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Tumor samples, packaged with gratitude, shipped to pathologist

Over the last 12 years, Eduardo Zambrano has received as many as 1,000 tumor samples sent by pediatric oncologists in Latin American countries who treat poor, young cancer patients.

- By Ruthann Richter

Eduardo Zambrano is regularly sent tumor samples from pediatric oncologists in Venezuela and other Latin American countries who treat poor, young patients. Volunteering his time and expertise, Zambrano examines the samples under a microscope and issues diagnoses.
Norbert von der Groeben

Eduardo Zambrano’s office displays some of the essentials of his pathology practice: a large microscope that dominates his desktop, and a cabinet overflowing with colorful, hand-painted wooden boxes, each one representing a Latin American child with cancer.

Over the last 12 years, Zambrano, MD, has received as many as 1,000 tumor samples sent by pediatric oncologists in Venezuela and other Latin American countries who treat desperately poor, young patients with various forms of cancer. Each sample is mounted on a glass slide or embedded in wax, then carefully wrapped in tissue paper and lovingly packaged in a wooden box painted by a patient’s mother or local artisan as a gesture of gratitude. The boxes are covered in suns, stars, flowers and other images of life and hope.

“To me, behind each one of these boxes is a child with cancer, and to know we’ve been able to help them is very special to me,” said Zambrano, chief of pathology at Lucile Packard Children’s Hospital Stanford. An expert in pediatric solid tumors, he volunteers his services on behalf of these youngsters.

One or two boxes a week

A professor of pediatrics and of pathology who came to the School of Medicine a year ago, Zambrano said he receives one or two of these boxes a week. He examines the samples under the microscope and then issues a diagnosis, some involving rare cancers. Clinicians ship the samples to him because they often don’t have the equipment or expertise needed to accurately diagnose the problem.

Each tumor sample is packaged in a wooden box painted by a patient’s mother or local artisan as a gesture of gratitude to Zambrano. 
Norbert von der Groeben

“Very frequently the diagnosis [from the home country] is either incomplete because they don’t have the resources to perform confirmatory tests, or it’s wrong because they don’t have expertise in pediatric tumors,” he said. “It’s frequent that I have to give them a significantly different diagnosis.”

Among the most common tumors he sees are pediatric sarcomas, which can originate in various parts of the body; neuroblastomas; lymphomas; and brain tumors.

Though he has reviewed cases from Mexico, Bolivia, Brazil and his native country of Ecuador, many of the samples come from Venezuela, where he has a long-standing collaboration with a pediatric oncologist whom he texts or emails every day. She also sends him many photos of children in recovery, as well as notes of thanks: “You are a little angel who helps all of us,” reads one in Spanish.

Rewarding work

Zambrano has visited Venezuela and met some of his patients and their families, but in recent years the country, worn down by years of oppressive governance, has become too dangerous for travel, he said.

Behind each one of these boxes is a child with cancer.

“It’s a tragedy in Venezuela,” which is now one of the southern continent’s poorest countries, he said. “For me, it’s really an obligation to provide this service to them and a way to pay back for what I received in my childhood in South America.”

Because some of the cases he diagnoses are rare or advanced forms of cancer not often seen here, they also serve as valuable teaching tools, he said.

“These cases have served me tremendously in teaching my residents,” he said.

Zambrano said the work is a particularly rewarding part of his day. “I consider it very valuable, and it’s something that really moves me,” he said. “A lot of meaning would be lost if I couldn’t do this work. And it’s important to have meaning.”

He said he is now looking for an outside funding source to help support the service.

Stanford Medicine integrates research, medical education and health care at its three institutions - Stanford University School of Medicine, Stanford Health Care (formerly Stanford Hospital & Clinics), and Lucile Packard Children's Hospital Stanford. For more information, please visit the Office of Communication & Public Affairs site at http://mednews.stanford.edu.

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