Senin 3 Juli 2017 Mapping Bedah Onkologi HRE/SQB/ARV/RAP/ZIC/IKY/DAV

KM NAMA / TGL LHR USIA NO RM MRS DIAGNOSA STATUS PLAN DPJP PEMERIKSAAN PENUNJANG

MAWAR 1
Post Eksisi + Diseksi Axilla (S) ai Ca Mammae 29/6/2017 Hb 11.3 HT 34 AL 7.8 AT 367 AE 3.90 PT 11.8 APTT 28.4 INR 0.920 GDS 97 Alb 3.8 Cr 0.8
(S) TxNxM0 residif Ur 26 Na 138 K 4.0 Cl 104 HbsAg NR
9/6/2015 Hb 13.1 HT 38 AL 6.9 AT 299 AE 4.46 GDS 90 OT 22 PT18 Cr 0.5 Ur 19
Riw kemo: Paclitaxel 200 mg, epirubicin 100 21/6/2017 Thorax PA: tak tampak pullmonal metastasis
Sri Siyamsi
mg (6x) Post Op 21/6/2017 USG Abd: multiple nefrolithiasis pole medial kanan, tak tampak effusi pleura maupun
8B 11/07/1966 50 01245852 29/6 Perawatan Post Op JKP
Tamofen 20 mg (6x) 1/7 ascites, tak tampak intraabdominal metastase
Tamofen 20 mg, zoladex 3.6 mg (6x) 21/6/2016 USG Mammae: Massa residif dinding dada kiri pada jam 9 dan 1 cm dari lokasi post Op,
Tamofen 20 mg, Arimidex (6x) mammae kanan tak tampak kelainan, limfadenopati di axilla (S)
Tamofen 20 mg (1x) 24/2/2014 PA: inv ductal Ca mammae
Tamofen 20 mg zoladex 3.5 mg (5x) 26/11/2014 Estrogen res: negatif, progesteron reseptor: positif, CeRb B2/HER-2/Neu: positif (Skor 3)

