Fetus in fetu

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Anteroposterior abdominal radiograph shows a soft-tissue mass in the right hemiabdomen. The mass contains calcified osseous-appearing structures of varying sizes and shapes. Fetus in fetu radiograph.jpg
Anteroposterior abdominal radiograph shows a soft-tissue mass in the right hemiabdomen. The mass contains calcified osseous-appearing structures of varying sizes and shapes.
The postoperative specimen from the previous image shows a fairly well developed fetus lying on its back, with rudimentary digits. Fetus in fetu after operation.jpg
The postoperative specimen from the previous image shows a fairly well developed fetus lying on its back, with rudimentary digits.
A computed tomography scan of the same patient's abdomen pre-operation reveals a large retroperitoneal soft-tissue mass. There are long hyperdense opacities that resemble fetal bones. Fetus in fetu Computed Tomography scan.jpg
A computed tomography scan of the same patient's abdomen pre-operation reveals a large retroperitoneal soft-tissue mass. There are long hyperdense opacities that resemble fetal bones.

Fetus in fetu (or foetus in foetu) is a rare developmental abnormality in which a mass of tissue resembling a fetus forms inside the body of its twin. An early example of the phenomenon was described in 1808 by George William Young. [1]

Contents

There are two hypotheses for the origin of a fetus in fetu. One hypothesis is that the mass begins as a normal fetus but becomes enveloped inside its twin. [2] The other hypothesis is that the mass is a highly developed teratoma. Fetus in fetu is estimated to occur in 1 in 500,000 live births. [3]

Classification as life

A fetus in fetu can be considered alive, but only in the sense that its component tissues have not yet died or been eliminated. Thus, the life of a fetus in fetu is akin to that of a tumor in that its cells remain viable by way of normal metabolic activity. However, without the gestational conditions in utero with the amnion and placenta, a fetus in fetu can develop into, at best, an especially well differentiated teratoma; or, at worst, a high-grade metastatic teratocarcinoma. In terms of physical maturation, its organs have a working blood supply from the host, but all cases of fetus in fetu present critical defects, such as no functional brain, heart, lungs, gastrointestinal tract, or urinary tract. Accordingly, while a fetus in fetu can share select morphological features with a normal fetus, it has no prospect of any life outside of the host twin. Moreover, it poses clear threats to the life of the host twin on whom its own life depends. [4]

Hypotheses of development

There are two main hypotheses about the development of fetus in fetu.

Teratoma hypothesis

Fetus in fetu may be a very highly differentiated form of dermoid cyst, itself a highly differentiated form of mature teratoma. [5]

Parasitic twin hypothesis

Fetus in fetu may be a parasitic twin fetus growing within its host twin. Very early in a monozygotic twin pregnancy, in which both fetuses share a common placenta, one fetus wraps around and envelops the other. The enveloped twin becomes a parasite, in that its survival depends on the survival of the host twin, by drawing on the host twin's blood supply. The parasitic twin is anencephalic (without a brain) and lacks some internal organs, and as such is unable to survive on its own. As the host twin has to "feed" the enveloped twin from the nutrients received over a single umbilical cord, they usually die before birth.[ citation needed ]

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<span class="mw-page-title-main">Placenta</span> Organ that connects the fetus to the uterine wall

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<span class="mw-page-title-main">Stillbirth</span> Death of a fetus before or during delivery, resulting in delivery of a dead baby in some manner

Stillbirth is typically defined as fetal death at or after 20 or 28 weeks of pregnancy, depending on the source. It results in a baby born without signs of life. A stillbirth can often result in the feeling of guilt or grief in the mother. The term is in contrast to miscarriage, which is an early pregnancy loss, and sudden infant death syndrome, where the baby dies a short time after being born alive.

<span class="mw-page-title-main">Teratoma</span> Type of germ cell tumor

A teratoma is a tumor made up of several types of tissue, such as hair, muscle, teeth, or bone. Teratomata typically form in the tailbone, ovary, or testicle.

<span class="mw-page-title-main">Viviparity</span> Development of the embryo inside the mother

In animals, viviparity is development of the embryo inside the body of the mother, with the maternal circulation providing for the metabolic needs of the embryo's development, until the mother gives birth to a fully or partially developed juvenile that is at least metabolically independent. This is opposed to oviparity, where the embryos develop independently outside the mother in eggs until they are developed enough to break out as hatchlings; and ovoviviparity, where the embryos are developed in eggs that remain carried inside the mother's body until the hatchlings emerge from the mother as juveniles, similar to a live birth.

