ASL Roma 6, in the emergency room with abdominal pain: 18-year-old saved from a rare neoplasm

It is a very rare neoplasm which occurs with an incidence of 1 case in a million and is difficult to diagnose

ROME – It happened to a very young man who, thanks to the high specialization of the doctors at the Castelli Hospital, was treated by a multidisciplinary team that identified the critical issue. The Extraordinary Commissioner of the ASL Roma 6 Dr. Francesco Marchitelli complimented: “The commitment and dedication of our professionals involved in the case of the young patient is truly admirable. Their ability for multidisciplinary collaboration was fundamental to successfully face such a complex challenge. Their teamwork and their expertise certainly made the difference in the diagnosis and treatment of this rare neoplasm, offering the boy the best chance of recovery. I applaud them all for their extraordinary commitment and professionalism.”

It is a very rare neoplasm which occurs with an incidence of 1 case in 1000,000, which is difficult to diagnose and which if not treated is associated with high mortality and cardiovascular morbidity as well as compression of the surrounding organs. The young man, B.F., showed up in the emergency room with severe abdominal pain, so persistent that no painkiller up to that point had taken effect. When the doctors found themselves faced with a boy in the throes of a major hypertensive crisis, without wasting time, they subjected the young man to a CT scan of his abdomen. The examination immediately gave a clear result: a “rounded expansive neoformation of approximately 7cm, richly vascularized, on the left side of the abdominal aorta”. In the eyes of the radiologists it was immediately suspected of being a malignant neoplasm (GIST vs paraganglioma).

At that point, the young man was admitted to the General Surgery department, and immediately underwent a careful diagnostic process including: blood chemistry tests, tumor markers, a total body CT scan, an electrocardiogram with cardiological evaluation and an echocardiogram as well as a MRI of the abdomen which confirmed the presence of the malignant nodular formation. The clinical case was immediately the subject of a multidisciplinary meeting in which General Surgeons, Vascular Surgeons, Urologists, Radiologists, Interventional Radiologists, Endocrinologists, Oncologists and Anesthesiologists participated. The collegial discussion, which took place based on national and international guidelines, on the clinical evaluation of the patient, on the evaluation of the radiological images of the CT and Magnetic Resonance Imaging and of the images resulting from the 3D reconstruction of the vascularization of the neoplasm, obtained thanks to latest generation available in the Radiology department, has allowed us to define the patient’s therapeutic process. Using the resources of the technological hybrid room present at the Castelli Hospital, the patient underwent a procedure that allowed the Interventional Radiologists to perform the embolization, therefore the closure, of the arterial vessels afferent to the neoplasm in order to reduce the risk of bleeding during surgery. Subsequently the patient underwent a complex surgical operation in which various medical specialties participated: the General Surgeons and the Vascular Surgeons, assisted by the operating room nursing team, who completed the painstaking removal of the neoplasm, the Anesthesiologists who promptly addressed the hypotensive crises that occurred during the operation, the urologists positioned a ureteral stent ensuring the preservation of renal function.

The Anesthesiologists who promptly dealt with the hypotensive crises that occurred during the operation, the Urologists who positioned a ureteral stent ensuring the preservation of renal function. The innovative technology with indocyanine green, which the operating block does not lack, has made it possible to verify the vascularisation, and therefore the vitality, of the abdominal organs. The patient, entrusted to the careful care of the Intensive Care doctors for the 24 hours following the surgery, returned to the General Surgery department where, after a rapid recovery, he was discharged in good clinical conditions and without complications. The histological examination of the surgical specimen, examined at the Pathological Anatomy, was positive for an extra-adrenal paraganglioma, completely removed and therefore requiring no further therapy. The comparison and collaboration between the different medical specialties, the excellent nursing care together with the technological systems available at the Castelli Hospital have made it possible to manage the case in the best possible way, guaranteeing the patient a rapid recovery and return to daily activities .