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25723000: Dysplasia (morphologic abnormality)

Status: current, Not sufficiently defined by necessary conditions definition status (core metadata concept). Date: 31-Jan 2002. Module: SNOMED CT core

Descriptions:

Id Description Lang Type Status Case? Module
43110010 Dysplasia en Synonym (core metadata concept) Active Entire term case insensitive (core metadata concept) SNOMED CT core
756074016 Dysplasia (morphologic abnormality) en Fully specified name Active Entire term case insensitive (core metadata concept) SNOMED CT core
1080891000241117 dysplasie fr Synonym (core metadata concept) Active Entire term case insensitive (core metadata concept) SNOMED CT Switzerland NRC maintained Module

38 descendants. Search Descendants:

Expanded Value Set

Outbound Relationships Type Target Active Characteristic Refinability Group Values
Dysplasia Is a Growth alteration true Inferred relationship Some
Dysplasia Is a Lesion (morphologic abnormality) true Inferred relationship Some
Inbound Relationships Type Active Source Characteristic Refinability Group
Dentate dysplasia Associated morphology True Dysplasia Inferred relationship Some 1
Papillon-Lefèvre syndrome Associated morphology True Dysplasia Inferred relationship Some 1
Neonatal osteosclerotic dysplasia (disorder) Associated morphology True Dysplasia Inferred relationship Some 1
Blomstrand dysplasia (disorder) Associated morphology True Dysplasia Inferred relationship Some 1
A rare disorder defined by generalised osteosclerosis with periosteal bone formation, characteristic facial dysmorphism, brain abnormalities including intracerebral calcifications, and neonatal lethal course. Mutations in the FAM20C gene have a causative role in lethal osteosclerotic bone dysplasia. The condition is transmitted in an autosomal recessive manner. Associated morphology True Dysplasia Inferred relationship Some 1
Ectodermal syndrome with hair-tooth-sweating defects (disorder) Associated morphology True Dysplasia Inferred relationship Some 1
Ectodermal syndrome with hair-sweating defects (disorder) Associated morphology True Dysplasia Inferred relationship Some 1
Jarcho-Levin syndrome Associated morphology True Dysplasia Inferred relationship Some 1
Seckel syndrome Associated morphology True Dysplasia Inferred relationship Some 1
Klippel-Feil sequence Associated morphology True Dysplasia Inferred relationship Some 1
Desmosterolosis (disorder) Associated morphology True Dysplasia Inferred relationship Some 1
A rare X-linked syndromic intellectual disability considered to be a severe variant of dyskeratosis congenita characterized by intrauterine growth retardation, microcephaly, cerebellar hypoplasia, progressive combined immune deficiency and aplastic anemia. Associated morphology True Dysplasia Inferred relationship Some 2
Autosomal recessive dyskeratosis congenita Associated morphology True Dysplasia Inferred relationship Some 2
Autosomal dominant dyskeratosis congenita (disorder) Associated morphology True Dysplasia Inferred relationship Some 2
Congenital pulmonary lymphatic dysplasia syndrome (disorder) Associated morphology True Dysplasia Inferred relationship Some 1
X-linked dyskeratosis congenita (disorder) Associated morphology True Dysplasia Inferred relationship Some 2
Marshall-Smith syndrome Associated morphology True Dysplasia Inferred relationship Some 1
Dyskeratosis congenita Associated morphology True Dysplasia Inferred relationship Some 2
Revesz syndrome is a rare severe phenotypic variant of dyskeratosis congenita with an onset in early childhood, characterized by features of DC (e.g. skin hyper/hypopigmentation, nail dystrophy, oral leukoplakia, high risk of bone marrow failure (BMF) and cancer, developmental delay sparse and fine hair) in conjunction with bilateral exudative retinopathy, and intracranial calcifications. Associated morphology True Dysplasia Inferred relationship Some 11
Wildervanck syndrome Associated morphology True Dysplasia Inferred relationship Some 1
A rare genetic mandibulofacial dysostosis characterized by bilateral symmetrical oto-mandibular dysplasia including underdeveloped cheekbones (malar hypoplasia), a very small low jaw (micrognathia) and downward-slanting palpebral fissures, coloboma of the lower eyelids, microtia, hearing loss and without abnormalities of the extremities. Intelligence is normal. Associated morphology True Dysplasia Inferred relationship Some 2
