胎兒中胎兒：一病例報告

Fetus in Fetu: Report of a Single Case

蕭雨青(Yu-Ching Hsiao) ； 陳秋江(Chiu-Chiang Chen) ； 施宗義(Tzung-Yi Shih) ； 徐惠松(Hwei-Song Shih) ； 陳偉德(Walter Chen) ； 吳康文(Nd Kang-Wen Wu)

《Acta Paediatrica Sinica》 34卷2期 (1993/04) Pp. 151-156

摘要

胎兒中胎兒(Fetus in fetu)是一種相當罕見的先天性異常。回顧文獻報告自從1800年到1965年全世界共有四十四個病例報告。病患為一個五歲大的女孩，因腹脹到小兒科門診求診，發現腹部腫塊，遂入院接受進一步檢查。腹部檢查在右上腹部可摸到15×10公分大腫塊，質地堅硬、表面平滑、無壓痛。腹部X光在右上腹部可以見到脊椎體、助骨、骨盆及長骨的構造。MRI發現在後腹膜的上半部有一個腫塊，內含有骨骼、囊腫和脂肪的成分。病患於住院後，在胎兒中胎兒的診斷下接受外科手術切除腫塊，腫塊外覆包膜，內含有一個寄生的胎兒，病患於手術後健康情況良好，目前門診繼續追蹤中。1935年Willis提出「胎兒中胎兒」與高度分化的畸胎瘤(teratoma)的鑑別診斷，主要是依據胎兒中胎兒具有脊椎長軸及以此長軸依序排列的其他器官或四肢。本病例符合以上診斷，特提出報告。

並列摘要

A five-year-old girl had been noted, since birth to have abdominal distension. There was no history of twinning or teratoma in the family. Physical examination discovered a 15×l0 cm mass in the abdomen. Roent-genologic examination demonstrated the presence of an axial skeleton and long bones within the mass. MRI showed a retroperitoneal mass with components of cystic, bony and fatty tissues. When the mass was surgically removed from the retroperitoneal cavity, pathologic examination disclosed a parasitic fetus measuring l5.3×6.3×6.0 cm in size and suspended by a peduncle within a capsule. The fetus was covered with skin, sebaceous materials and black hair. There were bilateral and symmetric upper extremities with a flapper-like, deformed hand. No obvious genital organ was noted. Dissection of the midline, revealed a vertebral column with spinal cord. An atrophic skull bone containing cephalized glial tissue was noted. A thoracic cavity and scapular .bone were found in the thoracic cage; however, no heart was noted. Gastrointestinal tract and kidney-like organs were seen within the abdominal cavity. Microscopically, there were glial tissues within the skull bone, spinal cord and vertebra. The uppper extremities revealed two long bones surrounded by myxomatous and fibrous tissue. A welldeveloped intestine and an ovary containing follicles with nearby lympy nodes were seen. The capsule showed fibrous tissue with calcification and hairs. It was distinguished from the teratoma by the presence of a vertebral axis and by an approproiate arrangement of other organs or limbs with respect to the axis, and corresponding to the generally recognized diagnostic criteria of fetus in fetu.

並列關鍵字

fetus in fetu