3-year old back to cheerful self following complex surgery for rare aggressive chest tumor

contributed by Tessa Roy and Beata Mostafavi

A detailed 3D printed replica of child’s large tumor helps surgical team plan for successful surgery

Martina is back to playing with her little sister and family following cancer treatment and complex surgery.

Photos courtesy of the Abraham family

Three-year-old Martina Abraham is known for her bright personality and impressive imagination, often caught “playing pretend” by acting out stories or scenes from her favorite movies.

"She has this mischievous kind of laugh," said her mom, Marta Abraham.

"It started when she was little, and it stayed with her.”

But in late 2023, the Abrahams noticed that their daughter, which they describe as sweet, loving and having a kind and gentle nature toward her younger sister, didn’t seem quite like herself and started getting frequent fevers.

There were multiple doctor’s appointments, but no real answers until one winter night when they brought Martina to an emergency room near their home.

Initially, local doctors suspected pneumonia, but an X-ray revealed something far more serious—a large mango sized tumor in Martina’s lung.

Martina was hospitalized for two weeks, during which she underwent her first round of chemotherapy.

She was discharged after she was feeling better, but shortly after her second chemotherapy treatment, Martina was struggling to breathe again.

“That's when they told us that they thought the tumor was breaking down, and that there was more fluid restricting her breathing,” her mother said.

Getting to pediatric cancer experts

Martina needed emergency surgery, but the complex procedure required a high level of expertise.

After several calls, Martina was eventually airlifted to University of Michigan Health C.S. Mott Children’s Hospital by Survival Flight, Michigan Medicine’s critical care transport program.

“We knew she required high levels of oxygen to help maintain her respiratory function. We also knew if her respiratory function worsened, she would require a breathing tube placed in her trachea before we could safely bring her back to the university,” said Michael Warzocha, a flight nurse that flew with Martina to Mott.

Warzocha noted that a breathing tube could have created additional issues for Martina, but thankfully, she didn’t end up needing one.

The flight went smoothly, thanks in part to Martina’s dad, Dan Abraham.

“Dan was instrumental in helping keep Martina calm and relaxed,” Warzocha said.

“We were able to fly Martina to Michigan Medicine without any further complications.”

At Mott, doctors confirmed that Martina had a pleuropulmonary blastoma, a rare and aggressive type of tumor that develops in the lungs.

In her case, the tumor was growing despite treatment.

“As the tumor grew, it started taking up so much of Martina’s lung space that she couldn’t breathe,” said Tammy Stoll, a physician assistant who coordinates the Mott pediatric solid tumor oncology program.

Martina’s new team at Mott recognized the urgency of her case.

Next Steps

Using U-M’s pioneering 3D print lab, teams created a detailed replica of the tumor and surrounding organs using Martina's previous CT scan.

This gave the surgical team an intricate blueprint of what they were up against, allowing them to plan with precision.

"We reached out to anesthesia, the pediatric ICU, and cardiothoracic surgeons and we quickly put together a plan to get Martina here and into the operating room the next day,” said Erika Newman, M.D., section head of pediatric surgery and surgical director of the Mott solid tumor oncology program.

“Everyone worked together seamlessly to ensure she received the best care possible."

"This case highlights the collaborative care across multiple departments, especially during a time when the hospital was extremely busy,” Stoll added.

“Everyone recognized the urgency and prioritized getting Martina the care she needed.”

During the surgery, Martina was lightly sedated to avoid affecting her breathing, but was technically awake.

Registered nurse Michele Lewis stayed with her throughout the procedure, holding her hand and singing to her to keep her calm.

Lewis also gave the family updates as the surgery progressed.

“The family was so kind and grateful. It was an honor to be part of her care,” Lewis said.

"Newman quickly became a “goddess” to Martina’s family.

"She’s an incredible person. She has this very calm presence and explained everything about the surgery to us in detail,” Dan Abraham said.

“She told us she felt in her heart that she could perform the surgery successfully, and it went off without a hitch.”

Newman’s team removed the entire tumor.

She required some treatment following the procedure, including 27 days of radiation and several more rounds of chemotherapy.

Martina, and the Abraham family, post-surgery

Since then, life at the Abraham home has shifted.

"Our lives have changed completely," Marta Abraham said.

"I was so laid back before, but I’m a little more strict now. We have a schedule now, and I make sure Martina eats lots of healthy foods.”

Despite experiencing a harrowing health journey at such a young age, Martina has returned to her cheerful self, much to the delight of her care team.

“Martina and her family are so special,” Newman said.

“The way that our teams came together to care for her so quickly is inspiring, and we are all thrilled to see how well she has recovered.”

Learn more about supporting U-M Health C.S. Mott Children's Hospital in the fight to #BlockOutCancer

Sign up for Health Lab newsletters today. Get medical tips from top experts and learn about new scientific discoveries every week by subscribing to Health Lab’s two newsletters, Health & Wellness and Research & Innovation.

Sign up for the Health Lab Podcast: Add us on Spotify, Apple Podcasts or wherever you get you listen to your favorite shows.