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Alnajjar SF, Ahyad RA, Alhashmi GH, Alturkustani M, Alharthi M, Bustangi NM. A case report of hepatic fetus-in-fetu: Approach to diagnosis. Radiol Case Rep 2024; 19:3211-3215. [PMID: 39022112 PMCID: PMC466967 DOI: 10.1016/j.radcr.2024.04.063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Revised: 04/13/2024] [Accepted: 04/20/2024] [Indexed: 07/20/2024] Open
Abstract
Multiple theories have been proposed about the pathophysiology of Fetus-in-fetu (FIF). The most widely accepted theory is abnormal embryogenesis in diamniotic monochorionic pregnancies, in which a malformed parasitic fetus is found within the body of a twin host. Hepatic FIF has been reported in almost 1% of FIF cases, with only 2 case reports being published in the literature. This article presents the third case report of intrahepatic FIF. Additionally, we review the role of radiology in diagnosing these cases and guiding their proper management. This case report supports the monozygotic twin theory of FIF and the diagnostic dilemma of FIF vs. teratoma can be solved through collaborative work between radiologists and pathologists.
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Affiliation(s)
- Sara F. Alnajjar
- Department of Radiology, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Rayan A. Ahyad
- Department of Radiology, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Ghufran H. Alhashmi
- Department of Radiology, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Murad Alturkustani
- Department of Pathology, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Mohammed Alharthi
- Department of Surgery, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Nasir M. Bustangi
- Department of Pediatric Surgery, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
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2
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Gagnon MH, Derenoncourt PR, Rayamahi S, Taylor S, Parikh AK, Ponisio MR, Khanna G. Unusual imaging findings associated with abdominal pediatric germ cell tumors. Pediatr Radiol 2024; 54:1093-1104. [PMID: 38462578 DOI: 10.1007/s00247-024-05894-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 02/19/2024] [Accepted: 02/20/2024] [Indexed: 03/12/2024]
Abstract
Germ cell tumors of childhood are tumors arising from germline cells in gonadal or extragonadal locations. Extragonadal germ cell tumors are characteristically located in the midline, arising intracranially or in the mediastinum, retroperitoneum, or pelvis. These tumors are generally easily diagnosed due to typical sites of origin, characteristic imaging findings, and laboratory markers. However, germ cell tumors can be associated with unusual clinical syndromes or imaging features that can perplex the radiologist. This review will illustrate atypical imaging/clinical manifestations and complications of abdominal germ cell tumors in childhood. These features include unusual primary tumors such as multifocal primaries; local complications such as ovarian torsion or ruptured dermoid; atypical presentations of metastatic disease associated with burned-out primary tumor, growing teratoma syndrome, and gliomatosis peritonei; endocrine manifestations such as precocious puberty and hyperthyroidism; and antibody mediated paraneoplastic syndrome such as anti-N-methyl-D-aspartate-receptor antibody-mediated encephalitis. This review aims to illustrate unusual imaging features associated with the primary tumor, metastatic disease, or distant complications of abdominal germ cell tumors of childhood.
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Affiliation(s)
- Marie-Helene Gagnon
- Department of Radiology & Imaging Sciences, Emory University and Children's Healthcare of Atlanta, 1405 Clifton Road NE, Atlanta, GA, 30322, USA.