Focal facial dermal dysplasias (FFDD) are rare ectodermal dysplasias, characterized by congenital bitemporal (resembling forceps marks) or preauricular scar-like lesions associated with additional facial and or systematic manifestations. 4 types of FFDD are described. FFDD types II and III present with a variable facial dysmorphism including distichiasis (upper lashes) or lacking eyelashes, and upward slanting and thinned lateral eyebrows with a flattened nasal bridge and full upper lip. FFDD types I and IV are infrequently associated with extra-cutaneous anomalies. Associated morphology True Dysplasia Inferred relationship Some 1
Focal facial dermal dysplasia type I (FFDD1), also known as Brauer syndrome, is a focal facial dysplasia with characteristics of congenital bitemporal cutis aplasia. The bitemporal rarely unilateral hypoplastic scar-like lesions in FFDD, resembling forceps marks, are usually the only manifestations of FFDD1. Most patients usually have normal intelligence. Transmitted in an autosomal dominant manner with full penetrance. Associated morphology True Dysplasia Inferred relationship Some 1
Focal facial dermal dysplasia type II (FFDD2) is a focal facial dermal dysplasia with characteristics of congenital bitemporal scar-like depressions with additional facial dysmorphic features. Cardiac and genital or urinary abnormalities have been rarely noted. Developmental delay, severe intellectual disability, behavioural problems, and learning difficulties may be observed. Transmitted in an autosomal dominant manner with variable expressivity and incomplete penetrance. Associated morphology True Dysplasia Inferred relationship Some 1
Focal facial dermal dysplasia type III (FFDD3) is a rare focal facial dermal dysplasia with primary characteristics of congenital bitemporal scar-like depressions and a typical but variable facial dysmorphism. Caused by homozygous mutations in the TWIST2 gene, which encodes a bHLH transcription factor involved in dermal facial development in mammals. However, the majority of unrelated FFDD3 patients evaluated have had normal TWIST2 sequences, indicating the molecular genetic heterogeneity of the disorder. Many cases are sporadic. Inheritance is autosomal recessive for patients with TWIST2 mutations. Associated morphology True Dysplasia Inferred relationship Some 1
Focal facial dermal dysplasia type IV (FFDD4) is a rare focal facial dysplasia with characteristics of congenital isolated preauricular and/or cheek blister scar-like lesions. Affected FFDD4 patients typically do not present with extra-cutaneous manifestations, although in a small number of cases, a hair collar sign (circumscription of the cutaneous lesion with terminal hairs), polyps on the buccal mucosa with a similar distribution pattern, and developmental delay have been reported. An autosomal recessive trait. Associated morphology True Dysplasia Inferred relationship Some 1
An extremely rare type of severe combined immunodeficiency (SCID) characterized by the classical signs of T-B- SCID (severe and recurrent infections, diarrhea, failure to thrive, absence of T and B lymphocytes), associated with skeletal anomalies like short stature, bowing of the long bones and metaphyseal abnormalities of variable degree of severity. Associated morphology True Dysplasia Inferred relationship Some 1
A rare congenital ectodermal disorder characterised by vascularising keratitis, hyperkeratotic skin lesions and hearing loss. Associated morphology True Dysplasia Inferred relationship Some 5
Autosomal recessive keratitis-ichthyosis-deafness syndrome (disorder) Associated morphology True Dysplasia Inferred relationship Some 4
Barber-Say syndrome (disorder) Associated morphology True Dysplasia Inferred relationship Some 2
Segmental odontomaxillary dysplasia (disorder) Associated morphology True Dysplasia Inferred relationship Some 1
Congenital dysplasia of aortic valve (disorder) Associated morphology True Dysplasia Inferred relationship Some 1
Congenital dysplasia of truncal valve Associated morphology True Dysplasia Inferred relationship Some 1
Severe achondroplasia-developmental delay-acanthosis nigricans syndrome is characterized by the association of severe achondroplasia with developmental delay and acanthosis nigricans. It has been described in four unrelated individuals. Structural central nervous system anomalies, seizures and hearing loss were also reported, together with bowing of the clavicle, femur, tibia and fibula in some cases. The syndrome is caused by a Lys650Met substitution in the kinase domain of fibroblast growth factor receptor 3 (encoded by the FGFR3 gene; 4p16.3). Associated morphology True Dysplasia Inferred relationship Some 3
Cerebro-costo-mandibular syndrome Associated morphology True Dysplasia Inferred relationship Some 2
