Fetus in fetu is a rare condition that has been defined as the presence of one of the twins in the body of the other. It is most frequently located in retroperitoneal area; however, it has been reported in other locations as well. Fetus in fetu FIF is a rare congenital anomaly. It is a condition in which malformed and parasitic fetus is located in the body of its twin. The anomaly was first defined in early nineteenth century by Meckel.
What is included. What is MyAccess? Fetus in fetu highmore RJ: A large teratoma containing rudimentary arm bones and a hand. W V Med J Upon the incision of the capsule, we getu a fetal head, a trunk and an arm and two leg-like structures representing the extremities along with nearly cc of serohemorragic fluid. Since no fetus-in-fetu has ever been described to contain a urinary system, and the segments of gastrointestinal tract that are found are too incomplete to have any reabsorptive capabilities, the fluid is probably maintained in the amniotic cavity solely by osmotic and oncotic pressure. Case of Highmore 16 : anterior and posterior views of the year-old fetus in fetu Etio logy Several etiologies have been proposed. The borderland of embryology and pathology 2nd ed. Fetus in Fetus in fetu highmore report of a single case.
Haper teen fan lit. INTRODUCTION
Department of Bj rn bergs Surgery, Dr. By the fifth month the fetus's body is covered with a cheeselike substance vernix caseosawhich serves to protect it in its watery environment. The suffering of Fetus in fetu highmore souls pales Ftus comparison to that of John Harea baby born on May 18, Fetus in fetu highmore There have been no recorded cases of dizygosity. Views Read Edit View history. When several fetuses are present, they usually share a same sac 50but some have their own sacs Fetus in fetu starts to develop very early in a monozygotic twin pregnancy, in which both fetuses share a common placenta, and one fetus wraps around and envelops the other. This argument may lead to differences in the follow-up and treatment of such cases. P revalence. The split notochord syndrome. The evolution of the fetus-in-fetu is usually arrested at the first trimester, and highmode evolution is by mass Bbw orgy more than by development.
A fetus-in-fetu is an encapsulated, pedunculated vertebrate tumor.
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- Fetus in fetu is a rare condition that has been defined as the presence of one of the twins in the body of the other.
- As fascinating as it is horrifying, fetus-in-fetu is a developmental abnormality where, in utero , the larger of a set of twin fetuses absorbs the other into her body.
- Synonyms: Cryptodidymus, double monster, endocyme fetus, fetiform teratoma, fetal inclusion, included heteropagus twin, suppressed twin.
Murtaza A, et al. A case of fetus in fetu, a pathologic condition resulting from abnormal embryogenesis in a diamniotic, monochrionic pregnancy is reported. This condition usually presents in infancy and childhood. In this present case, a 30 year old patient misdiagnosed preoperatively as retroperitoneal dermoid is presented.
This is the oldest patient reported with fetus in fetu in literature. From 1 Department of Surgery, N. Received: 27 Dec Accepted: 19 Jan E:mail: murtazaakhtar indiatimes. Fetus in Fetu is a fetiform calcified mass or an encapsulated pendunculated vertebral tumor. A 30 year-old married female was admitted with a lump in the right side of the abdomen of 8 years duration. The lump was noticed immediately after pregnancy and it was gradually increasing in size.
The patient had not conceived after the appearance of the lump. There were no gastrointestinal or genitourinary complaints. There was also no history of twinning or Teratoma in the family. A large 18cms x 15cms mass of firm consistency was palpable in the right hypochondriac and lumbar region.
Conventional Radiography of the abdomen showed irregular radio dense lesion with calcification. Abdominal Ultrasound showed a cystic mass with mixed echogenecity. CT scan of the abdomen showed a cystic lesion with solid component of varying densities which was diagnosed as retroperitoneal dermoid.
Alpha Fetoprotein levels were normal. On exploration, there was a well encapsulated mass occupying the right side of the retroperitoneal space, extending from the under surface of the liver reaching up to the pelvic rim. Apart from a network of vascularity around the capsule, there was a vascular pedicle attached to the tumor mass from the right renal artery.
