Thoracolumbar rachipagus parasite

Abstract

A rare example of rachipagus conjoint parasitic twinning in a newborn girl is described. A lipomatous mass with an attached hind limb (with fused feet) and a rudimentary vertebral arch were found adherent to the dorsal vertebral arches of the autosite in the thoracolumbar region. There was a clear cleavage plane between the autosite and the parasite. Microscopic sections of the excised specimen showed gut only. The autosite had no other congenital anomalies except for spina bifida in the thoracolumbar region with unfolding of the underlying cord. In the absence of underlying life-threatening anomalies, surgical excision of the parasite and treatment of the associated anomalies of the autosite is known to offer gratifying results.

Parasitic Rachipagus Conjoined Twins With Spina Bifida, Diplomyelia, Scoliosis, Tethered Cord Syndrome, and Ventricular Septal Defect -Case Report-

“…9,11,12) A neurovascular bundle may be present between the parasitic body and autosite. 1,2,7) In our case, we also found a neurovascular bundle connecting the ectopic breast to the vertebral column.…”

“…9) In addition, cartilage, nipple, eyeball, lung, gland, kidney, genital organ, urinary bladder, uterine tube, anus, scrotum, and intestinal canal are also found in parasites. 1,2,5,7,8,11,12) Cardiac and central nervous system tissue are rare in parasites, although some nervous tissue from the rachipagus autosite may dominate the parasite. 9) Rachipagus autosite is commonly associated with other malformations in rachipagus conjoined twins.…”

“…Other malformations may also be found in the rachipagus autosite such as patent ductus arteriosus, atrial septal defect, clubfoot, gallbladder hypoplasia, rectovaginal fistula, syndactyly, and horseshoe kidney. 1,2,5,7,8,11,12) Based on the typical clinical manifestation and pathologic characteristics, rachipagus conjoined twins are unlikely to be misdiagnosed, but must sometimes be discriminated from fetus in fetu and teratoma. Fetus in fetu is also a rare developmental malformation first described by Meckel and the standard of diagnosis proposed by Willis in 1953.…”

Dorsolumbar Parasitic Rachipagus Twin, Case Report

“…In patients with rachipagus, a lipoma at the base of the parasitic mass with an intraspinal extension has frequently noticed. 10,14,21 In the case presented here, the mass was firmly attached to the posterior elements of the dorsal D12 vertebra to the 3 rd lumbar vertebrae, and the intraspinal lipoma was found at the same level.…”

“…7,21 This attached part composed of primitive embryonic tissue prevents closure of the neural tube during later development, resulting in spina bifida, or other neural tube defects. 8,14 Thus, the most A C B anticipated anomaly of the living fetus is the closure defect of the dorsal vertebral column. Location of the spinal lipoma at the same level and the origin of the parasite support this explanation.…”