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Craniopagus parasiticus is an extremely rare type of parasitic twinning occurring in about 4 to 6 of 10,000,000 births. In craniopagus parasiticus, a parasitic twin head with an undeveloped body is attached to the head of a developed twin. Fewer than a dozen cases of this type of conjoined twin have been documented in literature.

<span class="mw-page-title-main">Parasitic twin</span> Medical condition

A parasitic twin, also known as an asymmetrical twin or unequal conjoined twin, occurs when a twin embryo begins developing in utero, but the pair does not fully separate, and one embryo maintains dominant development at the expense of the other. It results from the same processes that also produces vanishing twins and conjoined twins, and may represent a continuum between the two. In parasitic twins, one ceases development during gestation and is vestigial to a mostly fully formed, otherwise healthy individual twin. The undeveloped twin is termed as parasitic, because it is incompletely formed or wholly dependent on the body functions of the complete fetus. The independent twin is called the autosite.

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A vestigial twin is a form of parasitic twinning, where the parasitic "twin" is so malformed and incomplete that it typically consists entirely of extra limbs or organs. It also can be a complete living being trapped inside the host person, however the parasitic twin is anencephalic and lacks consciousness.

<i>Campylobacter fetus</i> Species of bacterium

Campylobacter fetus is a rod-shaped, gram-negative species of bacteria within the genus Campylobacter of phylum Pseudomonadota. Identification of C. fetus species in infected animals or people is routinely performed by culture on blood or cefoperazone deoxycholate agar. Subspecies of C. fetus commonly causes reproductive disease in ruminants and gastrointestinal disease in humans. Transmission of C. fetus subspecies venerealis occurs mainly through venereal contact while transmission of C. fetus subspecies fetus occurs mainly through ingestion of bacteria in a contaminated environment. Infertility in cattle and abortion in sheep are common outcomes of infection associated with C. fetus subspecies venerealis and C. fetus subspecies fetus, respectively. Disease in humans occurs through zoonotic transmission of C. fetus mainly via ingestion of contaminated food or water sources. C. fetus can be diagnosed with polymerase chain reaction assays, enzyme linked immunosorbent assays and vaginal mucus agglutination testing. As vaccines are typically not efficient in preventing future spread, infected bulls are often culled. Human infections may be treated with erythromycin as antimicrobial resistance has been emerging for the fluoroquinolones.

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Epignathus is a rare teratoma of the oropharynx. Epignathus is a form of oropharyngeal teratoma that arises from the palate and, in most cases, results in death. The pathology is thought to be due to unorganized and uncontrolled differentiation of somatic cells leading to formation of the teratoma; sometimes it is also referred to as fetus in fetu, which is an extremely rare occurrence of an incomplete but parasitic fetus located in the body of its twin. This tumor is considered benign (non-cancerous) but life-threatening because of its atypical features and high risk of airway obstruction, which is the cause of death in 80-100% of the cases at the time of delivery.

References

  1. Young GW (1808). "Case of a Fœtus found in the Abdomen of a Boy". Medico-Chirurgical Transactions. 1: 236–264. PMC   2128792 . PMID   20895115.
  2. Chua JH, Chui CH, Sai Prasad TR, et al. (2005). "Fetus-in-fetu in the pelvis" (PDF). Annals of the Academy of Medicine Singapore. 34: 646–9. doi:10.47102/annals-acadmedsg.V34N10p646. Archived from the original (PDF) on 2007-10-11.
  3. Grant P, Pearn JH (May 1969). "Foetus-in-foetu". The Medical Journal of Australia. 1 (20): 1016–1019. doi:10.5694/j.1326-5377.1969.tb49866.x. PMID   5815070. S2CID   209072187. — source not consulted; cited here following Hoeffel CC, Nguyen KQ, Phan HT, Truong NH, Nguyen TS, Tran TT, Fornes P (June 2000). "Fetus in fetu: a case report and literature review". Pediatrics. 105 (6): 1335–1344. doi:10.1542/peds.105.6.1335. PMID   10835078.
  4. Khalifa NM, Maximous DW, Abd-Elsayed AA (January 2008). "Fetus in fetu: a case report". Journal of Medical Case Reports. 2 (1). Jmedicalcasereports.com: 2. doi: 10.1186/1752-1947-2-2 . PMC   2253549 . PMID   18186928.
  5. Basu A, Jagdish S, Iyengar KR, Basu D (October 2006). "Fetus in fetu or differentiated teratomas?". Indian Journal of Pathology & Microbiology. 49 (4): 563–565. PMID   17183856.