FETUS IN FETU
Asok Kumar Datta, Arvind Kumar Singh, Taraknath Ghosh, Narendranath Mukherjee
Pediatric Medicine and Pediatric Surgery, Burdwan Medical College, India
Address for Correspondence
Asok Kumar Datta, Ulhas Mini Township, CRAV-01, Joteram, Burdwan-713101.
Email
asokdatta31@yahoo.com
Keywords
Fetus in Fetu, abdominal mass
A 3 months old boy presented to pediatric outpatient department with an abdominal mass since birth. Infant appeared healthy with normal growth and developmental pattern. On local examination a mass on right side of abdomen was palpable that was large, round, firm, non- tender and fixed. Straight x-ray abdomen showed bone densities consistent with a well organized fetal spine and other fetal bony parts in right abdomen (Figure 1). Ultrasound (USG) abdomen showed a cystic space occupying lesion in right lumber region and right iliac fossa. Two well formed structures resembling fetal head and parts of fetal long bone were seen. In CT scan of the abdomen, large cystic area was noted in right lumber and right iliac fossa region and contents were fetal bony parts including spine, large bone and calvarium. Right kidney of the child could not be seen properly. Patient was operated and a firm retroperitoneal sac was seen in which right dysplastic kidney incorporated within the sac and blood supply from superior mesenteric artery. The mass was removed enroot. Postoperative course was uneventful and the patient was discharged on 7th postoperative day. Gross examination of the fetus showed it to be anencephalic. It was covered entirely with skin, there were two malformed lower limbs with two rudimentary upper limbs (Figure 2). On follow up the child was found to be normal.

Figure 1: Straight x-ray abdomen showed bone densities consistent with a well organized fetal spine and other fetal bony parts in right abdomen


Figure 2: Gross examination of the fetus showed it to be anencephalic. It was covered entirely with skin; there were two malformed lower limbs with two rudimentary upper limbs.


The term fetus in fetu was first described by Meckel in late 18th century to describe an encapsulated fetoid tumor with a fetus. (1) It occurs relatively equal in male and female patients presenting with an abdominal mass in infancy. (2) There exists much controversy whether a fetus in fetu is a well-formed teratoma (tumor composed of three germ layers) or not. The distinction between the two is based on the "Willis criteria" which stress on the development of an axial skeleton with vertebral axis (having passed through the primitive streak stage) and an appropriate arrangement of other organs and limbs with respect to the axis.(3) In our case the presence of vertebral column was clearly observed. The incidence is 1 in 500000 births, (4) with fewer than 100 cases reported worldwide.(5) It commonly present as an abdominal mass that is typically located in upper retro peritoneum as it was found in our case. Other more unusual sites being cranial cavity, oral cavity, sacroccocygeal region and scrotum. (1,5) Symptoms are mainly related to mass effect and include abdominal distension, feeding difficulty, emesis, jaundice, pressure effect on renal system and dyspnea. Vascular supply of mass is usually from superior mesenteric vessels or may be derived from plexus were fetus-in-fetu and the sac is attached to the host abdominal wall. (2) In our patient blood supply was from superior mesenteric artery. Diagnosis is based mainly on radiological findings. The treatment of choice is operative removal.
Funding
None
Conflict of Interest
None
References :
  1. Senyuz OF, Rizalar R, Celayir S, Oz F. Fetus in fetu or giant epignathus protruding from the mouth. J Pediatr Surg. 1992; 27: 1493-1495.
  2. Thakral CL, Maji DC, Sajwani MJ. Fetus-in-fetu: a case report and review of the literature. J Pediatr Surg. 1998; 33: 1432-1434.
  3. Willis RA. The borderland of embryology & pathology. 2nd ed. Washington DC . Bulterworths; 1962: 442-462.
  4. Hopkins KL, Dickson PK, Ball TI, Ricketts RR, O'Shea PA, Abramowsky CR. Fetus-in-fetu with malignant recurrence J Pediatr Surg. 1997; 32: 1476-1479.
  5. Kakizoe T, Tahara M. Fetus in fetu located in the scrotal sac of a newborn infant: a case report. J Urol. 1972; 107: 506-508.
Last Updated : Saturday, September 01, 2012 Vol 9 Issue 9 Art #56
DOI: 10.7199/ped.oncall.2012.56
How to Cite URL :
Datta K A, Singh K A, Ghosh T, Mukherjee N. FETUS IN FETU. Pediatric Oncall [serial online] 2012[cited 2012 September 1];9. Art #56. Available From : http://www.pediatriconcall.com/Journal/Article/FullText.aspx?artid=507&type=J&tid=&imgid=&reportid=163&tbltype=
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