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