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Editing terahir: 30 Agustus 2009


               STUDENTS’ MODULE



                ONCOLOGY




          Given to 5th Semester Medical Students Of
                   Hasanuddin University


                           Created By


                ONCOLOGY SYSTEM
                MEDICAL FACULTY
              HASANUDDIN UNIVERSITY
                      2009




BENJOLAN DI LEHER (MAHASISWA)
MODULE

 INTRODUCTION

       Oncology system has provided four modules for the 2008 academic year, which are
NECK LUMP, BREAST LUMP, CONTACT BLEEDING and LUMP OF THE TIGHT.
There are all given to the fifth semester students of oncology System. The study objectives
are provided inside the module in order to help the student to gain the overall picture of the
basic concept of infectious disease mechanism.
        This module includes several scenarios showing some clinical signs and symptoms
which are possibly found in certain diseases. Discussion session will not merely talk about
the chief complain but also everything that is considered related to it. The students are
expected to be able to explain all aspects of the oncology based disease including basic
principle of the anatomy, histology, and physiology; pathomechanism of infection; microbes
causing the infection; cell, tissue and body fluid abnormalities due to infection; basic
mechanism of human body self-defense; infection transmission pathway; and infection
prevention    Discussion has to follow 7 steps of problem solving process.
       Prior to the PBL process, both students and tutors must read the goals and objectives
of the module to assure the process is accomplished according to the designated objectives,
as well as to achieve the desired competition. Discussion materials can be obtained either
from lecture handouts or other references provided by the lecturers or tutors.
       We strongly hope that this module can be very useful in helping the students in
solving problems related to oncology system.


                                                                          Makassar, July 2009


                                                                             Oncology System




                                               18
STUDENTS’ TASKS

After reading the above scenarios thoroughly, the students must discuss the cases in a leader-
led group discussion. Both the leader and the secretary are chosen by the students
themselves.
1.    Conducting a self study by providing data/information that will support the discussion
2.    Conducting a self-coached group discussion (without tutor)
3.    Consulting the problems revealed during the PBL to the experts for a better
      understanding
4.    Attending provided experts’ lecture for unsolved problems


 STUDY STRATEGIES
     1.    A leader-led group discussion, facilitated by a tutor
     2.    A leader-led group discussion, without a tutor
     3.    Experts consultation
     4.    Experts lecture in a general class
     5.    Self-study activities in the library with books, magazines, slides, tape recorder,
           video or the internet.
     6.    Conducting laboratory practical work in the laboratory


 PROBLEM SOLVING PROCESS
In a leader-led group discussion, the students are expected to solve the problems in the
scenarios by conducting these following 7 jumps of problem solving process:
      1. Clarifying the un-clear terms stated in the scenario, then defining the keywords/key
          statement(s)
      2. Identifying the basic problem of the scenario, by creating some leading important
          questions
      3. Analyzing the problems by answering the above questions
      4. Classifying the answers
      5. Developing study objectives that must be achieved by the students during the case
          discussion
      6. Looking for other supporting information related to the above cases



                                                19
7. Reporting the result of discussion and synthesizing the other identified information
Important Notes:
     •   Step 1 to 5 are conducted during the first coached-tutorial with the tutor
     •   Step 6 is a self study; performed out of the class either by a group discussion or by
         student solely, which will then be discussed together in an un-coached group
     •   Step 7 is conducted during the second coached-tutorial with the tutor


 ACTIVITIES SCHEDULE
1.   First meeting in a general class lecture; the lecture delivers a one way communication
     of lecturing followed with asking question session
     Objective:
     •    explaining the module and how to complete the provided tasks
     •    developing several discussion groups. During this first meeting, the modules will
          also be distributed to the students.
2.   Second meeting: self-study. Objectives:
     •    choosing a group leader and secretary
     •    brain storming for step 1 to 3
     •    distributing tasks for members of the group
3.   Third meeting: a leader-led group discussion, facilitated by a tutor. Objective: to report
     the self-study result and accomplish the PBL process to the fifth step
4.   Self-study, either together with other students in a group discussion or solely.
     Objective: Collecting other new necessary information
5.   Fourth meeting: a leader-led group discussion, facilitated by a tutor. Objective:
     reporting the last discussion result as well as for synthesizing the recently identified
     information
6.   Fifth meeting (last one): conducted in a general class, applying a panel discussion form,
     in which students report the final results of each group’s discussion, and clarifying
     things that remain unsolved by the groups.




