1. Mrs. Nor Halifa/ 25 y.

o/1-21-39-75

Chief Complain:
Lump at back
History of Current Disease:
Since 5 months before admission, patient
complain lump at her back. The lump size was
initially like chicken egg, than it getting bigger
than before and get ruptur and bleeding. She also
complained fatigue (+), vomiting (-) nausea (-)
shortening of breath (-). History of cancer in family
(-). Lump in another part of body (-). History of
chemotherapy (-).
History of past disease :
 Vital Sign

Alert
BP 90/60 mmhg
Hr 90 Bpm
RR 24 tpm
T 36,4 0C
 Secondary
survey
Head :simetric, normocephal
Eye : Anaemic conj. (+/+), icteric sclera (-/-)
Head Mouth : Moist mucous membrane,

General Status Neck :Increasion level of JVP (-)

I : Symmetric respiratory movement, no retraction

P : Symmetric VF
Chest P : Sonor at all lung fields
A : symmetric VBS, rhonchi (-/-) , wheezing (-/-)

I : distension (-) wound (-) hematoma(-)

A : Bowel sound normal
Abdomen P : defence muscular (-) tenderness (-) mass (-)
P : Tymphani (+)

Extremities warm extremities, edema (-), parese (-)

Clinical picture
 Local Status

At Colli Posterior :
Mass (+) sized 20x15 cm, irreguler edge
, Immobile, solid (+), ulcus (+), bledding(-),
pus (+)
Laboratory
Examination Result Normal value
hemoglobin 8,6 11.00-16.00 g/dl
Leucosit 5,7 4.0-10.5 Thousand /ul
eritrosit 3,28 4.50-6.00 milion /ul
hematocrit 27,1 42.00-52.00 Vol%
trombocit 162 150-450 Thousand /ul
Random Blood 100 <200 Mg/dL
Glucose
AST 48 0-46 U/I
ALT 24 0-45 U/I
Urea 5 10-50 Mg/dL
Creatinine 0,5 0.7-1.4 Mg/dL
Thorac X-ray
FNAB

Conclusion:
-Swanoma
-Fibrosarcoma
Working Diagnosis

Fibrosarcoma + Anemia + KS 70-

80%
Management
VS Obs
IVFD NS
Analgetic
H2 blocker
Complete blood count
Thorax X ray
Blood Transfussion

Co to Oncology surgery :
Hospitalized
-Pro chemotherapy
1. Mrs. Hermawati / 42 y.o

Chief Complain :
Wound at breast

Current History :
2 weeks before admission, patient complained wound at
her breast. She got wound on the surface of mass. The
mass in the right breast. Two years ago, she had excision of
the mass with oncology surgery. But the patient didnt
control. Now the the mass has enlarged. The skin surface of
the mass has changed blackish and secreted blood. Nausea
(+) and vomiting (-), fever (+).
Vital sign
BP 130/80 mmhg
Hr 82 Bpm
RR 23 tpm
T 37,8 0C
 Phisic Diagnostic
Head :simetric, normocephal
Eye : Anemic conj. (+/+), icteric sclera (-/-),
Head Mouth : Moist mucous membrane,

General Status Neck :Increasion level of JVP (-)

I : Symmetric respiratory movement, no retraction, wound at right

breast (+)
Chest P : Symmetric VF
P : Sonor at all lung fields
A : symmetric VBS, no rhonchi , no wheezing

I : distension (-) flat.

A : Bowel sound Increase
Abdomen P : defence muscular (-) tenderness (-) ascites (-)
P : tympani (+)

warm extremities, edema (-), parese (-)

Extremities Limfadema at right hand (+)
Clinical picture
At right breast :
I : Mass (+), bleeding (+), pus (+),
irregular edge
P : tenderness (+), 16x10x3cm in
length, irregular surface, immobile

At left breast :
I : Mass (+), bleeding (-), pus (-), peau
dorange
P : tenderness (+), 16x10x3cm in
length, irregular surface
X-Ray
Laboratory
Examination Result Normal value
hemoglobin 7,7 11.00-16.00 g/dl
Leucosit 26,2 4.0-10.5 Thousand /ul
eritrosit 2,55 4.50-6.00 milion /ul
hematocrit 22,6 42.00-52.00 Vol%
trombocit 30 150-450 Thousand /ul
Random Blood 88 <200 Mg/dL
Glucose
SGOT 240 0-46 U/I
SGPT 39 0-45 U/I
Urea 112 10-50 Mg/dL
Creatinine 1,2 0.7-1.4 Mg/dL
Examination Result Normal value
Na 128 135-146 Mmol/l
K 3.3 3.4-5.4 Mmol/l

Cl 104 95-110 Mmol/l

Working Diagnosis

Right Breast Mass susp. malignancy +

Karnofsky score 50-60% +
Anemia
MANAGEMENT
VS Obs
O2 3-5 lpm
IVFD RL
Antibiotic
Analgetic
H2 blocker
Complete blood count
Chest X-Ray

Co to Oncology Surgery
Palliative Therapy
PRC Transfusion
USG Liver
Education