Case Conference June 6th 2012

06-Jun-2012, Divisi Ginekologi Onkologi RSCM

 Case Conference

June 6^th  2012

 

Resume

Ms. W, 18  yo

359-66-79, Jamkesda

 

Patient post laparotomy suboptimal debulking at Karawaci Hospital at November 2011 with post-op diagnosis: ovarian cancer st III C.  PA result was Germ cell tumor, yolk sac type/endoderm sinus, with invasion to omentum, chronic appendicitis with acute exacerbation.

 

First came to RSCM on December 2011 with chief complain anuria since 1 week, Renal US was done and the result was bilateral hydronephrosis and solid mass in abdominal cavity.

Performed bilateral nefrostomy ( 5/12/2011)

BEP chemotherapy was done from December 2011 until February 2012.

BEP  seri : 15th December 2011

                   25th January 2012  

                   17th February 2012

Marriage history: not married yet

 

PA (1109841) result: Sinus endodermal tumor

Laboratoy (5/3/2012) :

Tumor marker

Pre-chemo :  AFP : 54.390   à 347,5

                        LDH: 2.203      à 647

                       Ca-125 : 114,1 à 12,8

                  

US examination (08/03/2012):

Conclusion:

Right hydronephrosis, minimal right pleural efussion,

Mass shrinken (61x47 mm) compaed to US exam on 12 Des 2011 (190x96 mm).

Ro Thorax : No abnormalty at lung and heart.

Consult to Pulmonology : Low risk

Consult to Anesthesia : ASA II

 

23/04/2012

Performed Laparotomy with operation procedure : Secondary debulking, debulking of tumor (Salpingoophorectomy sinistra), Total Omentectomy, with residu from  ileum 4 x 4 x 1 cm and rectum 5 x 4 x 0,5 cm.

 

PA Result ( 24/4/2012 ) :

Histologycally correspond with endodermal sinus (residu?) to the tissue : left tumor, implant on bowel and rectum

 

USG ( May 25^th 2012 )

Left adnexa with lobulated solid lesion size 19,8 x 10,6 x 17,6 cm suspected residif. No metastatic lesion in liver and lien.

Solid lesion on paraaorta size 6 cm suspected lymph node enlargement

Left renal with hydronephrosis grade I

No pleural effusion. Ascites (+).

 

May 28^th 2012 à 4^th chemotherapy (BEP), but during chemotherapy the patient went home by her own will

 

A/ Ovarian cancer residif post chemotherapy and suboptimal debulking

P/  Palliative care :

è 1. Length of life with chemotherapy

or

è 2. Quality of life