CHAPTER I INTRODUCTION A. BACKGROUND. fascia, nerves, fibrous tissues, fat, blood vessels, and synovial membranes. WHO

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1 1 CHAPTER I INTRODUCTION A. BACKGROUND Soft tissue tumors are tumors derived from muscles, tendons, ligaments, fascia, nerves, fibrous tissues, fat, blood vessels, and synovial membranes. WHO had classified soft tissue tumors into several subtypes based on its histological features [National Cancer Institute, 2016]. Various studies had been conducted regarding Soft Tissue Tumor prevalence all over the world. A study in United Stated by The American Cancer Society estimates statistical incident for soft tissue sarcomas for 2016 are about new soft tissue sarcomas will be diagnosed (6.980 cases in males and cases in females), and Americans (2.680 males and females) are expected to die of soft tissue sarcomas [cancer.org, 2016]. However, in Indonesia, there is lack of soft tissue tumor incidents report and its clinicopathological description. The most recent data about cancer in Indonesia by Health Ministry Centre of Information (Riskesdas) 2015 about the incidence of cancer in Indonesia, D.I Yogyakarta province rank the highest prevalence with 1,4% or estimated about cases. Further epidemiological research is expected to conduct in order to define more clearly about environmental risk factors [Burningham et al, 2012]. The purpose of this study is to perform an evaluation on epidemiology of soft tissue tumor in Dr. Sardjito General Hospital, Yogyakarta. Conclusions will 1

2 2 be made on the statistic result which taken by drawing conclusions on correlations of soft tissue tumor with other factor, in order to establish risk factors and appropriate prevention. B. PROBLEM FORMULATION Is there correlation between histopathological subtype soft tissue tumor with age, gender, predilection, and clinical diagnosis? C. RESEARCH OBJECTIVES a. General Objectives This research purpose is to know the clinicophatological profile of soft tissue tumor in in Dr. Sardjito General Hospital Yogyakarta from 1 st January 2012 until 31 st December b. Specific Objectives Describing the incidence rate of soft tissue tumor and clinicopathological profile that includes age, gender, predilection, clinical diagnosis, malignancy, and histopathological subtype of soft tissue tumor in Dr. Sardjito General Hospital from January 1 st 2012 until 31 st December Finding correlation between age, gender, predilection, clinical diagnosis, malignancy, and histopathological subtype of soft tissue tumor. D. RESEARCH AUTHENTICITY There are several studies conducted about clinicopathological profile of

3 3 soft tissue tumor in other country as provided in the table 1. of previous studies. The most recent journal in Asia Pacific conducted in 2013 talked about systematic review of soft tissue incidence cited that out of 35 publications included, there is none from Indonesia [Ngan et al., 2013]. However, a Journal in 2011 provided cancer prevalence in Indonesia.

4 4 Table 1. Previous studies No Name Year Title Design Subject Result 1. C.Wibmer, A. Leithner, N. Zielonke, M. Sperl & R. Windhager 2009 Increasing incidence rates of soft tissue sarcomas? A population-based epidemiologic study and literature review Retrospective, population-based analysis. A total of 5333 cases of STS were found during the observed period of 21 years. A total of 5333 cases were registered; male-to-female ratio was 0.8. The most common histotypes were sarcoma not otherwise specified (36%), leiomyosarcoma (24%), liposarcoma (12%), malignant fibrous histiocytoma (9%) and fibrosarcoma (5%). Ageadjusted incidence rate was 2.4 per per year. Analysis of annual incidence rates and 3-year periods showed no increase (annual increasing gradient = ). 2. Gogi AM, Ramanujam R Clinicopathological study and management of peripheral soft tissue tumors. Prospective study conducted at a rural teaching hospital in India A total of 74 patients were included in the study, with male to female ratio of 1:1 and average age of years All of them presented with a swelling. The lower extremities and trunk were the most common sites, with each comprising about 25%. The size of tumor varied from 2 to 10 cm in diameter. Seventy one were benign and three were malignant. About one third of patients complained of pain. Comorbid illnesses were present in threepatients.

5 5 For benign tumors, simple excision was done, while for the malignant ones, multimodal therapeutic approach was taken. Post-operatively, two patients developed skin ulceration over the tumor, and six had wound infection. 3. Ratih Oemiati, Ekowati Rahajeng, Antonius Yudi Kristanto 2011 Prevalensi Tumor dan Beberapa Faktor yang Mempengaruhinya di Indonesia Descriptive analytic using cross-sectional method All patients all ovetr Indonesia in Riskesdas that go through inclusion criteria respondens were included. The high prevalence of tumor in Yogyakarta region, Centre of Java, and Jakarta, also the low prevalence of tumor in Maluku, North Maluku and South Sumatera affected by information and health promotion about cancer itself in Indonesia. The more people who get exposed, so the data of tumor/cancer in Riskesdas will also increase. 4. Bharti G Ramnani,Ashut osh Kumar, Shruti Chandak, Amar Ranjan, and Mehul Kumar Patel 2014 Clinicopathological Profile of Benign Soft Tissue Tumors: A Study in a Tertiary Care Hospital in Western India Descriptive non experimental study Patient of benign soft tissue tumors received from January, 2010 to July, Total 120 cases were collected. Only mesenchymal lesions originating in soft tissue were included in the study. The result are as follow: most common benign soft tissue tumor was lipoma (50.8%) followed by hemangioma (17.5%) which in turn was followed by neurofibroma, angiofibroma & schwannoma. Most common age group for benign soft tissue tumor were 31-40y (27.5%)followed by 21-30y (22,5%).

6 6 Overall a male predominance was seen with 60.83% in males. The most common site of occurrence of benign soft tissue tumor overall was found to be trunk (25%), followed by upper extremities (21.7%), lower extremities (17.5%) and nose and nasopharynx (10.8%) in that order. 5. Reily Ann Ivan, Shameema S. and Sarada V Incidence of various soft tissue tumors among benign and malignant cases A study report A total of 155 cases of soft tissue tumors including all 4,045 surgical biopsy specimens of both incision and excision biopsy materials of different soft tissue tumors were included in this study for histolopathological examination. Among the 4,045 surgical biopsy materials, 454 (11.2%) were malignant and 3,591 (88.8%) were benign. The soft tissue tumors were encountered with 155 (3.8%)specimens; out of them 139 (89.7%) were benign and 16(10.3%) were malignant. Benign soft tissue tumors were encountered more in female than male, while malignant tumors were more among male population than females. Peak age incidence of benign and malignant soft tissue tumors was observed in and respectively.

7 7 E. RESEARCH BENEFIT This research will provide information and statistic data about the clinicopathological profile in Dr. Sardjito General Hospital Yogyakarta that can be used as a reference for the next following research and can be used for helping the clinician to find out more about the histopathological profile for building up the diagnosis. This research also let the researcher to learn how to build up a research.