Mr.

Darusman/
Mrs. J /6322years
yearsold/
old01146026/
/ 01111464BPJS
/ JR-Umum
Attending:
Attending: dr.dr.
Muhammad,
Eko Setiawan,
SpB(K)Onk
Sp.OT

April, 24th 2024

Dika
Hadiyan
Delta
Zharan – Deny
Aldi
 Mrs. J /63 years old/ 01146026/ BPJS
Attending: dr. Muhammad, SpB(K)Onk
Chief complaint:

Weakness since 2 days before admission

History Of Present Illness:

• The patient came with complaints of weakness experienced since 2 days before admission.
• Weakness accompanied by nausea (+), vomiting (+) frequency >10x, everything was eaten and drunk is
vomited, decreased of appetite (+). The complaint was accompanied by pain at epigastric region.
• She also complained of a lump on the left thigh, the lump was accompanied by pain, pain in the left thigh, the
pain was intermittent and had been getting worse since 1 day, the pain did not radiate to other parts of the body
and was not affected by position and activity.
• Previously, she had a lump on the left thigh that had been felt since 3 years ago. Initially the lump was felt the
size of a quail egg and was getting bigger. In 2021 at Syafira Hospital, the patient underwent tumour excision
surgery and was examined, but the family did not follow up (no results). After that she controlled 2 X to the
hospital.
• It was not April 2024 that she returned to Syafira Hospital because of complaints of pain at the surgical site and
a lump that was getting bigger. Then she was referred to the Arifin Achmad Hospital Oncology Clinic for
 Mrs. J /63 years old/ 01146026/ BPJS
Attending: dr. Muhammad, SpB(K)Onk
• From the Oncology Policlinic, it is planned to do an Abdominal Ultrasound, Thoracic
Ro, and MRI Pelvic to Left Femur with Contrast (scheduled for 30/04/2024).
Complaints of shortness of breath (-), headache (-), seizures and decreased
consciousness (-)
• Due to complaints of aggravation, she was taken by the family to the Arifin Achmad
Hospital Emergency Room for further treatment.
 Mrs. J /63 years old/ 01146026/ BPJS
Attending: dr. Muhammad, SpB(K)Onk
History of Past Illness :
• History of Hypertension (-)
• History Of Diabetes Melitus (-)
• History of previous tumour(-)
• History Of Tumour excision at Syafira Hospital in 2021
 Physical Examination

• Awareness : GCS 15
• Vital Sign
• VAS : 3-4 out of 1-10 scale
• BP : 110/71 mmHg
• HR : 88 bpm
• RR : 20 x/m
• Temp : 37 oC
• SpO2 : 99 % on room air
• Karnofsky Score : 80
 Physical Examination
• Head: Normal • Abdomen:
• Eyes: anemic conjunctiva(+/+), icteric - I : distended (-), bruise (-), wound
sclera (-/-) (-)
• Chest: - A: normal bowel sound
- I : Symmetrical chest wall
movement, imprint (+) in the sinistra - P: tympani
hemithorax, crepitation (-) - P: firm, tenderness at epigastrium
- P : Normal Vocal Fremitus right (-), rebound tenderness (-).
and left • Extremity: Localized
- P : Resonance (+/+)
- A : Vesicular sound (+/+),
Rales (-/-), Wheezing (-/-),
• Heart : normal heart sound regular, no
gallop, no murmur
 Localized Status of Left Thigh

• Look:
Mass (+), Swelling (+), redness (-), nodules,
active bleeding (-)
• Feel:
Palpable mass (+), flat surface (+),
immobile/fixed (+), indistinct borders (+), solid
consistency (+), tenderness (-), temperature over
tumour same as surrounding, lump size
16x9x3cm.
• Move:
Active and passive movements of the dextra
genu joint are normal.
Localized Status of Left Thigh
Localized Status of Left Thigh
 Node

