"Fetus in Fetu," coming soon
to a television near you

It wasn't rickets it was his living twin brother --
and he'd been carrying it for 7 years

By Mary-Ev Anderson

Now that I've seen it all, I can really retire, says Dr Virginia Baldwin with a chuckle. She's emerita professor of Pathology at the University of British Columbia and emerita consultant at BC Women's and BC Children's Hospitals.

What she saw was a fetus in fetu, which occurs when an early, developing embryonic cell mass divides unequally and one of the resulting potential twins has an incomplete program for further development. The incomplete, asymmetrical twin may survive in its sibling's body if it establishes a blood supply. However, it cannot be independently viable because it lacks crucial cellular material. Only 70 instances have been recorded in the last 200 years.

Dr Baldwin, author of The Pathology of Multiple Pregnancy, had seen every other anomaly of multiple pregnancy during her career in the laboratory that serves one of Canada's two largest birthing facilities.

A TRIP TO THE OLD WORLD
A world-renowned pediatric pathologist, Dr Baldwin examined the specimen recently in Kazakhstan. Local surgeons suspected a teratoma, a tumour that recapitulates portions of the three embryonic layers. A teratoma can arise in the ovaries and some midline regions of the body, such as the sacrococcus, intracranial area or thyroid. But Dr Baldwin's expertise was required to differentiate between that and a fetus in fetu. She was flown in to make a diagnosis as part of a documentary.

The material she examined, preserved in formalin, had been taken from a seven-year-old boy named Alamjan. Although his abdomen was distended as if he were in advanced pregnancy, and other children teased him relentlessly, his family had not taken him to a doctor. They assumed he had rickets and would recover. It was only when he complained at school of stomach pain and difficulty breathing that a doctor there discovered a mass pushing up against his stomach and lungs.

The boy was rushed into surgery, where it was discovered that the arteries of the mass were connected to his aorta. Once surgeons cut open the abnormally tough sac, they were horrified by what they found. Dr Baldwin examined the mass after it had been fixed in formalin.

"It was a roughly spherical mass consisting of four distorted, incomplete, malpositioned limb-like structures attached to a central tissue mass," she says "There was an area that could be construed as an incomplete attempt at facial structures. Around and over the top half of this mass was an enormous, long mane of black hair, and in its middle was a cystic structure that ended behind the face. There was no evidence of a brain cavity or a brain."

The fetus had no spine, thorax, abdomen, internal organs or body cavities, and just shreds of muscle and fat. It weighed 1.8kg and was 20cm in diameter. Unfortunately, the fluid from the sac had been discarded.

Dr Baldwin quickly ruled out a teratoma. "Teratomas have the potential for having malignant foci and some can look quite fetiform," says the pediatric pathologist. "Some of the fetuses in fetu can look quite amorphous, so the borderline isn't always distinct." Because a fetus in fetu does not exhibit malignant cells, Alamjan was not at risk.

CULTURAL STIGMA
Dr Baldwin reassured the boy's mother that the fetus was an accident of pregnancy and not her fault. Her words carried weight. If the boy's father and his rural, conservative family decided the boy's mother might produce more abnormal children, he could divorce her.

For now, Alamjan's parents have decided to tell him that his swollen belly resulted from eating unwashed fruit. Dr Baldwin concurs with this choice. While Western children are taught in primary school how fertilization occurs and how sex cells divide, she says, the boy and his family don't have that background. Alamjan may learn the truth later, she says, "but for trying to deal with the current tough situation, I don't think his mother made a bad choice." Dr Baldwin reassured the woman and local doctors there was no possibility of recurrence.

Dr Baldwin did not conduct a histological study on the fetus in fetu, and will not publish her observations. The specimen remains in Kazakhstan for future examination.

The documentary, titled "Vanished Twins", will air in Canada at a later date