SummaryBackgroundFetus in fetu (FIF) is a rare entity in which a malformed diamniotic monochorionic parasitic fetal twin develops inside a normal co-twin’s body, most commonly in the abdominal cavity. FIF is differentiated from the teratoma by the presence of vertebral column often with an appropriate arrangement of other organs or limbs around it.Case ReportA two-and-a-half-year-old girl presented with a painless abdominal swelling in the right hypochondrium. On imaging, a heterogenous soft tissue mass with internal calcific densities was noted in the retroperitoneum. The mass had vertebral organization, limb and pelvic bones. The presence of a fetiform teratoma was suspected and surgery revealed an encapsulated mass with an anencephalic head, spine, upper and lower limb buds. Histopathology confirmed the presence of a fetus in fetu. The postoperative period was uneventful with no evidence of recurrence.ConclusionsFIF is a pediatric rarity. Cross-sectional imaging helps in differentiating it from a teratoma, meconium peritonitis and abdominal ectopic pregnancy. Surgical excision is the treatment of choice for this benign condition, which requires a follow-up only in certain cases. This case report describes a retroperitoneal fetus in fetu and discusses its clinical presentation, differential diagnosis and embryologic origin.

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(homogeneous), DNA binding 52% (normal less than 25 %), IgG 210 IU/ml (normal 128-199 IU/ml), IgA 330 IU/ml (normal 99-181 IU/ml), IgM 299 IU/ml (normal 60-129 IU/ml), complement 93 mg/dl (normal 104-161 mg/dl), rheumatoid factor titre positive. (SI conversion: IU/ml x 1000 = IU/l; mg/dl x 0 01 = g/l.) Clotting studies showed a prothrombin time 16 seconds (normal 13 seconds), activated partial thromboplastin time 54 seconds (normal 34 seconds), kaolin clotting time 36 seconds (normal 28 seconds), thrombin clotting time 18 seconds (normal 14 seconds), euglobulin clot lysis time 270 seconds (increased), fibrinogen and fibrin degradation products normal. These changes were consistent with circulating 'lupus' anticoagulant.Arteriography showed marked narrowing of all her arteries in the right forefoot, probably secondary to severe tissue oedema, with an absent dorsalis pedis and planter arch. A mid tarsal amputation was performed, but at operation there was only a gradual ooze of blood with minimal spurting from the stump vessels.Histology on the forefoot was consistent with ischaemic necrosis, showing only fibrin plugging of small vessels without involvement of the vessel wall 347 on 9 May 2018 by guest. Protected by copyright.

Background: Congenital anomalies of the kidney and urinary tract (CAKUT) are a group of disorders responsible for the majority of pediatric end-stage renal disease cases. There are only a few studies on CAKUT. Objectives: A study was conducted to determine the clinical and biochemical profile of children with CAKUT and to estimate the prevalence and the factors associated with hypertension in CAKUT. Methods: A cross-sectional study was conducted in a tertiary center for 18 months from March 2014 to August 2015. Demographic data were recorded, and clinical examination including blood pressure measurement was performed. Various biochemical parameters including plasma renin activity (PRA), urinary beta-2-microglobulin (B2M), and microalbuminuria were evaluated. Results: A total of 81 patients with CAKUT were studied. Twenty-two (27%) patients were underweight, 4 (5%) patients were stunted, and 26 (32%) were both underweight and stunted. Children with bilateral disease had a higher incidence of underweight (21/44 vs. 8/37; p = 0.04; 95% CI; Fisher exact test), and both underweight and stunted (25/44 vs. 10/37; p = 0.006; 95% CI; Fisher exact test) compared to children with unilateral disease. Hypertension was found in 27% cases. No association was found between hypertension and PRA, BM2, or microalbuminuria in our study. PRA was inversely proportional to the estimated glomerular filtration rate (eGFR) (Pearson test; 95% CI; p = 0.006). Conclusions: Bilateral disease in CAKUT was significantly associated with poor somatic growth. PRA was inversely proportional to eGFR. The prevalence of hypertension was higher in children with CAKUT than in normal children and is possibly multifactorial as it was not associated with elevated PRA, B2M, or microalbuminuria.

Primary renal lymphoma (PRL) is a rare condition and bilateral PRL even rarer. Most of these bilateral PRL have been reported in adults. We describe a 3-year-old male with bilateral primary renal B cell lymphoma with orbital metastases. We discuss the difficulties in diagnosis and management of this rare presentation of lymphoma.