Biology Concepts – conjoined twins, resorbed twin,
monozygotic twin, spina bifida, fetus in fetu, vanishing twin
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Abby and Brittany Hensel are
the ultimate in teamwork.
They drive a car, walk, go
swimming, even use a computer
keyboard with each twin
controlling one arm and one leg.
They each had to pass the
driver’s test to get their license.
This picture is from their 22nd
birthday, but they are now
25 and teach elementary math.
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The girls represent a form of conjoined twins called
symmetrical or equal. Each twin is developed to the same degree as the other. Even
for symmetric conjoined twins, Abby and Brittany are unusually symmetric. Many
of their internal organs are doubled; each has their own heart, spleen, stomach
and spinal column.
Unfortunately, this isn’t always the case. All conjoined twins
are termed imperfect, since the single embryo did not split completely, but
some are more imperfect than others. Remember that 40-60% of conjoined twins
are stillborn; we only see the miracles where they can be separated or where
they can function and grown up to be strong, independent people.
Asymmetrical, or unequal conjoined twins lie along a continuum. In some instances, one twin is slightly larger and stronger, even in
symmetrical cases like Brittany and Abby, Abby’s leg is two inches taller than
Brit’s, so Brittany has a larger calf muscle from standing on her tip toes all
the time. In other cases, one twin is unrecognizable as a small tumor in the
body of the other twin, but more on that later.
If one asymmetrically conjoined twin is much larger and
healthier than the other, it can have it’s health put at risk by the parasitic twin
(ie. the smaller, less developed twin is terms the parasite). In many cases,
the parasitic twin is dependent on
the autosite (larger twin) for
survival because he/she does not have a complete cardiovascular system of
his/her own.
Despite it’s weaker state, the parasitic twin does survive
to delivery because it gains energy and oxygen from the larger twin. Remember
that these are conjoined twins, so they will share a blood system. This is why
the otherwise doomed parasitic twin can live before and after delivery. This is
one characteristic that distinguishes parasitic twinning from conditions
like absorbed twin or vanishing twin (see below).
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The first Total Recall movie
had Arnold Schwarzenegger,
but the real star was a
mutant, parasitic twin named Kuato.
His mutation allowed him to
read the thoughts of other,
but you had to hold his
hands. Kuato wasn’t far from the
real thing in some people –
except for the being alive and
having mutant powers, of
course. There are pictures of
parasitic twins on the web,
but I wouldn’t recommend
eating before you look at
them.
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In a newly described case, one set of rachipagus (joined at the spine) conjoined twins consisted of an individual whose only indication that they had a twin was a single leg extending from his back.
And sometimes it isn’t even that simple to see the twin.
Spina bifida is an all too common congenital defect in which the spinal column
and backbone do not close completely. There are varying degrees of spina
bifida; including a mild form (occulta) in which has perhaps a dimple or some
hair and no symptoms and a severe form (myelomengiocele) where the spinal column could
be open to the environment. One reported case of parasitic twins consisted of a
conjoined twin hidden within the defect of a spina bifida patient (2012).
Then there was a 2005 case in Egypt where the young boy had a
parasitic twin that consisted of only a head. The head was located on the
surface of the larger twin’s body. It could blink, cry, and even smile. The
parasite didn’t cause the death of the larger twin, but he did unfortunately die from an
infection obtained from the surgery undertaken to remove his sibling.
In other cases, the parasitic twin is completed enveloped in
the larger twin’s body. The tissue is still alive, but invisible to the naked
eye. This is sometimes called fetus in
fetu (fetus within a fetus). But the definition is a bit more involved.
Most fetus in fetu cases have a specific location in the body, the
retroperitoneal space.
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Kind of silly, but this is
how fetus in fetu got its name. A baby
is born and it has a small
fetus inside its abdomen. It looks
like the baby is pregnant; ie. fetus in a fetus. In real life, some
aphid insects are born
pregnant (see this post).
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However, if the axes are maintained and the tissues are organized,
the site of the mass can be given a bit of leeway and still term the case as
fetus in fetu. Amazingly, there is a case described in which the parasitic twin was found in the cranial cavity of the surviving twin, and even one
where the twin mass was found in the scrotum of the survivor!
Even weirder, a case reported in India described two fetuses within the abdominal cavity of their male sibling. Talk about a bully, he ate his siblings. Notice that most of these
cases involve boys as the surviving individual.
The known cases of fetus in fetu have a strong male predilection.
Is there something genetic there, or is it the difference in how parents treat
boys and girls? Maybe not.
When tissue is not viable, many things can happen, including
calcification. Calcium can get added to the tissues so that the body kind of
walls it off. This happens to some fetus in fetu tissues if they lose their
blood supply as they grow. It can also happen in cases where the twin passes
away while still in the uterus and is then absorbed by the surviving fetus.
Appropriately enough, these are called absorbed twins or resorbed
twins. Like fetus in fetu, absorbed twins end up inside the other twin.
Unlike fetus in fetu or parasitic twins, absorbed twins don’t have to be conjoined
twins and the absorbed twin is not alive. They don’t even have to be MZ twins; they usually are, but they could be
any type of multiples.
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Dwight Schrute bragged that
he grew strong by
reabsorbing his twin in the
womb. If his twin is still inside
him, he resorbed it. If
there’s no evidence, then it’s
a vanished twin.
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Absorbed twins can cause some problems that other types of
twins can’t. For instance, there is the potential to misdiagnose a trisomy or other nondisjunction problem (see this post) because there is extra DNA
floating around in the amniotic fluid.
The mass of tissue that was a twin can be found just about anywhere in the
body - but it doesn’t have to be a mass. In some cases, the twin tissues can be
flattened against growing tissues of the other fetus and ends up paper thin and
spread out – fetus papyraceous. This
condition occurs about once in every 200 twins pregnancies, so it is not too
uncommon in multiple gestations.
In vitro
fertilization (IVF) techniques are increasing the rates of MZ twinning,
dizygotic twinning, parasitic twinning (including fetus in fetu) and absorbed
twins. As we said above, as many as 25% of pregnancies with more than one
embryo could end up losing an individual to one of these phenomena.
One of these possible outcomes is closely related to
absorbed twin. If the reabsorption comes early in the pregnancy with little or
no evidence of the absorbed twin found in the survivor, then it can be called a
vanished twin.
The vanishing twin becomes non-vital in utero, but it
usually occurs earlier in the pregnancy and is diagnosed by ultrasound. The
mother will have an image taken at, say, four weeks gestation, and there will
be X number of small embryos implanted and developing placentas and amniotic
sacs. Two weeks later she will be imaged again, and there will be one or two
fewer embryos and amnions. The other(s) vanished; hence the name.
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Gross picture, but you can
see the different kinds of tissues
in the teratoma. You can even
see some teeth (arrow). Some
clinicians consider parasitic
or resorbed twins to be highly
differentiated teratomas, but
it just ain’t so.
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You may have heard of a teratoma.
Many people use the term teratoma when fetus in fetu/absorbed twin/vanishing
twin would be more appropriate. While they may appear similar, they have
different origins. A teratoma is a tumor of stem cells, not the result of
changes in an embryo. As they grow and propagate, some teratoma cells will
start to differentiate into specific cell types – they are pluripotent after
all. Teratomas may include fully or partially formed teeth, hair, and other
recognizable structures, but there is no organization to the growth as one
would see in fetus in fetu or an absorbed twin.
Today’s subjects have been interesting, but kind of a
downer. Next week let’s talk about some happier kinds of MZ twins. There are
several types, and they’re definitely not identical.
For more information or
classroom activities, see:
No real classroom activities
for lost twins, thank goodness.
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