Pemicu 4

Rizky Lumalessil
4051300171

LO 1
Tumor di Otot dan Jaringan
Lunak

Lipoma

Lipoma
A growth of fat cells in a thin, fibrous
capsule usually found just below the skin
Are found most often on the torso, neck,
upper thighs, upper arms, and armpits, but
they can occur almost anywhere in the
body.
One or more lipomas may be present at the
same time.
Lipomas are the most common
noncancerous soft tissue growth.

Epidemiology
Lipomas occur in all age groups but
most often appear in middle age.
Single lipomas occur with equal
frequency in men and women.
Multiple lipomas occur more
frequently in men.

Etiology
The cause of lipomas is not
completely understood, but the
tendency to develop them is
inherited.
A minor injury may trigger the
growth.
Being overweight does not cause
lipomas.

Risk Factors
Being between 40 and 60 years old.
Although lipomas can occur at any age,
they're most common in this age group.
Lipomas are rare in children.
Having certain other disorders. People
with other disorders, including adiposis
dolorosa, Madelung disease, Cowden
syndrome and Gardner's syndrome, have
an increased risk of multiple lipomas.

Sign and Symptoms

small [0.4 in. (1 cm) to 1.2 in. (3 cm)] and
felt just under the skin.
movable and have a soft, rubbery
consistency.
Do not cause pain.
Remain the same size over years or grow
very slowly.
Often the most bothersome symptom is the
location or increased size that makes the
lipoma noticeable by others.

Diagnosis
Usually be diagnosed by its
appearance alone

Treatment
Lipomas do not generally require treatment.
There is no known treatment to prevent lipomas or affect their
growth.
A lipoma may be surgically removed if symptoms develop,
such as if the lipoma:
Becomes painful or tender.
Becomes infected or inflamed repeatedly.
Interferes with movement or function.
Increases in size.
Becomes unsightly or bothersome.

Most lipomas can be removed in the doctor's office or

outpatient surgery center. The doctor injects a local anesthetic
around the lipoma, makes an incision in the skin, removes the
growth, and closes the incision with stitches (sutures)

Rhabdomiosarkoma

Rhabdomyosarcoma
A cancerous (malignant) tumor of the
muscles that are attached to the bones.
It can occur in many places in the body.
The most common sites are the
structures of the head and neck, the
urogenital tract, and the arms or legs.
The most common soft tissue tumor in
children.

Etiology
The cause of rhabdomyosarcoma is
unknown.
It is a rare tumor with only several
hundred new cases per year
throughout the United States.
Some children with certain birth
defects are at an increased risk, and
some families have a gene mutation
that elevates risk.

Types
Embryonal rhabdomyosarcoma
Alveolar rhabdomyosarcoma
Anaplastic rhabdomyosarcoma
and undifferentiated sarcoma

Types
Embryonal rhabdomyosarcoma
(ERMS)
most common type. It usually affects
children in their first 5 years of life.
The cells of ERMS look like the developing
muscle cells of a 6- to 8-week-old embryo.
ERMS tends to occur in the head and neck
area, bladder, vagina, or in or around the
prostate and testicles.

Types
Alveolar rhabdomyosarcoma (ARMS)
Typically affects all age groups equally, but it is
the type most often seen in older children and
teens.
This type of rhabdomyosarcoma most often
occurs in large muscles of the trunk, arms, and
legs.
ARMS cells look like the normal muscle cells
seen in a 10-week-old fetus.
ARMS tends to grow faster than ERMS and
usually requires more intensive treatment.

Types
Anaplastic rhabdomyosarcoma and
undifferentiated sarcoma
Anaplastic rhabdomyosarcoma (formerly called
pleomorphic rhabdomyosarcoma) is an
uncommon type that occurs in adults but is
very rare in children.
Using lab tests, doctors can tell that these
cancers are sarcomas, but the cells dont have
any features that help classify them further.
Both of these uncommon cancers tend to grow
quickly and usually require intensive treatment.