| | - Paul-Robert Derenoncourt
- Mallinckrodt Institute of Radiology, Washington University in Saint Louis, 510 S Kingshighway Blvd, St. Louis, MO, 63110, USA
| | - Sampanna Rayamahi
- Mallinckrodt Institute of Radiology, Washington University in Saint Louis, 510 S Kingshighway Blvd, St. Louis, MO, 63110, USA
| | - Susan Taylor
- Department of Radiology & Imaging Sciences, Emory University and Children's Healthcare of Atlanta, 1405 Clifton Road NE, Atlanta, GA, 30322, USA
| | - Ashishkumar K Parikh
- Department of Radiology & Imaging Sciences, Emory University and Children's Healthcare of Atlanta, 1405 Clifton Road NE, Atlanta, GA, 30322, USA
| | - Maria R Ponisio
- Mallinckrodt Institute of Radiology, Washington University in Saint Louis, 510 S Kingshighway Blvd, St. Louis, MO, 63110, USA
| | - Geetika Khanna
- Department of Radiology & Imaging Sciences, Emory University and Children's Healthcare of Atlanta, 1405 Clifton Road NE, Atlanta, GA, 30322, USA
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3
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Stevanny B, Mirani P, Thene ERF, Kesty C. Prenatal diagnosis of well-developed fetus in fetu with spontaneous movement in a resource-limited setting: A case report. Case Rep Womens Health 2024; 41:e00581. [PMID: 38298889 PMCID: PMC10827577 DOI: 10.1016/j.crwh.2024.e00581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 12/30/2023] [Accepted: 01/05/2024] [Indexed: 02/02/2024] Open
Abstract
Fetus in fetu (FIF) is a rare congenital anomaly characterized by the presence of a parasitic monozygotic twin encased within the body of its host twin. Because FIF is asymptomatic throughout pregnancy, it is mainly diagnosed in children with an abdominal mass after birth. In the case reported here, at 38-39 weeks of gestation, a 33-year-old woman (gravida 4, para 3) was referred for routine obstetric ultrasonography. Fluid accumulation was identified along with calcification resembling two well-developed legs and trunk with undifferentiated organs inside. Slight spontaneous movement of the legs was observed. The fetus was delivered based on the presumed diagnosis of FIF. Postnatal sonography and computed tomography (CT) supported the diagnosis. The neonate underwent surgical excision of the tumor and was discharged on the eighth postoperative day. Ultrasound can be used to provide accurate prenatal diagnosis of FIF. Early diagnosis is important to improve outcomes.
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Affiliation(s)
- Bella Stevanny
- Department of Obstetrics and Gynecology, Dr. Mohammad Hoesin General Hospital/Faculty of Medicine, Universitas Sriwijaya, Palembang, Indonesia
| | - Putri Mirani
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Dr. Mohammad Hoesin General Hospital/Faculty of Medicine Universitas Sriwijaya, Palembang, Indonesia
| | | | - Cindy Kesty
- Department of Obstetrics and Gynecology, Dr. Mohammad Hoesin General Hospital/Faculty of Medicine, Universitas Sriwijaya, Palembang, Indonesia
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Toms A, Govender TR, Brisighelli G, Harrison D. Neonatal Sacrococcygeal Fetiform Teratoma Containing Bowel: A Case Report. European J Pediatr Surg Rep 2024; 12:e11-e15. [PMID: 38259260 PMCID: PMC10803182 DOI: 10.1055/a-2206-4825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Accepted: 10/21/2023] [Indexed: 01/24/2024] Open
Abstract
A fetiform sacrococcygeal teratoma (homunculus) is a highly differentiated subgroup of mature cystic teratoma that resembles a malformed fetus. These tumors originate at the base of the coccyx and may vary in their intrapelvic and extrapelvic extent and location. It is important to differentiate this anomaly from fetus-in-fetu which has a higher degree of structural organization. A 5-day-old neonate presented with a type II sacrococcygeal fetiform teratoma. The mass contained both cystic and solid components. Upon surgical excision and coccygectomy, fully formed bowel was found inside the mass, as well as bones and other well-defined structures. The tumor was confirmed to be fully excised and no malignant or immature features were found on histopathological examination. The patient was last seen growing well with an alpha-fetoprotein of 3.5 μg/L, 14 months after resection.
