Case Conference July 6th 2011

06-Jul-2011, Divisi ginekologi onkologi RSCM

Mrs. T/ 42 years old/ JAMKESDA/P4A0

May. 18. 2011

Anamnesis :

She was referred by private hospital in Batam with Cervical Cancer (the result of histopathology examination was non keratinizing squamous cell carcinoma).

Vaginal bleeding had been complained since 1 month ago, accompanied with foul vaginal discharge. She went to RS Otorita Batam. Based on the result of the biopsy performed at the hospital, she was referred to RSCM.

Neither urination nor defecation abnormality was reported.

She was married once, at the age of 18 years old. And so was her husband.

 

Physical examination :

General status : no enlargement of the supraclvicular and axillar or inguinal lymph nodes.

Gynecological status :

I           : v/u within normal limit.

Io         : exophytic mass measuring 3 X 3 X 3 cm, flx (-), flr (-)

RVT    : exophitic mass measuring 3 X 3 X 3 cm, fragile, no involvement to the vaginal wall, loose

 parametrium, no adnexal mass, uterine corpus wnl.

 

Histopathology review result :

Non keratinizing squamous cell carcinoma, moderate differentiation.

 

USG examination :

Malignancy of the cervix (no information of the lesion size).

 

Assessment :

Cervical cancer stage I B 1

 

Management plan :

Radical hysterectomy

June. 14. 2011

Pre operative diagnosis         : stage I B 1 cervical cancer.

Post operative diagnosis        : stage II A cervical cancer.

Operation procedure               : Radical hysterectomy, right salphyngoovorectomy, transposition of the

  left ovary, bilateral pelvic lymphadenectomy.

Operation report                   :

• RVT examination under narcosis : tumor infiltration to vaginal fornix (right lateral), 3.2 X 3.1 X 3 cm, loose parametrium, smooth rectal mucous.
• Exploration after peritoneum was opened : normal size uterus, normal ovaries, no tumor infiltration to parametrium, enlargement of pelvic LN sized 1 X 1 X 1 cm, no enlargement of paraaortal LN, normal liver and spleen.
• Radical hysterectomy, right salphyngoovorectomy, transposition of the  left ovary, bilateral pelvic lymphadenectomy were performed.
• Post operative evaluation : tumor sized 3.2 X 3.1 X 3 cm, border of incision : ant 1.5 cm, right lateral 0 cm (unclear border), left lateral 2.5 cm, posterior 2.5 cm.

 

June. 22. 2011

Post operative histopathology result

• Non keratinizing squamous cell carcinoma, moderate differentiation, with metastasis to right pelvic LN.
• Border of vaginal incision : not free from the tumor.
• Small leomyoma.

Analysis :

• Cervical cancer stage II A
• Post radical hysterectomy, right salphyngoovorectomy, transposition of the  left ovary, bilateral pelvic lymphadenectomy
• Tumor metastasis on the right pelvic LN.
• No clear explanation on how much the vaginal incision was free from the tumor (it is supposed to be reported).

Management plan :

Chemoradiation (she was scheduled on the 8^th of August 2011).