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Year : 2018  |  Volume : 61  |  Issue : 4  |  Page : 626-627
Partial “fetus-in-fetu”


1 Department of Histopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
2 Department of Paediatric Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India

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Date of Web Publication10-Oct-2018
 

How to cite this article:
Madakshira MG, Kakkar N, Menon P. Partial “fetus-in-fetu”. Indian J Pathol Microbiol 2018;61:626-7

How to cite this URL:
Madakshira MG, Kakkar N, Menon P. Partial “fetus-in-fetu”. Indian J Pathol Microbiol [serial online] 2018 [cited 2018 Dec 15];61:626-7. Available from: http://www.ijpmonline.org/text.asp?2018/61/4/626/242964




A 3-h-old female neonate, with a birth weight of 2500 g, born at 40 weeks of gestation following full-term normal vaginal delivery and had a large globular mass in anterior aspect of the neck [Figure 1]a. On examination, the mass was seen to be attached to the underlying mandible [Figure 1]b. There was a raw area below the mass with the presence of transmitted pulsations and expansion with each respiration. Systemic examination revealed a cardiac murmur, which on a two-dimensional echocardiography was shown to be a result of a complex congenital heart disease – double outlet right ventricle with left-to-right ventricular septal defect. Following a cardiology consultation and after informed consent from the parents about the condition and possible outcome, the child was taken up for excision of the globular mass. The child succumbed 4 h postoperatively due to cardiac failure.
Figure 1: (a) Photograph showing the globular mass arising from the neck. (b) Lateral X-ray showing the calcified structures in the mass suggesting a rudimentary head. (c) Gross pathology of the mass. (d) Serial slices of the mass with gray-white cut surface with a cystic space

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The excised mass was 5 cm × 3.4 cm × 3 cm and resembled a rudimentary head [Figure 1]c. The mass had hairs on the ventral aspect. The cut sections were solid cystic with the presence of cartilage, bone, and a developing tooth [Figure 1]d.

The histopathological sections revealed the presence of developing mandible, glial tissue, part of vertebral bones, and optic placodes arranged symmetrically. No primitive neuroectodermal tissue was identified [Figure 2]a, [Figure 2]b, [Figure 2]c, [Figure 2]d. A diagnosis of partial fetus-in-fetu was made considering the symmetrical arrangement of the various recognized tissues and the presence of part of vertebral column.
Figure 2: (a) Whole-mount section of the mass. (b) Developing mandible with primitive mesenchyme. (c) Developing spine. (d) Glial tissue

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Fetus-in-fetu is a rare congenital anomaly which is the presence of a parasitized twin on or inside the other twins.[1] Some authors argue that this entity could be a well-organized “fetiform” teratoma.[2] Since its first description by Meckel, cases have been reported from various parts of the body, with retroperitoneum being the most common site.[1],[3] The other sites of involvement include mediastinum, cranial cavity, back, Scrotum, and sacrococcygeal region. Involvement of the neck region is exceptionally rare with few anecdotal reports.[4] Although there are no definite guidelines for diagnosis, most pediatric pathologists follow the criteria propounded by Willis and Lord, in demonstrating the presence of vertebral column, limbs, or organs seen at appropriate places.[2] Prenatal radiological screening followed up by magnetic resonance imaging may be vital in postulating a possible diagnosis and planning the surgical approach in these cases.[5]

The rare possibility of a malignant transformation in the mass and grotesque appearance in some cases mandates the surgical removal of these rare lesions.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Karaman I, Erdoğan D, Ozalevli S, Karaman A, Cavuşoğlu YH, Aslan MK, et al. Fetus in fetu: A report of two cases. J Indian Assoc Pediatr Surg 2008;13:30-2.  Back to cited text no. 1
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2.
Sitharama SA, Jindal B, Vuriti MK, Naredi BK, Krishnamurthy S, Subramania DB, et al. Fetus in fetu: Case report and brief review of literature on embryologic origin, clinical presentation, imaging and differential diagnosis. Pol J Radiol 2017;82:46-9.  Back to cited text no. 2
    
3.
Federici S, Prestipino M, Domenichelli V, Antonellini C, Sciutti R, Dòmini R, et al. Fetus in fetu: Report of an additional, well-developed case. Pediatr Surg Int 2001;17:483-5.  Back to cited text no. 3
    
4.
Borges E, Lim-Dunham JE, Vade A. Fetus in fetu appearing as a prenatal neck mass. J Ultrasound Med 2005;24:1313-6.  Back to cited text no. 4
    
5.
Sewell EK, Massa-Buck B, Rubio EI, Massaro AN, Badillo A, Puscasiu E, et al. Impact of prenatal diagnosis of fetus-in-fetu. J Neonatal Perinatal Med 2017;10:333-8.  Back to cited text no. 5
    

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Correspondence Address:
Manoj Gopal Madakshira
Department of Histopathology, Post Graduate Institute of Medical Education and Research, Chandigarh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/IJPM.IJPM_143_18

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