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Affiliation(s)
- Ashley Toms
- Department of Paediatric surgery, Chris Hani Baragwanath Academic Hospital, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - Tarlia Rasa Govender
- Department of Paediatric surgery, Chris Hani Baragwanath Academic Hospital, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - Giulia Brisighelli
- Department of Paediatric surgery, Chris Hani Baragwanath Academic Hospital, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - Derek Harrison
- Department of Paediatric surgery, Chris Hani Baragwanath Academic Hospital, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
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5
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Nandan R, Kachhap S, Sengar P, Ghosh A, Pandey V, Indal M. Fetus-in-Fetu: A Tale of the Trapped Triplets. J Indian Assoc Pediatr Surg 2023; 28:439-441. [PMID: 37842209 PMCID: PMC10569286 DOI: 10.4103/jiaps.jiaps_113_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 06/05/2023] [Accepted: 06/23/2023] [Indexed: 10/17/2023] Open
Abstract
A 7-day-old male child presented with abdominal distention and jaundice. Radiological investigations revealed an encapsulated sac encasing three fetus-in-fetu (FIF) in the retroperitoneum. Laparotomy revealed a sac occupying almost the whole of the abdomen. The sac was stretching the duodenum and barely visible common bile duct, which were carefully separated. The rest of the bowel was displaced to the left. The sac containing three FIFs was excised intact. One of the fetuses was highly differentiated and had thoracic meningomyelocele, which has never been reported in FIF.
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Affiliation(s)
- Ruchira Nandan
- Department of Pediatric Surgery, IMS-Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Seth Kachhap
- Department of Pediatric Surgery, IMS-Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Pratishtha Sengar
- Department of Pathology, IMS-Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Amrita Ghosh
- Department of Pathology, IMS-Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Vaibhav Pandey
- Department of Pediatric Surgery, IMS-Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Manish Indal
- Department of Radiology, IMS-Banaras Hindu University, Varanasi, Uttar Pradesh, India
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Muacevic A, Adler JR, Mohamed AA, Alkouz Y, Bahlawan IH. Fetus-in-Fetu: A Differential Diagnosis of Neonatal Fetiform Encysted Abdominal Mass. Cureus 2023; 15:e33725. [PMID: 36793819 PMCID: PMC9925022 DOI: 10.7759/cureus.33725] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/12/2023] [Indexed: 01/15/2023] Open
Abstract
Fetus-in-fetu (FIF) is a rare embryological anomaly in which an encysted fetiform mass develops within the infant or adult host body. It mainly occurs intraabdominal. There are embryo-pathogenetic debates over whether it belongs to the spectrum of highly differentiated teratomas or is a parasitic twinning from a monozygotic monochorionic diamniotic pregnancy. The presence of vertebral segments and an encapsulating cyst can reliably distinguish FIF from teratoma. The diagnosis may be initially made by imaging modalities such as computed tomography (CT) and magnetic resonance imaging (MRI), and a confirmatory diagnosis made by histopathology of the excised mass. Our center experienced a case of a male neonate presented after emergency cesarean delivery at 40-week gestation with the suspicion of an intraabdominal mass identified antenatally. Antenatal ultrasonography at 34 weeks gestation suggested the presence of an intraabdominal cystic mass measuring 6.5 cm with a hyperechoic focus. A follow-up MRI performed after the delivery showed a well-defined mass with the cystic formation in the left abdominal region with a centrally located fetiform structure. Vertebral bodies and long limb bones were visualized. The diagnosis of FIF was initially made preoperatively by the characteristic findings of imaging studies. Laparotomy was scheduled on day 6, revealing a large encysted mass with fetiform content. FIF should be considered a possible differential diagnosis of neonatal encysted fetiform mass. Routine antenatal imaging permits more frequent antenatal detection with earlier workup and management.