The mass was removed. On examination, the tumor contained 2. The radiograph of the specimen after removal showed vertebral column, Fig. Fetus in fetu is a rare condition occurring once in , deliveries. The oldest patient reported to date was 29 years old.
Other rare sites include sacro-coccygeal region, intracranial, thorax, pelvis and the scrotum. The role of radio diagnosis is undeniable and CT scan is the most reliable, showing fat collection around central bony structures. The present fetal size was 15 cm x 12 cm, the reported size varies between 4cm and 24 cm.
The fetal weight varies between 1. This fulfills the? Willis criteria? The majority of fetus in fetu present in early years of life and only three cases have been reported in patients over 15 years of age, the oldest being This age factor was responsible for the misdiagnosing as Teratoma.
There is a controversy whether a fetus in fetu is the distinct entity or a highly organized Teratoma. It is difficult to differentiate the two. Some authors claim that fetus in fetu is a well differentiated highly organized Teratoma, while others claim it to be a different pathological entity.
The presence of vertebral column is an important diagnostic criterion which suggests the development of a notochord which in turn is an advanced primitive streak stage. However, the presence of a bony vertebral axis with appropriate limb arrangement on gross is an important diagnostic feature which was observed in the studied case, thus confirming the diagnosis of fetus in fetu.
A new diagnostic modality molecular analysis is using an informative genetic marker, for uniparental isodisomy of chromosomes 14 and 15, if it shows no genetic difference between the host and the Fetiform mass, then it is diagnostic of fetus in fetu.
Fetus in fetu derives its blood supply from the rich vascular plexus around the cyst wall. Vascular pedicle is rare and usually observed in large growing masses with delayed presentation. Surgical excision is the treatment of choice in both Fetiform Teratoma and fetus in fetu.
Under strict post surgical follow up, if recurrence occurs, the diagnosis could be revived to Fetiform Teratoma. Fetus in fetu is commonly seen in childhood. Presentation at the age of 31 years is very rare. Fetus in fetu should always be kept as differential diagnosis of retro peritoneal dermoid in adults. The authors reported no conflict of interest and no funding was received on this work.
Fetus in fetu: A case report and literature review. Pediatric ; 6 Z Kindercher, ; Double Fetus in fetu: diagnostic imaging. Paediatr Radiol. Grant P, Pearn JH. Foetus in foetu, Med J. Aust ; Dysphagia caused by a fetus in fetu in a 29 year old man. Surg, ; 71 45 Foetus in Fetu. J Postgrad Med ; Willis RA. The borderland of embryology and pathology 2nd ed. Washington DC: Butterworth, ; Potter EL.
Pathology of the fetus and the newborn. In: Potter EL, ed. Chicago, Ill: Year Book, ; Highly differenciated Teratoma and fetus in fetu: a single pathology? J Pediatr Surg ; Fetus in fetu with malignant recurrence.
J Pediatr Syrg ; Fetus in fetu or a retroperitoneal teratoma--a controversy revisited. A case report and review of literature. Indian J Cancer.
Fetus in fetu: report of a single case. Fetus in Fetu- Diagnostic criteria and differential diagnosis -A case report and literature review. J Ped Surg. Fetus in fetu: CT appearance report. Radiology ;
Part I: A unified theory of embryogenesis for double spinal cord malformations. Arch Dis Child , Ann Acad Med Singapore. Case rep ort A year-old, G 3 P 2 , white woman presented at 30 weeks gestation for evaluation of a fetal intra-abdominal cystic mass recognized at routine obstetrical sonography. Do you know the primary source of the claim, which you repeat citing a TV news story, that the incidence of fetus in fetu is ,? Taylor S: Case of included ovum.
Fetus in fetu highmore. CASE REPORTS
A fetus-in-fetu is an encapsulated, pedunculated vertebrate tumor. It represents a malformed monozygotic, monochorionic diamniotic parasitic twin included in a host or autosite twin. Characteristically the fetus-in-fetu complex will be composed of a fibrous membrane equivalent to the chorioamniotic complex that contains some fluid equivalent to the amniotic fluid and a fetus suspended by a cord or pedicle. The presence of a rudimentary spinal architecture is used to differentiate a fetus-in-fetu from a teratoma, since teratomas are not supposed to develop through the primitive streak stage days.
