Case Conference May 25th 2011

01-Jun-2011, Divisi ginekologi onkologi RSCM

Mrs.S/46 YO/P6/Jamkesmas

Chief  Complain
Post  second-line Chemotherapy (Oxaliplatin and Gemcitabine)

History
Jun 11 th 2009 :  Patient referred from PMI Hospital Bogor with Solid Ovarian Neoplasm suspect Malignancy.

July 15 th 2009 : In the ward She felt ascites and  performed pungtie with result : (+) Adenocarcinoma. The diagnosis becomes : advanced Stage ovarian cancer and chemotherapy Cyclophosphamide and Platosin (CP) was given 2 series (CP I : 29-7-2009. II : 27-8-2009). The respon therapy : Partial respon
December 17 th 2009 :  the operation was performed with procedural operation : Optimal Debulking : Hysterectomy Radical and Bilateral salpingo-oophorectomy, omentectomy and appendectomy. And continued with adjuvand Chemotherapy CP 4 series. ( CP III:3-2-2010, IV : 8-3-2010, V : 13-4-2010, VI : 17-5-2010 )

September 23 th 2010 :  patient complain abdominal erlagement with Ca 125 result increased 585. The diagnosis becames:  ovarian cancer advanced stages progressive ( platinum resistant), the patient brought to Case conference and decided : No treatment

March 15 th 2011 : patient complains abdominal erlargement, with massive ascites. Advise to pungtie ascites  and give second-line chemotheraphy with cel site

Mei 19  th  2011 : Operation was performed for cell site
General states : BP :110/80, P: 82, RR : 18 x/m, T : 36,2 C
Conj : anemies -/-
Thorax : Within Normal Limit 
Abdomen : Abdominal erlargement, ascites (+) massive, midline operation scar 4  finger  above umbilicus
Extremities : warm, edema -/-

Gynecological states
Inspeculo  : v/u calm
Io  : vaginal stump calm, fluxus (-), flour A(-)
RVT : there was palpable vaginal stump calm, vaginal wall smooth, Ampulla  rectum not collapses

Supportive Examination :
(15/4/11)  : Laboratorium : HB : 10,4 HT : 31,5, Leukosit :8360. Trombosit :  471.   SGOT/SGPT  28/12.  Alb 3.37   Ur/Cr 26/0,8 GDS 96 Na/K/Cl   144/4,9/102
HbsAg non reaktif. 
(12/6/09)  : Ca 125 :  3703 (first come)
(23/9/2010): Ca 125 : 585 (pasca chemotheapy)
(19/1/11) : Ca 125 : 1540 (control polyclinic)
(31/3/11 ) : USG :
Metastasis mass (abdominal cavity was filled massive ascites with intestines was swim). In the right para umbilical regio there was hipoechoic mass in surface intestines, size from mm to cm
 
Histophatology Report : 28-12-2009
Conclusion  :Adenocarcinoma ovarii A and B, moderate differenteated
Right and Left pelvic Lymph nodes was 6 with 1 positive tumor mass
Chronic appendicitis with tumor mass
Mesenterium with tumor mass

Diagnosis

Ovarian Cancer Stage III C progressive ( platinum resistant), post chemotheraphy (Oxaliplatin and Gemcitabine)

Problem
Ovarian cancer stage III C progressive ( platinum resistant), post chemotheraphy  (Oxaliplatin and Gemcitabine)