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Kudalmana A, Kim BR, Chong E. Term Male Infant with Abdominal Mass. Neoreviews 2022; 23:e262-e264. [PMID: 35362038 DOI: 10.1542/neo.23-4-e262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Arya Kudalmana
- Department of Pediatrics, Driscoll Children's Hospital, Corpus Christi, TX
| | - Bo Rum Kim
- Department of Pediatrics, Driscoll Children's Hospital, Corpus Christi, TX
| | - Euming Chong
- Department of Neonatology, Driscoll Children's Hospital, Corpus Christi, TX
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8
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Foote DC, Kirsch A, Metz T, Brahmamdam P. Fetus in fetu: use of intraoperative ultrasound for safe excision of a rare entity. BMJ Case Rep 2022; 15:e245371. [PMID: 35256360 PMCID: PMC8905894 DOI: 10.1136/bcr-2021-245371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/24/2022] [Indexed: 11/04/2022] Open
Abstract
A prenatally diagnosed abdominal mass at 36 weeks and 0 days was further characterised by postnatal ultrasound and MRI to be likely a rare case of fetus in fetu in an otherwise healthy male. Due to close proximity to both the coeliac axis and superior mesenteric artery (SMA), surgical excision was delayed for several months. Interim CT with intravenous contrast performed at 2 months of age demonstrated the SMA travelling through the posterior aspect of the mass. Surgery proceeded at 2 months of age. Intraoperative ultrasound was used to definitively identify both the coeliac axis and SMA in order to facilitate a safe excision. The patient recovered well with an uneventful discharge to home on postoperative day 8. Pathology confirmed the diagnosis of fetus in fetu.
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Affiliation(s)
| | - Alyssa Kirsch
- Radiology, Beaumont Health, Royal Oak, Michigan, USA
| | - Terrence Metz
- Radiology, Beaumont Health, Royal Oak, Michigan, USA
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Sun RC, Cheng LS, Shah RH, Lohmann P, Cortes-Santiago N, Ketwaroo PD, Keswani SG, King A, Lee TC. Case Report: The Medical and Surgical Management of an Infant With Extreme Prematurity and Fetus-In-Fetu. Front Surg 2022; 9:856837. [PMID: 35310432 PMCID: PMC8931197 DOI: 10.3389/fsurg.2022.856837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 01/31/2022] [Indexed: 11/23/2022] Open
Abstract
Fetus-in-fetu (FIF) is a rare congenital anomaly where a parasitic twin is within the body of a host twin. FIF is reported to occur in 1:500,000 live births. Herein, we report the first case of the medical and surgical treatment of a FIF patient who was born with extreme prematurity at 25-weeks gestation. With the multi-disciplinary coordination of neonatology, surgery, and interventional radiology, the patient was able to achieve a window of medical stability 4 weeks after birth. A decision was made at that time to proceed with an intra-abdominal and perineal resection of the FIF. The FIF was successfully resected and the patient was able to recover from the operation, with eventual discharge from the NICU. In conclusion, extreme prematurity and FIF may be amenable to surgical resection and a multi-disciplinary approach is crucial to achieve the desired outcome.
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Affiliation(s)
- Raphael C. Sun
- Division of Pediatric Surgery, Doernbecher Children's Hospital, Oregon Health & Science University, Portland, OR, United States
- Division of Pediatric Surgery, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, United States
| | - Lily S. Cheng
- Division of Pediatric Surgery, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, United States
| | - Rita H. Shah
- Division of Neonatology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, United States
| | - Pablo Lohmann
- Division of Neonatology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, United States
| | - Nahir Cortes-Santiago
- Department of Pathology & Immunology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, United States
| | - Pamela D. Ketwaroo
- Edward B. Singleton Department of Radiology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, United States
| | - Sundeep G. Keswani
- Division of Pediatric Surgery, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, United States
| | - Alice King
- Division of Pediatric Surgery, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, United States
| | - Timothy C. Lee
- Division of Pediatric Surgery, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, United States
- *Correspondence: Timothy C. Lee
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10
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Krishnan V, Belle P, Gonzalez D, Hewitt G, McCracken K. Fetus-in-Fetu: A Case of Ovarian Involvement and Residual Regrowth in a Teenager. J Pediatr Adolesc Gynecol 2021; 34:882-884. [PMID: 34311094 DOI: 10.1016/j.jpag.2021.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 06/20/2021] [Accepted: 07/12/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Fetus-in-fetu (FIF) is a rare, congenital soft tissue mass typically occurring retroperitoneally in neonates younger than 18 months. We present a 13-year-old girl with an ovarian FIF occurrence and subsequent residual regrowth after resection. CASE A 13-year-old girl presented with abdominal pain and was found to have a 19-cm, complex, right adnexal mass. Preoperative tumor markers were normal and risk assessment favored a benign process. She underwent open ovarian cystectomy with pathology showing FIF. Nine months later, she had a recurrence of her ovarian mass and underwent right oophorectomy, with FIF on pathology. SUMMARY AND CONCLUSION In patients in whom FIF is discovered within the ovary, consider postoperative surveillance, because of the risk of recurrence or residual disease.
