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Trevisani V, Balestri E, Napoli M, Caraffi SG, Baroni MC, Peluso F, Colonna A, Iughetti L, Gargano G, Superti-Furga A, Garavelli L. Diprosopus: A Rare Case of Craniofacial Duplication and a Systematic Review of the Literature. Genes (Basel) 2023; 14:1745. [PMID: 37761885 PMCID: PMC10530716 DOI: 10.3390/genes14091745] [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] [Received: 07/19/2023] [Revised: 08/23/2023] [Accepted: 08/28/2023] [Indexed: 09/29/2023] Open
Abstract
In 1990, Gorlin et al. described four types of craniofacial duplications: (1) single mouth with duplication of the maxillary arch; (2) supernumerary mouth laterally placed with rudimentary segments; (3) single mouth with replication of the mandibular segments; and (4) true facial duplication, namely diprosopus. We describe a newborn born with wide-spaced eyes, a very broad nose, and two separate mouths. Workup revealed the absence of the corpus callosum and the presence of a brain midline lipoma, wide sutures, and a Chiari I malformation with cerebellar herniation. We conducted a systematic review of the literature and compared all the cases described as diprosopus. In 96% of these, the central nervous system is affected, with anencephaly being the most commonly associated abnormality. Other associated anomalies include cardiac malformations (86%), cleft palate (63%), diaphragmatic hernia (13%), and disorder of sex development (DSD) (13%). Although the facial features are those that first strike the eye, the almost obligate presence of cerebral malformations suggests a disruptive event in the cephalic pole of the forming embryo. No major monogenic contribution has been recognized today for this type of malformation.
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Affiliation(s)
- Viola Trevisani
- Medical Genetics Unit, Department of Mother and Child, Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy (F.P.)
- Post-Graduate School of Pediatrics, Department of Medical and Surgical Sciences of the Mother, Children and Adults, University of Modena and Reggio Emilia, 41125 Modena, Italy
| | - Eleonora Balestri
- Neonatal Intensive Care Unit, Department of Mother and Child, Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy
| | - Manuela Napoli
- Neuroradiology Unit, Department of Diagnostic Imaging and Laboratory Medicine, Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy
| | - Stefano Giuseppe Caraffi
- Medical Genetics Unit, Department of Mother and Child, Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy (F.P.)
| | - Maria Chiara Baroni
- Medical Genetics Unit, Department of Mother and Child, Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy (F.P.)
- Department of Medical and Surgical Science, Alma Mater Studiorum University of Bologna, 40126 Bologna, Italy
| | - Francesca Peluso
- Medical Genetics Unit, Department of Mother and Child, Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy (F.P.)
| | - Anna Colonna
- Department of Biomedical Technologies, School of Dentistry, University of Siena, 53100 Siena, Italy
| | - Lorenzo Iughetti
- Post-Graduate School of Pediatrics, Department of Medical and Surgical Sciences of the Mother, Children and Adults, University of Modena and Reggio Emilia, 41125 Modena, Italy
| | - Giancarlo Gargano
- Neonatal Intensive Care Unit, Department of Mother and Child, Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy
| | - Andrea Superti-Furga
- Division of Genetic Medicine, Lausanne University Hospital (CHUV), University of Lausanne, 1011 Lausanne, Switzerland
| | - Livia Garavelli
- Medical Genetics Unit, Department of Mother and Child, Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy (F.P.)
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Du XZ, Del Bigio MR, Stefanovici C, Miller E, Fan C, Bunge M, Rozovsky K. A case of diprosopus: a rare form of twinning radiology-pathology correlation. CASE REPORTS IN PERINATAL MEDICINE 2020. [DOI: 10.1515/crpm-2020-2004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Abstract
Objectives
Diprosopus is a rare subtype of conjoined twinning, with approximately 30 reported cases in English literature. Due to the rarity of conjoined twins, the mechanism leading to this developmental anomaly is not yet understood.
Case presentation
We present a case of diprosopus with multimodality imaging (prenatal and postnatal), and with pathological correlations. Developmental anomalies include partial duplication of frontal lobes, formation of a midline “third” frontal lobe, as well as orofacial and cardiac anomalies. The constellation of anomalies coincide with development during embryonic days 23–26, where the anterior prosencephalon, prechordal plate/oropharyngeal membrane, and cardiogenic plate are in very close proximity to each other.
Conclusions
This case offers an opportunity to better appreciate the radiologic and pathologic manifestations of diprosopus, and adds to the current body of evidence.