A rare complex overgrowth syndrome characterised by progressive overgrowth of the skeleton, skin, adipose, and central nervous systems. Associated morphology True Dysplasia Inferred relationship Some 1
Port-wine stain in proteus syndrome (disorder) Associated morphology True Dysplasia Inferred relationship Some 4
Short rib polydactyly syndrome Associated morphology True Dysplasia Inferred relationship Some 2
Type IV short rib polydactyly syndrome Associated morphology True Dysplasia Inferred relationship Some 2
Type III short rib polydactyly syndrome Associated morphology True Dysplasia Inferred relationship Some 2
The more common type of Robinow syndrome characterized by mild to moderate limb shortening and abnormalities of the head, face and external genitalia. Associated morphology True Dysplasia Inferred relationship Some 2
Autosomal recessive Robinow syndrome Associated morphology True Dysplasia Inferred relationship Some 2
Bilateral Madelung deformity (disorder) Associated morphology True Dysplasia Inferred relationship Some 1
Bilateral Madelung deformity (disorder) Associated morphology True Dysplasia Inferred relationship Some 2
Bilateral Madelung deformity (disorder) Associated morphology True Dysplasia Inferred relationship Some 3
Bilateral Madelung deformity (disorder) Associated morphology True Dysplasia Inferred relationship Some 4
Bilateral Madelung deformity (disorder) Associated morphology True Dysplasia Inferred relationship Some 5
Bilateral Madelung deformity (disorder) Associated morphology True Dysplasia Inferred relationship Some 6
Chondrodysplasia punctata due to maternal autoimmune disease (disorder) Associated morphology True Dysplasia Inferred relationship Some 1
Benign mammary dysplasia of left breast Associated morphology True Dysplasia Inferred relationship Some 1
Benign mammary dysplasia of right breast (disorder) Associated morphology True Dysplasia Inferred relationship Some 1
Congenital dysplasia of bone caused by drug Associated morphology True Dysplasia Inferred relationship Some 1
Congenital dysplasia of ear vestibule Associated morphology True Dysplasia Inferred relationship Some 1
Congenital retinal dysplasia caused by teratogenic substance (disorder) Associated morphology True Dysplasia Inferred relationship Some 1
Focal cortical dysplasia is a congenital abnormality with abnormal organisation of the cortical layers of the brain. These lesions frequently cause refractory epilepsy. Type II usually presents in children. More extensive changes occur outside the temporal lobe and commonly in the frontal lobe. Associated morphology True Dysplasia Inferred relationship Some 1
Focal cortical dysplasia type Ib Associated morphology True Dysplasia Inferred relationship Some 1
Focal cortical dysplasia is a congenital abnormality with abnormal organisation of the cortical layers of the brain. These lesions frequently cause refractory epilepsy. Type I presents late with mild symptoms and is more often seen in adults. Changes are present in the temporal lobe. Associated morphology True Dysplasia Inferred relationship Some 1
Focal cortical dysplasia is a congenital abnormality with abnormal organization of the cortical layers of the brain. These lesions frequently cause refractory epilepsy. Type Ia presents late with mild symptoms and is more often seen in adults. Changes are present in the temporal lobe and are restricted to cortical dyslamination. Associated morphology True Dysplasia Inferred relationship Some 1
Mandibuloacral dysostosis co-occurrent with type A lipodystrophy (disorder) Associated morphology True Dysplasia Inferred relationship Some 2
Mandibuloacral dysostosis co-occurrent with type B lipodystrophy (disorder) Associated morphology True Dysplasia Inferred relationship Some 2
A rare genetic bone development disorder characterized by involvement of the clavicles and symmetrical generalized metaphyseal enchondromas particularly in the distal femur, proximal humerus, and bones of the wrists, hands, and feet. Lesions regress later in life with growth cartilage obliteration. Clinical examination is normal and the course of the disease is benign. Associated morphology True Dysplasia Inferred relationship Some 1
Focal cortical dysplasia is a congenital abnormality with abnormal organisation of the cortical layers of the brain. These lesions frequently cause refractory epilepsy. Type II usually presents in children. More extensive changes occur outside the temporal lobe and commonly in the frontal lobe. Type IIa is histologically distinct due to the absence of balloon cells. Associated morphology True Dysplasia Inferred relationship Some 1