Symptoms
The most common symptom is a mass that may or may not be
painful.
Other symptoms vary depending on location of the tumor.
Tumors in the nose or throat may cause bleeding, congestion,
swallowing problems, or neurological problems if they extend
into the brain.
Tumors around the eyes may cause bulging of the eye,
problems with vision, swelling around the eye, or pain.
Tumors in the ears, may cause pain, hearing loss, or swelling.
Bladder and vaginal tumors may cause lead to trouble starting
to urinate or having a bowel movement, or poor control of
urine.
Muscle tumors may lead to a painful lump and are often
thought to be an injury.

Exam and Tests

Diagnosis of rhabdomyosarcoma is often delayed because of
lack of symptoms, and because the tumor may appear at the
same time as a recent injury. Early diagnosis is important
because rhabdomyosarcomaspreads quickly.
A complete physical exam should be done. Tests may
include:
Biopsy of the tumor
Chest x-ray
CT scan of the chest to look for spread of the tumor
CT scan of the tumor site
Bone marrow biopsy (may show the cancer has spread)
Bone scan to look for spread of the tumor
MRI scan of the tumor site
Spinal tap (lumbar puncture)

Treatment
The precise treatment depends on the site and type of
rhabdomyosarcoma.
Either radiation or chemotherapy, or both, will be used before or
after surgery. In general, surgery and radiation therapy are used
to treat the primary site of the tumor. Chemotherapy is used to
treat disease at all sites in the body.
Chemotherapy is an essential part of treatment to prevent further
spread of the cancer. Many different chemotherapy drugs are
active against rhabdomyosarcoma. Some of these drugs include:
Dacarbazine
Doxorubicin
Epirubicin
Gemcitabine
Ifosfamide

Complication
Complications from chemotherapy
Location in which surgery is not
possible
Metastasis

Prognosis
While aggressive treatment is usually
necessary, most children with
rhabdomyosarcoma will achieve
long-term survival. Cure depends on
the specific type of tumor, its
location, and the amount that has
spread.

Fibrosarkoma

Fibrosarcoma
Fibrosarcoma is a tumor of
mesenchymal cell origin that is
composed of malignant fibroblasts in
a collagen background.
It can occur as a soft-tissue mass or
as a primary or secondary bone
tumor.

Epidemiology
Fibrosarcoma represents only about 10% of musculoskeletal sarcomas and
less than 5% of all primary tumors of bone. No known racial predilection
exists.
Fibrosarcoma of bone occurs slightly more commonly in men than in
women.
Fibrosarcoma of bone can be diagnosed in patients of any age, but it is
diagnosed more commonly in patients in the fourth decade of life. It is
usually located in the lower extremities, especially the femur and tibia.
Fibrosarcoma of the soft tissues usually affects a wider age spectrum of
patients than fibrosarcoma of the bone does, with an age range of 35-55
years. It often arises in the soft tissues of the thigh and the posterior knee.
It is generally a large, painless mass deep to fascia and has an ill-defined
margin.
An infantile form (in children < 10 y) of fibrosarcoma exists. Unlike
fibrosarcoma in adults, it has an excellent prognosiseven in the face of
metastatic disease at presentationwhen treated with a combination of
neoadjuvant and adjuvant chemotherapy and resection

Etiology
Fibrosarcoma, like other soft-tissue
sarcomas, has no definite cause.
Current research indicates that many
sarcomas are associated with genetic
mutations.

Sign and Symptoms

Sarcomas involving bone:
pain and swelling after a long duration of symptoms.
They may even grow large enough to threaten the structural integrity
of the bone and cause pathologic fracture as the initial presentation.

Soft-tissue sarcomas:
painless masses.
Because these lesions frequently arise deep to the muscular fascia,
they may become extremely large tumors prior to diagnosis.

