Caase Conference Jan 25th 2012

25-Jan-2012, Divisi Ginekologi Onkologi RSCM

CASE CONFERENCE

JANUARY 25^th 2012

1 OUTPATIENT

 

Mrs. S, 42 yo, P1, 357-81-80, Jamkesmas

 

 

 

HISTORY

 

September 14^th, 2011

 

Patient was referred from RSU dr. H. Marzoeki Mahdi Bogor with ovarian carcinoma st IV

 

Patient already have been perform laparatomy exploration and biopsy in RSU dr. H. Marzoeki Mahdi Bogor, with PA result: ovarian carcinoma, poor differentiated. The surgery has held on August 24^th, 2011.

Before surgery, she has complaint abdominal enlargement since 2 months. Abdominal pain (+), feel fullness, and difficulty in defecation. No difficulty in micturition, and no vaginal bleeding.

 

Married 1x, 28 yo. P1, 10 yo

Already divorced since 10 years ago

Housewife

 

PHYSICAL EXAMINATION on admission

 

General status, Compos mentis

BP 140/90 mmHg     Pulse 88x/min           RR 18x/min   T afebrile

Height 158 cm           BW 41 kg       BSA 1.37

Conjunctiva    : not anemic

Heart/lung     : wnl

Abdomen       : cystic mass with solid part until navel, limited mobility,

                              tenderness (+). Scar mediana, good.

Extremities     : edema -/-

 

Gynecological status

Inspection      : wnl

Inspeculo       : smooth portio, fluor (-), fluxus (-)

VRE                 : uterus hard to asses, cystic mass filling abdominal and pelvic

                             cavity, parametrium was loose, rectal mucose smooth

 

Tumor marker examination

Ca125             3915 U/mL  (September 15^th 2011)

Ca125             7300 U/mL  (October 21^st 2011)

 

Chest X-Ray on September 22^th 2011

Within normal limit. No metastatic mass

 

BNO-IVP on September 22^th 2011

Radioopaque view on right hemiabdomen at the level ovary, ec suspected ovarian tumor calcification.

Left nephrolithiasis.

Secretion and excretion function both kidney good.

 

CT-Scan Abdominopelvic on September 22^th 2011

Heterogen big mass in the pelvic cavity enlarge to the abdomen with solid, cystic, fat and calcification (like tooth) components à DD/ Teratoma maligna

Minimal ascites

Nodul at right-left liver suspected metastatic mass

 

US examination on September 28^th 2011

-          Anteflexed uterus, shape, contour and size normal. Regular endometrium.

-          Portio and endocervix normal.

-          In Douglas pouch until pelvic cavity was filled by solid mass with cystic part, inhomogen, with neovascularization (RI: 0,45). The mass was attached with sorrounding tissue, originated from suspected ovarian malignancy

-          Liver, spleen and both kidney normal

-          Ascites (-)

Conclusion :

Ovarian malignancy fill in pelvic cavity

 

PA Result (Review Slide) on October 5^th 2011

Adenocarcinoma serosum papiliferum poor differentiated

 

FNAB from nodul at liver on October 12^th 2011

Positif. Adenocarcinoma. Sugested metastatic.

 

October 18^th 2011

Assessment by consultant: Prof. Dr. dr. Andrijono, SpOG-K

Patient was diagnosed as Ovarian carcinoma stad IV

è Chemotherapy

 

NAC were given for 3 series using Cyclophosphamide 800 mg and Platosin 70 mg.

 

NAC schedule

I.                    October 25^th 2011

II.                  November 18^th 2011

III.               December 9^th 2011

 

 

 

 

Evaluation after giving NAC 3 series

 

US Examination on December 15^th 2011

Ovarian malignancy. As compared to us examination before NAC is not much different

 

Tumor Marker on December 19^th 2011

Ca125             465,2 U/mL

 

CT-Scan Abdominopelvic on December 30^th 2011

Ovarian carcinoma with metastatic nodules to liver after NAC, for the moment tumor size minimized insignificant amount, not visible nodules at liver and ascites any more

 

ASSESMENT

Advanced stage ovarian cancer post NAC CP 3 series, stable disease or partial response

(The mass size was not much different as compared to before NAC from us examination. Tumor marker Ca125 decreased (3915 U/mL and 7300 U/mL to 465,2 U/mL. There were no nodules at liver and ascites any more from CT-Scan abdominopelvic)

 

	Before NAC	After NAC
Ca125	3915 U/mL and 7300 U/mL	465,2 U/mL
US Examination	Ovarian malignancy fill in pelvic cavity	Ovarian malignancy. As compared to us examination before NAC is not much different
CT-Scan Abdominopelvic	Heterogen big mass in the pelvic cavity enlarge to the abdomen with solid, cystic, fat and calcification (like tooth) components à DD/ Teratoma maligna. Minimal ascites. Nodul at right-left liver suspected metastatic mass.	Ovarian carcinoma with metastatic nodules to liver after NAC, for the moment tumor size minimized insignificant amount, not visible nodules at liver and ascites any more.

 

PLAN

Laparatomy debulking