Case Conference June 15th 2011

15-Jun-2011, Divisi ginekologi onkologi RSCM

Mrs. Metiah/ 74 yo/ P12/ Jamkesmas
(23/05/11) Patient come to CM hospital with chief complain mass protruded in front of vagina

History:
Patient felt there was a mass in front of vagina since 1 year ago. First, patient went to  alterntive medicine, but the mass still growth, then patient went Adjidarmo hospital (Lebak). D/ tumor from labia mayora ? referred to CM hospital.

23/05/2011--> perform biopsy from the mass and FNAB at right inguinal lymph node.
27/05/2011--> FNAB result (111358)  positive carcinoma metastases.
30/05/2011--> PA (1103917) Epitelial malignant tumor probably adenocarcinoma, origin hard to defined.
07/06/2011 --> perform Ro thorax and BNO-IVP
14/06/2011--> USG FM and staging by consultant
Staging by consultant --> vulvar cancer stage IIIA--> planned for radiation.
Patient married once with twelve children. Menopause since 20 years ago.
No difficulties in defecation but felt pain when micturition.
  
NOW
General status conscious, mildly ill, vital sign BP 130/80 mmHg, HR 84x/minutes, RR 24 x/minutes, temp afebris
Conjunctiva not anemic
No enlargement of supraclavicular, axilla and enlargement at right inguinal lymph node
Cor and pulmo wnl
Abdomen : normal, no mass palpated.
Extremities were warm, edema -/-

Gynecological status
I   : There is  mass originated from right labia minora and border of vagina - vulva anterior, size 10 x 8 x 5 cm, the mass fragile and easy to bleed.  Another vagina wall was smooth.
RVT :  portio and uterine was atropic. Mass pushed the urethra. Rectum mucous is smooth, mass (-). Ampulla rectum not collapses.

SUPPORTIVE EXAMINATION
(11/06/11) Blood Count : Hb : 9,8, Leuco : 11.070, Trombo : 409.000
Gluc : 91 Ur/Cr: 22/0,5,   Alb: 2,6, AST/ALT : 17/18
(14/06/11) US (FM) --> Uterine retroflexion size and shape normal.Miometrium homogen. Endometrium stratum basale thin, portio and endocervix normal. Both ovarian atrophy.
There was echogenic mass at right inguinal size 3,2 x 1,9 cm probably originated from lymph node metastases.
Bladder, both kidney and liver was normal
No ascites.
Conclusion: No abnormality at internal genitalia organ. Mass at vulva with lymph node enlargement susp metastases.

06/06/11 --> Ro Thorax: No signs of metastases
07/06/11--> BNO IVP: Excretion and secretion both kidney normal
 
PROBLEM :
Vulvar cancer stage IIIA with right inguinal lymph node metastases.

PLAN:
Radiation.