Most lesions occur around the knee, in the proximal femur and
hip region, or in the proximal arm. Findings are nonspecific and
can vary from a fixed, firm mass to a localized area of
tenderness.
Neurologic or vascular changes are late findings and indicate
extensive disease involvement

DD

Fibrous dysplasia
Fibrous histiocytoma
Osteosarcoma
Paget sarcoma
Malignant fibrous histiocytoma
Malignant neurosarcoma

Treatment
Medical Therapy
Radiation treatment and chemotherapy, can
improve local control and may make the
appearance of clinically evident metastatic
disease less likely. The use of chemotherapy is
controversial, but chemotherapy is generally
used in bone lesions. Radiation therapy is used
in conjunction with surgery for soft-tissue
fibrosarcomas, with or without chemotherapy

Surgical Therapy
Surgical resection with a cuff of normal tissue
(wide margins)

Complication
Local recurrence may occur in up to
60% of cases and is the reason that
postoperative radiation, preoperative
radiation, or both are often
recommended. Local recurrence is
reduced to about 25% when
postoperative irradiation is used.

Prognosis
For congenital fibrosarcoma of bone in
children, the prognosis (which is related
to age and to time to diagnosis) is much
better, with the disease having longterm survival rates of higher than 50%.
Soft-tissue fibrosarcoma is associated
with a 40-60% survival rate at 5 years.
The infantile form has an even better 5year survival rate, in excess of 80%.

Fibromatosis

Definition
Fibromatosis is a condition where
fibrous overgrowths of dermal and
subcutaneous connective tissue
develop tumors called fibromas.
These fibromas are usually benign
(non-cancerous).

Classification
Juvenile
Adult
Superficial (facial) fibromatoses
Deep (musculoaponeurotic)
fibromatoses

Classification
Juvenile
Congenital generalised fibromatosis
(infantile myofibromatosis)
Aponeurotic fibroma
Infantile digital fibromatosis
Aggressive infantile fibromatosis
Fibromatosis colli
Dermatofibrosis lenticularis (BuschkeOllendorf syndrome)

Classification
Adult
Superficial (facial) fibromatoses
Palmar (Dupuytren contracture) and plantar (Ledderhose
disease) fibromatosis
Penile fibromatosis (Peyronie disease)
Knuckle pads
Dermatofibroma
Nodular fasciitis
Elastofibroma
Fibrous papule of the face

Deep (musculoaponeurotic) fibromatoses

Desmoid tumours (aggressive fibromatoses)
Extraabdominal fibromatosis
Abdominal fibromatosis
Intraabdominal fibromatosis (e.g. pelvic fibromatosis)

Feature of Fibromatosis
Superficial fibromatoses
Slow growing tumour
Small size
Arise from fascia or aponeurosis
Less aggressive

Deep fibromatoses
Rapidly growing tumour
Usually reach large size
Often involve deeper structures (muscles of
the trunk and extremities)

Infantile digital
fibroma

Knuckle pads

Fibrous papule

Periungual
fibroma

Dermatofibrom
a

Etiology
The cause of fibromatosis remains unclear.
In some types of fibromatosis such as
desmoid tumours it is thought that the
condition may be related to trauma, hormonal
factors, or have a genetic association.
Superficial fibromatoses such as palmar,
plantar and penile fibromatosis have
sometimes been linked to certain diseases
such as diabetes, liver disease and
hypertension.

Treatment
Management of fibromatosis
depends on the individual disease.

Liposarkoma

Liposarcoma
A cancerous (malignant) tumor that
develops from fat cells.
Can develop anywhere, but typically
appear in the deep fat tissues of the
limbs or abdomen in people ages 50
to 65.

Epidemiology
Liposarcomas are slightly more common
in males than in females
The mean patient age at onset is 50
years. Although liposarcomas account for
about 17% of all soft tissue sarcomas,
they are involved in only 4% of childhood
soft tissue sarcomas. Cases of liposarcoma
are reported in young adults and
teenagers, but cases in children are rare

Pathophysiology
Liposarcoma is a lipogenic tumor of large
deep-seated connective tissue spaces. Fusion
proteins created by chromosomal
abnormalities are key components of
mesenchymal cancer development. An
abnormality of band 12q13 has been
associated with the development of
liposarcomas. The most common
chromosomal translocation is the FUS-CHOP
fusion gene, which encodes a transcription
factor necessary for adipocyte differentiation.

