The spectrum of 4q- syndrome illustrated by a case series

Deletions of the long arm of chromosome 4 detectable by cytogenetic analysis (standard karyotyping), fluorescent in situ hybridisation (FISH), multiplex ligation-dependent probe amplification (MLPA) or comparative genomic hybridisation (CGH) cause 4q- syndrome. Here we describe 3 cases of 4q- syndrome which demonstrate the variations in clinical presentation, diagnosis and prognosis observed in this condition. Patient 1 was a female foetus diagnosed with del(4)(q33) following chorionic villus sampling (CVS) at 14 weeks, and the pregnancy was terminated at 18 weeks. Patient 2 was a 5-month-old boy with del(4)(q31.3) and complex congenital heart disease. He also had a duplication of chromosome 6p and died of cardiac failure. Patient 3 is a 2-year-old girl with mild dysmorphic features and an interstitial deletion del(4)(q22.1q23). She has no major malformations and only slight developmental delay.

► The 4q deletion syndrome is a multiple congenital anomaly and mental retardation syndrome.
► Affected patients show similar features despite differences in location and size of the deletion.
► This may be explained by interaction of distant genes, gene dosage effects and epigenetic factors.
► Array-CGH improves diagnostic accuracy and genotype-phenotype correlations in 4q- syndrome.