RSPAU Dr. S. HARDJOLUKITO NO.

MR 23 03 02

TREATMENT PLAN Name : Tn S

MULTI DISCIPLINARY Date of Birth : 22/10/1974
Gender : 1. Male (√) 2. Female
TEAM

Please placing a check mark (√) in the answer box, according the patient data

Meeting Date :

Place : RSPAU Dr. S. HARDJOLUKITO

Medical and Family :

History

Diagnosis : SUSP MULTIPLE MYELOMA, BISITOPENIA, AKI

PATHOLOGY

PA Number : HS 655/22

Date-Result Issued : 26-09-22

Result : Head humerus: biopsy; Suggestive of Plasmacytoma, with differential

diagnosis Plasma Cell Myeloma and Plasmablastic lymphoma
(Mohon korelasi klinis dan radiologis)

PA Number : -

Date-Result Issued :

Result

PA Number : -

Date-Result Issued :

Result

OTHER INVESTIGATION

USG abdomen (28 Sep 2021): massa dengan batas tegas kesan lobukated hyperechoic uk 10 x 9 x 6 Cm
diantara spleen dan ren sinistra. Kesimpulan suspect massa abdomen di luar ren diantara spleen dan ren
sinistra
MSCT Abdomen I (13 Okt 2021): Massa retroperitonel sinistra ukuran 9,7 x 8 x 6 Cm
yang mengencase ren sinistra di retroperitoneal sinistra.
MSCT Abdomen II (RSAU Malang, 17 Jan 2022): Liposarcoma retroperitoneal sinistra uk 10,9 x 8,1 x 10,6
cm, yang mengencase ren sinistra
MSCT Abdomen III (RSAU Malang, 19 Jul 2022): Liposarcoma retroperitoneal sinistra uk 11 x 9,2 x 8,3 cm,
yang mengencase ren sinistra. Staging T2B N0 M0
 TREATMENT PLAN

Treatment Setting : Adjuvant Neoadjuvant Metastatic Palliative

Surgery : No Yes Date of Surgery : ____/_____/______

Kind of Surgery : ________________

Chemoterapy : No Yes

Start Date :
Regimen :

Drugs Dose

1.

2. ___________ ________

3. ___________ ________

4. ___________ ________

5. ___________ _________

Cycle :

Interval :

Radiotherapy :

No Yes :
Start Date

Method :

Dose : _____________

OTT : _____________

Hormonal Therapy :

No Yes Start Date : ____/_____/_______

Drugs Dose

Regimen : 1. ___________ _________

__________ 2. ___________ _________

3. ___________ _________

Duration : _____________

Other : ____________________________________________________________

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SUPPORTIVE CARE

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FOLLOW-UP PLAN

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Bantul, 2022

Leader,

Participants :

1. __________________________ 1.______

2. __________________________ 2.______

3. __________________________ 3.______

4. __________________________ 4._____ dr. Muhammad Faris SpPD-KHOM

5. __________________________ 5.______

6. __________________________ 6.______

7. __________________________ 7.______

8. __________________________ 8.______

9. __________________________ 9.______

10. __________________________ 10._____

11. __________________________ 11._____

12. __________________________ 12._____

13. _________________________ 13._____

14. __________________________ 14._____

15. __________________________ 15._____