                                                 20
TIME-TABLE

               PERTEMUAN
I              II            III             IV           V              VI            VII
1st Meeting    2nd Meeting; 1st Tutorial     Self         Lecture,       2ndTutorial   Last
Explanation    self study    Collecting      Study        Consultation   (Reporting    Meeting
               (Brain        information,                                and           (Reporting)
               Storming)     analyzing       Practical                   discussing)
                             and             Work,
                             synthesizing    CSL
                             data


      Lecturers

       No.              LECTURERS                 DEPARTMENT             OFFICE NO.     HP/FLEXI
        1.    Dr. Fachruddin Benyamin             Penyakit Dalam           584461       0811440252
              Sp.PD
       2.     DR.dr. Bakhtiar Murtala,            Radiologi                581666       0811444920
              Sp.Rad
       3.     Dr. Daniel Sampepayung,             Bedah Onkologi           587107            5052867
              Sp.B.Onk
       4.     Dr. Freddy Kuhuwael, Sp.THT         THT                      590737        08124212
       5.     Dr. William Hamdani,                Bedah Onkologi           587107       08124229793
              Sp.B.Onk
       6.     Dr. Haryasena, Sp.B.Onk             Bedah Onkologi           587107       0816279483
       7.     Prof. dr. Farid Nurmantu,           Bedah Anak               585771       0811467020
              SpBA, FICS
       8.     Dr. A. Asadul Islam Tahir,          Bedah Saraf              585771       0811442630
              SpBS
        9.    Dr. Nuralim Mallapasi               Bedah Thoraks            585771        0811418564
       10.    Dr. Syamsulhilal Salam. SpAn        Anestesiologi            589777       08152545370
       11.    Dr. Syafruddin Gaus. Ph.D           Anestesiologi            589777       08524217811
                                                                                              0
       12.    Dr. Syahrul Rauf, SpOG              Obgin                    585859        0811416070
       13.    Dr. Junus Patau, SpPD, SpP          Penyakit Dalam           315415        0811414013
       14.    DR. dr. Dasril Daud, SpAK           Anak                     584461
       15.    Dr. Siswanto Wahab                  Kulit Kelamin            580345         5092625
       16.    Prof.dr. Suryani As’ad, MSc.        Gizi                     586010       08152535240
       17.    Dr. Gunawan, SpPA                   Patologi                 324003         5092625
       18.    Dr. Azhier Gani                     Fisiologi                584730         434567




                                                     21
MODULE 1
                                BREAST LUMP
  STUDY GOAL
 After learning the module, the students are expected to have the ability in explaining the
disease with breast lump; the cause, pathomechanism, signs and symptoms, how to diagnose,
the management/therapy as well as the complication.

CASES
 Scenario 1.
       A woman, 20 year old, came to PUSKESMAS with breast lump on the right
 side, 2 cm in diameter. She has been having it for about a year, sometimes it felt sore.
 History of breast cancer is recorded in the family.


 Scenario 2.
       A 60 year old woman, came to PUSKESMAS with lump on the left side of her
 breast, 3 cm in diameter. Painless, undefined border, moveable.



 OTHER SOURCE OF INFORMATION

Handouts/journal
1. Singletary SE, Robb GI. Advanced Therapy of Breast Disease, 2nd edition, BC Decker Inc.
  Hamilton, london. 2004.
2. Harris JR, Lippman ME, Marrow M, Hellman S. Disease of Breast. Lippmlott Raven. 1996.
3. Sukarja IDG,. Onkologi Klinik, Edisi 2, Airlangga University Press. Surabaya, 2000.
4. Devita HT, Hellman S, Rosenberg SA. Cancer Principles & Practice of Oncology, 6th ed.,
  Lippmcott Williams & Wilkins. 2001.
5. Syamsuhidajat R., de Jong W. Buku Ajar Ilmu Bedah. Edisi 2. EGC. 2003.
6. Guyton AC, Jall JE. Pregnancy and Lactation, in Textbook of Medical Physiology, 10th edition,
  Saumnders Co., Harcourt Internacional Edition, Sydney, 2000. p. 944-957.




                                                 22
MODULE 2
                                 NECK LUMP
 STUDY GOAL
After learning the module, the students are expected to have the ability in explaining the
disease with neck lump; the cause, pathomechanism, signs and symptoms, how to diagnose,
the management/therapy as well as the complication.


CASE
 SKENARIO : NECK LUMP
         A 40 year old man came to Puskesmas with lump on the lateral side of his
 neck. She started experiencing the lump since 4 months ago. It started with a little
 lump, then grew larger progressively, solid with palpation, painless. She also
 complained oh headache.