This last criterion has been considered too stringent by many authors who regard a rudimentary body architecture metameric segmentation, craniocaudal and lateral differentiation, body coelom, "gestational sac" , or the presence of an associated fetus-in-fetu as equivalent criteria.
Although teratomas can achieve striking degrees of differentiation by the inductive effect of adjacent tissues on one another, they do not present the criteria mentioned above.
The few cases detected prenatally all presented as a complex mass. The general appearance is a well-delineated capsule, with an echogenic mass suspended in fluid or partially surrounded by fluid. Occasionally, the diagnosis can be suggested by the recognition of a rudimentary spine. Longitudinal and axial section of a fetus-in-fetu. Notice the faintly visible spinal organization on the longitudinal view Courtesy Dr.
Patricia Dix. When discovered in a newborn child during physical examination, the differential diagnosis includes all the common masses such as Wilms" tumor, hydronephrosis, and neuroblastomas. Prenatally, the main differential diagnosis is with teratoma. Teratomas are disorganized congregations of pluripotential cells from all three primitive tissue layers. By differentiation and induction, they can achieve striking organization, with examples of several organs being well formed.
However, teratomas do not have vertebral segmentation, craniocaudal and lateral differentiation, body coelom or systemic organogenesis. Thus the presence of a mass with a spinal organization and surrounded by fluid suggests the correct diagnosis. When spinal structures are not present, most authors have considered that the diagnosis of fetus-in-fetu can still be made when the alternate criteria described under Definition are found. These criteria are sufficiently restrictive that even well-organized teratomas cannot fulfill all of them.
Teratomas have a definite malignant potential, a feature that has not been reported in fetus-in-fetu. Teratomas occur predominantly in the lower abdomen, not the upper retroperitoneum.
Yet, the coexistence of a fetus-in-fetu and a teratoma as well as the occurrence of a teratoma 14 years after removal of a twin fetus-in-fetu have been reported, supporting the older hypothesis of a continuum between twin and teratoma.
Cases of sacrococcygeal fetus-in-fetu should probably be regarded and treated as teratoma, because of the high incidence of teratoma in this region.
Ectopic testicles have a higher incidence of germ cell tumors, and the differentiation between fetus-in-fetu and teratoma is particularly important.
Although the characteristics of intracranial teratoma differ from those of intracranial fetus in fetu, Wakai found, in a large review of intracranial teratomas, that there are some transitions between certain teratoma and fetus-in-fetu. In the older literature, several descriptions of fetus-in-fetu were too vague to be acceptable by current criteria.
For example, the case reported by Phillips does not unequivocally suggest the criteria described above and therefore should probably be considered a teratoma. Some have argued that fetus-in-fetu should be considered as teratomas since they do not evolve into lithopedion like fetuses of abdominocyesis.
That argument is probably not valid since in abdominocyesis the antigen complements of the host and fetus are different, which contrasts with fetus-in-fetu. A fetus-in-fetu recovered from a year old boy From Highmore, Sonographic features The few cases detected prenatally all presented as a complex mass.
Differential diagnosis When discovered in a newborn child during physical examination, the differential diagnosis includes all the common masses such as Wilms" tumor, hydronephrosis, and neuroblastomas. Pediatr Pathol 8: , Revue de la litterature. Asia Oceania J Obstet Gynaecol , Med J Aust 1: , Kafka J: Teratoma: an explanation of its cause based on the organizer theory of embryology.
Arch Pathol , Arch Anat Cytol Pathol , Pediatrie , Pediatr Pathol , Bol Med Hosp Infant Mex , Potter EL: Pathology of the fetus and newborn 2nd Ed. Chicago, Year Book Med Pub p. Willis RA: The structure of teratoma. J Pathol Bacteriol , Young GW: Case of a fetus found in the abdomen of a boy.
Med Chir Trans , Highmore N: Case of a fetus found in the abdomen of a young man, at Sherborne, in Dorsetshire. Royal Collegue of Surgeons, London, 30pp 2pl. Phillips E: Account of a case in which parts of a fetus were found in a tumour situated in the abdomen of a girl two and a half year old.
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