Case study: Retinoblastoma
During Emory’s second day in clinic our first case in pediatrics was a two-year old male with right eye retinoblastoma/retro orbital mass. Based on research, it is a malignant tumor on the retina, the light-sensing part of the eye, and would be preventable if found early. While in this case the cancer is present in the child’s right eye, it can show up in both. In the US it is standard to test for the red-eye reflex at birth, and if a baby does not have this reflex, treatment is started immediately. It occurs most often in children five years and under. Caused by rapidly growing cells in the eye, retinoblastoma sometimes creates specialized cells that won’t stop reproducing. Eventually theses cells mature in the retina in the form of a tumor. These tumors may continue to grow, filling almost the entire vitreous humor (the jellylike substances the fills the eyeball). These tumors can also break off and migrate to the entire orbital space, and eventually outside to lymph nodes and other organs.
This child’s grandmother reported that the boy was healthy three months prior to the clinic visit. Today he presents with a large, infected, oozing right orbital mass. Parents first noted swelling of the right eye in September of 2007. The family took him to be evaluated at a referral hospital where he was treated with eye drops. At present he had no fever, headache, and reported to have good vision in his left eye. His developmental history is normal for his age (walking, talking, and feeding self). The doctor diagnosed him with bilateral cervical lymphadenopathy. The family stated that they did not want the child to die and they appeared to be very worried the boy’s survial.
“Miss se Bondye ki voye nou pou mwin, mwin lage pitit la nan min nou.” Miss God sent the team for me, the life of my child is in your hands, the grandmother said.
This translator linked the patient with one of Project Medishare’s health agents to follow up with Zanmi la Sante and the Bascom Palmer Eye Institute team which is expected to arrive in December. Dr. Desai Sachin instructed a nurse to teach the family how to manage the child’s wound until surgery is scheduled. The family was also given enough material and medication to prevent further infection.