DEPARTEMEN MEDIK PATOLOGI ANATOMIK

RS DR. CIPTO MANGUNKUSUMO

JL. Diponegoro no 71, Tromolpos 1086, Jakarta 10430
Telp. (021) 31930487 Fax. (021) 31934465

REGISTRATION DATA

Medical Record Number: - Patient Name : Charly Amenehung Utomo, Mr.

Date Received : 05/10/2021 12:56:21 Sex / Age (DOB) : Male/67 y.o (31/05/1954)
Date of Payment : 05/10/2021 Immunology Number : 2211744
Date of Sign-Out : 13/10/2021 11:58:00 Hospital Origin : Medistra
Doctor : dr. Ibrahim/dr. Agnes, SpPA(K)

PRELIMINARY DATA
CLINICAL DIAGNOSIS : Abdominal tumor, suspect GIST
PATHOLOGICAL DIAGNOSIS : Histologic consistent with malignant mesenchymal neoplasm dd/
GIST, MPNST, other sarcoma. Specimen was taken from intestine.

IMMUNOHISTOCHEMICAL
RESULT : CD117, DOG1, CD34: Positive
S100, Desmin, Synaptophysin, AE1/3: Negative
SMA: non specific

CONCLUSION : Immunohistochemical profile consistent with Gastrointestinal

Stromal Tumor (GIST).

SUGGESTION : Please refer to histopathological expertise regarding histologic grade and

risk assessment.

2021

dr. Marini Stephanie, SpPA (K)