MAWAR 2
19/6/2017 Hb 11.2 HT 37 AL 4.3 AT 247 AE 5.01 GDS 113 Alb 3.2
7/6/2017 Thorax PA: Cardiomegali, Pneumonia
Ca Mammae invasif TxNxM1 (bone, paru) 29/5/2017 Cervical Ap/Lat Kompresi VC 3 disertai penyempitan FIV VC 3-4, paracervical muscle spasm
Marinem Perbaikan KU 29/5/2017 Lumbosacral AP/Lat: Kompresi VL 5 Penyempitan FIV L4-5
1A 52 01374607 30/6 Up HK
1/7/1965 Riw. Kemo: Cyclopospamid 750 mg, Lanjut kemo Zometa sesuai jadwal 12/6/2017 MSCT Thorax, abd: subpleural type pulmonal metastasis, suspicious limfadenopati axilla kiri dan
Epirubisin 85 mg, Zometa (1x) curiga limfadenopati axila kanan, bone maetastasis
8/5/2017 PA: invasif carcinoma Grade III, metastasis ke 4 limfonodi
19/5/2017 IHC: ER negatif, PR negatif, HER-2 positif, skor 3
1/7/2017 Hb 13.5 HT 40 AL 7.5 AT 222 AE 4.47 PT 11.6 APTT 26.7 INR 0.830 GDS 77 Alb 4.9 Cr 0.7 Ur 19 Na
133 K 4.0 Cl 101 HbsAg NR Anti HCV NR
01362652 Fibrosarcoma R. Epigastrium G2T2N0M0
Sudarsi Pro Eksisi 2/6/2017 Hb 9.8 HT 29 AL 3.9 AT 367 AE 3.44 GDS 90 OT 42 PT 42 Cr 0.5 Ur 15
2A 32 30/6 Pre Op JKP
6/5/1985 Tutup defek dengan prolene mesh 19/12/2016 Thorax PA: tak tampak gambaran pulmonal metastasis
Ko Psikiatri Psikiatri: Depresi sedang tanpa gejala psikotik
19/12/2016 USG Abd: Tak tampak intraabdominal metastasis
27/1/2017 PA: Massa epigastrium: fibrosarcoma grade 2
Ca Mammae (D) residif TxNxM1 (Paru,
Hepar)
26/6/2017 Hb 10.0 HT 32 AL 7.9 AT 248 AE 349
Dispepsia Ulcer like type
25/6/2017 Hb 9.9 HT 29 AL 13.2 AT 323 AE 3.04 OT 23 PT 18 Ur 42 Cr 0.7 Na 129 K 3.3 Cl 103 HbsAg NR
Sinem Post Kemoterapi: 23/6/2017 Thorax PA: Susp. Pulmonal ketastase noduller dan subpleural type
2F 56 01243986 25/6 R.kemo: Epirubisin 50mg, cyclophospamid 60 Kemo HK
31/12/1960 Novelbin 40 mg, cisplatin 60 mg, 25/6/2017 USG Abd: liver metastase di segmen 7/8 lobus (D) hepar diameter 1.84 cm
mg (3x)
25/6/2017 USG Mammae (D) tampak lesi hipoechoic batas tegas tepi ireguler dengan vaskular intralesi
Brexel 100 mg (3x)
diameter 1.78 x 2.72 x 2.54 cm; USG mammae (S) tak tampak kelainan
Gemsical 1200 mg, carboplatin 400 mg (4x)
Xelloda 3-0-3
30/6/2017 Hb 13.1 HT 38 AL 5.7 AT 304 AE 3.72 Golda B+ PT 11.9 APTT 28.3 INR 0.850 GDS 83 OT 20 PT 17
Alb 3.7 Cr 0.7 Ur 34 Na 137 K 3.7 Cl 111 HbsAg NR Anti HCV NR
9/6/2017 Hb 13.5 HT 40 AL 4.5 AT 227 AE 3.66 Golda B+ PT 13.2 APTT 25.3 INR 0.970 GDS 145 OT 26 PT 15
Ca Mammae Invasif (S) T4bN1Mo
Semi Alb 4.3 Ur 17 Cr 0.6 Na 137 K 4.0 Cl 111 HbsAg NR
3C 59 01362446 29/6 Pre Op Pro MRM JKP
21/8/1967 7/6/2017 Thorax PA: tak tampak pulmonal dan bone metastasis
Riw. Kemo: Xelloda 3-0-3 (6x)
7/6/2017 USG Abd: Tak tampak intraabdomminal metastasis
7/6/2017 USG Mammae: Massa solid di mammae kiri, limfadenopati axilla kiri
6/1/2017 PA:Invasif carcinoma
Ca Ductal Mammae INfiltratif (D) TxN3M1
29/6/2017 Hb 12.7 HT 38 AL 6.0 AT 191 AE 4.44 Golda O PT 12.9 APTT 27.8 INR 1.030 OT 81 PT 44 Cr 0.5 Ur
01307017 (Paru, liver) Perbaikan KU
Kasih 21 HbsAg NR
3E 41 29/6 Metastasis ca di paru tipe pneumonik & Work Up MP 125mg/12jam WY
1/5/1973 18/1/2017 Hb 14.0 HT 43 AL 5.8 AT 221 AE 5.07 GDS 123 OT 108 PT 261 Alb 2.6 Cr 0.6 Ur 11 Na 138 K 3.9 Ca
Ko Pulmo subpleural Ceftriaxon 2gr/24jam
1.02
 Riw kemo: Doxorubisin 70 mg, 5/6/2017 Thorax PA: Cardiomegali dan oedem pulmo, pneumonia type dan subplural type pulmonal
cyclophospamid 750 mg (6x) metastasis
Paclitaxel 20 mg (3x) 5/6/2017 USG Abd: nodul liver metastasis, effusi plura bilateral
Xelloda 2-0-2 (1x) 5/6/2017 USG Mammae: lesi residif di dinding dada kanan, tak ada kelainan di mammae (S)
16/6/2015 Poorly Differentiated Infiltrating Ductal Carcinoma
2/7/2017 Hb 8.3 HT 27 AL 9.0 AT 584 AT 3.54 Golda A GDS 105 OT 30 PT 24 Cr 0.9 Ur 18 Na 136 K 3.6 Cl 107
Ca Mammae (D) TxNxM1 (Paru)
Perbaikan KU HbsAg NR
Supiyem Anemia sedang
4B 46 01257069 2/7 Work Up Transfusi PRC WY 1/7/2017 Thorax PA: pneumonic dan subpleural type pulmonal metastasis
20/8/1970
8/6/2017 USG doppler mammae: multipel massa residif hemithorax kanan
Riw. Kemo: pasien tidak membawa arsiran
4/5/2017 USG Abd: tak tampak intraabdominal metastasis
