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
M.H, 14 years 7 month old (male)
MR Number 1011742
Date of Birth july 18th, 2008
Admission Date March 04, 2023

MEDICAL DIAGNOSIS
- Intra-abdominal tumor et causa suspeck Limphoma
 Chief Complaint HISTORY TAKING
Abdominal pain
History of Present Illness
A boy 14 years old was reffered from Thalia Hospital with diagnosed intraabdominal mass
et causa suspek lymphoma retroperitonium.

There was abdominal pain since 1 years, and getting worsed 2 days before admitted to the
hospital.
No fever, no seizure
No cough no shortness of breath
Good appetite
Defecation: not yet, since 3 days
Urination : yellow normal
 HISTORY TAKING
History of Past Illness
- No history of bleeding gums, epistaxis, reddish urine and melena
- No history of joint pain
- No History of weight loss
- Family history of malignancy.( grandmother)
- No history of living near rice fields and factory
 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 √
Measles √ √ √
Rotavirus √

Influenza √
Japanese √
Encephalitis
PCV √
Varicella √
Hepatitis A √
Tifoid √
 PHYSICAL EXAMINATION
Vital Sign Antropomethry
General condition: Moderate illness/ Body weight : 49kg
good nourished/GCS 15 (E4M6V5)
Length : 165 cm
Blood pressure : 120/90mmhg
Head circumference: 56 cm ( Normal 52-57 cm)
Heart Rate : 72 times/min
Anthropometry:
Temperature: 36,6°C
Respiration Rate : 22 times/min Weight for heigth: 49/51 x100%= 96% (good
nourished)
SpO2 : 99 % Weight for age: 49/55 x100%= 89% (normoweight)
Pain Scale : 2 NRS Height for Age: 165/168x100% = 98% ( normal stature)
Head circumference: 56 cm ( Normal 52-57 cm)
Weight for heigth: 49/51 x100%= 96%
(good nourished)
Weight for age: 49/55 x100%= 89%
(normoweight)
Height for Age: 165/168x100% = 98%
( normal stature)

There was no pale. No icterus
No stomatitis
Pharynx not Hyperemesis
Tonsil T1-T1 not 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, not distended
Palpable mass in the umbilical region, size 4,5x7x2,1 centimeters,
hard consistency, flat surface, flat edges, firm boundaries, does not
follow breathing movements, immobile, no tenderness, no
pulsation, no prominent veins, color and temperature equal to
arround.
Hepar and spleen not palpable
Extremities
Warm acral, , CRT < 3 detik
Manifestations of spontaneous bleeding : none
 LABORATORY FINDING
Thalia Wahidin
Laboratory Normal Value
02/03/23 03/03/23

Hb 13,3 12,4 12.0 – 16.0 gr/dL

WBC 8.090 7.100 4.0 – 10.0/μL
ANC - 4.359 >2000
PLT 314.000 334.000 150.000 – 400.000/mm3
MCV 81,2 82 80 -100 μm3
MCH 26,7 26 27 - 32 Pg
%NEUT - 61,4 52 – 75 103/μL
%LYMPH - 30 20 – 40 103/μL
%MONO - 7,9 2 – 8 103/μL
Ret - - 0,5 – 1 /μL
 Wahidin
Laboratory 03/03/23
Normal Value

GDS 118 <140 gr/dl

Ureum 19 10 - 50 mg/dl

Creatinine 0,74 <1.3 mg/dl

SGOT 14 < 38 u/l
SGPT 11 < 41 u/l
Albumin 4,3 3.5 – 5.0 mg/dl
136-145
Natrium 141

Kalium 3,9 3,5-5,1

Clorida 103 97-111
 Radiology FINDING

USG Thalia Hospital 02/03/2023

Impression: intraabdominal mass et causa suspeck
limfoma retroperitonium
 ASSESMENT
Intra-abdominal tumor et causa. Suspected Limphoma
 TREATMENT
- Infusion Dextrose 5%
- Paracetamol 500mg/8jam/intravenous ( if pain scale >3NRS)

Planning:
- MSCT Abdomen with contrast
- Check LDH
- Consult to pediatric surgeon
THANK YOU