  OTHER SOURCE OF INFORMATION
A. Handouts and Journals
1. Adam GL, Boies Lr and Higler Peter A. : Fundamentals of Otolaryngology,
   (Buku Ajar Penyakit THT), Penerbit Buku Kedokteran EGC, 1997.

2. Efiaty Soepardy, Nurbaiti Iskandar : Buku Ajar Ilmu Kesehatan THT, Ed 5,
  Fakultas Kedokteran Universitas Indonesia, 2000.

3. Ballenger JJ. Disease of the Ear, Nose, Throat and Head and Neck, 13th ed.
   Lea and Febiger , 1985

4. Lee K.J : Essential Otolaryngology Head and Neck Surgery, 8th ed, Mac Graw
   Hill, 2003

5. Cameron John : Current Surgical Therapy-3, International Ed, BC Decker, 1989

B. Other Sources: The Internet, VCD, Tape, Slide

C. Lecturers




                                             23
MODULE 3
                         CONTACT BLEEDING
 STUDY GOAL
After learning the module, the students are expected to have the ability in explaining diseases
with contact bleeding in vagina; the cause, pathomechanism, signs and symptoms, how to
diagnose, the management/therapy as well as the complication.


CASE

A 45 year old woman, came with spotted bleeding from her vagina particularly after

sexual intercourse with her husband. History of smelly fluor albus ever recorded before.



 OTHER SOURCE OF INFORMATION
A.Handouts and Journals
1. Winkjosastro H, Saifuddin AB, Rachimhadhi T. Ilmu kandungan. Edisi ke-3. Jakarta.
   Yayasan Bina Pustaka Sarwono Prawirohardho. 1997
2. Berek JS, Hacker NF, eds. Practical gynecologic oncology. 3rd ed. Philadelphia.
   Lippincott Williams & Wilkins. 2000
3. Berek JS, Adashi EY, Hillard PA. Novak;’s gynecology. 12ed. Philadelphia. Williams &
   Wilkins. 1996
4. Ransom SB, Dombrowski MP, McNeely SG, Moghissi KS, Munkarah AR, eds. Practical
   strategies in obstetrics and gynecology. Philadelphia. W.B. Saunders Company.2000
5. Cotran. Cell injury and necrosis. In: Robbins pathologic basis of disease. 6th ed. 1999.
   W.B.Saunders Company. Available from: http://www.home.mdconsult.das/book/body.
6. Lonky NM. Risk factors related to the development and mortality from invasive cervical
   cancer: clinical utility and impact on prevention. Obstetrics and Gynecology Clinics 2002
   December;29(4).                  Available                 from:             http://home.
   mdconsult/das/article/body/jorg=journal&source.
7. Lopez A, Kudelka AP, Edwards CL, Kavanagh JJ. Carcinoma of the uterine cervix.
   Medical oncology: a comprehensive review. Available from : URL:
   http://www.cancernetwork.com/textbook/morev24.htm. Acessed 10/1/02.
8. Andrijono. Sinopsis kanker ginekologi. Divisi Onkologi, Departemen Obstetri dan
   Ginekologi Fakultas Kedokteran Universitas Indonesia. RSUPN dr. Cipto
   Mangunkusumo. Jakarta. Januari 2004. hal.35-55.




                                              24
MODULE 4
                         LUMP ON THE TIGHT
 STUDY GOAL
After learning the module, the students are expected to have the ability in explaining diseases
with lump symptoms on the tight; the cause, pathomechanism, signs and symptoms, how to
diagnose, the management/therapy as well as the complication.


CASE
 Scenario 1

 A 14 year old man, came to a hospital with lump on the upper side his left
 tight. He has been having it for 2 months before hospital administration.
 3 months ago he felt down from his school’s stairs, that is when the side
 start to develop a swollen and painful lump particularly during the night. He
 has no appetite, and kept loosing weight. In the age of 12 he underwent a 6
 months regular therapy.


 Scenario 2

 A 20 year old girl, came to a hospital with lump on the lower side his right
 tight. It started 4 years ago, initially just as size of a marble, but kept on
 growing, solid, and painless.


 OTHER SOURCE OF INFORMATION

1. Rasjad, Chairuddin : Pengantar Ilmu Bedah Ortopedi. Bintang Lamupatue : Makassar.
             2003. 297-298.

2. Jacobs, McInerney and Middlemiss: Rontgen Sign In Diagnostic Imagine 2nd. W.B
            Saunders Company : USA. 1985. 276-279, 297-298.