2/7/2017 Hb 11.8 HT 38 AL 4.4 AT 161 AE 4.53
30/6/2017 Hb 9.7 HT 29 AL 3.4 AT 234 AE 3.33
Alveolar Solt Part Sarcoma + anemia Usul: kemoterapi
24/6/2017 Hb 6.9 HT 21 AL 10.3 AT 259 AE 2.43 Golda A+ GDS 97 OT 22 PT 14 Cr 0.8 Ur 30 HbsAg NR
Sriyatun Riw Kemo: Cyclopospamid 500 mg, Pro kemo:
4H 56 01358632 29/6 Work Up JKP 24/6/2017 Thorax PA: Cardiomegali, tak tampak pulmonal metastase
20/6/1960 Epirubicin 50 mg, vincristin 1.5 mg Prednison Epirubisin 80 mg, Holoxan 5000mg,
9/11/2016 USG Abd: complex cyst ren (D), tak tampak intraabdominal metastase
7-7-6 (4x) Mesna hari 1 5000mg, hari 2 2500mg
19/11/2017 FNAB: AJH sternum: dijumpai sel ganas, maligna
19/5/2017 PA: Alveolar solt part Sarcoma
30/6/2017 Hb 11.9 HT 36 AL 7.3 AT 484 AE 4.70 Golda B+ PT 12.2 APTT 28.4 INR 0.880 GDS 91 OT 21 PT 19
Post eksisi + diseksi axilla (D) ai Ca Mammae Alb 3.3 Cr 0.9 Ur 15 Na 135 K 3.3 Cl 105 HbsAg NR Anti HCV NR
(D) TxN2M0 post MRM residif 8/6/2017 Thorax PA: Tak tampak gambaran Pulmonal metastase
Lusi Widayati Post Op
4J 41 01370193 29/6 Perawatan Post Op JKP 8/6/2017 USG MAmmae: Tak tampak massa residif di dinding dada kanan post MRM, tak tampak kelaianan
10/6/1976 1/7
Riw Kemo: Cycloforpamid 800 mg, di mammae kiri, suspicious limfadenopati axilla (D)
doxorubicin 60 mg, 5FU 750 mg (3x) 8/6/2017 USG Abd: tak tampak intraabdominal metastase
9/2/2017 PA: Invasif Ca no special tipe grade 3
30/6/2017 Hb 13.4 HT 41 AL 7.6 AT 306 AE 4.74 PT 12.5 APTT 31.8 INR 0.910 GDS 99 Alb 3.2 Cr 0.8 Ur 19 NA
136 K 3.7 Cl 107
2/6/2017 Hb 12.7 HT 38 Al 7.6 AT 411 AE 4.51 PT 13.1 APTT 32.3 INR 0.970 GDS 107 Alb 3.6 Cr 0.7 Ur 21 Na
134 K 4.1 Cl 1054
13/6/2017 hb 12.7 hmt 41 AL 108 AT 386 GDS 82 SGOT 25 SGPT 21 alb 3.1 cr 0.7 ur 28 Na 137 K 4.1
Parmin 01376855 Post Wide eksisi 5/6/2017 HB 14.0, HT 43, AL 11.2 AT 456 gds 98 ot 23 pt 26 alb 3.8 cr 0.7 ur 19 na 134 k 4 hbsag NR
6B 52 6/6 Myxoid Liposarcoma grade II R. Femur Post Op JKP
13/5/1965 Ko plastik B.Plastik : post evaluasi STSG (17/6) 15/5/2017 thoraks PA tak tampak metastase
15/5/2017 ro femur soft tisue massa 1/3 distal os femur sinistra aspek lateroposteror cednderung benign
15/5/2017 USG abdomen tak tampak metastase abdomen
17/5/2017 massa solid kistik soft tisue regio 1/3/ distal aspek atnterolateral tanpa melibatkan jaringan otot
dan tulang disektarnya
17/6/2017 PA: Myxoid liposarcoma grade 2
28/6/2017 Hb 13.2 HT 39 AL 6.8 AT 268 AE 4.35 PT 12.9 APTT 48.2 INR 1.030 GDS 110 Alb 3.4 Cr 0.8 Ur 3.5
Cl 104 Ca 1.25
Pro Eksisi Luas + Partial Maxillectomy 6/6/2017 Hb 14.1 HT 44 AL 7.4 AT 433 AE 4.97 PT 13.5 APTT 34.6 INR 1.000 GDS 75 OT 27 PT 18 Alb 3.6 Cr
Sudirman 01330764
7C 59 28/6 Basalioma R.Maxilla (D) DD SCC R.Maxilla (D) Pre Op (D) JKP 0.7 Ur 17 HbsAg NR
23/3/1958 Ko Plastik
Jont op b.plastik 6/6/2017 Thorax PA: Tak tampak gambaran pulmonal metastasis
6/6/2017 Skull AP Lat: Lesi sklerotik dabn destruksi di dinding inferior infraorbtae (D), dinding lateral sinus
maxillaris (D) dan Os Zygaoma (D), sinusitis maxillaris (D), Septum deviasi (D)
1/7/2017 Hb 10.7 HT 33 AL 6.1 AT 315 AE 4.10
29/6/2017 Hb 8.3 HT 27 AL 4.9 AT 479 AE 3.23 PT 13.4 APTT 29.5 INR 1.090 GDS 123 Alb 2.8 cr 0.9 Ur 30 Na
134 K 4.3 Cl 103
13/6/2017 Hb 9.0 HT 29 AL 7.9 AT 332 AE 3.44 Golda A+ PT 14.7 APTT 27.8 INR 1.110 GDS 87 OT 25 PT 15
Alb 3.6 Cr 0.8 Ur 28 Na 131 K 4.2 Cl 101 HbsAg NR
2/6/2017 TSH 0.07 FT4 22.61
Pariyo 3/5/2017 Thorax PA: cardiomegali, bronchitis, soft tissue swelling regio colli bilateral, tak tampak pulmonal
7F 65 01377808 29/6 Tumor Tiroid T4aN0M0 susp malignancy Pre Op Pro Total Thyroidectomy HK
1/11/1951 dan bone metastase
30/6/2017 Cervical AP/Lat: Soft tissue mass regio colli terproyeksi setinggi VC 4-7 dapat merupakan
gambaran massa thyroid, airway tampak menyempit terproyeksi setinggi V.cervicalis 3-4 sampai 4-5
17/4/2017 USG Tiroid: Massa hipoechoic pada kedua lobus tiroid DD struma diffusa, tak tampak
limfadenopati coli bilateral
11/4/2017 FNAB: AJH Tiroid dijumpai sel atipi bethesda system: categori III, atipia of undertemined
significance
MAWAR 3

