CLINICAL CONFERENCE

HEMATOLOGY ONCOLOGY DIVISION

(New Case)
March 04, 2023
Dhody Setiamal/ Junior Divisi
Randy suryawan,A. Alfia Mutmainnah, Nicholas Redly/ Madya Divisi
Dina Fadihilah Monika,Syahrurrahman, Arwini Avissa Abdullah,Kartika Setiawaty
/ Senior Divisi
 PATIENT IDENTITY
A.T, 2 years old (male)
MR Number 10113045
Date of Birth july 18th, 2008
Admission Date March 13, 2023

MEDICAL DIAGNOSIS
- Intra-abdominal tumor et causa suspected Hepatoblastoma differential diagnosis of hepatocellular
- Anemia of Chronic Disease dd Iron deficiency anemia
- Leukocytosis
- Elevated transaminase Enzyme
- hypoalbuminemia
 Chief Complaint HISTORY TAKING
Enlarged abdominal
History of Present Illness
A boy 2 years old was reffered from Elim Rantepao Hospital with diagnosed intraabdominal
mass et causa suspek hepatoblastoma

There was abdominal enlarged since 2 weeks before admitted to the hospital.
No fever, no seizure
No cough no shortness of breath
Good appetite
Defecation: normal
Urination : yellow normal
 HISTORY TAKING
History of Past Illness
- History of pale since 1 week before admission to the hospital
- No history of bleeding gums, epistaxis, reddish urine and melena
- No history of joint pain
- No History of weight loss
- No Family history of malignancy.
- No history of living near rice fields and factory
- History patient was hospitalized at Elim Hospital for 2 days and received
ceftriaxone/intravenous, paracetamol/intravenous, zinc/oral.
 PHYSICAL EXAMINATION
History of Vaccine
Month Years
Vaccine
Not 0 1 2 3 4 5 6 7 8 9 12 15 18 24 3 5 6 7 8
given
Hep B √ √ √ √ √ √

BCG √
DPT √ √ √ √

Hib √ √ √ √

OPV √ √ √ √

IPV √

MR √ √
Rotavirus √

Influenza √
Japanese √
Encephalitis
PCV √
Varicella √
Hepatitis A √
Tifoid √
 PHYSICAL EXAMINATION
Vital Sign Antropomethry
General condition: severe illness/ under Body weight : 9,3 kg
nourished/GCS 15 (E4M6V5)
Length : 84 cm
Blood pressure : 90/60mmhg
Head circumference: 46 cm ( Normal 52-57 cm)
Heart Rate : 100times/min
Anthropometry:
Temperature: 38°C
Respiration Rate : 22 times/min PB/Age : Between -2SD and median (normal stature)
BB/Age : Between -2SD and -3SD (underweight)
SpO2 : 99 % BB/PB: Between -2SD and -3SD (undernourished)
Pain Scale : 1 FLACC
Head circumference: 46 cm ( Normal 46-51 cm)
BB/PB: Between -2SD and -3SD
(undernourished)
BB/Age : Between -
2SD and -3SD
(underweight)
PB/Age : Between -2SD
and median (normal
stature)

There was pale. No icterus
No stomatitis
Pharynx not Hyperemesis
Tonsil T2-T2 hyperemis
no Lymphadenopathy
Pulmo
Vesicular breath sounds
no ronkhi, no wheezing.
Cardiovascular
I / II heart sound, Regular rhythm
no murmur
PHYSICAL EXAMINATION
Abdomen
Peristalsis was normal, distended
prominent veins, palpable mass in the right hypochondrium
measuring 10 x 10 x 7 cm, flat surface, solid consistency, immobile,
non-tender, past midline shift, blunt edge, color and same as
around.
spleen not palpable
Extremities
Warm acral, , CRT < 3 detik
Manifestations of spontaneous bleeding : none
 LABORATORY FINDING
Elim Wahidin
Laboratory Normal Value
10/03/23 13/03/23

Hb 8,9 7,2 12.0 – 16.0 gr/dL

WBC 16.800 16.200 4.0 – 10.0/μL
ANC 1075 7824 >2000
PLT 596.000 435.000 150.000 – 400.000/mm3
MCV 60 63 80 -100 μm3
MCH 19 19 27 - 32 Pg
%NEUT 64,3 48,3 52 – 75 103/μL
%LYMPH 28,7 39,4 20 – 40 103/μL
%MONO 4 9,7 2 – 8 103/μL
Ret - 2,35 0,5 – 1 /μL
 Wahidin
Laboratory 13/03/23
Normal Value

Ureum 15 10 - 50 mg/dl

Creatinine 0,29 <1.3 mg/dl

SGOT 145 < 38 u/l
SGPT 23 < 41 u/l
Albumin 3,3 3.5 – 5.0 mg/dl
136-145
Natrium 140

Kalium 4,5 3,5-5,1

Clorida 101 97-111
LDH 600 210-425 U/L
AFP >400 0-7.02 IU/ml
Beta HCG <2.00 <=4 mIU/ml
Ferritin 171,87 13-400 ng/ml
Peripheral blood Wahidin hospital (13/03/2023
Erythrocytes: Normocytic normochrome,
anisopoikilositosis, ovalocytes (+),akantocyte (+) target
cell (+) helmet cell (+), iclusion (-), normoblast (-)
Leukocytes: increased, PMN>limfocyte, hypersegmentasi
(+), granulasi toxic (+), young cell (-)

Platelets: normal
Impression: anemia normositik normokrom, suspeck
cronic disease with liver function disorder
 Radiology FINDING

USG Elim Hospital 11/03/2023

Impression: The mass in the liver matches the
appearance of hepatoblastoma

Thorax's photo of 11/03/2023

Impression: Elevation of the right diaphragm ec process
on the liver
 ASSESMENT
- Intra-abdominal tumor et causa suspected Hepatoblastoma
differential diagnosis of hepatocellular
- Anemia of Chronic Disease dd Iron deficiency anemia
- Leukocytosis
- Elevated transaminase Enzyme
- hypoalbuminemia
 Working Diagnosis

- Intra-abdominal tumor et causa suspected Hepatoblastoma

differential diagnosis of hepatocellular
- Anemia of Chronic Disease dd Iron deficiency anemia
 TREATMENT
- Infusion Dextrose 5%
- Tranfusion packed red cells/intravenous ( target by age)
- watch for signs of tissue anoxia
- 2) Ceftriaxon/intravenous
- Paracetamol 100mg/8jam/intravenous ( if pain scale >3FLACC)

Planning:
- MSCT Abdomen with contrast
- Consult to Gastrohepatology division
- Consult to pediatric surgeon
THANK YOU