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Conjoined twins
Published in Prem Puri, Newborn Surgery, 2017
Juan A. Tovar, Leopoldo Martinez
Asymmetric conjoined twins represent, in general, surgical challenges that are not unlike other ones met in this specialty. The acardius acephalus parasitic twin is inviable and dies upon clamping the umbilical cord of the host (autositus) twin. The fetus in fetu is treated as a tumor, and heteropagus asymmetric parasitic twins are removed with attention to preserving as much tissue as possible in order to respect the organs and allow wall reconstruction of the host.
Twin Fetus-in-Fetu: The Story of an Encaged Twin
Published in Fetal and Pediatric Pathology, 2023
Md Ali Osama, Priti Chatterjee, Amit Gupta
Fetus in fetu is a result of an abnormal embryogenesis in which a vertebrated heteropagus fetus (the parasite) is located in the body of its normally developed twin. This terminology was first used by Lewis, and was subsequently described by Meckel as a malformed vertebrate fetus with identifiable organogenesis, found inside the body of its twin partner [3]. The essential feature that entails for FIF is the presence of well-developed fetal organs macroscopically, vertebral columns and limbs. Variable degree of organogenesis have led to the development of lungs, kidneys, liver, intestine, and genitalia of the parasitic twin in the published case reports. The existence of a distinct spinal column connotates that the fetus has passed through a primary stage of gastrulation which involves formation of neural tube, metamerization, and symmetrical development around the vertebral axis. The diagnosis of FIF is difficult when the mass does not contain an obvious vertebral axis. The FIF is attached to the host twin via a body stalk containing a single main feeding artery and vein, representing umbilical vessels. There is absence of an independent circulatory system and a true placenta for the twin fetus. The growth of the parasitic twin may be hindered either due to the vascular dominance of the host twin or an inherent defect in the parasitic twin.
Diagnostic Dilemma of an Umbilical Mass in a Newborn Infant - a Twin or a Tumor?
Published in Fetal and Pediatric Pathology, 2021
Thangaraj Abiramalatha, Rekha Balasubramanian, Febe Renjitha Suman, Prakash Agarwal, Umamaheswari Balakrishnan, Prakash Amboiram
Omphalopagus heteropagus is an uncommon type of heteropagus, where the parasitic twin is attached externally to the umbilicus of the autosite. [4,7]. In almost all previous case reports of heteropagus, the parasitic twin mass resembled an incomplete fetus, had identifiable anatomical features such as limbs or head and was covered with skin [4,8]. In our baby, the parasitic twin presented as two amorphous soft tissue masses without external identifiable anatomical structure except for the patch of hair. Hence the diagnostic dilemma, whether it is a twin or a teratoma, persisted until the histopathological examination.
TRAP Sequence in Monochorionic/Monoamniotic (MC/MA) Discordant Twins: Two Cases Treated with Fetoscopic Laser Surgery
Published in Fetal and Pediatric Pathology, 2018
Gabriele Tonni, Gianpaolo Grisolia, Paolo Zampriolo, Federico Prefumo, Anna Fichera, Paola Bonasoni, Mathilde Lefebvre, Suonavy Khung-Savatovsky, Fabien Guimiot, Jonathan Rosenblatt, Edward Araujo Júnior
In MC/MA pregnancies, the treatment can be further complicated by the presence of cord entanglement, a finding that may be seen in 74% of MA twins and usually does not involve a worse perinatal outcome in such twins [20, 21]. Often in TRAP sequence the umbilical cord of the parasitic twin is very short, and in this case the choice of treatment modality is not affected.