3. Brunning D Richard: Surgical Pathology 9th. Mosby: USA.2004. 2169-2272.

4. Neff, R James : Clinical Oncology 3rd. Elsevier : USA. 2004. 2546-2547.

5. Randall RL. Tumors in orthopedics in current. Diagnosis and treatment in orthopedic
            3rd. McGrow-Hill:USA. 2003. 310-311.



                                              25

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Student modul oncology i

  • 1. Editing terahir: 30 Agustus 2009 STUDENTS’ MODULE ONCOLOGY Given to 5th Semester Medical Students Of Hasanuddin University Created By ONCOLOGY SYSTEM MEDICAL FACULTY HASANUDDIN UNIVERSITY 2009 BENJOLAN DI LEHER (MAHASISWA)
  • 2. MODULE INTRODUCTION Oncology system has provided four modules for the 2008 academic year, which are NECK LUMP, BREAST LUMP, CONTACT BLEEDING and LUMP OF THE TIGHT. There are all given to the fifth semester students of oncology System. The study objectives are provided inside the module in order to help the student to gain the overall picture of the basic concept of infectious disease mechanism. This module includes several scenarios showing some clinical signs and symptoms which are possibly found in certain diseases. Discussion session will not merely talk about the chief complain but also everything that is considered related to it. The students are expected to be able to explain all aspects of the oncology based disease including basic principle of the anatomy, histology, and physiology; pathomechanism of infection; microbes causing the infection; cell, tissue and body fluid abnormalities due to infection; basic mechanism of human body self-defense; infection transmission pathway; and infection prevention Discussion has to follow 7 steps of problem solving process. Prior to the PBL process, both students and tutors must read the goals and objectives of the module to assure the process is accomplished according to the designated objectives, as well as to achieve the desired competition. Discussion materials can be obtained either from lecture handouts or other references provided by the lecturers or tutors. We strongly hope that this module can be very useful in helping the students in solving problems related to oncology system. Makassar, July 2009 Oncology System 18
  • 3. STUDENTS’ TASKS After reading the above scenarios thoroughly, the students must discuss the cases in a leader- led group discussion. Both the leader and the secretary are chosen by the students themselves. 1. Conducting a self study by providing data/information that will support the discussion 2. Conducting a self-coached group discussion (without tutor) 3. Consulting the problems revealed during the PBL to the experts for a better understanding 4. Attending provided experts’ lecture for unsolved problems STUDY STRATEGIES 1. A leader-led group discussion, facilitated by a tutor 2. A leader-led group discussion, without a tutor 3. Experts consultation 4. Experts lecture in a general class 5. Self-study activities in the library with books, magazines, slides, tape recorder, video or the internet. 6. Conducting laboratory practical work in the laboratory PROBLEM SOLVING PROCESS In a leader-led group discussion, the students are expected to solve the problems in the scenarios by conducting these following 7 jumps of problem solving process: 1. Clarifying the un-clear terms stated in the scenario, then defining the keywords/key statement(s) 2. Identifying the basic problem of the scenario, by creating some leading important questions 3. Analyzing the problems by answering the above questions 4. Classifying the answers 5. Developing study objectives that must be achieved by the students during the case discussion 6. Looking for other supporting information related to the above cases 19
