Clinical and Genetic Characteristics of a Cohort with Distal Vaginal Atresia

Abstract

Distal vaginal atresia is a rare abnormality of female reproductive tract in which the vagina is closed or absent. The distal vagina may be replaced by fibrous tissue and the condition is often not diagnosed until a girl fails to begin having periods at puberty. Although it is a congenital disorder, potential genetic causes of distal vaginal atresia are still unknown. We recruited a cohort of 39 patients with distal vaginal atresia and analyzed their phenotypic and genetic features. In addition to the complaint of distal vaginal atresia, approximately 17.9% (7/39) of the patients had other Müllerian anomalies, and 17.9% (7/39) of the patients had other structural abnormalities, including renal-tract, skeletal and cardiac anomalies. Using genome sequencing, we identified two fragment duplications on 17q12 encompassing HNF1B and LHX1, two dosage-sensitive genes with candidate pathogenic variants, in two unrelated patients. A large fragment of uniparental disomy was detected in another patient, affecting genes involved in cell morphogenesis and connective tissue development. Additionally, we reported two variants on TBX3 and AXL, leading to distal vaginal atresia in mutated mouse model, in our clinical subjects for the first time. Essential biological functions of these detected genes with pathogenic variants included regulating reproductive development and cell fate and patterning during embryogenesis. We displayed the comprehensive clinical and genetic characteristic of a cohort with distal vaginal atresia and they were highly heterogeneous both phenotypically and genetically. The duplication of 17q12 in our cohort could help to expand its phenotypic spectrum and potential contribution to the distal vaginal atresia. Our findings of pathogenic genetic variants and associated phenotypes in our cohort could provide evidence and new insight for further research attempting to reveal genetic causes of distal vaginal atresia.

A Chinese patient with Rothmund–Thomson syndrome

“…The DNA concentration was measured using the Qubit Fluorometer 3.0, and WGS libraries were constructed using the BGISEQ‐500 Library Kit. Each sample's library was sequenced on the DNBSEQ‐T1 platform, generating at least 600 million reads in 2 × 100 paired‐end reads (~40× coverage from ~120 Gb raw data for each sample) (Kang et al., 2022).…”

Efficacy and safety of laparoscopic vaginoplasty with peritoneal flaps and cervicoplasty in patients with congenital cervical and complete vaginal atresia: a pilot study

“…Congenital vaginal atresia is a rare malformation of the female reproductive tract that can be classified into partial and complete vaginal atresia ( 1 ). Congenital vaginal atresia can obstruct menstrual blood flow and may also lead to a series of clinical problems, such as amenorrhea, abdominal pain, pelvic mass, and endometriosis, which require timely surgical dissociation to relieve the obstruction ( 2 ). Complete vaginal atresia is usually associated with cervical dysplasia or cervical atresia ( 1 , 3 , 4 ).…”