Identical twins don’t look alike but find unique tumour solution
How a woman sacrificed her own tissue to help her sister remove a cancerous growth
The growth on Marian Fields’ back first appeared in 2011. Her sister, Mary Jane, took one look and told her she needed to see a doctor.
“We figured it was a cyst,” Mary Jane said. “We were wrong,” Marian said. It took a half-dozen surgeries and 30 radiation treatments over the course of six years before the 66-year-old sisters finally learned the complete, horrifying truth. By then, the tumour had been cut and zapped so many times, it had been transformed into a painful, festering wound at the centre of Marian’s back.
Mary Jane accompanied her sister in April from Missouri, where they’ve shared a home for three decades, to MD Anderson Cancer Center, refusing to let her face a barrage of medical tests on her own.
“I don’t care how many times you’ve done this before,” she’d told one of Marian’s doctors back in Kansas City, “I only have one sister.”
Both were relieved to finally receive a definitive diagnosis in Houston, even if the news seemed bleak: Dr. Keila Torres, a sarcoma expert, explained that Marian had been suffering from a type of skin cancer so rare there have been only 150 known cases, and so aggressive that it had spread by then to cover her entire back, straight through to the bone.
Torres said she and Dr. Jesse Selber, a reconstructive plastic surgeon at MD Anderson, could remove the massive tumour and repair the excision with skin and muscle taken from other parts of Marian’s body. But there was a big problem: Marian was so petite and the tumour so large, she likely did not have enough excess tissue in other parts of her body to completely repair the gaping hole that would be left by surgery.
As Selber started to explain how he’d have to do “a suboptimal” patchwork repair, Mary Jane interrupted: “Just use me.”
Selber looked the sisters over. Mary Jane was a few inches taller and a bit heavier than her sister, so she probably had enough tissue to donate. They didn’t look alike, however, and a transplant would require a perfect genetic match.
“That’s a great idea,” Selber told her, “but that would only work if you were identical twins.”
“You don’t understand,” Mary Jane said. “We are.” ‘A certain symbiosis’ Nobody doubted the sisters were identical when they were young.
The twins were born12 minutes apart in the summer of 1951. The way their dad used to tell it, he had prayed for a girl after fathering three sons. “But after we came . . .” Mary Jane said. “He never prayed for a girl again,” Marian said, finishing the sentence.
They do that. Like other identical twins, they say “there’s a certain symbiosis” to their relationship.
“We don’t trade favours or anything like that,” Mary Jane said.
“You give as you can and you take as you need,” Marian said. “That’s how it’s always been with us.”
When they were12, Mary Jane was goofing off with a pair of garden clippers and accidentally cut off the tip of Marian’s index finger. Mary Jane wrapped the bleeding finger in a rag and asked her sister to cover for her: “Tell Mom and Dad you did it. You’re hurt, they won’t be mad at you.” Marian agreed, no questions asked. Later, when they were in high school, they sometimes traded places in class, just to mess with their teachers and classmates. Or they’d trick boyfriends by going on each other’s dates. They looked so much alike back then, nobody noticed.
After high school, though, Mary Jane’s looks began to change. She grew a few inches one year. Noticed that she couldn’t stop gaining weight, even as her sister remained small. Struggled with paranoia and mood swings.
When she finished college, she had to have a graduation cap custom-made, because her head was too big.
Adecade passed before she found a doctor who didn’t dismiss her concerns. He ran tests revealing she had been suffering from a benign brain tumour that had been causing her pituitary gland to produce excessive growth hormone.
The condition, Acromegaly, was treatable with steroids, but by then, she and her sister no longer appeared identical. Mary Jane had changed so much, they stopped telling people they were twins, because it wasn’t worth the hassle of explaining.
They could not have known it then, but there was an upside to the ordeal: Four decades before Marian’s cancer diagnosis, Mary Jane’s body had produced the excess tissue that would be needed to save her. Agenetic match Selber, the plastic surgeon, called the twins after ordering genetic tests. He said he was surprised to learn that, not only were the sisters identical, they were a 100-per-cent genetic match.
That meant they were even more compatible than typical identical twins.
“I told you so,” Mary Jane said, and the MD Anderson team got to work planning an unusual operation. Selber, who had performed the first-ever skull-scalp transplant, told the sisters he believed this would be the first twin-to-twin largetissue transplant.
“It was certainly the first one at MD Anderson,” Selber said.
On June 30, the sisters hugged before being moved into conjoining operating rooms. Selber, working with a team of five plastic surgeons, first harvested skin, muscle and blood vessels from Mary Jane’s midsection. They cut away a huge section of flesh — 54 centimetres by 21 centimetres and five centimetres deep — then stitched her back together, in what amounted to a massive tummy-tuck.
Selber moved with the tissue to the adjacent room, where he began the painstaking work of connecting Mary Jane’s flesh to her sister’s back. Four days earlier, Torres, the surgical oncologist, had removed the tumour, known as Plexiform Fibrohistiocytic Sarcoma.
Selber and the team connected eight different arteries and veins to the tissue graft, which spanned all of Marian’s back. When they were finished, 14 hours later, Selber snapped photos. He had never seen anything like it.
“It’s probably the largest free tissue transfer I’ve ever seen,” Selber said, “and the most extensive twin transplant that’s ever been done.”
Without the tissue donation, Selber would have struggled to remove all of the cancerous tissue without leaving Marian hobbled. The cancer still could return, he said, but thanks to the donation from her sister, the odds are less likely.
Mary Jane awoke from surgery first. “How’s Marian?” she asked.
Soon, Marian was stirring in a recovery room down the hall. The first words she managed to choke out: “How’s Mary Jane?” Overwhelmed with attention The sisters, who generally shy from the spotlight, were overwhelmed with the attention they received after the operation.
“Every single fellow and intern at the hospital came to look at us,” said Mary Jane, who has been slow to recover from the surgery.
Several wanted to talk to her. They wanted to know what inspired her to donate her flesh. It’s a ridiculous question, she said.
When a BBC reporter asked the same question, Mary Jane explained it this way: “We are two bodies with one soul. She is my other self.”