Etiology
No well-established causative factor
has been identified, although trauma
has been implicated.

Symptoms
Most people with liposarcoma do not
feel sick. They might notice a lump
(which can be soft or firm to the
touch) that is usually painless and
slow growing. Unfortunately, tumors
in the abdomen can grow to be quite
large before they are found.

Diagnosis
A physical exam
Lumps that are 5cm or larger and deepseated, firm and fixed to underlying
structures are usually considered
suspicious.

Imaging tests and often include an Xray and an MRI.

A needle or a surgical biopsy.

DD
Lipomas
Neurofibromatosis

Treatment
Surgery is the treatment for primary liposarcomas
that have not yet spread to other organs
The combination of surgery and radiation
therapy has been shown to prevent recurrence at
the surgical site in about 85-90% of liposarcoma
cases
The role of chemotherapy in the treatment of
liposarcoma is not clearly defined, but it may be
recommended in certain situations where patients
are at high risk of recurrence or already have
widespread disease.

LO 2
Ulkus pada Tungkai

Ulkus Tropicum

Definisi
suatu ulkus dengan ciri-ciri khas
sering terdapat didaerah tropik,
berbentuk khas, berbau busuk dan
disebabkan oleh mikroorganisme

Penyebab
penyebab yg paling pasti belum
diketahui, diduga disebabkan
simbiosis dua macam
mikroorganisme Borrelia vincenti dan
Bacillus fusiformis

Epidemiologi
umur : 6-10 tahun
jenis kelamin : lebih banyak pada
pria

Faktor-faktor yg mempengaruhi
timbulnya penyakit
daerah : tropis
musim : hujan
kebersihan : higiene yg buruk dan
gizi yg kurang. terkadang dpt timbul
akibat gigitan serangga

Gejala
dimulai dg luka kecil ==> terbentuk
papula yg dg cepat meluas menjadi
vesikel ==> vesikel pecah dan
menjadi ulkus kecil, setelah diinfeksi
oleh mikroorganisme, ulkus meluas
ke samping dan ke dalam dan
memberi bentuk khas ulkus tropikum

Pemeriksaan Kulit
lokalisasi : tungkai bawah dan lengan
efloresensi/sifat-sifatnya :
ulkus solitar, numular, kadang2 ada lesi
satelit akibat autoinokulasi
pinggir ulkus meninggi, dinding
menggaung, dasar kotor, cekung
berbenjol-benjol, tepi teratur, sekret
produktif berwarna kuning coklat
kehijauan dan berbau

Gambar Histopatologi
ulkus dg sebukan sel radang akut
PMN serta sel darah merah
pada dermis, ditemukan pelebaran
ujung2 pembuluh darah disertai
sebukan sel plasma

Pemeriksaan pembantu/lab
pemeriksaan rutin : leukositosis, LED
meningkat
pemeriksaan khusus : mikroskop
lapangan gelap mencari Borrelia
vincenti atau Bacillus fusiformis
pewarnaan Burry : utk melihat
Borrelia vincenti

Diagnosis Banding
ulkus banal
ulkus varikosus
ulkus karena jamur, tuberkulosis

Penatalaksanaan
umum : istirahat, diet tinggi kalori
tinggi protein, menghindar gigitan
serangga
khusus :
sistemik : injeksi penisilin 900.000 IU
selama 7 hari atau amoksisilin 4x500
mg selama 5-10 hari
topikal :
kompres KMnO4 1/5000-1/10.000
jika lesi bersih diberi salep salisil 2%

