Fetus in fetu

Foetus in foetu (or fetus in fetu) is a developmental abnormality in which a mass of tissue resembling a foetus forms inside the body. An early example of the phenomenon was described in 1808 by George William Young.[1]

Anteroposterior abdominal radiograph shows a soft-tissue mass in the right hemiabdomen. The mass contains calcified osseous-appearing structures of varying sizes and shapes.
The postoperative specimen shows a fairly well developed foetus lying on its back, with rudimentary digits.
Computed Tomography scan of the patient's abdomen reveals a large retroperitoneal soft-tissue mass. There are long hyperdense opacities that resemble fetal bones.

There are two theories of origin concerning "foetus in foetu". One theory is that the mass begins as a normal foetus but becomes enveloped inside its twin.[2] The other theory is that the mass is a highly developed teratoma. "Foetus in foetu" is estimated to occur in 1 in 500,000 live births.[3]

Classification as life

A foetus in foetu can be considered alive, but only in the sense that its component tissues have not yet died or been eliminated. Thus, the life of a foetus in foetu is akin to that of a tumor in that its cells remain viable by way of normal metabolic activity. However, without the gestational conditions in utero with the amnion and placenta, a foetus in foetu can develop into, at best, an especially well differentiated teratoma; or, at worst, a high-grade metastatic teratocarcinoma. In terms of physical maturation, its organs have a working blood supply from the host, but all cases of foetus in foetu present critical defects, such as no functional brain, heart, lungs, gastrointestinal tract, or urinary tract. Accordingly, while a foetus in foetu can share select morphological features with a normal foetus, it has no prospect of any life outside of the host twin. Moreover, it poses clear threats to the life of the host twin on whom its own life depends.[4]

Theories of development

There are two main theories about the development of foetus in foetu.

Teratoma theory
Main article: Teratoma

Foetus in foetu may be a very highly differentiated form of dermoid cyst, itself a highly differentiated form of mature teratoma.[5]

Parasitic twin theory
Main article: Parasitic twin

Foetus in foetu may be a parasitic twin fetus growing within its host twin. Very early in a monozygotic twin pregnancy, in which both foetuses share a common placenta, one foetus wraps around and envelops the other. The enveloped twin becomes a parasite, in that its survival depends on the survival of the host twin, by drawing on the host twin's blood supply. The parasitic twin is anencephalic (without a brain) and lacks some internal organs, and as such is unable to survive on its own. As the host twin has to "feed" the enveloped twin from the nutrients received over a single umbilical cord, they usually die before birth.

References
  1. George William Young (1808). "Case of A Foetus found in the Abdomen of a Boy". Med Chir Trans. 1: 236–64. PMC 2128792. PMID 20895115.
  2. Chua, JHY; Chui CH; Sai Prasad TR; et al. (2005). "Fetus-in-fetu in the pelvis" (PDF). Annals of the Academy of Medicine Singapore. 34: 646–9. Archived from the original (PDF) on 2007-10-11.
  3. Grant P, Pearn JH (May 1969). "Foetus-in-foetu". Med. J. Aust. 1 (20): 1016–9. PMID 5815070. — source not consulted; cited here following Hoeffel CC, Nguyen KQ, Phan HT, et al. (June 2000). "Fetus in fetu: a case report and literature review". Pediatrics. 105 (6): 1335–44. doi:10.1542/peds.105.6.1335. PMID 10835078.
  4. "Journal of Medical Case Reports | Full text | Fetus in fetu : a case report". Jmedicalcasereports.com. Retrieved 2012-11-22.
  5. Basu A, Jagdish S, Iyengar KR, Basu D (October 2006). "Fetus in fetu or differentiated teratomas?". Indian J Pathol Microbiol. 49 (4): 563–5. PMID 17183856.
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