Kemo: 29/6/2017 Hb 14.8 HT 46 AL 14.7 AT 464 AE 5.12 Golda A Ot 12.0 APTT 29.3 INR 0.940 GDS 103 OT 46 PT 14
Sumirah 01383676
Ca epitel ductus mammae infiltratif (D) Epirubisin 50 mg, Paxus 180 mg, Cr 0.8 Ur 37 HbsAg NR
1C 6/3/1965 61 29/6 Kemo WY
T4bN3M1 (paru) Novelbin 40 mg 19/6/2017 Thorax PA: Metastasis multiple pulmo kanan dan kiri, pneumonia
Ko Pulmo
20/6/2017 PA: carcinoma epithel ductus mammae infiltratif (NOS) grade III lengan LVI positif
29/6/2017 OT 43 PT 26
Kemoterapi 25/6/2017 Hb 10.6 HT 34 Al 8.0 AT 392 AE 4.60 GDS 104 Alb 2.9 Cr 0.8 Ur 27 Na 127 K 3.2 Cl 98
Ca Mammae (S) residif TxNxM1 (Paru, hepar)
Juninem Paxus 160 mg, Cisplatin 80 mg 20/6/2017 Thorax PA: Efusi pleura bilateral, subpleural dan pneumonic type metastasis
6B 64 01285010 25/6 Riw kemo: Paclitaxel 200 mg, Doxorubicyn 60 Work Up HK
20/5/1953 Tambah Novelbin 40 mg 20/6/2017 USG Abd: Nodul hepar metastasis, efusi pleura bilateral, subpleural type pulmonal metastasis
mg (6 siklus) tahun 2015
20/6/2017 USG Mammae: Massa residif di dinding dada kiri disertai metastasis aksila dan infraclavicula (S)
29/1/2015 Adeno Carcinoma Mammae

