"A Man can't make a mistake can't make anything"

Friday 27 March 2015

case perineal tumor by herry setya yudha utama

I.      IDENTITY

Name                                 : Mrs. YI
Age                                    : 23 years
Gender                              : female
Occupation                       : Merchant
Address                             : Battembat
Sign Rs date                      : March 2, 2015

II.    HISTORY (ALLOANAMNESIS)

Main complaint          : Lumps in the groin
Additional complaints: -

History Disease Now:
Ny.YI 23 years, the patient complained of a lump in the groin there since 10 years ago, the lump is felt arise and getting bigger. Bumps also felt pain when sitting too long and quite disturbing activity. Complaints urination and defecation denied.

Formerly Disease history:
The patient had never performed the operation. The patient denied any history
high blood pressure and diabetes. Previous patient also never had the same complaint.

Family disease history:
Patients admitted in the family no one has ever experienced the same thing as a patient.

III.  PHYSICAL EXAMINATION


Status generalist

General Situation: Moderate Pain
Awareness: Compos mentis
Vital Signs: BP            : 120/80 mmHg
                    N             : 88x / min
                    S              : 36,9
º C
                    R             : 24 x / minute

Head                : Normocephal
Eyes                : Conjunctival pallor - / -
                           Scleral jaundice - / -
                           Pupillary Reflex - / -
Neck                : The thyroid was not palpable enlarged
Thorax:
Cor                I  : iktus cordis not visible
                      P : iktus cordis palpable at ICS V line midclavikula
                      P : cardiac border is assessed
                         A        : BJ regular I-II, murmur (-), gallops (-)
Pulmo              I          : symmetrical piston movement in a static state and dynamic
                        P          : vocal fremitus same right and left hemithorax
                        P          : resonant in both lung fields
                        A         : vesicular, rhonki - / -, wheezing - / -
 Abdomen
                        I           : convex, symmetric, surgical wound (-)
                        A         : bowel (+) normal
                        P          : Timpani entire field abdomen
                        P          : soft, tenderness (-)
Extremity
            Superior Right Left     : edema (-), warm akral
            Right inferior left        : edema (-), warm akral


Localist Status                       : palpable lump in the groin oas big as chicken eggs , chewy,  and  
hard driven     

IV.  SUPPORTING INVESTIGATION

Routine Blood
LAB
RESULT
NORMAL VALUE
Hemoglobin
14.1 gr/dl
12-16/13-17
Leukocyte
5.900 /mm3
4000-10000
Platelet
299.000/mm3
150000-450000
Hematocrit
42.1 %
37-43/40-48


LAB
RESULT
FLAGS
Method
NORMAL
Satuan






Glucose
Glucose during

91


GOD-PAP

70-150

mg/dl


Renal Function
Ureum                   18.3                             urease UV Liqui        10.0-50.0                       mg/dl
Creatinin               0.71                             Jaffe Comps STA       0.6-1.38                       mg/dl
      HBsAg                  0.00                             ELFA                      <0.13
      HIV Rapid                        non reaktif                   kualitatif                non reaktif


V.    WORKING DIAGNOSIS

Perineal Tumor

VI.   PROPOSED EXAMINATION

         Pathology Anatomy
 

VIII.               MANAGEMENT

     - Observation
           - Surgery (wide local excision)

IX. PROGNOSIS
Ad Vitam                     : dubia ad bonam
Ad Functionam           : dubia ad bonam



























CHAPTER I
INTRODUCTION


The soft tissues are part of the body which lies between the skin and bones and internal organs. Are classified as soft tissues include muscles, tendons, connective tissue, fat and synovial tissue (tissue around the joints).
Tumors are abnormal lump or swelling in the body, but in a special sense of tumors are lumps caused by neoplasms. Clinically, the tumor is classified into categories such nonneoplasma neoplasms and cysts, as a result of inflammation or hypertrophy.
Soft tissue tumors can occur in all parts of the body from head to toe. There are soft tissue tumors are benign and there are malignant. Malignant or cancerous tumors in soft tissue known as soft tissue sarcomas Soft Tissue Sarcoma or (STS).
Soft tissue cancers including cancer rare, the incidence is only about 1% of all malignancies in adults and 7-15% of all malignancies in children. Can be found in all age groups. In children, most often at about 4 years of age and in adults most in the age of 45-50 years.
The most common location is in the lower limbs is equal to 46% of which 75% are above the knee, especially in the thigh area. In the upper limbs from the upper arm, forearm to the palm of the hand about 13%. 30% on the outside and inside of the body, such as the abdominal wall, and also the soft tissues in the abdomen and near the kidneys or the so-called area retroperitoneum. In the head and neck region around 9% and 1% in other places, among others in the chest.









