He’s only 18 days old, but he’s already in danger of dying. It was the doctors of the Policlinico San Matteo of Pavia who saved her by subjecting her to a delicate and exceptional surgery to remove the thymic mass, performed through the thoracoscopic route by the team led by Professor Giovanna Riccipetitoni, director of pediatric surgery. The neonatal age and the thoracoscopic technique applied in such a small patient make her an exceptional case to date.
The clinical case
The child’s mother, suffering from gestational diabetes and maternal-fetal isoimmunization, was sent to the specialists of the Obstetrics and Gynecology Department of the Pavia Polyclinic for the pathology of pregnancy.
And it was subjected to various diagnostic investigations. In particular, a fetal ultrasound performed by Dr. Alessia Arossa, at the Prenatal Diagnosis Service; a fetal magnetic resonance performed in pediatric radiology by doctor Luca Lungarotti and a fetal echocardiography, in pediatric cardiology, performed by doctor Claudia Codazzi.
The first ultrasound revealed a voluminous right paracardiac mass, while the other examinations revealed the extracardiac site: adhering to the pericardium and the great vessels.
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Neonatal treatment
These elements have made it possible to plan the neonatal treatment of the baby at the San Matteo Polyclinic, thanks to the specialized skills of Obstetrics and Gynecology 1 (directed by Arsenio Spinillo), of Neonatology and Neonatal Intensive Care (directed by Stefano Ghirardello) and of Pediatric Surgery (directed by by Giovanna Riccipetitoni).
The birth took place naturally; the little girl was hospitalized in Neonatal Intensive Care and subjected to a numerous series of tests.
Postnatal investigations
Postnatal investigations confirmed the prenatal diagnosis of paracardiac mass, starting from the thymus (lymphoepithelial organ located in the anterior mediastinum) and attributable to thymic teratoma, occupying the mediastinum and part of the right thorax.
Consequently, surgery was arranged using the thoracoscopic technique.
Surgical intervention
The team that operated on the child was made up of Professor Giovanna Riccipetitoni; Mirko Bertozzi, pediatric surgeon; Marta Gazzaneo, doctor in specialist training; Simonetta Mencherini, anesthetist; Valeria Bertolini and Rosella Mezzadra, instrumentalists; Michela Besutti Nurse; Monica Maniezzo and Cristina Marra, social health workers.
After the surgery, the patient was followed up in intensive post-operative care by the team of neonatologists, led by Dr. Stefano Ghirardello, and discharged in excellent condition.
“Exceptional case”
“The intervention carried out at San Matteo has exceptional characteristics, as other cases of thymic teratoma removed by thoracoscopic route in neonatal age are not described in the literature”, explained Riccipetitoni, who boasts previous experience in the treatment of thymic masses in pediatric patients .
“The mass was isolated from the pericardium and from the great vessels, taking care not to injure the attached vascular and nervous structures – concluded the professor -. The operation was perfectly successful with the recovery of the child, who was discharged from the neonatal intensive care unit in excellent health conditions “.