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Affiliation(s)
- Xiao-Zhou Du
- Department of Pediatric Radiology , University of Manitoba , Winnipeg , Manitoba , Canada
| | - Marc R. Del Bigio
- Department of Pathology , University of Manitoba , Winnipeg , Manitoba , Canada
| | - Camelia Stefanovici
- Department of Pathology , University of Manitoba , Winnipeg , Manitoba , Canada
| | - Elka Miller
- Department of Pediatric Radiology , University of Ottawa , Ottawa, Ontario , Canada
| | - Charity Fan
- Department of Genetics , University of Manitoba , Winnipeg , Manitoba , Canada
| | - Martin Bunge
- Department of Pediatric Radiology , University of Manitoba , Winnipeg , Manitoba , Canada
| | - Katya Rozovsky
- Department of Pediatric Radiology , University of Manitoba , Winnipeg , Manitoba , Canada
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Yazici B, Yuksel NO, Kologlu N. A Case of Diprosopus Tetraophthalmos: Ocular Findings and Surgical Treatment of Exposure Keratopathy. Ophthalmic Plast Reconstr Surg 2018; 34:e192-e193. [PMID: 30320715 DOI: 10.1097/iop.0000000000001238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Diprosopus is a rare variation of conjoined twinning. In this report, ophthalmic findings in an infant with diprosopus tetraophthalmos are presented. A male infant who was born at 33 weeks of gestation to a nonconsanguineous 42-year-old mother and 47-year-old father was examined for orbital abnormalities. The infant had a large head, 2 faces, and 4 eyes, of which 2 were placed laterally and 2 were fused in the midline. In the laterally placed eyes, the pupils were unresponsive to light, and the optic discs were hypoplastic. In the fused eyes, the lower and upper eyelids were also fused, horizontally wide, vertically short, and immobile, resulting in a progressive exposure keratopathy. On the 33rd day of life, a modified total tarsorrhaphy was performed with the use of inhalational mask anesthesia. The patient died due to pneumonia and septicemia on the 45th day of life.
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Affiliation(s)
| | - Nilay O Yuksel
- Ophthalmology Department, Ataturk Training and Research Hospital, Ankara, Turkey
| | - Nuri Kologlu
- Department of Neonatology, Jimer Hospital, Bursa, Turkey
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Bidondo MP, Groisman B, Tardivo A, Tomasoni F, Tejeiro V, Camacho I, Vilas M, Liascovich R, Barbero P. Diprosopus: Systematic review and report of two cases. ACTA ACUST UNITED AC 2016; 106:993-1007. [PMID: 27704687 DOI: 10.1002/bdra.23549] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Diprosopus is a subtype of symmetric conjoined twins with one head, facial duplication and a single trunk. Diprosopus is a very rare congenital anomaly. METHODS This is a systematic review of published cases and the presentation of two new cases born in Argentina. We estimated the prevalence of conjoined twins and diprosopus using data from the National Network of Congenital Anomalies of Argentina (RENAC). RESULTS The prevalence of conjoined twins in RENAC was 19 per 1,000,000 births (95% confidence interval, 12-29). Diprosopus prevalence was 2 per 1,000,000 births (95% confidence interval, 0.2-6.8). In the systematic review, we identified 31 diprosopus cases. The facial structures more frequently duplicated were nose and eyes. Most frequent associated anomalies were: anencephaly, duplication of cerebral hemispheres, craniorachischisis, oral clefts, spinal abnormalities, congenital heart defects, diaphragmatic hernia, thoracic and/or abdominal visceral laterality anomalies. One of the RENAC cases and three cases from the literature had another discordant nonmalformed twin. CONCLUSION The conjoined twins prevalence was similar to other studies. The prevalence of diprosopus was higher. The etiology is still unknown. The presence of visceral laterality anomalies may indicate the link between diprosopus and the alteration or duplication of the primitive node in the perigastrulation period (12-15 days postfertilization). Pregnancies of more than two embryos may be a risk factor for diprosopus. Given the low prevalence of this defect, it would be useful to perform studies involving several surveillance systems and international consortiums. Birth Defects Research (Part A), 2016. © 2016 Wiley Periodicals, Inc. Birth Defects Research (Part A) 106:993-1007, 2016. © 2016 Wiley Periodicals, Inc.