Focal cortical dysplasia is a congenital abnormality with abnormal organization of the cortical layers of the brain. These lesions frequently cause refractory epilepsy. Type II usually presents in children. More extensive changes occur outside the temporal lobe and commonly in the frontal lobe. Type IIb is histologically distinct due to the presence of balloon cells. Associated morphology True Dysplasia Inferred relationship Some 1
Osteogenesis imperfecta type 5 (disorder) Associated morphology True Dysplasia Inferred relationship Some 1
Onycho-tricho-dysplasia neutropenia syndrome Associated morphology True Dysplasia Inferred relationship Some 1
Rhizomelic chondrodysplasia punctata type 1 Associated morphology True Dysplasia Inferred relationship Some 1
Sabinas brittle hair syndrome (disorder) Associated morphology True Dysplasia Inferred relationship Some 1
Rhizomelic chondrodysplasia punctata type 2 Associated morphology True Dysplasia Inferred relationship Some 1
Rhizomelic chondrodysplasia punctata type 3 Associated morphology True Dysplasia Inferred relationship Some 1
Developmental dysplasia of left hip Associated morphology True Dysplasia Inferred relationship Some 1
Developmental dysplasia of right hip Associated morphology True Dysplasia Inferred relationship Some 1
Bilateral dysplastic hip Associated morphology True Dysplasia Inferred relationship Some 2
Stickler syndrome type 1 Associated morphology True Dysplasia Inferred relationship Some 2
A rare congenital malformation syndrome, most commonly presenting with hemifacial microsomia associated with ear and/or eye malformations and vertebral anomalies of variable severity. Additional malformations involving the heart, kidneys, central nervous, digestive and skeletal systems may also be associated. Associated morphology True Dysplasia Inferred relationship Some 1
Stickler syndrome type 2 Associated morphology True Dysplasia Inferred relationship Some 2
Stickler syndrome type 4 (disorder) Associated morphology True Dysplasia Inferred relationship Some 2
Mesomelic dysplasia of upper limb (disorder) Associated morphology True Dysplasia Inferred relationship Some 1
Cystic dysplasia of kidney (disorder) Associated morphology True Dysplasia Inferred relationship Some 1
A rare overgrowth syndrome with skeletal involvement characterized by pre- or postnatal onset of overgrowth, accelerated bone age in infancy and early childhood, tall stature, bony overgrowth of the skull base, spondylar dysplasia, and undermodeling of the tubular bones. Facial dysmorphism includes mild hypertelorism, depressed nasal bridge, short and broad nose, and full lower lip. Additional reported features are scoliosis, as well as delayed puberty, cryptorchidism, and hypospadias. Associated morphology True Dysplasia Inferred relationship Some 1
A rare primary bone dysplasia characterised by reduced bone mineral density (defined as a Z score below -2.0), vertebral compression fractures, and recurrent peripheral fractures caused by low-impact trauma, leading to bone pain and impaired mobility. Patients typically become symptomatic in childhood or adolescence. Associated morphology True Dysplasia Inferred relationship Some 1
A rare X-linked malformation syndrome characterized by craniofacial abnormalities such as uni- or bicoronal synostosis, hypertelorism and a bifid nose, grooved or split nails, frizzy hair, abnormalities of the shoulder girdle, hands and feet. Associated morphology True Dysplasia Inferred relationship Some 1
A rare X-linked malformation syndrome characterized by craniofacial abnormalities such as uni- or bicoronal synostosis, hypertelorism and a bifid nose, grooved or split nails, frizzy hair, abnormalities of the shoulder girdle, hands and feet. Associated morphology True Dysplasia Inferred relationship Some 2
A rare frontonasal dysplasia characterized by a craniofacial phenotype comprising frontal bossing with high anterior hairline, ptosis, hypertelorism, epicanthus inversus, flat nasal bridge, and broad nasal tip. Large anterior fontanelle, sagittal synostosis, and cranial base anomalies have also been described. Associated morphology True Dysplasia Inferred relationship Some 1
Incontinentia pigmenti syndrome Associated morphology True Dysplasia Inferred relationship Some 1
A rare syndromic genetic deafness characterized by profound congenital bilateral sensorineural deafness, developmental delay, moderate intellectual disability, generalized delay in bone maturation, short stature, epiphyseal dysplasia particularly of the capital femoral epiphyses, and mild dysmorphic facial features such as prominent forehead and small, pointed chin. Bilateral obstruction of lacrimal ducts and inguinal and umbilical hernias have also been described. Associated morphology True Dysplasia Inferred relationship Some 2
