PMC3351264_01
(A) The parasitic twin in case 1 had a fully developed pelvis, two pairs of limbs, and a well-developed penis, which produced urine discharge. (B) The livers of the parasite and autosite were physically attached in case 1. (C) The parasitic twin in case 1 contained a pair of well-developed kidneys. (D) The autosite in case 1 during the twelfth month after the operation to remove the parasitic twin.
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The parasite was attached to the epigastrium of the autosite. The parasite possessed two upper limbs, two lower limbs, a pelvis, and a well-developed scrotum and penis, which produced urine discharge (Figure 1-A). Furthermore, the liver of the parasite was connected to the liver of the autosite such that the extrahepatic bile duct system was absent (Figure 1-B). The pelvis of the parasite contained two functioning kidneys (Figure 1-C), a urinary bladder, and a small intestine but lacked a large intestine and anus. Figure 1-D shows a representative image of the autosite in case 1 at 12 months after the operation.
PMC3351264_02
(A) Large hernia of the abdominal wall (H), omphalocele (O) and limbs (L) of the parasitic twin in case 2. (B) View of the hernia in case 2. The parasitic twin was excised, and the omphalocele was repaired. (C) The pelvis of the parasitic twin in case 2 contained one small kidney and a cyst. (D) The hernia in case 2 was repaired using VYPRO II mesh. (E) Condition of the repaired ventral hernia in case 2 at 14 days after surgery. (F) The autosite in case 2 during the twenty-third month after the operation to remove the parasitic twin.
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The parasitic twin was attached to the epigastrium of the autosite, in whom an infected omphalocele and a large ventral hernia were found (Figure 2-A). The autosite was generally stable, and no respiratory distress was observed. The omphalocele was repaired on the eighth day after birth, and the parasitic twin was successfully removed on the twentieth day after birth (Figure 2-B). The pelvis of the parasite contained one small kidney and a cyst (Figure 2-C). The hernia was eventually repaired using Ethicon VYPRO II mesh (Ethicon, Somerville, N.J., USA) (Figure 2-D) when the autosite reached 20 months of age. The patient recovered from the hernia surgery without complications (Figure 2-E). The autosite was followed up for 30 months, and Figure 2-F shows the patient in case 2 at 23 months after the surgical removal of the parasitic twin.
Case 2. Results of the DNA analysis of the twins in case 2. (A) Skin from the autosite. (B) Skin from the parasite. (C) Hair from the autosite. (D) Kidney from the parasite.
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DNA analysis revealed that the parasitic twin in the second case had an identical genotype to the autosite, which indicated that they were of monozygotic origin (Figure 3).