A low frequency mosaicism for monosomy 21 in a live born female

Monosomy 21, whether homogeneous or as a mosaicism, is very uncommon. We report here a 3-month-old white female with a low degree of monosomy 21 in the blood karyotype (6.5%, 110 cells counted) but not in the skin fibroblasts, which contained only the normal chromosome complement. The patient's physical features included microcephaly with frontal slanting; prominent occiput; ridge-shaped sutures; agenesis of the corpus callosum; large, prominent ears; high and narrow palate; micrognathia; tetralogy of Fallot; crowded toes; and dry, thick skin with very little subcutaneous tissue. The case is discussed in light of the suggested clinical features of the "monosomy 21" syndrome and the possible implications of such a low-grade mosaicism in prenatal diagnosis.