A rare genetic multiple congenital anomalies/dysmorphic syndrome characterized by postnatal tall stature with long hands and feet, scoliosis, distinctive dysmorphic facial features (prominent forehead, proptosis, downslanting palpebral fissures, broad nasal bridge, thin upper lip, and pointed chin), hyperelastic, thin, and fragile skin, lipodystrophy, and variable intellectual disability and neurological deterioration. Additional reported manifestations include craniosynostosis, camptodactyly, progressive flexion contractures, joint dislocation, and cerebrovascular complications, among others. Brain MRI may show extensive periventricular white matter lesions and other anomalies. Associated morphology True Dysplasia Inferred relationship Some 1
A rare syndromic frontonasal dysplasia characterized by distinctive facial dysmorphic features including hypertelorism, almond-shaped palpebral fissures, nasal deformity with creased ridge, depressed or absent tip, and asymmetry and partial absence of nasal bones, and downturned corners of the mouth. Additional reported manifestations are limb anomalies (e. g. Poland anomaly, transverse limb agenesis, and anomalies of the hands and feet, such as camptodactyly, oligodactyly, clinodactyly, and syndactyly), frontonasal encephalocele, choanal atresia, congenital renal/cardiac malformations, and corpus callosum agenesis. Associated morphology True Dysplasia Inferred relationship Some 1
A rare multiple congenital anomalies/dysmorphic syndrome characterized by early-onset progressive bone marrow failure with anemia, leukopenia, mild thrombopenia, and myelodysplastic features, as well as non-hematologic manifestations, such as developmental delay, cataracts, facial dysmorphism, short stature, and skeletal anomalies. Immunodeficiency primarily affects B-cells and may lead to increased susceptibility to infections. Additional reported features include dry skin and eczema, cardiac anomalies, hearing loss, and reduction of cerebral volume on brain imaging. Associated morphology True Dysplasia Inferred relationship Some 2
A rare genetic multiple congenital anomalies/dysmorphic syndrome characterized by the association of developmental delay, variable intellectual disability, skeletal dysplasia, and in many cases T-cell immunodeficiency and other immunologic abnormalities. Skeletal findings include short stature, anomalies of the long bones, hands and feet, and pelvis, platyspondyly, cervical malformation, and pectus excavatum. Dysmorphic facial features, such as coarse face, hypertelorism, and broad nasal tip, may be present. Additional reported manifestations are seizures, hyperreflexia, nystagmus, and muscular hypotonia, as well as multiple liver cysts. Associated morphology True Dysplasia Inferred relationship Some 1
A rare ciliopathy characterized by oral anomalies (multiple oral frenula, missing incisors), facial dysmorphism (such as square face with small forehead, upslanting palpebral fissures, and cleft lip, among other features), digital anomalies (brachydactyly, brachymesophalangy, polydactyly), and short stature. Additional reported manifestations include short femoral neck, bilateral cervical ribs, abnormal vertebral bodies, and gracile long bones. Associated morphology True Dysplasia Inferred relationship Some 2
Conductive deafness-ptosis-skeletal anomalies syndrome is a rare, genetic ectodermal dysplasia syndrome characterized by conductive hearing loss due to atresia of the external auditory canal and the middle ear complicated by chronic infection, ptosis and skeletal anomalies (internal rotation of hips, dislocation of the radial heads and fifth finger clinodactyly). In addition, a thin, pinched nose, delayed hair growth and dysplastic teeth are associated. There have been no further descriptions in the literature since 1978. Associated morphology True Dysplasia Inferred relationship Some 4
NEK9-related lethal skeletal dysplasia is a rare, lethal, primary bone dysplasia characterized by fetal akinesia, multiple contractures, shortening of all long bones, short, broad ribs, narrow chest and thorax, pulmonary hypoplasia and a protruding abdomen. Short, bowed femurs may also be associated. Associated morphology True Dysplasia Inferred relationship Some 1
A rare syndromic mitochondrial disease characterized by exocrine pancreatic insufficiency, dyserythropoietic anemia, and calvarial hyperostosis. Associated morphology True Dysplasia Inferred relationship Some 7