  • 4. 7. Reporting the result of discussion and synthesizing the other identified information Important Notes: • Step 1 to 5 are conducted during the first coached-tutorial with the tutor • Step 6 is a self study; performed out of the class either by a group discussion or by student solely, which will then be discussed together in an un-coached group • Step 7 is conducted during the second coached-tutorial with the tutor ACTIVITIES SCHEDULE 1. First meeting in a general class lecture; the lecture delivers a one way communication of lecturing followed with asking question session Objective: • explaining the module and how to complete the provided tasks • developing several discussion groups. During this first meeting, the modules will also be distributed to the students. 2. Second meeting: self-study. Objectives: • choosing a group leader and secretary • brain storming for step 1 to 3 • distributing tasks for members of the group 3. Third meeting: a leader-led group discussion, facilitated by a tutor. Objective: to report the self-study result and accomplish the PBL process to the fifth step 4. Self-study, either together with other students in a group discussion or solely. Objective: Collecting other new necessary information 5. Fourth meeting: a leader-led group discussion, facilitated by a tutor. Objective: reporting the last discussion result as well as for synthesizing the recently identified information 6. Fifth meeting (last one): conducted in a general class, applying a panel discussion form, in which students report the final results of each group’s discussion, and clarifying things that remain unsolved by the groups. 20
  • 5. TIME-TABLE PERTEMUAN I II III IV V VI VII 1st Meeting 2nd Meeting; 1st Tutorial Self Lecture, 2ndTutorial Last Explanation self study Collecting Study Consultation (Reporting Meeting (Brain information, and (Reporting) Storming) analyzing Practical discussing) and Work, synthesizing CSL data Lecturers No. LECTURERS DEPARTMENT OFFICE NO. HP/FLEXI 1. Dr. Fachruddin Benyamin Penyakit Dalam 584461 0811440252 Sp.PD 2. DR.dr. Bakhtiar Murtala, Radiologi 581666 0811444920 Sp.Rad 3. Dr. Daniel Sampepayung, Bedah Onkologi 587107 5052867 Sp.B.Onk 4. Dr. Freddy Kuhuwael, Sp.THT THT 590737 08124212 5. Dr. William Hamdani, Bedah Onkologi 587107 08124229793 Sp.B.Onk 6. Dr. Haryasena, Sp.B.Onk Bedah Onkologi 587107 0816279483 7. Prof. dr. Farid Nurmantu, Bedah Anak 585771 0811467020 SpBA, FICS 8. Dr. A. Asadul Islam Tahir, Bedah Saraf 585771 0811442630 SpBS 9. Dr. Nuralim Mallapasi Bedah Thoraks 585771 0811418564 10. Dr. Syamsulhilal Salam. SpAn Anestesiologi 589777 08152545370 11. Dr. Syafruddin Gaus. Ph.D Anestesiologi 589777 08524217811 0 12. Dr. Syahrul Rauf, SpOG Obgin 585859 0811416070 13. Dr. Junus Patau, SpPD, SpP Penyakit Dalam 315415 0811414013 14. DR. dr. Dasril Daud, SpAK Anak 584461 15. Dr. Siswanto Wahab Kulit Kelamin 580345 5092625 16. Prof.dr. Suryani As’ad, MSc. Gizi 586010 08152535240 17. Dr. Gunawan, SpPA Patologi 324003 5092625 18. Dr. Azhier Gani Fisiologi 584730 434567 21
  • 6. MODULE 1 BREAST LUMP STUDY GOAL After learning the module, the students are expected to have the ability in explaining the disease with breast lump; the cause, pathomechanism, signs and symptoms, how to diagnose, the management/therapy as well as the complication. CASES Scenario 1. A woman, 20 year old, came to PUSKESMAS with breast lump on the right side, 2 cm in diameter. She has been having it for about a year, sometimes it felt sore. History of breast cancer is recorded in the family. Scenario 2. A 60 year old woman, came to PUSKESMAS with lump on the left side of her breast, 3 cm in diameter. Painless, undefined border, moveable. OTHER SOURCE OF INFORMATION Handouts/journal 1. Singletary SE, Robb GI. Advanced Therapy of Breast Disease, 2nd edition, BC Decker Inc. Hamilton, london. 2004. 2. Harris JR, Lippman ME, Marrow M, Hellman S. Disease of Breast. Lippmlott Raven. 1996. 3. Sukarja IDG,. Onkologi Klinik, Edisi 2, Airlangga University Press. Surabaya, 2000. 4. Devita HT, Hellman S, Rosenberg SA. Cancer Principles & Practice of Oncology, 6th ed., Lippmcott Williams & Wilkins. 2001. 5. Syamsuhidajat R., de Jong W. Buku Ajar Ilmu Bedah. Edisi 2. EGC. 2003. 6. Guyton AC, Jall JE. Pregnancy and Lactation, in Textbook of Medical Physiology, 10th edition, Saumnders Co., Harcourt Internacional Edition, Sydney, 2000. p. 944-957. 22