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Affiliation(s)
- Vidhya Krishnan
- Department of Obstetrics and Gynecology, The Ohio State University College of Medicine, Columbus, Ohio.
| | - Patricia Belle
- The Ohio State University College of Medicine, Columbus, Ohio
| | - Dani Gonzalez
- Department of Pediatric Surgery, Nationwide Children's Hospital, Columbus, Ohio
| | - Geri Hewitt
- Department of Obstetrics and Gynecology, The Ohio State University College of Medicine, Columbus, Ohio; Department of Pediatric and Adolescent Gynecology, Nationwide Children's Hospital, Columbus, Ohio
| | - Katherine McCracken
- Department of Obstetrics and Gynecology, The Ohio State University College of Medicine, Columbus, Ohio; Department of Pediatric and Adolescent Gynecology, Nationwide Children's Hospital, Columbus, Ohio
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11
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Al Wadi KA, Mal HA, Amin Ur Rahman M, Abuzaid M, Abu-Zaid A. Ovarian Fetiform Teratoma in a 17-Year-Old Adolescent Girl. Cureus 2021; 13:e15644. [PMID: 34306854 PMCID: PMC8279903 DOI: 10.7759/cureus.15644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/14/2021] [Indexed: 11/17/2022] Open
Abstract
Fetiform teratoma, also recognized as a homunculus, is a largely uncommon form of mature cystic teratoma. Here, we present the case of a 17-year-old single female who presented to the emergency department complaining of abdominal distension and pain for four months. Abdominal examination revealed a left-sided mass. Magnetic resonance imaging showed a multi-loculated and multi-septated left cystic ovarian mass, suspicious for a teratoma. The patient underwent laparoscopy and a left cystectomy was performed. The final histopathologic diagnosis was consistent with fetiform teratoma. Although extremely rare, ovarian fetiform teratoma should be considered in the differential diagnosis of women presenting with an abdominopelvic mass. It should be discerned from fetus-in-fetu and ectopic pregnancy. Careful clinical presentation, laboratory testing for beta-human chorionic gonadotropin, histopathologic examination, and cytogenetic analysis can greatly aid in pinpointing the diagnosis. Overall, fetiform teratoma carries a favorable prognosis; however, follow-up surveillance is advised to monitor for uncommon occasions of tumor persistence or relapse.
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Affiliation(s)
- Khalid A Al Wadi
- Department of Obstetrics and Gynecology, King Fahad Medical City, Riyadh, SAU
| | - Hanan A Mal
- Department of Obstetrics and Gynecology, King Fahad Medical City, Riyadh, SAU
| | | | - Mohammed Abuzaid
- Department of Obstetrics and Gynecology, King Fahad Medical City, Riyadh, SAU
| | - Ahmed Abu-Zaid
- College of Graduate Health Sciences, The University of Tennessee Health Science Center, Memphis, USA
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Ha TN, Nguyen TNT, Huynh C, Nguyen HC, Le QT, Dao TH. Intra-abdominal fetus in fetu presenting at 31 weeks gestational age. Radiol Case Rep 2021; 16:863-866. [PMID: 33552341 PMCID: PMC7850940 DOI: 10.1016/j.radcr.2021.01.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 01/05/2021] [Accepted: 01/11/2021] [Indexed: 01/05/2023] Open
Abstract
Fetus in fetu (FIF) is a rare anomaly of diamniotic monochorionic twins, in which a malformed fetus resides in its twin's body. This report shows a case with the prenatal diagnosis of FIF at Tu Du hospital. A 23-year-old woman, first-time pregnant, presented at the hospital with an abdominal mass in the fetus at 31 weeks and 4 days of gestation. The ultrasound showed an abnormal mass with the images of calcified features located in the left hypochondriac region and the kidney's upper pole. These images had shapes of skull, femur, spine and became more apparent as the fetus grew. Then, the patient was monitored and delivered at our hospital. The infant was moved to the Children's Hospital 1 and diagnosed with FIF by ultrasound. The surgical resection was performed at 12 days of birth.