CHAPTER II
LITERATURE REVIEW


A.   DEFINITIONS

The soft tissues are part of the body which lies between the skin and bones and internal organs. Are classified as soft tissues include muscles, tendons, connective tissue and fatty tissue.
Soft tissue tumors or Soft Tissue Tumors (STT) is an abnormal lump or swelling caused by the growth of new cells.


B.    ANATOMY PHYSIOLOGY

According to Evelyn C. Pearce (2008: 15), soft tissue anatomy physiology is as follows:

1. Muscles
Muscle is the tissue that has a special ability that is contracted to move. Consists of a cylindrical muscle fibers that have the same properties as the other networks, all tied into bundles of small fibers by a type of connective tissue that contains elements of the contractile
2. Tendon
Tendons are binding on bone muscle, tendon fibers in the form of white hoops, shiny, and no elastic.
3. Connective Tissue
Connective tissue framework complements the body, and consists of areolar tissue and elastic fibers.




C.    ETIOLOGY

Etiology Soft Tissue Tumors:
1. Genetic Conditions
There is certain evidence of the formation of mutagens is a predisposing factor for some soft tissue tumors, the report lists the abnormal gene, that gene has an important role in the diagnosis.
2. Radiation
Pathogenic mechanism is the emergence of radiation-induced gene mutations that drive neoplastic transformation.
3. Environmental carcinogens
An association between exposure to various carcinogens and after it reported increased incidence of soft tissue tumors.
4. Infection
Epstein-Barr virus infection in people who infirm will also increase the likelihood of soft tissue tumors.
5. Trauma
The relationship between trauma and Soft Tissue Tumors apparently accidental. Trauma may draw medical attention to pre-existing injuries.

D.   INCIDENCE

Soft tissue cancers including cancer rare, the incidence is only about 1% of all malignancies in adults and 7-15% of all malignancies in children. Can be found in all age groups. In children, most often at about 4 years of age and in adults most in the age of 45-50 years.
The most common location is in the lower limbs in the amount of 46% with 75% of it is above the knee, especially in the thigh area.
In the upper limbs from the upper arm, forearm to the palm of the hand about 13%. 30% in body parts on the outside and inside, as in the abdominal wall, and also the soft tissue in the stomach and near the kidneys or the so-called area retroperitoneum. In the head and neck region around 9% and 1% in other places, among others in the chest.

E.    CLINICAL

Symptoms and signs of non-specific soft tissue cancer, depending on where the tumor is located, general symptoms such as the presence of a lump under the skin that does not hurt. Only a few patients who complain of pain, which usually occurs as a result of hemorrhage or necrosis in the tumor, and could also be due to the emphasis on the nerves edge.
Benign tumors of soft tissue usually grow slowly, not rapidly enlarging, when touched feels soft and when the tumor is moved relatively easily moved from surrounding tissue and never spread to distant places.
Generally soft tissue cancer growth relatively quickly enlarged, developed into a hard lump, and when you move it a bit difficult and can spread to distant places to the lungs, liver and bones. If the size of the cancer is so large, it can cause ulcers and bleeding in the skin above.

F.    PATHOPHYSIOLOGY

In general, soft tissue tumors or Soft Tissue Tumors (STT) is the proliferation of mesenchymal tissue that occurs in nonepitelial extraskeletal tissues of the body. Can arise in a place anywhere, even though approximately 40% occurred at lower ekstermitas, especially the thigh area, 20% in ekstermitas above, 10% in the head and neck, and 30% in weight.
Soft tissue tumors grow centripetally, although some benign tumors, such as fiber cuts. Once tumors reached anatomical boundaries of place, then the tumor enlarged cross the line to the neurovascular structures. Soft tissue tumors arising in locations such as indentations body.
The natural process of the most malignant tumors can be divided into four phases, namely:
1. malignant changes in the target cells, referred to as transformation.
2. Growth of cells transformation.
3. The local invasion.
4. Distant metastases.