  • 7. MODULE 2 NECK LUMP STUDY GOAL After learning the module, the students are expected to have the ability in explaining the disease with neck lump; the cause, pathomechanism, signs and symptoms, how to diagnose, the management/therapy as well as the complication. CASE SKENARIO : NECK LUMP A 40 year old man came to Puskesmas with lump on the lateral side of his neck. She started experiencing the lump since 4 months ago. It started with a little lump, then grew larger progressively, solid with palpation, painless. She also complained oh headache. OTHER SOURCE OF INFORMATION A. Handouts and Journals 1. Adam GL, Boies Lr and Higler Peter A. : Fundamentals of Otolaryngology, (Buku Ajar Penyakit THT), Penerbit Buku Kedokteran EGC, 1997. 2. Efiaty Soepardy, Nurbaiti Iskandar : Buku Ajar Ilmu Kesehatan THT, Ed 5, Fakultas Kedokteran Universitas Indonesia, 2000. 3. Ballenger JJ. Disease of the Ear, Nose, Throat and Head and Neck, 13th ed. Lea and Febiger , 1985 4. Lee K.J : Essential Otolaryngology Head and Neck Surgery, 8th ed, Mac Graw Hill, 2003 5. Cameron John : Current Surgical Therapy-3, International Ed, BC Decker, 1989 B. Other Sources: The Internet, VCD, Tape, Slide C. Lecturers 23
  • 8. MODULE 3 CONTACT BLEEDING STUDY GOAL After learning the module, the students are expected to have the ability in explaining diseases with contact bleeding in vagina; the cause, pathomechanism, signs and symptoms, how to diagnose, the management/therapy as well as the complication. CASE A 45 year old woman, came with spotted bleeding from her vagina particularly after sexual intercourse with her husband. History of smelly fluor albus ever recorded before. OTHER SOURCE OF INFORMATION A.Handouts and Journals 1. Winkjosastro H, Saifuddin AB, Rachimhadhi T. Ilmu kandungan. Edisi ke-3. Jakarta. Yayasan Bina Pustaka Sarwono Prawirohardho. 1997 2. Berek JS, Hacker NF, eds. Practical gynecologic oncology. 3rd ed. Philadelphia. Lippincott Williams & Wilkins. 2000 3. Berek JS, Adashi EY, Hillard PA. Novak;’s gynecology. 12ed. Philadelphia. Williams & Wilkins. 1996 4. Ransom SB, Dombrowski MP, McNeely SG, Moghissi KS, Munkarah AR, eds. Practical strategies in obstetrics and gynecology. Philadelphia. W.B. Saunders Company.2000 5. Cotran. Cell injury and necrosis. In: Robbins pathologic basis of disease. 6th ed. 1999. W.B.Saunders Company. Available from: http://www.home.mdconsult.das/book/body. 6. Lonky NM. Risk factors related to the development and mortality from invasive cervical cancer: clinical utility and impact on prevention. Obstetrics and Gynecology Clinics 2002 December;29(4). Available from: http://home. mdconsult/das/article/body/jorg=journal&source. 7. Lopez A, Kudelka AP, Edwards CL, Kavanagh JJ. Carcinoma of the uterine cervix. Medical oncology: a comprehensive review. Available from : URL: http://www.cancernetwork.com/textbook/morev24.htm. Acessed 10/1/02. 8. Andrijono. Sinopsis kanker ginekologi. Divisi Onkologi, Departemen Obstetri dan Ginekologi Fakultas Kedokteran Universitas Indonesia. RSUPN dr. Cipto Mangunkusumo. Jakarta. Januari 2004. hal.35-55. 24
  • 9. MODULE 4 LUMP ON THE TIGHT STUDY GOAL After learning the module, the students are expected to have the ability in explaining diseases with lump symptoms on the tight; the cause, pathomechanism, signs and symptoms, how to diagnose, the management/therapy as well as the complication. CASE Scenario 1 A 14 year old man, came to a hospital with lump on the upper side his left tight. He has been having it for 2 months before hospital administration. 3 months ago he felt down from his school’s stairs, that is when the side start to develop a swollen and painful lump particularly during the night. He has no appetite, and kept loosing weight. In the age of 12 he underwent a 6 months regular therapy. Scenario 2 A 20 year old girl, came to a hospital with lump on the lower side his right tight. It started 4 years ago, initially just as size of a marble, but kept on growing, solid, and painless. OTHER SOURCE OF INFORMATION 1. Rasjad, Chairuddin : Pengantar Ilmu Bedah Ortopedi. Bintang Lamupatue : Makassar. 2003. 297-298. 2. Jacobs, McInerney and Middlemiss: Rontgen Sign In Diagnostic Imagine 2nd. W.B Saunders Company : USA. 1985. 276-279, 297-298. 3. Brunning D Richard: Surgical Pathology 9th. Mosby: USA.2004. 2169-2272. 4. Neff, R James : Clinical Oncology 3rd. Elsevier : USA. 2004. 2546-2547. 5. Randall RL. Tumors in orthopedics in current. Diagnosis and treatment in orthopedic 3rd. McGrow-Hill:USA. 2003. 310-311. 25