MELATI 3

30/6/2017 Hb 12.3 HT 37 5 AL 16.1 AT 257 AE 4.42 Golda B+ PT 12.5 APTT 30.0 INR 0.90 GDS 141 OT 15 PT
1 Alb 3.7 Cr 0.7 Ur 17 Na 134 K 5.1 Cl 107 HbsAg NR Anti HCV NR
Wahyudiarto 7/6/2017 Hb 15.4 HT 48 AL 11.3 AT 308 AE 5.60 Golda B+ PT 13.1 APTT 31.6 INR 0.960 GDS 94 OT 20 PT 18
4C 41 01379960 29/6 Dermatofibrosarcoma R. Maxilla (D) Pre Op Pro Eksisi Luas JKP
11/3/1976 Alb 4.1 Cr 0.6 Ur 17 Na 137 K 4.1 Cl 108 HbsAg NR
7/6/2017 Thorax PA: tak tampak pulmonal metastasis
27/5/2017 PA: Reg fascialis: dermatofibrosarcoma
2/7/2017 Hb 10.5 HT 34 AL 27.6 AT 289 AE 3.75
Pro kemoterapi ke 4: 29/6/2017 Hb 5.6 HT 17 AL 41.5 AT 370 AE 1.74 PT 13.5 APTT 23.1 INR 1.000 GDS 67 OT 24 PT 16 Alb 3.2 Cr
Lilik Suparlan
7C 34 01376446 30/6 Hemangiopericitoma maligna Work Up Haloxan 6000mg, Mesna 6000mg KY 0.7 Ur 34 Na 135 K 4.4 Cl 104 HbsAg NR
28/01/1983
Doxorubicin 60 mg 23/3/2017 PA: Malignant STT neoplasma jenis Hemangiopericytoma (Maligna) pada omentum dan
peritoneum
30/6/2017 Hb 11.5 HT 36 AL 10.7 AT 171 AE 4.17 Golda AB+ PT 12.4 APTT 26.8INR 0.90 GDS 159 OT 66 PT
72 Alb 3.8 Cr 0.8 Ur 19 Na 136 K 3.7 Cl 109 HbsAg NR Anti HCV NR
Ca Mammae (D) T4bN1M1 (hepar) post 17/5/2017 Hb 11.8 HT 37 AL 6.3 AT 195 AE 4.31 GDS 142 OT 40 PT 43 Cr 0.7 Ur 16
Patmi Krismiyarti
Neoadjuvant 31/3/2017 Thorax PA: tak tampak pulmonal metastasis
14A 22/12/1963 54 01374967 29/6 Pre Op Pro MRM WY
Epirubisin 50 mg, Cyclophospamide 900mg 31/3/2017 USG Abd: nodul hepar metastasis mengarah hepatal metastasis
(3x) 31/3/2017 USG Mammae: Tampak massa hipoekoik ukuran 3x3.5x6cm retropapilla dengan spikula (+),
vaskularisasi prominen mengarah ke arah malignancy
7/4/2017 PA: invasif ductal Carcinoma NST grade 3

10/6/2017 Hb 13.7 HT 42 AL 7.2 AT 330 AE 5.09 OT 16 PT 8 Cr 0.6 Ur 16 Na 133 K 3.6 Cl 102 HbsAg NR
Ririn Andriani
14C 32 01381757 1/7 Tumor Desmoid R.illiaca (D) Pre Op Pro Biopsi Insisi KY 14/6/2017 CT Scan Abd: Soft tissue mass regio iliaca (D) incase m. Rectus abdominis (D) dapat merupakan
29/09/1984
suatu rhabdomyosarcoma DD abses

30/6/2017 Hb 14.9 HT 45 AL 10.1 AT 291 AE 5.14 PT 11.1 APTT 29.4 INR 0.840 GDS 122 OT 14 PT 12 Biltot
Ko Pulmo
Jimin Wignyo STT susp lipoma Perbaikan KU 0.26 Alb 3.7 Ur 37 Cr 1.2 Na 130 K 4.4 Cl 97 HBSAg NR
17C 69 1/7 Work Up JKP
31/12/1947 Pulmo: Tumor Paru (D) Pro Biopsi Eksisi 30/6/2017 Thorax Lat: Susp massa paru (D) lobus superior segmen anterior DD massa mediastinum,
01383771
pneumonia dapat merupakan pneumonic type metastasis

