Fetus-in-fetu: a pediatric rarity

Abstract

Fetus-in-fetu (FIF) is a rare entity resulting from abnormal embryogenesis in diamniotic monochorionic twins, being first described by Johann Friedrich Meckel (1800s). This occurs when a vertebrate fetus is enclosed in a normally growing fetus. Clinical manifestations vary. Detection is most often in infancy, the oldest reported age being 47. We report the case of a 4-day-old girl who was referred postnatally following a prenatal fetal scan which had revealed the presence of a multi-loculated retroperitoneal mass lesion with calcifications within. A provisional radiological diagnosis of FIF was made. Elective laparotomy revealed a well encapsulated retroperitoneal mass containing among other structures a skull vault and rudimentary limb buds. Recovery was uneventful. Here we discuss the difference between FIF and teratomas, risks of non-operative therapy and the role of serology in surveillance and detection of malignant change.

Figure 1:

Calcifications seen over right upper abdomen on radiograph.

Figure 2:

Sonographic long bones.

Figure 3:

Resected specimen seen encapsulated by a thin, intact membrane.

Figure 4:

Rudimentary limb buds and an anencephalic fetus extracted from the sac.

Figure 5:

The divided sac containing rudimentary pulmonary structures.