A Little Girl, A Big Story


Keren Rabinovich at Rambam Medical Center. (Photo: Pioter Fliter.)

— Michele Segelnick

Last month, a four year old girl underwent surgery at the Rambam Medical Center in Haifa for an exceptionally rare tumor, which was in her pancreas. In fact, Keren is among the youngest people in Israel and throughout the world to have been diagnosed with pancreatic cancer. Insightful – and bold – diagnostic skills and top notch surgery saved the little girl’s life.

In November 2010, a local hospital sent four-year old Keren Rabinowitz to Rambam for serious and unexplained abdominal pain.   A CT scan examined at RHCC showed that Keren’s bile ducts were obstructed, causing jaundice, and indicating a tumor could be in the bile ducts or pancreas.

More after the jump.
Suspecting cancer, head of the hospital’s Endoscopic Ultrasound (EUS) Service, Dr Jesse (Yishai) Lachter conducted a biopsy, which verified that the child had a malignant neuro-endocrine tumor of the head of her pancreas. Uncommon  in adults, such tumors are almost unheard of in children. In fact, the well-known cancer hospital, Memorial Sloan Kettering Cancer Center in New York, has seen only 30 cases of any pancreatic tumors among patients of any ages under 21.  

Dr Lachter’s decision to do the biopsy was bold. “Rambam is doing a lot of cutting-edge pancreatic work, and we have the latest equipment, but pediatric endoscopic ultrasound devices for taking biopsies do not exist anywhere,” he says. Despite the lack of tools and medical community’s inexperience in handling pancreatic growths among children, Dr Lachter did the procedure. “We took a chance and it worked out well,” he says. “We don’t give up easily.”

The good news was that while cancerous, Keren’s growth could be removed.  Unlike many other pancreatic tumors, this rare type of tumor was definitively identified; it had been diagnosed in time and was operable.

“Rambam gave my little princess a chance to live,” said Keren’s mother, Valentina Vobek, who stood behind the hospital team all through this trying time. “Keren’s parents were terrific,” says Dr Lachter. “Even though we had never faced this type of problem, they were supportive, trusting and hopeful throughout.”

A true multi-disciplinary effort, Keren’s treatment also  involved  pediatricians, pediatric gastrointestinal specialists, general surgeons,  a pediatric surgeon,  a general anesthesiologist and a pediatric oncologist. The Rambam doctors involved have submitted the lessons from this case for publication, to share their newly-found knowledge with the medical community.
Pediatric Surgeon Dr. Marc Arkowitz performed the operation together with Prof Yoram Kluger, Head of General Surgery.

Several days afterwards, the little girl was home from the hospital and eating regularly. At this point, she will not receive post-operative treatment, but must be monitored by Dr Arkowitz every few months. “I am very optimistic about the outcome here,” says Dr Arkowitz. “Keren was diagnosed correctly and her surgery went well. She had a very rare tumor, especially for such a young patient. For me, this was a once-in-a-career case.”
Incidentally, Dr Arkowitz’s career and that of Dr Lachter began in New York, where they were both born and raised. Having immigrated to Israel in 1979, Dr Lachter is now a veteran Israeli. Dr Arkowitz made aliyah just one year ago.

A father of four, and new grandfather, Dr Lachter admits to having been strongly emotionally involved in this care of a small child. “Keren is four now, but she may well live to be 84, the average life expectancy for women in Israel,” he says, “This is a happy ending to a rare case.”