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MESH Headings
- Abnormalities, Multiple/epidemiology
- Abnormalities, Multiple/pathology
- Abnormalities, Multiple/physiopathology
- Anencephaly/epidemiology
- Anencephaly/pathology
- Anencephaly/physiopathology
- Argentina/epidemiology
- Cerebrum/abnormalities
- Cleft Palate/epidemiology
- Cleft Palate/pathology
- Cleft Palate/physiopathology
- Face/abnormalities
- Female
- Heart Defects, Congenital/epidemiology
- Heart Defects, Congenital/pathology
- Heart Defects, Congenital/physiopathology
- Hernia, Diaphragmatic/epidemiology
- Hernia, Diaphragmatic/pathology
- Hernia, Diaphragmatic/physiopathology
- Humans
- Male
- Neural Tube Defects/epidemiology
- Neural Tube Defects/pathology
- Neural Tube Defects/physiopathology
- Nose/abnormalities
- Prevalence
- Risk Factors
- Twins, Conjoined/pathology
- Twins, Conjoined/physiopathology
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Affiliation(s)
- María Paz Bidondo
- National Network of Congenital Anomalies of Argentina (RENAC), National Center for Genetic Medicine (CNGM), National Administration of Labs and Health Institutes (ANLIS), Buenos Aires, Argentina
- Department of Cellular Biology, Histology, Embryology and Genetics. Medicine College, University of Buenos Aires (UBA), Buenos Aires, Argentina
| | - Boris Groisman
- National Network of Congenital Anomalies of Argentina (RENAC), National Center for Genetic Medicine (CNGM), National Administration of Labs and Health Institutes (ANLIS), Buenos Aires, Argentina
| | - Agostina Tardivo
- National Network of Congenital Anomalies of Argentina (RENAC), National Center for Genetic Medicine (CNGM), National Administration of Labs and Health Institutes (ANLIS), Buenos Aires, Argentina
| | - Fabián Tomasoni
- National Network of Congenital Anomalies of Argentina (RENAC), National Center for Genetic Medicine (CNGM), National Administration of Labs and Health Institutes (ANLIS), Buenos Aires, Argentina
- Neonatology Service in the Evita Pueblo Hospital, Buenos Aires, Argentina
| | - Verónica Tejeiro
- National Network of Congenital Anomalies of Argentina (RENAC), National Center for Genetic Medicine (CNGM), National Administration of Labs and Health Institutes (ANLIS), Buenos Aires, Argentina
- Neonatology Service in the Evita Pueblo Hospital, Buenos Aires, Argentina
| | - Inés Camacho
- National Network of Congenital Anomalies of Argentina (RENAC), National Center for Genetic Medicine (CNGM), National Administration of Labs and Health Institutes (ANLIS), Buenos Aires, Argentina
- Neonatology Service in the 25 de Mayo Hospital, Catamarca, Argentina
| | - Mariana Vilas
- National Network of Congenital Anomalies of Argentina (RENAC), National Center for Genetic Medicine (CNGM), National Administration of Labs and Health Institutes (ANLIS), Buenos Aires, Argentina
| | - Rosa Liascovich
- National Network of Congenital Anomalies of Argentina (RENAC), National Center for Genetic Medicine (CNGM), National Administration of Labs and Health Institutes (ANLIS), Buenos Aires, Argentina
| | - Pablo Barbero
- National Network of Congenital Anomalies of Argentina (RENAC), National Center for Genetic Medicine (CNGM), National Administration of Labs and Health Institutes (ANLIS), Buenos Aires, Argentina
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Morabito R, Colonna MR, Mormina E, Stagno d'Alcontres F, Salpietro V, Blandino A, Longo M, Granata F. Accessory oral cavity associated with duplication of the tongue and the mandible in a newborn: A rare case of Diprosopus. Multi-row detector computed tomography diagnostic role. J Craniomaxillofac Surg 2014; 42:1924-8. [DOI: 10.1016/j.jcms.2014.07.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2014] [Revised: 07/02/2014] [Accepted: 07/30/2014] [Indexed: 10/24/2022] Open
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A case of diprosopus: perinatal counseling and management. Case Rep Pediatr 2014; 2014:279815. [PMID: 25254133 PMCID: PMC4164124 DOI: 10.1155/2014/279815] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Accepted: 07/31/2014] [Indexed: 11/25/2022] Open
Abstract
Diprosopus is a rare congenital malformation associated with high mortality. Here, we describe a patient with diprosopus, multiple life-threatening anomalies, and genetic mutations. Prenatal diagnosis and counseling made a beneficial impact on the family and medical providers in the care of this case.
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