A rare genetic disease characterized by early-onset respiratory difficulties and frequent respiratory infections, congenital heart defects, dysostosis multiplex, hepatosplenomegaly, renal involvement, hematopoietic abnormalities, facial dysmorphism (coarse facial features, large forehead, synophrys, long eyelashes, broad nasal bridge, macroglossia, short neck, and low hairline), and global developmental delay. Laboratory examination shows increased urinary excretion of glycosaminoglycans and increased plasma heparan sulfate, but no lysosomal enzyme deficiency. The disease is usually fatal in the first years of life. Associated morphology True Dysplasia Inferred relationship Some 1
A rare genetic syndrome with limb malformations as a major feature characterized by preaxial polydactyly of the hands and feet with variable phenotypic expressivity in combination with hypertrichosis extending from the posterior hairline to the middle of the back. Reported limb malformations include triphalangeal thumbs, duplicated thumbs, preaxial extra ray, and syndactyly between digits I and II in the hands, and large or duplicated hallux and syndactyly between toes I and II in the feet. Associated morphology True Dysplasia Inferred relationship Some 1
Sugarman brachydactyly is a rare, genetic, congenital limb malformation characterized by brachydactyly of fingers, with major proximal phalangeal shortening and immobile proximal interphalangeal joints, as well as dorsally and proximally placed, non-articulating great toes (with or without angulation). Radiographic findings of hands include bilateral double first metacarpals and biphalangeal fifth fingers. There have been no further descriptions in the literature since 1982. Associated morphology True Dysplasia Inferred relationship Some 3
A rare genetic central nervous system malformation characterized by dysplasia of the superior cerebellum (especially the vermis), brainstem asymmetry, dysplasia of the basal ganglia, and cortical irregularities with asymmetric abnormalities in gyral size and orientation, as well as varying sulcal depth, but without lissencephaly, pachygyria, or polymicrogyria. Clinically, patients present global developmental delay with motor development usually being more affected that speech. Variable features are abnormal eye movements including oculomotor apraxia, strabismus, seizures, and behavioral problems. Associated morphology True Dysplasia Inferred relationship Some 1
A rare genetic central nervous system malformation characterized by dysplasia of the superior cerebellum (especially the vermis), brainstem asymmetry, dysplasia of the basal ganglia, and cortical irregularities with asymmetric abnormalities in gyral size and orientation, as well as varying sulcal depth, but without lissencephaly, pachygyria, or polymicrogyria. Clinically, patients present global developmental delay with motor development usually being more affected that speech. Variable features are abnormal eye movements including oculomotor apraxia, strabismus, seizures, and behavioral problems. Associated morphology True Dysplasia Inferred relationship Some 2
A rare genetic, multiple congenital anomalies syndrome characterized by short stature, hand brachydactyly with hypoplastic distal phalanges, global development delay, intellectual disability, and more variably seizures, obesity, and craniofacial dysmorphism that includes microcephaly, high forehead, flat face, hypertelorism, deep set eyes, flat nasal bridge, averted nostrils, long philtrum, thin lip vermilion, and short neck. Associated morphology True Dysplasia Inferred relationship Some 2
A rare genetic multiple congenital anomalies/dysmorphic syndrome characterized by global developmental delay and intellectual disability, progressive spondyloepimetaphyseal dysplasia, short stature, short fourth metatarsals, and dysmorphic craniofacial features (including microcephaly, hypertelorism, epicanthal folds, mild ptosis, strabismus, malar hypoplasia, short nose, depressed nasal bridge, full lips, small, low-set ears, and short neck). Craniosynostosis, generalized hypotonia, as well as asymmetry of the cerebral hemispheres and mild thinning of the corpus callosum on brain imaging have also been described. Associated morphology True Dysplasia Inferred relationship Some 2
A rare congenital anomaly in which one kidney is large, distended by multiple cysts and non-functional. Unilateral multicystic kidney disease is typically asymptomatic if the other kidney is fully functional but may occasionally present with abdominal obstructive signs when the cysts become too large. Associated morphology True Dysplasia Inferred relationship Some 2

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