• Axilla Lymph Node

• Right axilla : No palpable of lymph gland enlargement
• Left axilla : No palpable of mass
• Right of Supraclavicular : No palpable of mass
• Left of Supraclavicular : No palpable of mass
• Both of Infraclavicular : No Palpable of lymph gland enlargement
• Both of Neck site : No palpable of lymph gland enlargement
• Inguinal Lymph Node
• Right inguinal : No palpable of lymph gland enlargement
• Left inguinal : No palpable of mass
 Working Diagnosis
• Tumour in the sinistra femur
region suspected malignancy
T3N0M0
Differential Diagnosis
• Rhabdomyosarcoma
Performed
Emergency Room Therapy:
• IVFD NaCl 0.9% 30tpm
• Ketorolac 30 mg iv
• Omeprazole 40 mg iv
Plan:
- Hospitalisation
- Sodium, Albumin Correction
- PRC transfusion 3 lb
- Ro. Thoracic, Pelvic, Femur
 Laboratory Result (April, 24th 2024)
Type Value Unit Normal Value Type Value Unit Normal Value
Haemoglobin 7,6 g/dL 13,0 - 16,0 AST 21 U/L 10 – 40
Haematocrit 23,8 % 40,0 - 48,0 APT 9 U/L 10 – 40
WBC 10,4 10^3/µl 5,00 - 10,00 Glucose 120 mg/dL < 140
Platelet 466 10^3/µl 150 - 400 Ureum 19,0 mg/L 17.1 – 49.2
Sodium 119 nmol/L 136 - 145 Creatinin 0,72 mg/L 0.55 – 1.30
Potassium 4,3 nmol/L 3,5 – 5,5 HIV Non-reactive Non-reactive
HBsAg Non-reactive Non-reactive
 Chest X-ray (April, 24th 2024)

• Airway: normal, trachea was at middle

site
• Bone : no discontinuity
• Cardiac: normal (CTR < 50%)
• Diaphragm: normal
• Field of the lung: normal
• Soft tissue: normal
• Conclusion: within normal limit
 Diagnosis Performed

• Tumour in the left thigh region Consult to dr. Muhammad, SpB(K)Onk

suspected malignancy T3N0M0 dd Adv :
Sarcoma • Hospitalisation
• Anaemia gravis • PRC transfusion 2x200cc
• Hypoalbuminemia • Nacl 3% 500cc/12 hours (2x) electrolyte
• Hyponatremia recheck post correction
• Ondansentron 3x8 mg iv
• Omeprazole 2x40 mg iv
• MST 2x10 mg po
 Follow Up (April, 25th 2024)
S/ weakness (+), vomit (-), fever (-), pain at left thigh (-)
A/

O/ • Tumour in the left thigh region suspected malignancy T3N0M0

GCS 15
dd Sarcoma
BP 119/78 mmHg
HR 88 bpm • Severe anaemia
RR 18 bpm • Hypoalbuminemia
Temp 36,7
• Hyponatremia
Localized status of left thigh :
• Look:
Mass (+), Swelling (+), redness (-), nodules, active bleeding (-) P/
• Feel: • PRC transfusion 2x200cc
Palpable mass (+), flat surface (+), immobile/fixed (+), indistinct
• Nacl 3% 500cc/12 hours (2x) electrolyte recheck post correction
borders (+), solid consistency (+), tenderness (-), temperature
over tumour same as surrounding, lump size 16x9x3cm. • Ondansentron 3x8 mg iv
• Move: • Omeprazole 2x40 mg iv
Active and passive movements of the dextra genu joint are
• MST 2x10 mg po
normal.
 Follow Up (April, 26th 2024)
S/ weakness (-), vomit (-), fever (-), pain at left thigh (-)
A/

O/ • Tumour in the left thigh region suspected malignancy T3N0M0

GCS 15
dd Sarcoma
BP 109/88 mmHg
HR 78 bpm • Severe anaemia
RR 18 bpm • Hypoalbuminemia
Temp 36,7
• Hyponatremia
Localized status of left thigh :
• Look:
Mass (+), Swelling (+), redness (-), nodules, active bleeding (-) P/
• Feel: • PRC transfusion 2x200cc
Palpable mass (+), flat surface (+), immobile/fixed (+), indistinct
• Nacl 3% 500cc/12 hours (2x) electrolyte recheck post correction
borders (+), solid consistency (+), tenderness (-), temperature
over tumour same as surrounding, lump size 16x9x3cm. • Ondansentron 3x8 mg iv
• Move: • Omeprazole 2x40 mg iv
Active and passive movements of the dextra genu joint are
• MST 2x10 mg po
normal.
THANK YOU