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Affiliation(s)
- To-Nguyen Ha
- Department of Radiology, Tu Du Hospital, Ho Chi Minh, Vietnam
| | | | - Chinh Huynh
- Department of Radiology, Tu Du Hospital, Ho Chi Minh, Vietnam
- Corresponding author.
| | - Huu-Chi Nguyen
- Department of Radiology, Children Hospital 1, Ho Chi Minh, Vietnam
| | | | - Trung-Hieu Dao
- Department of General Surgery, Children Hospital 1, Ho Chi Minh, Vietnam
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13
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Surgical Removal of a Gigantic Retroperitoneal Fetus in Fetu: One Case Report. JOURNAL OF FETAL MEDICINE 2021. [DOI: 10.1007/s40556-020-00277-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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14
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Smith K, Moore A, Popov S, Adams M, Folaranmi E, Sekaran P. Fetus-in-fetu found at excision of antenatally diagnosed abdominal mass: Multi-disciplinary approach. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2021. [DOI: 10.1016/j.epsc.2020.101679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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15
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Sherbaf FG, Tavallaei N, Ghanbarinasab Z, Hoseinyazdi M, Movahedipour M, Lotfi R, Dehghanian A. First Case Report of Adnexal Fetus in Fetu. J Pediatr Adolesc Gynecol 2020; 33:745-747. [PMID: 32889084 DOI: 10.1016/j.jpag.2020.07.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 07/15/2020] [Accepted: 07/20/2020] [Indexed: 12/27/2022]
Abstract
BACKGROUND There is an ambiguous and controversial line between fetiform teratoma and fetus in fetu (FIF) as differential diagnoses of a fetiform mass. Classically, the presence of vertebral column often with a relatively proper arrangement of other organs around the central axis favor the diagnosis of FIF over teratoma. CASE Based on previously proposed criteria and the presence of vertebral organization in the radiological and histopathological assessment of the fetiform mass, we present an extremely rare case of adnexal FIF in a 10-year-old girl presenting with acute abdominal pain. SUMMARY AND CONCLUSION Whether FIF and fetiform teratoma are one entity or two, clinical discrimination for the choice of treatment seems to be unnecessary and the patient should be clinically followed for the probable malignant potential.
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Affiliation(s)
- Farzaneh Ghazi Sherbaf
- Medical Imaging Research Center, Department of Radiology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Nazfar Tavallaei
- Department of Gynecology, Yasuj University of Medical Sciences, Yasuj, Iran
| | - Zahra Ghanbarinasab
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Meisam Hoseinyazdi
- Medical Imaging Research Center, Department of Radiology, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Reza Lotfi
- Department of Radiology, Yasuj University of Medical Sciences, Yasuj, Iran
| | - Amirreza Dehghanian
- Molecular Pathology and Cytogenetics Division, Department of Pathology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran; Trauma Research Center, Shahid Rajaee (Emtiaz) Hospital, Shiraz University of Medical Sciences, Shiraz, Iran.
