PURPOSE OF INVESTIGATION: To propose a multidisciplinary protocol for postmortem disclosure of complex fetal malformations, comparing ultrasound, computed tomography (CT), magnetic resonance imaging (MRI), and autopsy in a case of conjoined ischiopagus twins. MATERIALS AND METHODS: A screening second-trimester ultrasound diagnosed ischiopagus twins at 20 gestational weeks in a 31-year-old woman without any previous ultrasound examination. The couple decided for pregnancy termination. The formalin-fixed fetuses underwent full-body CT, MRI, and autopsy. RESULTS: ultrasound accurately diagnosed ischiopagus twins. CT was very accurate in the description of bone components. MRI allowed better visualization of the visceral organs than CT. Only autopsy could disclose the aspect of the two gastrointestinal tracts and the external genitalia. CONCLUSIONS: Prenatal ultrasound represents the standard diagnostic exam for conjoined twins. CT-MRI virtual autopsy (virtopsy) may be an option if the couple refuses to authorize necropsy or may be useful to plan a minimally invasive autopsy preserving the external phenotype.
Twins, Conjoined/pathology , Adult , Autopsy/methods , Female , Humans , Magnetic Resonance Imaging/methods , Pregnancy , Pregnancy Reduction, Multifetal/methods , Pregnancy Trimester, Second , Tomography, X-Ray Computed/methods , Ultrasonography, Prenatal/methods
PURPOSE OF INVESTIGATION: Hydatidiform mole (HM) is an abnormal pregnancy characterized by proliferation of cytotrophoblast and syncytiotrophoblast and vesicular swelling of placental villi. The fetus or embryo can be absent or abnormal. HMs can be complete or partial. CASE REPORT: A case of diginyc partial HM at 12 weeks of gestational age was referred to the present center of prenatal diagnosis. The patient showed ovarian hyperstimulation syndrome. At ultrasonography, increased fetal nuchal translucency (NT) with fetal anomaly was evident, without sonographic signs of placental mole. Pregnancy was terminated with legal abortion. RESULTS: Partial HM (PHM) was suspected by ultrasonographic fetal markers with ovarian hyperstimulation syndrome, but the diagnosis was performed only with fluorescent in situ hybridization. In particular fetal NT appeared increased also in diginyc mole. CONCLUSION: In order to improve the detection rate of PHM, routine histological examinations may be associated to fluorescent in situ hybridization in all cases of fetal anomalies.
Hydatidiform Mole/diagnosis , Ovarian Hyperstimulation Syndrome/diagnosis , Uterine Neoplasms/diagnosis , Abortion, Induced , Adult , Female , Gestational Age , Humans , Hydatidiform Mole/complications , Hydatidiform Mole/therapy , In Situ Hybridization, Fluorescence , Nuchal Translucency Measurement , Ovarian Hyperstimulation Syndrome/complications , Ovarian Hyperstimulation Syndrome/therapy , Pregnancy , Ultrasonography, Prenatal , Uterine Neoplasms/complications , Uterine Neoplasms/therapy
