alexiev et al ., 2018 W r i t i n g

alexiev et al ., 2018 W r i t i n g


As this clinical session ends, I realize that the universe saved the best patient experience for last for me. The challenges are the same to be honest, sometimes I find it difficult to know what is wrong with a patient or to find the appropriate differential diagnosis. Pediatric patients for the most part can be difficult to diagnose and administer the proper treatment. I met a three-year-old patient status post craniotomy for a benign tumor located in the cavernous sinus.

Schwannomas can be seen in pediatric patients with neurofibromatosis and occur generally in the limbs. I didn’t know much about this particular type of benign tumor. Solitary schwannoma rarely occurs in pediatric patients who do not have neurofibromatosis. As per the patient’s mother, for about two months she noticed that the child’s left eye was getting “lazy”, and the child occasionally complained of a dull headache. Eventually, the eye got to the point where the mother got worried and brought the patient in and patient was referred to an ophthalmologist, which then after thorough examination referred the patient to Bascom Palmer Eye institute. An MRI was performed which revealed that the patient had schwannoma. Patient was quickly rushed to the hospital and a craniotomy was performed to remove the tumor.

Unfortunately, the location of the tumor made it difficult for it to be removed and the patient is now in the office for her post hospitalization visit, but she is also being followed by several other healthcare care teams: Neurosurgery, neurology, ophthalmology, hematology, and primary care. This visit was not complicated, although the patient’s case is quite fascinating and complicated. We monitored the patient’s vital sign, completed a head-to-toe assessment, we ensure the incision site was demonstrated any sign of infection. No redness, inflammation, irritation, or purulent drainage was noted. The site was approximated with stapples, the patient did not complain of any discomfort or pain at site. The mother explained that she has not complained of a headache ever since the surgery. No apparent distress noted. The patient’s history was dictated by the parent and documented by me.

Quite honestly, I still don’t know much about this tumor and will continue to search and educate myself about it. However, here is what I could find. There are several types of schwannomas. Melanotic schwannoma is a nerve sheath tumor with a uniform composition of variably melanin-producing Schwann cells and metastatic potential. The MS is an uncommon neoplasm, accounting for less than 1% of all nerve sheath tumors, with a predilection for spinal nerve involvement. Microscopically, the tumors are characterized by spindle and epithelioid cells arranged in interlacing fascicles, with marked accumulation of melanin in neoplastic cells and associated melanophages. (Alexiev et al., 2018) Melanotic schwannoma is a tumor of the young (mean age, 38 years), with no sex predilection. It has no known geographic, racial, or ethnic preference; it is seen worldwide. The tumor may occur anywhere in the peripheral nervous system but is most frequently found in the paraspinal sympathetic chain and the gastrointestinal tract (esophagus and stomach). Rarer sites include cerebellum, orbit, heart, trachea, bronchus, cervix, bone, soft tissue, and skin.