | yes | yes |
Difficulty swallowing? | yes - G-tube - age 37 yr | yes - G-tube - age 44 yr | normal | normal |
Primary ovarian failure? | no | unknown | yes | yes |
Anterior eye abnormalities | bilateral pinguecula, exposure keratopathy2 | bilateral pinguecula, exposure keratopathy2 | corneal scar, pterygium | blateral orbital exenterations for infiltrative SCC of globe3 |
Eye - retinal degeneration | optic nerve atrophy2 | no2 | no | unknown |
Imaging of brain | diffuse cerebral and cerebellar atrophy (41 yr −2006) | minimal cortical atrophy (19 yr- 1983) | left frontal lobe tumor | slight cerebral cortical atrophy and ventricular enlargement (44 yr) |
AUTOPSY FINDINGS | Â | Â | Â | Â |
Thick calvarium? | no | yes; cortical sclerosis, no tumor seen | no | no |
Brain weight [normal 1240 g (1050–1550)] | 660g (~ 6mo) | 760g (~1 yr) | 1330g [normal] | 1300g [normal] |
Brain atrophy? | yes - diffuse | yes - diffuse | no atrophy - tumor | no, except optic nerves secondary to orbital exenteration |
Dilated brain ventricles? | yes | yes | asymmetric due to tumor | no |
Thin corpus callusum? | yes | yes | no remarkable features | no |
Histological neuronal loss? | yes - hippocampus, pons, medulla, midbrain, thinned cortex, small cerebellum | yes – outer cortex (neuronal loss and vacuolization resembling status spongiosis), hippocampus (CA2 and CA3 regions), basal ganglia, cerebellum | no remarkable features | no |
Histological gliosis? | yes - midbrain, pons, medulla, basal ganglia, thalamus, hippocampus | yes - cortex, hippocampus | no remarkable features | yes - molecular layer of cerebellum |
Histological myelin pallor? | yes - temporal lobe, frontal lobe, cerebellum | yes - basal ganglia, cerebellum | no remarkable features | no remarkable features |
Cerebellum | Atrophy, loss of Purkinje cells with axonal swelling, Bergmann astrocytosis | atrophy, patchy Purkinje cell loss | no remarkable features | moderate to marked Purkinje cell loss with Bergmann astrocyte proliferation |
Dorsal root ganglia | no remarkable features | no remarkable features | no remarkable features | severe neuronal loss |
Histology of peripheral nerves | minimal focal perivascular inflammation in the adjacent connective tissue | no pathologic changes | femoral nerve - unremarkable | median nerve mild focal interstital fibrosis, sural nerve - no pathologic diagnosis |
EM of peripheral nerves | axonal neuropathy | not done | not done | not done |
Eye pathology? | neovascularization of cornea, optic atrophy2 | neovascularization of cornea, cataract2 | not done | sockets of orbits lined with skin |
Histology of muscles | myofiber type -grouping | no pathologic changes | unremarkable | angulated fibers of skeletal muscles |
Histology of Pharynx | inflammation and fibrosis | chronic inflammation | normal | normal |
Esophagus | no pathologic changes | T-lymphocyte infiltration of Auerbach's plexus | no pathologic changes | no pathologic changes |
Larynx | no pathologic changes | ulceration with chronic and acute inflammation | pink mucosa | delicate pink mucosa |
Lungs | normal | bronchopneumonia | bilateral pneumonia | pulmonary emboli |
Thyroid | normal | normal | cystic nodule filled with pink, amprphous material, consistent with goiter | follicular adenomas |
Ovaries | no pathologic changes | no pathologic changes | small - microscopic fibrosis, no follicles | covered by tumor |
Uterus | leiomyomas | adenomyosis | small - calcified nodules 1 cm, leiomyomas | covered by tumor |
Breasts | fibrocystic changes | fibrocystic changes | no masses | no masses |
Cause of death | XP-related neurologic degeneration | XP-related neurologic degeneration | Glioblastoma WHO grade IV. Tumor cells positive for GFAP and IDH1, negative for EGFR. P53 positive in <5% tumor cells. | metastasis of well differentiated mucinous adenocarcinoma of uterine endocervix |