Wing Melati 3
 Ko Interna Tumor Mammae (D) T2N0M0 30/6/2017 Anti HCV total negatif Anti HCV NR CEA 22.56 AFP 1.16 Ca 19-9 7
Nugroho Pujiastuti
2A 44 1/7 Work Up USG Mammae JKP 28/6/2017 Hb 13/6 HT 41 AL 11.9 AT 263 AE 4.66 GDS 118 OT 240 PT 130 Biltot 3.94 Alb 3.3 Cr 1.1 Ur 20 Na
20/6/1973
01383548 Interna: tumor hepar 136 K 4.0 Cl 1.34 HBSAg NR

Anggrek 3

29/6/2017 Hb 11.7 HT 36 AL 6.3 AT 416 AE 4.90 PT 12.5 APTT 29.1 INR 0.990 GDS 108 OT 113 PT 114 Cr 0.9
Ur 11 Na 132 K 3.8 Cl 98 HbsAg NR
Rhabdomiosarcoma Residif R. Femur (S)
Tapping pleura 5/3/2017 Hb 10.4 HT 32 AL 4.7 AT 279 AE 4.55
G3TxNxM1 (Paru)
Sitologi pleural fluid 1/7/2017 Thorax PA/Lat tegak: efusi peura dapat merupakan subpleual type pulmonal metastasis, opasitas
Effusi Pleura (D)
Curcuma 3x1 di lobus anterior segmen anterior kemungkinan metastasis tipe nodular dan golf ball DD massa primer,
Karmin
32 50 01339399 29/6 Work Up Ro Thorax PA/Lat tegak JKP pneumonic type pulmonal metastasis
7/8/1966 Riw. Kemoterapi: Epirubicin 100 mg, Holoxan
MST 2x10mg 29/6/2017 Thorax PA: efusi pleura (D) dapat merupakan subpleural type pulmonal metastasis, adanya
6000mg, Mesna hari 1 6000mg, hari 2: 3200
Ciprofloxacin 2x500 mg PO massa paru/ mediastinum belum dapat disingkirkan, noduler dan pneumobic type pulmonal metastasis
mg
MP 125mg/8jam 1/9/2016 USG Abd: tak tampak intraabdominal metastasis
Post Radioterapi di RSDM 30x
28/11/2016 PA: residif pleomorfik rhabdomyosarcoma grade 3
9/3/2017 PA: Malignant soft tissue neoplasma jenis rhabdomyosarcoma (residif)

RGB

2/7/2017 Albumin 2.3

30/6/2017 Hb 10.0 HT 31 AL 8.4 AT 298 AE 3.76 GDS 123 OT 22 PT 14 Alb 2.4 Cr 0.5 Ur 21 Na 139 K 3.9 Ca
1.12
29/6/2017 Hb 9.3 HT 29 AL 6.4 AT 438 AE 3.39 Alb 2.6 Na 137 K 2.8 Cl 108
28/6/2017 Hb 9.4 HT 29 AL 8.4 AT 495 AE 3.40 PT 13.5 APTT 28.5 INR 1.100 Alb 2.1 Cr 0.6 Ur 15 Na 139 K
2.9 Cl 108 Ca 1.13
Gemi Post Eksisi Luas ai Tumor Phyloides Mammae Post Op
C 44 01381550 28/6 Perawatan Post Op HK 19/6/2017 Hb 10.8 HT 34 AL 9.1 AT 527 AE 3.99 PT 13.9 APTT 28.2 INR 1.040 GDS 65 OT 21 PT 14 Ur 19 Cr
6/11/1972 (D) 29/6
0.5 Na 136 K 2.9 Cl 106 HbsAg NR
19/6/2017 Thorax PA: Tak tampak gambaran pulmonal metastasis
19/6/2017 USG Abd: Lesi hipoechoic batas tak tegas didaerah proyeksi rectum, tak tampak gambaran
intrabdominal nodul metastasis
19/6/2017 USG Mammae: massa mammae kanan cenderung maligna, tak tampak limfadenopati axilla
biateral