Case Conference July 27th 2011

27-Jul-2011, Divisi ginekologi onkologi RSCM

Mrs. Dj/ 77 yo/P0/ Jamkesmas

History

29/10/09 à Patient had operation at “S” Hospital (Sukabumi), from operation report, patient had Total Hysterectomy Salphingoovorectomy Bilateral.

03/11/09 à PA result (“S” Hospital): Serous cystadenocarcinoma ovary bilateral with invasion to uterine wall, patient had been advised to get chemotherapy but patient refused then choose to take herbal medicine.

13 months later (17/12/10) patient controlled to “S” hospital with abdominal enlarged, then patient referred to CM hospital.

15/12/2010 à patient came CM hospital referred by “S” Hospital. We plan to performed review PA result, CA-125 and ultrasonography.

17/12/2010 à CA-125: 39.4

04/01/2011 à Review PA result (PA: 1009020): Serous cystadenocarsinoma bilateral ovary with metastases to myometrium.

05/01/2011 à USG (Onco) with impression : abdomen with cystic mass vol> 6300cc, suspect pseudocyst dd/ malignant ovarian mass. Pelvic cavity with cyst volume 110 cc suspect pseudocyst dd/ malignant ovarian mass.

10/01/2011 à Assessment by consultantà adjuvant chemotherapy CP.

Performed 3 series CP à 12/01/2011 –> 02/02/2011 –> 08/03/2011

5/04/2011 à USG (Feto) with impression: Large pseudocyst dd/ permagna ovarian neoplasm. Compared with previous USG exam àrelatively no difference, except volume pseudocyst increased.

7/04/2011 à CA-125 : 227,4. à impression platinum resistant.

13/04/2011 à Case Conference à decided to give second line chemotherapy.

Performed second line chemotherapy àEloxatin – Gemzar à (I) 20/04/2011à      (II) 12/5/2011  à (III) 6/7/2011.

18/7/2011 à CA-125: 98,1

20/7/2011 à USG : Neoplasm cystic intraabdomen suspect residive ovarian tumour

Pseudocyst (at cervical stump and douglas cavity).

22/7/2011 à Assesment by consultant à prepared for interval debulking.

Patient felt the tumor decreased, after the second line chemotherapy, no difficulties in defecation and micturition.

Patient already menopause since 25 years ago, P0, married once, husband past away 12 years ago.

 

Physical exam:

General status :

BP :140/90, P: 90, RR : 20 x/m, T : 36,2 C

·         Conjunctiva :  not anemic

·       No enlargement of supraclavicular/axilla/inguinal lymph nodes

·         Abdomen: palpated cystic mass until 3 finger below proc xyphoideus, limited mobility. Operation scar mediana incision,

·         Extremities : warm, edema -/-

Gynecological status

·         Inspeculo         : portio retracted, vaginal wall smooth, mass (-).

·         RVT    : palpated cystic mass occupied abdominal cavity until 3 finger below proc. xyphoideus, with limited mobility. portio retracted. Rectal mucose smooth.

 

Supportive examination :

USG FM: 20/07/2011

Not visible uterine corpus and both ovarian not visible

Cervical stump normal. At douglas cavity there is cystic mass originated from pseudocyst.

There is cystic mass fill abdominal cavity, with papillary growth. With sliding technic, revealed the mass separated and do not attach to surrounding organ (sliding sign positive). No ascites.  

Liver and both renal are normal

Conclusion: Neoplasm cystic intraabdomen suspect residive ovarian tumour

Pseudocyst (at cervical stump and douglas cavity)

 

 Laboratory Result: 25/7/2011

CBC: 9,7/30,1/4.440/366.000.

Ur/Cr: 21/0.6, OT/PT: 18/11, Alb: 3.48.

Na/K/Cl: 148/3.98/103.7

(18/7/2011) Ca125: 98,1

 

Rontgen Thorax 26/07/2011

Right pleural effusion,calcified aorta.

 

PROBLEM:

Ovarian carcinoma recurrent (post subtotal hysterectomy bilateral salpingooforectromy outside), resistent platinum.

Partial respon to second line chemotherapy (Eloxatin-Gemzar)

 

PLAN:

Interval debulking followed by adjuvant second line chemotherapy