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16
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Matsubara N, Akasaka Y, Kanagaki M, Okamoto S. A case report of fetus in fetu with an aorta-like structure visualized by contrast-enhanced CT. Radiol Case Rep 2020; 15:2645-2648. [PMID: 33088380 PMCID: PMC7567927 DOI: 10.1016/j.radcr.2020.10.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 10/02/2020] [Accepted: 10/02/2020] [Indexed: 12/26/2022] Open
Abstract
Fetus in fetu (FIF) is a rare congenital anomaly resulting from abnormal embyogenesis in monochorionic diamniotic twins and appears as a cystic mass containing fetus-like structures mainly in the retroperitoneum of infants. Although there is a theory that FIF is a highly differentiated teratoma, it is commonly distinguished from teratoma as a mass containing a vertebral axis with appropriate arrangement of limbs or other organs around this axis. Here we present a case of FIF with aorta-like structure visualized by contrast-enhanced computed tomography. A 5-day-old girl was pointed out a cystic mass in the abdomen by ultrasound examination. Abdominal contrast-enhanced computed tomography revealed a retroperitoneal cystic mass with spine- and limb-like bone structures and blood vessel-like elongated structures and it was confirmed as FIF by surgery. The presence of major vascular structures along the skeletal axis is clearly different from teratoma and suggests that it occurred as an embryo and underwent some stage of development. Our findings strongly support the monozygotic twin theory.
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Affiliation(s)
- Naoko Matsubara
- Department of Diagnostic Radiology, Hyogo Prefectural Amagasaki General Medical Center, 2-17-77, Higashi-Naniwa-Cho, Amagasaki-shi, Hyogo, 660-8550, Japan
- Corresponding author.
| | - Yoshinobu Akasaka
- Department of Diagnostic Radiology, Hyogo Prefectural Kobe Children's Hospital, Hyogo, Japan
| | - Mitsunori Kanagaki
- Department of Diagnostic Radiology, Hyogo Prefectural Amagasaki General Medical Center, 2-17-77, Higashi-Naniwa-Cho, Amagasaki-shi, Hyogo, 660-8550, Japan
| | - Shinya Okamoto
- Department of Pediatric Surgery, Hyogo Prefectural Amagasaki General Medical Center, Hyogo, Japan
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Wang L, Long B, Zhou Q, Zeng S. Prenatal diagnosis of a "living" oropharyngeal fetus in fetu: a case report. BMC Pregnancy Childbirth 2019; 19:453. [PMID: 31783734 PMCID: PMC6884814 DOI: 10.1186/s12884-019-2612-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 11/19/2019] [Indexed: 12/25/2022] Open
Abstract
BACKGROUD Fetus in fetu (FIF) is a rare malformation in which a parasitic twin within its more mature twin. Most of the FIF locate in the retroperitoneum and are acardiac and anencephalic. CASE PRESENTATION Here, we describe a unique case of oropharyngeal fetus in fetu with a rudimentary two-chambered heart detected by prenatal ultrasonography. The parents terminated this pregnancy after counseling. Macroscopic examination found a solid mass between the oral and fetal chest, with a rudimentary two-chambered heart at the lowest part of the mass. Microscopic findings showed amniotic membrane, skin, cartilage, gastrointestinal and neural tissue. CONCLUSIONS Prenatal ultrasound can identify rudimentary organs suspecting FIF from early pregnancy. Detection of fetal heart beat facilitates differential diagnosis with teratomas, providing essential information for parental consulting and management.
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Affiliation(s)
- Ling Wang
- Department of Ultrasound Diagnosis, Maternal and Child Health Center of Zhuzhou, 128 Station Road, Zhuzhou, Hunan, China
| | - Baiguo Long
- Department of Ultrasound Diagnosis, Maternal and Child Health Center of Zhuzhou, 128 Station Road, Zhuzhou, Hunan, China
| | - Qichang Zhou
- Department of Ultrasound Diagnosis, The Second Xiangya Hospital of Central South University, 139 Renmin Road (M), Changsha, 410011, Hunan, China
| | - Shi Zeng
- Department of Ultrasound Diagnosis, The Second Xiangya Hospital of Central South University, 139 Renmin Road (M), Changsha, 410011, Hunan, China.
