Case Conference August 3rd 2011

03-Aug-2011, Divisi ginekologi onkologi RSCM

Mrs. MS/ 54 yo/ P4/ GAKIN

 

HISTORY

 

On April 26^th 2010, patient  came with chief complain unspecific abdominal discomfort since several days before, had been sought for medical attention at BA hospital, did US, and it was said that she had ovarian cyst, she was referred to RSCM. No complain about bloating. No complain in defecation, micturition, no abdominal enlargement

 

In RSCM, first patient examined in Gynecology Clinic and then consulted to Oncology Division with cystic ovarian neoplasm with solid part suspected malignant

 

Patient married 1 x on the age of 17

P4 (youngest child 27 yo)

Housewife

 

PHYSICAL EXAMINATION on admission

General status : compos mentis

BP 110/70 mmHg, HR 76x/minutes, RR 20 x/minutes,       temp 36,8˚C

Height is 154 cm, weight is 45 kg

No enlargement of supraclavicular/axilla/inguinal limph nodes.

 

Gynecologic status : On admission

I:no vaginal bleeding

Inspeculo: porsio seemed normal, no discharge

VRE: uterus normal size and shape, appeared to be pushed to the right by mass on left side.cystic mass with solid part sized 5x8 cm. no mass in the rectum.

 

Oncology ultrasound (04-05-2010) :

 cystic ovarian neoplasm with solid part (volume 900 cc) suspected malignant

 

Lab : CA 125 4810 U/ml

 

09/06/2010 : laparotomy suboptimal debulking .  Left tumor implant on bladder (2x2cm), colon (2x2 cm) and rectum (3x3 cm)à FS result: malignant epithelial ovarian tumor, moderately differentiated

 

21/06/2010, PA result no 1004603 : adenocarcinoma endometrioid type, moderately differentiated on right and left ovaries. Tumor cell evident in myometrium, omentum, rectum and intestine

 

 

19/07/10 chest x-ray: massive right pleural effusion à WSD à pleurodhesis (26/07/10)

cytology no 102014: Positive Adenocarcinoma.

 

 

Laboratory result 05/07/10 à CCT 36.54

 

16/07/10 chemotherapy I Cyclophosphamide 936 mg, Platosin 78 mg

31/08/10 chemotherapy II Cyclophosphamide 936 mg, Platosin 78 mg

07/10/10 chemotherapy III Cyclophosphamide 936 mg, Platosin 78 mg

06/11/10 chemotherapy IV Cyclophosphamide 936 mg, Platosin 78 mg

01/12/10 chemotherapy V Cyclophosphamide 936 mg, Platosin 78 mg

 

Laboratory result for kidney function:

Date	Ureum	Creatinine	CCT	Urine volume
30/06/10	28	0.8	36.54	1200
07/07/10	32	0.9	79.23	2070
05/08/10	27	1	55.83	1510
09/08/10	40	1.4	51.34	2400
23/08/10	22	1.4	56.3	5010
30/08/10	25	1.2	69.18	3780
27/09/10	28	1.1	60.83	3260
30/11/10	47	1.2	66.11	4250
28/12/10	50	1.5	56.71	3255
10/01/11	36	1.5	56.84	4075
17/01/11	53	1.7	49.07	5225
24/01/11	35	1.5	58.46	5125
07/02/11	50	1.5	48.31	3880

 

Oncology ultrasound 18/01/11

Normal pelvic, no residue/ relapsed mass, no ascites, no hydronephrosis

 

CC on 09/02/11 :

sixth chemotherapy reducing dose: Cyclophosphamide 936 mg, carboplatin 365 mg, given on 12/02/11 due to decreasing CCT. (12/02/11 chemotherapy was performed).

 

Fetomaternal ultrasound 03/03/11

No abnormal mass, no tumor spreading

 

Lab : CA 125

26/04/10   4810 U/ml

28/02/11  1992 u/ml,

Summary: still high after adjuvan chemotherapy.

 

Follow up :

01/04/11 first control after chemotherapy

Gyn st : vagina stump smooth

Plan: 3 months follow up.

 

13/05/11:

 physical examination: enlarged right inguinal lymph node sized 2x1x 0.5 cm

FNAB à cytology 111281 : positive adenocarcinoma.

Discuss with consultant : Ultrasound and CT scan abdomen.

 

08/06/11 fetomaternal ultrasound

Adhesion, pseudocyst on vaginal stump, no enlarged paraaortic lymph nodes

No ascites. Enlarged right inguinal node and left parailiac node sized 25 mm

 

 21/07/11 CT SCAN result:

Multiple lymph node enlargement on mesenterium, paraaortic, inguinal

Largest on right inguinal sized 3.5 x2.9 x3.5 cm, cystic lesion on right liver lobe ~ solitary liver cyst. No residif lesion in pelvic cavity

 

Laboratory result 27/06/11      Ureum     35  creatinine  1.4

19/07/11       

33                    1,3

27/07/11          

35                    1,4

 

 

Problem

• Ovarian cancer stage IIIC post suboptimal debulking and ajuvan chemotherapy progressive disease.
• Decreasing CCT

 

à Should we give second line chemotherapy ?