Asymmetric twinning: A preterm baby with Sacrococcygeal Teratoma and parasitic twin born to a 16-year-old Primigravida / Philippine Journal of Obstetrics and Gynecology

@#A 16-year-old primigravida, at 33 weeks and 5 days age of gestation came in due to preterm labor. Sonographic examination revealed an incidental finding of a mass attached to the sacrococcygeal area. The mass has a cystic and solid component diagnosed as sacrococcygeal teratoma. Attached to the mass were two lower extremity structures identified as femurs with feet and was considered as an underdeveloped parasitic twin. A classical cesarean section was performed because of the advanced preterm labor, and a live female infant weighing 2500 g was delivered. The parasitic lower limbs, however, inadvertently detached during delivery. There was a high index of suspicion because of a larger fundic height of 37 cm compared to the age of gestation and the difficult palpation on Leopold's maneuver. Accuracy of ultrasound findings helped the obstetricians to a timely and prepared for delivery.

Parasitic twin with major cardiac defect: a case report

Parasitic twins are an extremely rare form of asymmetrical conjoined monochorial monoamniotic twins where one of them has a mostly intact body that is able to survive and which is referred to as 'autosite', while the counterpart, referred to as 'parasite', is only rudimentarily developed being physically attached to and nourished by the other twin. Our case is a baby boy with Single Ventricle Heart defect with a thoraco-abdominal mass (epigastric heteropagus twin) attached to the anterior abdominal wall near the umbilicus with minimal visceral sharing. The twins had two external genitalia both in host and parasite micturating separately. After high risk surgery the parasite could be separated completely from the host and postoperative recovery was uneventful.

A rare case of craniopagus parasiticus delivered vaginally at a district hospital

Craniopagus Parasiticus is a very rare type of parasitic twinning. It has an incidence of only 4-6/10,00,000 births. Most of the babies with Craniopagus Parasiticus are still born with only few cases which survived after postpartum surgical separation. In Craniopagus Parasiticus the head of one of the twins is parasitic and protrudes from the head of the normal twin with an undeveloped or underdeveloped body. The skulls of the twins are fused but the body of one of the twins is not developed. The developed twin is known as the auto site while the undeveloped twin is the parasite. Age of the mother or certain nutritional factors have been implicated in the etiology of this type of twinning. This is a rare case report of a female baby with a parasitic craniopagus delivered vaginally at this district hospital. The patient was a fourth gravida 28 year old. There was antenatal polyhydramnios. The patient delivered preterm a still born female baby with a parasitic co-twin. In this case the heads of the twins were fused in temporal and parietal areas while the body of the parasitic twin was completely undeveloped. It was a morphologically female baby with rudimentary labia. The causes of Craniopagus Parasiticus are still not known. Scientists and researchers are continuing work to determine these and also to improve the prognosis and chances of post-surgical survival of these twins. Till present day however there have been only limited number of studies on Craniopagus Parasiticus owing to the rarity of the cases.

Fetus-in-fetu presenting as acute intestinal obstruction.

Fetus-in-fetu is a rare condition in which a fetiform calcified mass is often present in the abdomen of its host; a newborn or infant. We present the case of a three-month-old male baby with acute intestinal obstruction and abdominal mass. X-ray abdomen and ultrasonogram revealed a cystic mass with calcification. On laparotomy, a well encapsulated retroperitoneal mass causing high intestinal obstruction was identified. Total excision of the mass was done. Diagnosis of fetus-in-fetu was confirmed on histopathology. Postoperative recovery was uneventful.

A Case of Retroperitoneal Mass in Infancy, Fetus in Fetus / 대한산부인과학회잡지

"Fetus in fetus" is a rare pathologic feature consisting of a parasitic twin included within the body of the other twin, which most likely arises from inclusion of a monozygotic, diamniotic twin pregnancy. The exact embryogenesis of fetus in fetus is controversial. Some investigators propose that it is a highly organized teratoma. Since the condition was first described by Meckel in the late 18th centry, approximately 100 cases have been reported in the literature. Most cases present as an abdominal mass during the first year of life, with a few cases being detected prenatally by ultrasound examination. So we report one case of fetus in fetus detected by ultrasound examination prenatally.

Acardiac twins: an analysis of 10 cases

The pathological characteristics of the acardiac fetus were studied based on 10 autopsy cases. These cases were collected during a 13-year period at Seoul National University Hospital. All 10 fetuses were monochorionic twins, and six of them were male. Externally normal co-twins survived in five cases and died perinatally in three cases. The gestational period of these acardiacs ranged from 20 to 33 weeks. All of them showed a growth arrest of a fairly wide spectrum. Four cases belonged to acardius anceps, five were acardius acephalus, and one was acardius amorphus. Nine out of 10 cases were holoacardius, whereas one was hemiacardius with a vestigial heart tube present. Characteristic artery-to-artery anastomoses were demonstrated in all cases where examination was possible. The umbilical cords of the acardiacs often consisted of only two vessels, i.e., one umbilical artery and one umbilical vein, and these vessels were directly attached to the arteries and veins of the normal co-twins on the placental surface. The vascular system of the acardiac fetuses was simplified, providing only inflow and outflow pathways through common iliac vessels and vitelline vessels. When the head part was preserved (acardius anceps), the facial features were indistinguishable, particularly in the midfacial region, which resulted in a characteristic holoprosencephalic malformation of the brain in two out of four cases. Normal eyeball structure was not noted in any of these cases. The oral cavity and tongue were rarely recognized. Once the head part was absent (acardius acephalus) there was a wide variation of thoracic organ development. Hypoplastic lungs were seen in three cases, and they were connected to the trachea. A tracheoesophageal fistula was seen twice. The gastrointestinal tract was the most common feature of these acardiac monsters. However, it often lacked some portions, such as a stomach, midgut or part of a large intestine. The kidneys, testes and other parts of the urinary system were other common constituents of the acardiacs.