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Abstract
Human germ cell tumours (GCTs) are derived from stem cells of the early embryo and the germ line. They occur in the gonads (ovaries and testes) and also in extragonadal sites, where migrating primordial germ cells are located during embryogenesis. This group of heterogeneous neoplasms is unique in that their developmental potential is in effect determined by the latent potency state of their cells of origin, which are reprogrammed to omnipotent, totipotent or pluripotent stem cells. Seven GCT types, defined according to their developmental potential, have been identified, each with distinct epidemiological and (epi)genomic features. Heritable predisposition factors affecting the cells of origin and their niches likely explain bilateral, multiple and familial occurrences of the different types of GCTs. Unlike most other tumour types, GCTs are rarely caused by somatic driver mutations, but arise through failure to control the latent developmental potential of their cells of origin, resulting in their reprogramming. Consistent with their non-mutational origin, even the malignant tumours of the group are characterized by wild-type TP53 and high sensitivity for DNA damage. However, tumour progression and the rare occurrence of treatment resistance are driven by embryonic epigenetic state, specific (sub)chromosomal imbalances and somatic mutations. Thus, recent progress in understanding GCT biology supports a comprehensive developmental pathogenetic model for the origin of all GCTs, and provides new biomarkers, as well as potential targets for treatment of resistant disease.
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Affiliation(s)
- J Wolter Oosterhuis
- Laboratory for Experimental Patho-Oncology, Department of Pathology, Erasmus MC Cancer Institute, Rotterdam, Netherlands.
| | - Leendert H J Looijenga
- Laboratory for Experimental Patho-Oncology, Department of Pathology, Erasmus MC Cancer Institute, Rotterdam, Netherlands
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
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Abstract
Fetus in fetu (FIF) is an extremely rare condition in which malformed fetus is found most commonly in the retroperitoneum of living twin. It occurs in about 1 in 500 000 live births and less than 200 cases have been reported in medical literature. We report FIF in a 17-year-old woman unlike other cases which were usually detected in early age and in male gender. This is the eighth case of adult FIF and the first case of FIF in adult woman worldwide. Preoperative diagnosis of FIF on CT was made and planned for exploratory laparotomy. The excised malformed fetus in a sac was proven as FIF on the basis of histopathological examination. In view to avoid such late presentation, early detection of FIF with radiological imaging in clinically suspected case is recommended. Surgical excision is the ideal treatment even teratoma is the differential diagnosis.
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Affiliation(s)
- Anil Kumar
- General Surgery (Trauma), All India Institute of Medical Sciences, Patna, Bihar, India
| | - Shiv Shankar Paswan
- Trauma and Emergency, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Bindey Kumar
- Pediatric Surgery, All India Institute of Medical Sciences, Patna, Bihar, India
| | - Prem Kumar
- Radiodiagnosis, All India Institute of Medical Sciences, Patna, Bihar, India
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Fetus in fetu with skeletal dysplasia and hyperparathyroidism. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2019. [DOI: 10.1016/j.epsc.2019.02.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Yaacob R, Zainal Mokhtar A, Abang Jamari DZH, Jaafar N. The entrapped twin: a case of fetus-in-fetu. BMJ Case Rep 2017; 2017:bcr-2017-220801. [PMID: 28942402 PMCID: PMC5665320 DOI: 10.1136/bcr-2017-220801] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Fetus-in-fetu (FIF) is a rare entity in which malformed parasitic twin grows inside the body of its twin. It is most commonly presented with mass in the abdomen. We present a case of a 15-year-old boy who presented with abdominal mass since infancy. Radiological investigations are suggestive of FIF. Intraoperatively, malformed fetus in a sac was found and excised. Postoperatively the patient recovers well and was put on follow-up.
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Affiliation(s)
- Rashide Yaacob
- Department of General Surgery, Sultan Abdul Halim Hospital, Sungai Petani, Malaysia
| | | | | | - Norliana Jaafar
- Department of General Surgery, Sultan Abdul Halim Hospital, Sungai Petani, Malaysia
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