CLINICAL CONFERENCE

HEMATOLOGY ONCOLOGY DIVISION

(New Case)
July 07 , 2023
th

Dhody Setiamal,M.Jumatman, Monica Dewanti Paputungan/ Junior Divisi

Nicholas Redly, Julia Jolanet Syafrianty/ Madya Divisi
Liesa Ferawaty Lesomar, Irwandi Zakaria, Eunike Jaequeline Salipadang,
Zulfi Hidayat,Nursyamsuddin,Abdi Dwiyanto Putra S/ Senior Divisi
 PATIENT IDENTITY
S.S, 4 years 1 month (Female)
MR Number 1025788
Date of Birth Mei 31th, 2019
Admission Date July 07th, 2023

MEDICAL DIAGNOSIS

Retinoblastoma oculli Sinistra grade IV + Stunting

PATIENT PICTURE
 HISTORY TAKING
Chief Complaint
Lump left eye
History of Present Illness
A girl 4 years old 1 month come to the hospital with the left eye protruding and redness had been noticed since 3 years
ago, the left eye looked like a cat's eye then a lump appeared and got bigger and bigger.
There was pain in the left eye since 1 week ago.
There was history of bleeding in the left eye since 1 week ago
No fever No seizure.
No cough, no shortness of breath.
No vomiting.
Good appetite.
Urination and defecation within normal limit.
 HISTORY TAKING
History of Past Illness
- No history of bleeding gums, epistaxis, hematuria, and melena.
- There was no history of pale
- There was history of frequent fever 1 month ago
- There was history look like cat eyes since 3 years ago
- There was no history of weight loss
- No family history of malignancy.
- There was no history of living near rice fields.
- No history of living near the factory.
- There was history of control at mother and child and planning for chemotherapy.
 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
giv
en

Hep B V V V V V
BCG V
DPT V V V V
Hib V
OPV V V V V
IPV

Measles V
Rotavirus V

Influenza V

Japanese V
Encephali
tis

PCV V
Varicella V
Hepatitis V
A
Typhoid V
 PHYSICAL EXAMINATION
Vital Sign Antropomethry
General condition: severe illness/ good Body weight : 10 kg
nourished/GCS 15 (E4M6V5)
Length : 82 cm
Blood Pressure: 90/60mmhg Head Circumference : 49 cm (Normal:47 cm – 53 cm)
Heart Rate : 104 btimes/min
• Weight for age at -3sd line (underweight)
Temperature : 37,1°C
• height for age at below -3sd line (very
Respiration Rate : 24 times/min
short stature stature)
SpO2 : 99%
• Weight for age bel -3sd line and median
Pain Scale : 0 flacc
(good nourished)
Head circumference: 49 cm
(Normal: 47-53 cm)

Normocephal
 PHYSICAL EXAMINATION
There was no Pale. No icterus No distended. Peristaltic sound : normal

No stomatitis Liver and spleen not palpable

Pharynx not Hyperemis Bleeding Manifestations:

Tonsil T1-T1 Not Hyperemis None

Oculi dextra: proptosis size 5x4x3 cm, edem Genitalia : normal.

palpebra,hiperemis conjungtiva,secret (+), pus Bleeding Time : 8 minutes
(+) blood (+), cat eyes refleks (-) Rumple leede: negatif

Oculis sinistra: there was no proptosis,no edem

palpebra, no eritem, no lacrimasi, no, no cat
eyes refleks, no pus and blood.
No rhales. No wheezing.
Cardiovascular
I / II heart sound, Regular rhythm no murmur
Abdomen
 LABORATORY FINDING
Juny 13th 2023 July 06th 2023
Laboratory (Wahidin (Wahidin’s Normal Value
hospital) Hospital)

Ret 1,01 0.00 – 0.10%

Hb 12,6 12,6 12.0 – 16.0 gr/dL
WBC 10.300 9.500 4.0 – 10.0/μL
ANC

PLT 286.000 360.000 150.000 – 400.000/mm3

MCV 71 71 80 -100 μm3

MCH 23 24 27 - 32 Pg
NEUT 59,2 57,7 52 – 75 103/μL
LYMPH 27,7 30,5 20 – 40 103/μL
MONO 7,4 6 2 – 8 103/μL
 LABORATORY FINDING
Juny 13th 2023 July 06th 2023
Laboratory (Wahidin hospital) (Wahidin’s Hospital)
Normal Value

GDS 156 92 140 gr/dl

Ureum 10 15 10 - 50 mg/dl

Creatinine 0,39 0,4 <1.3 mg/dl

SGOT 33 33 < 38 u/l
SGPT 12 7 < 41 u/l
Albumin 4,4 3.5 – 5.0 mg/dl
136-145
Natrium 141 136

Kalium 3,3 5,1 3,5-5,1

Clorida 1,05 102 97-111
 Radiology finding
MRI Brain with contrast Wahidin hospital 06/27/2023
• There is an isointense mass at T1WI that is post contrast, isointense dominant heterointense at
T2WI, FLAIR, restricted diffusion DWI/ADC clear boundaries, irregular edges of impression
originating from the left intraorbita extending to the extra conal, infiltrating m.
superomediolateral rectus and optic nerve and cause proptosis. Post-contrasting isointense mass
is also seen on T1WI, isointense dominant heterointense on T2WI, FLAIR, restricted diffusion
DWI/ADC well demarcated, irregular edges, with size +/- 3.83 x 3.14 x 3.27 cm suprasellar
• Sulci and gyri within normal limits
• The position of the interhemisphere fissure appears normal in the midline
• The ventricular system and subarachnoid space are within normal limits
• Cerebellum, pons within normal limits
• Right orbit: shape, size, intensity and position within normal limits of both the bulbus oculi,
nerves, muscular and other retrobulber tissues.
• Hyperintense lesions appear on T2WI in the maxillary sinus and ethmoidalis bilaterally and the
left sphenois. Bilateral frontal sinuses have not been seen
• The scanned bones are intact
Impression:
- Left intraorbital mass with suprasellar mass suggestive of trilateral retinoblastoma
- Multisinusitis
 ASSESMENT
 Retinoblastoma oculi bilateral grade IV
 Stunting
 TREATMENT
- Fluid requirements : 1000 cc/24 hours
- Enteral : 4 x 150cc
- Parenteral : D5%/intravenous
- Chemoteraphy with retinoblastoma grade IVB protocol with regimen:
Vencristine/intravenous
Etopuside/intravenous
Carboplatin/intravenous
 Planning

- Check for LCS and BMP

- Planning for consult to THT division for chemoteraphy
- Consult to NPM for stunting
THANK YOU