A Caucasian boy with a de novo complex chromosome rearrangement owing to six chromosome breaks was small for gestation with microcephaly, complex heart defect, hypotonia, left auricular pit, simian creases, and ankyloblepharon filiforme adnatum. The rearrangement included two translocation, t(15;21) (q22;q22) and t(3;11)(q21;q11), with the derivative 3 showing in addition pericentric inversion (p11q11) and interstitial deletion (q11q21). Based on parental satellite polymorphisms of chromosomes 15 and 21, the paternal gamete appeared to be the source of the chromosome rearrangement. There was no evidence of mitotic chromosome instability. A review of 36 reported patients with complex chromosome rearrangements secondary to more than four breaks indicates that complex chromosome rearrangements are compatible with gamete survival, zygote formation, and postnatal life. The latter is usually compromised by structural defects, growth retardation, and often mental retardation.
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