G.   DIAGNOSIS

The most common method of diagnosis other than clinical examination is the examination of a biopsy, may be able to fine needle aspiration biopsy (FNAB) or biopsy of the tumor tissue directly in the form of an incisional biopsy, namely by taking a biopsy of the tumor tissue in part as an example when a large tumor size. When small tumor size, can be done by surgically removing the tumor biopsy. Tissue biopsies examined by the pathologist and it is known whether the soft tissue tumor is benign or malignant. If the lump is benign then simply just being named, but if after the removal of a malignant lump followed by the use of radiotherapy and chemotherapy. If malignant, can also be seen and determined the tumor histologic subtype, which is very useful to determine further action.

H.   MANAGEMENT

In general, treatment for soft tissue tumors depends on the stage of the tumor. Tumor stage based on the size and degree of tumor. Treatment options for soft tissue tumors include surgery, radiation therapy, and chemotherapy.
1. Treatment Surgery (Surgical Therapy)
Surgery is the most common treatment for soft tissue tumors. If possible, the doctor will remove the cancer and a safe margin of healthy tissue around it. It is important to obtain tumor-free margins to reduce the likelihood of local recurrence and provide the best for the eradication of the tumor. Depending on the size and location of the tumor, may, rarely, be required to remove all or part of an arm or leg.
2. Radiation Therapy
Radiation therapy may be used for operation either before or after any surgery shrink tumors to kill cancer cells that may be left behind. In some cases, can be used to treat tumors that can not be removed surgically. In some studies, radiation therapy has been found to improve the local level, but no one has an effect on the overall life.

3. Chemotherapy
Chemotherapy can be used with radiation therapy, either before or after surgery to try to hide in any tumor or kill any remaining cancer cells. The use of chemotherapy to prevent the spread of soft tissue tumors has not been proven to be more effective. If the cancer has spread to other areas of the body, chemotherapy may be used to shrink tumors and reduce pain and anxiety they cause, but it is not possible to eradicate the disease.

I.      COMPLICATION

The spread or metastasis of the cancer is most often through the blood vessels to the lungs, to the liver, and bone. Rarely spread through the lymph nodes.

J.     PROGNOSIS

In soft tissue cancer that is advanced, with a large size, the risk of recurrence after surgery can still occur. Therefore, after the operation the patient usually must often control to monitor the presence or absence of recurrence in the area of ​​operation or recurrence place away form metastases in the lung, liver, or bone.













CHAPTER III
CONCLUSION


The soft tissues are part of the body which lies between the skin and bones and internal organs. Are classified as soft tissues include muscles, tendons, connective tissue and fatty tissue.
Soft tissue tumors or Soft Tissue Tumors (STT) is an abnormal lump or swelling caused by the growth of new cells.
Symptoms and signs of non-specific soft tissue cancer, depending on where the tumor is located, general symptoms such as the presence of a lump under the skin that does not hurt. Only a few patients who complain of pain, which usually occurs as a result of hemorrhage or necrosis in the tumor, and could also be due to the emphasis on the nerves edge.
The most common method of diagnosis other than clinical examination is the examination of a biopsy, may be able to fine needle aspiration biopsy (FNAB) or biopsy of the tumor tissue directly in the form of an incisional biopsy, namely by taking a biopsy of the tumor tissue in part as an example when a large tumor size. When small tumor size, can be done by surgically removing the tumor biopsy.
Treatment options for soft tissue tumors include surgery, radiation therapy, and chemotherapy.












REFFERENCE
           
1.    Sjamsuhidajat, R., Jong, W.D., editor., “Soft Tissue Tumor”, dalam Buku Ajar Ilmu Bedah, Edisi 2. EGC, Jakarta, 2005,
2.    Harri Prawira Ezzedin. 2009. Fraktur. Faculty of Medicine – University of Riau Pekanbaru, Riau. available at (http://www.Belibis17.tk. Di akses tanggal 17 Agustus 2011.
3.    Tassya, A, 2010. Tumor Jaringan Lunak. (http://www.BlogSpot.com). Diakses tanggal 17 Agustus 2011
4.    http://www.dokterbedahherryyudha.com/2012/07/soft-tissue-tumor-diagnosis-and.html#more





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