Case Conference 2nd March 2011

19-Mei-2011, Divisi Onkologi Ginekologi RSCM

Mrs.M/42 yo/P2

 

 (24/2/11) Patient controlled to policlinic brought CT Scan result.

 

History

Patient first came to RSCM at 10/10/07, she was diagnosed ovarian cancer (CA-125 : 1.124 U/ml). We performed ultrasonography (10/10/07) with impression solid ovarian neoplasm with cystic part suspect malignant and massive ascitesàascitespunction. She also has supraclavicular lymph node enlargement à FNAB.

30/10/07 à FNAB PA (No: 072375) result was positive carcinoma. Ro thorax (no metastases at lung).

26/11/07 à Ascites cytology PA (No : 0072658) result was positive adenocarcinoma. Discuss with consultant à D/ Ovarian cancer advanced stage, metastases to supraclavicula lymph node and ascites (+) adenocarcinoma à Plan NeoadjuvantchemoterapyCyclophospamide – Platosin.

Treatment performed : NeoadjuvantChemoterapy CP (26/11/07, 19/12/07, 16/1/08)

24/01/08 à CA-125: 115,4 U/ml

28/01/08àperformed USGàOvarian cystic neoplasm improvement, ascites decreased.  àdiscuss and examination with consultant à impression operable à Plan Interval Debulking.

08/02/08àPerformed optimal debulking (Total hysterectomy, BSO, omentectomy, appendenctomy) at MedikaGria Hospital.

12/02/08à PA result (Royal Progress): Impresionwas Adenocarcinoma ovarian has metastases to omentum and appendix àContinue Treatment performed :Chemoterapy CP (29/02/08, 28/03/08, 28/04/08).

05/06/08à CA-125 : 17,6 U/ml

Follow up

Date	CA – 125 (U/ml)	Ultrasonography
09/09/08 11/09/08	13,8	Tumor mass (-)
01/12/08	10,0	Normal pelvic, residue/residive (-)
02/03/09	12,1
01/06/09 02/06/09	7,2	Normal pelvic, residue/residive (-)
01/09/09 02/09/09	12,9	Tumor mass (-)
09/11/09 10/11/09	54,6	Ovarian cystic neoplasm residive, with complex massive ascites

 

12/11/09 à Discuss with consultant à D/ Ovarian cancer advanced stageresidive, post NAC (CP 3 series), post optimal debulking, post adjuvant chemotherapy (CP 3 series) à Plan chemoterapyCyclophospamide – Platosin (6 series).

Treatment performed : Chemoterapy CP 6 series (23/11/09, 30/12/09, 22/01/10, 22/02/10, 22/03/10, 19/04/10)

Follow up

Date	CA – 125 (U/ml)	Ultrasonography
26/04/10 04/05/10	8,5	Normal pelvic, residue/residive (-)
05/08/10 09/08/10	6,4	Normal pelvic, mass (-)
29/10/10 01/11/10	13,2	Residive mass (-)
04/02/11 07/02/11	223,7	Gynecologic mass (-). Intrahepatic mass susp metastases, free fluid at pelvic cavity and left pleural effusion

 

10/02/11 à Ro Thorax : Left pleural effusion, no sign of metastases à Pleural cytology

14/02/11 à Pleural cytology result (PA : 3172802) : Pleural fluid positive adenocarcinoma

23/02/11 à CT Scan : Liverà Cyst at Left Lobes (KistaLobusKiri)

                                    Other organ within normal limit. Left and right adnexa was normal

24/02/11 à Patient control to polyclinic with CT Scan result.

P2, married once.

 

Now :

General status: Conscious CM, BP 120/80 mmHg, HR 80x/minutes, RR 20 x/minutes. Afebris.

Conjunctiva : notanemic

No enlargement of supraclavicular/axilla/inguinal lymphnodes

C/Pwnl

Abdomen: Midline scar, no mass palpated

Gynecologicalstatus :Inspeculo: vaginal stumpwas smooth. no mass,

RVT: There isno palpated mass. Mucosa rectum was smooth, ampula no collaps..

 

Ultrasonography finding  (07/02/2011) :

Gynecological US finding :

Uterus and both adnexa not visible.No mass visible. There is free fluid 19 cm3 echointerbal (+) at pelvic cavity.

Abdomen US finding :

Liver there is hypoechoic nodule homogen, clear margin, smooth edge at left lobe size             5 x 3 x 1 cm

Aortic abdominalis normal calibre, Para aorta and parailiac lymph node not enlarged,

Right and left kidney  no dilatation pelviocalyces.

Free fluid anechoic at left  pleuralcavity.

 

Conclusion :

GynecologicMass (-), Intrahepatic mass suspect metastases, Free fluid at pelvic cavity and left pleural effusion.

 

Lab(07/02/2011)Hb11,8 g%, WBC 7.780 /uL, PLt  318 10³/µL, AST/ALT 16/08, Alb 4,35. Ur/Cr 25/0,8.

 

Tumour marker

04/02/11 à CA-125 : 223,7

 

Ro  Thorax (10/02/11) : Left pleural effusion

 

CT Scan (23/02/11) :Liver not enlarged, there is hypodens lesion at left lobes and satellite nodules around the lesion. Right lobes was normal.

Lien not enlarged no any nodule or metastases.

Both renal were normal  no dilatation of pelviocalyces system

No enlargement of para aorta, parailiac,paraobturator and inguinal

Both adnexa is normal, SOL (-).

Bone intact

 

Impression:  Liver cyst at left lobes. Other organs were normal.

 

PROBLEM :

Ovarian cancer advanced stage residive, post NAC (CP 3 series), post optimal debulking, Post Adjuvant CP 3 series, Post Chemotherapy 6 series (CP), meta to pleura (positive adenocarcinoma).

Liver cyst at left lobes

 

PLAN :          

Palliative.