A top boss from the Gambino crime clan convicted in the U.S. of selling heroin was rearrested in a Rome clinic Thursday after he checked in for medical tests, police said.

Rosario Gambino, 69 — convicted by U.S. courts in a Pizza Connection heroin probe and sentenced to 45 years in prison in 1984 — was deported two years ago to Italy so he could serve a 20-year sentence in a separate drug case.

Italian news reports said an Italian tribunal earlier in the week had ordered him released while his lawyers pursue an appeal with the Court of Cassation, Italy's top criminal court. However, police said they moved to arrest him Thursday after an appeals tribunal in Palermo, Sicily, issued a fresh warrant.

Gambino "was surprised inside a clinic in the capital, where he had sought some tests" for an undisclosed medical problem, Rome police headquarters said in a statement. "He has a long career in the ranks of the Italian-Sicilian Mafia on his resume."

Police who carried out the arrest could not be reached for details Thursday night.

Court officers were closed, but the Italian news agency ANSA said that the Palermo court deemed Gambino a flight risk.

Gambino, an Italian-born New Jersey resident, was considered a top figure in the New York-based crime family led by his late cousin Carlo Gambino.

In 1984, Rosario Gambino was convicted in a multi-million-dollar conspiracy to sell heroin in southern New Jersey and sentenced to 45 years in jail. He was linked to a Pizza Connection case involving a then $1.6-billion heroin and cocaine smuggling operation that used pizzerias as fronts in the 1970s and early 80s.

He was released in 2007 and transferred to an immigrant detention center in California to await expulsion. Gambino was wanted in Italy since 1980 in a drug trafficking probe. When he was deported to Italy two years ago, he was served the 1980 warrant signed by Giovanni Falcone, the Sicilian prosecutor who was killed by the Sicilian Mafia in a 1992 bombing.

Police said Gambino was convicted by an Italian court in 1983 of criminal association for drug trafficking and sentenced to 20 years.