Prognosis
baik

Ulkus Trofik

Definisi
suatu ulkus kronik yg disebabkan
gangguan trofik, biasanya dijumpai
pada penderita lepra, DM, dan tabes
dorsalis
gangguan trofik : akibat neuropati
perifer
ulkus timbul didaerah kulit yg sering
mendapat tekanan anestetik

Penyebab dan Epidemiologi

Penyebab : gangguan trofik setempat
Epid
umur : pada usia dewasa
jenis kelamin : frekuensinya sama pada
pria dan wanita

Gejala
mula-mula terdapat koreng pd
telapak kaki/jari tangan, namun
karena pada penderita lepra terjadi
anestesi, akibatnya tidak lagi
merasakan tekanan saat bekerja shg
koreng makin membesar dg atrofi
jaringan sekitarnya serta anhidrosis

Pemeriksaan Kulit
Lokalisasi :telapak kaki, ujung jari
dan sela pangkal jari kaki
efloresensi : ulkus solitar, bulat,
pinggir rata, dinding menggaung,
dasar cekung, sekret tidak produktif,
tanpa indurasi dan nyeri, ulkus dapat
ditutupi krusta dan daerah
sekitarnya anhidrosis

Gambaran Histopatologi
ulkus dg sebukan sel radang kronik
disertai sel epiteloid
terkadang ditemuka sel datia
Langharns

Pemeriksaan Lab
pemeriksaan bakteriologik dr sekret
ulkus
pemeriksaan darah rutin, gula
darah,BTA
biakan sekret ulkus dan uji resistensi

Diagnosis Banding
Ulkus piogenik : btk oval, pinggir
meninggi, dasar berbenjol2, sekret
produktif, daerah sekitar reda,
perabaan nyeri, indurasi positif

Penatalaksanaan
umum : istirahat
khusus : terapi terhadap etiologi
primernya
sistemik : penisilin 900.000 IU selama 7
hari ; antibiotik lain yg sensitif
topikal : kompres KMnO4 1/10.000

Prognosis
baik, sepanjang pengobatan
penyebabnya baik

Ulkus Piogenik

Definisi
infeksi kulit yg menimbulkan ulkus
tidak khas, disebabkan oleh
streptokok atau stafilokok

Penyebab dan Epidemiologi

Penyebab : streptokok dan stafilokok
Epidemiologi
umur : lebih sering pd anak2
jenis kelamin : frekuensinya sama
dengan pria dan wanita

Gejala
timbul koreng/ulkus dg tanda2
radang di sekitarnya, scr lambat
mengalami nekrosis dan menyebar
scr serpiginosa

Pemeriksaan Kulit
lokalisasi : ekstremitas
efloresensi/sifat2nya : ulkus
berukuran kecil, pinggir tidak
meninggi, teratur, dinding tidak
menggaung, sekitar ulkus ada tanda
radang, sekret serosa kekuningan

Gambaran Histopatologi
tampak reaksi sel di jaringan dengan
sel plasma, dan sel limfoid

Pemeriksaan Lab
kultur sekret ulkus dan tes resistensi

Diagnosis Banding
Ulkus tropikum dan ulkus karena
penyebab lain spt antraks,
tuberkulosis atau frambusia

Penatalaksanaan
umum : bersihkan (debridement)
ulkus
khusus
sistemik : penisilin 600.000-1,2 juta IU
intramuskular selama 5-7 hari
eritromisin 4x500 mg selama 7 hari

topikal : salep salisil 2%; jika berat dg

kompres PK 1/10.000 atau AgNO3 1-2%

Prognosis
baik

Ulkus Dekubitus

Definisi
ulkus yg timbul karena tekanan berat
badan pada tempat tidur

Penyebab dan Epidemiologi

Penyebab : tekanan berat badan pd
tempat tidur
Epidemiologi
umur : semua umur terutama orang tua
jenis kelamin : frekuensinya sama pd
pria dan wanita

Faktor Predisposisi
penderita penyakit kronik spt DM,
malnutrisi, keganasan, dan orangorang yg tidak dapat bergerak lebih
mudah terkena ulkus dekubitus

