A Surprise Discovery

When a Cookstown couple took their daughter to the pediatrician for a cold, they had no idea they’d find something much bigger.

Savanna Tortorella was a few weeks away from turning 1 when she caught a cold. It was late December 2017, and her regular pediatrician was not available. Her parents wanted to make sure she was well enough for her birthday trip to Disney World, so they made an appointment with another pediatrician in the same office, Joann Alfonzo, M.D.

“She did a wellness check and pressed on her stomach,” recalls Savanna’s mom, Rachel. “She felt something, but she didn’t tell us what. She said, ‘I’d like you to take Savanna for an ultrasound.’”

Dr. Alfonzo sent the family to the Emergency Department (ED) at K. Hovnanian Children’s Hospital at Jersey Shore University Medical Center. After an ultrasound showed that Savanna had a mass in her stomach, she was admitted to the Pediatric Intensive Care Unit (PICU) around 2:30 a.m.

Investigating the Mass

Later that morning, Savanna met with our pediatric hematology-oncology team who ordered an MRI under sedation to confirm the mass and learn a little more about it. The mass looked like it could be attached to the ovary, but she wasn’t certain.

“Imaging can only guide us so much,” says Victoriya Staab, M.D., of Meridian Pediatric Surgical Associates, the pediatric surgeon who examined Savanna. “I told her parents that we won’t know for sure until we perform the surgery.”

Savanna’s surgery was scheduled for the next day on New Year’s Eve. Dr. Staab viewed the mass laparoscopically — that’s when the physician uses a small tool with a camera on the end. She soon realized that the MRI had been misleading. The baseball-sized mass had pushed Savanna’s ovary over, but it wasn’t attached. The mass was actually growing out of the back of her pelvis. After that discovery, Dr. Staab decided to perform an open surgery — a traditional type of surgery in which an incision is made — in order to remove the mass. Fortunately, Dr. Staab was able to remove the entire mass.

Savanna stayed in the hospital for two more days, and then she was able to go home. “The PICU was amazing,” Rachel says. “I felt like they treated her special.”

After the mass was removed, it was sent to the lab for testing. It turned out to be a neuroblastoma, a type of cancer that starts in the nerve cells. Fortunately, it was in stage 1, which is the earliest stage. Neuroblastomas can be very aggressive, especially once they start spreading to other parts of the body.

“It hadn’t spread to the lymph nodes, liver, lungs, or bone,” Dr. Staab says. “We were able to remove it completely thanks to Dr. Alfonzo’s very astute physical examination.”

Complex Coordination

For a complicated case like Savanna’s, many people are involved. The ED, PICU, Pediatric Surgery, Hematology-Oncology, Anesthesiology, and Radiology Departments all played a role. That’s where K. Hovnanian really shines.

“We have so many specialties here and we were able to get everything together quickly to find answers for the family,” Dr. Singh says. “In addition to all of the physicians, there are the nurses and child-life specialists who also helped make the experience great for the family. I was proud of how everyone stepped up.”

After the surgery, Savanna needed more tests to ensure the cancer was gone. That included a metaiodobenzylguanidine (MIBG) scan, in which a radioactive dye is inserted into the bloodstream to help pinpoint areas where there might be neuroblastoma cells. She also had to have a painful blood marrow test. Fortunately, everything turned up negative. Now, Savanna only has to visit the doctor for observation.

“I associate malignant with death, but that’s not always the case,” Rachel says. “There can be a good outcome even though you find a malignant mass.”

While it wasn’t the first birthday any parent would hope for their child, thanks to the care she received, Savanna will live to see many more birthdays. (And she did finally make it to Disney World!)