Case Conference June 15th 2011

15-Jun-2011, Divisi ginekologi onkologi RSCM

Mrs. R/ 49 yo/ P4/ Askes
(10/06/11)

Chief Complain
Patient came to polyclinic for preparation chemotherapy IV with no respon after radiation and 3 times chemotherapy due to  malignant melanoma of vagina 

History
Nov 19th 2010: patient came to oncology polyclinic Vaginal bleeding .
St gen wnl.

Gyn status:

I : v/u calm.

Io :  mass in 1/3 distal vagina posterior up to 1/3 proximal vagina. Portio smooth, palpable mass (colour: black) from OUI, diameter 4 cm, limited to vaginal mucose, distance from posterior fornix 1.5 cm, several mass in left and right lateral fornix, diameter ½ -1 cm.
RVT : uterus morphology and size normal. Portio smooth, palpable mass from OUI. Palpable irregular mass from 1/3 distal vagina up to 1/3 proximal vagina -->3,5
Diagnose :  Melanoma malignant Vagina

CASE CONFERENCE Nov 3rd 2011  decided : Radiation
28-12-2010 until 23-2-2011
Patient  got radiation : External radiation 25 x 2Gy + BT inflan 4 x 4 GY.
Evaluation result from radiology departement :
• Clynically respon ; No respon.
• Suggest : plant to chemotherapy  for this patient

March 22rd, 2011
Gynecological status :
I  : v/u within normal limit
Io : mass in portio measuring 1 x1 x 1,5 cm, fragille, and easy bleeding . 1/3 lower vagina there was massmeasuring 3 x 3 x 2 cm. All the mass look ” brown colour”
RVT : The mass was palpated on portio surface with measuring : 1 x 1 x 1,5 cm, fragille, easy bleeding, there was mass on 1/3 lower vagina measuring 3 x 3 x 2 cm dan all the mas look brown colour. Uterus within normal limit, both parametrium supple and good anal spincter tone, smooth mucous

CASE CONFERENCE March 23rd 2011

Diagnose :  malignant melanoma of  vagina with no response radiation decided : chemotherapy with Adriamycin and Ipospamida 3 cycle. Because of the chemotherapy drugs unavailable, chemotherapy change with Eloxatin dan Haloxan
o Patient  got Eloxatin 150 mg and Ipospamida 8 g
May 11th, 2011 : 1st  chemotherapy
May 12th, 2011 : 2nd chemotherapy
June 1st, 2011 : 3rd chemotherapy
Menstruation 1x/3-6 months since 2 years ago. KB pil 19 yo, injection 2  th. Married 1x (19 yo), P4.

PHYSICAL EXAMINATION
CM, 110/70 mmHg, 79x/m, 36 C, 19x/m
General status : within normal limit
Gynecological status :
 I  : v/u within normal limit
Io : Lession at cervix, covered cervical surface, up to 1/3 distal of posterior wall
RVT : Lession at lateral wall was still the same size.

Supportive Examination
US Oncology (20/10/10) Uterus: normal morphology, size 6.4x2.5x2.5 cmRight and left adnexa: not visible, no visible mass, no enlargement of cervix, no hydronephrosis
MRI (29-10-2010) : mass in proximal  vagina wall posterolateral dextra spread to cervical canalis. Limitted to vaginal wall cervical canalis.
Histopathology (06/10/10) No PA: 1006898,  Conclusion: Melanoma Malignum
Histopathology (31/03/11) No PA: 1102131,  Conclusion: Melanoma Malignum post radiation with good response

Assesment  : 

malignant melanoma of  vagina with no clinical respon with radiation and chemotherapy

Discussion :  

The next plan is operation or continue chemotherapy or repeated radiation