Gejala
dimulai dg eritema pd daerah yg
tertekan
ulkus mengeluarkan jaringan
nekrosis berwarna kecoklatan
sebagian ulkus ditutupi oleh jaringan
nekrosis berwarna hitam yg
menyerupai membran

Pemeriksaan Kulit
lokalisasi : pinggang, bokong dan
tempat2 yg banyak mengalami
tekanan
efloresensi/sifat2nya : ulkus plakat,
ditutupi oleh jar nekrosis yg
berwarna coklat sampai hitam yg
berbentuk tidak teratur

Gambaran Histopatologi
ulkus dg dinding rata atau bergaung
pada dasarnya ditemukan sebukan
sel2 radang akut
pd subkutis didapatkan pelebaran PD
dan sebukan sel2 radang

Pemeriksaan Lab
kultur darah dan tes resistensi

Diagnosis Banding
ulkus gangrenosa oleh karena DM,
biasanya berbau busuk dg jar
nekrosis yg produktif
ulkus banal: sering berbentuk tidak
teratur dan bersifat akut

Penatalaksanaan
hilangkan tekanan pd daerah2 yg terkena
dg mengubah-ubah posisi
mengusahakan agar ventilasi antara
badan dan tempat tidur berjalan lancar
sistemik : antibiotik spektrum luas spt
amoksisilin 4x500 mg selama 15-30 hari.
Siklosporin 1-2 g/hari selama 3-10 hari
atau golongan kuinolon 4x500 mg/hari
selama 14 hari
topikal : salep antibiotik spt salep
kloramfenikol 2%

Prognosis
baik selama pengobatan penyakit
dasar berhasil baik

Ulkus Gangrenosum

Definisi
ulkus yg timbul pd penderita2 dg
keadaan umum buruk atau penderita
penyakit kronik

Penyebab dan Epidemiologi

Penyebab : streptokok dan
mikroorganisme lain
Epidemiologi
umur : lebih banyak pd orang tua
jenis kelamin : frekuensi yg sama pd pria
dan wanita

Faktor Predisposisi
biasanya timbul pd penderita
penyakit2 yg menyebabkan keadaan
tubuh lemah, spt DM, keganasan,
kusta dan malnutrisi

Gejala
mula2 timbul papula2 kecil di kulit,
dalam waktu cepat timbul abses dan
selanjutnya terbentuk ulkus dg sifat2
==> tak teratur, sekret ulkus, jar
nekrosis yg hitam, dg berbau busuk
penderita mengeluh panas dan nyeri

Pemeriksaan Kulit
lokalisasi : ekstremitas inferior dan
ujg2 jari
efloresensi/sifat2nya : ulkus yg tidak
teratur, mengeluarkan jar nekrosis
berwarna hitam/coklat, disertai
edema dan eritema yg tidak
berbatas tegas

Gambaran Histopatologi
Ulkus tidak khas, ditutupi oleh jar
nekrosis dan sel2 polinuklear, sel
plasma dan limfosit
pada dermis/subkutis terdpt
pelebaran PD

Pemeriksaan Lab
pemeriksaan darah utk gula darah,
kultur dan tes resistensi

Diagnosis Banding
ulkus banal : biasanya tidak berbau,
keadaan umum penderita tak
terpengaruh
ulkus trofik : biasanya terjadi
gangguan sensibilitas, tak produktif
dg dasar yg lebih bersih

Penatalaksanaan
kombinasi pengobatan dg
pengobatan penyakit dasarnya
sistemik : antibiotik spektrum luas
spt amoksisilin 4x500 mg/hari
selama 10-14 hari. Siklosporin 1-2
g/hari selama 10-14 hari. Preparat
kuinolon 2x250 mg/hari selama 1014 hari
topikal : kompres KMnO4 1/5.000
atau larutan povidon yodium 5-10%

Prognosis
biasanya baik bila penyakit dasarnya
dapat diatasi