Case Conference August 1st 2012

01-Aug-2012, Divisi Ginekologi Onkologi RSCM

 

High Risk Gestational Tropholastic Neoplasia

 

Identity

Mrs.NK,19 yo ,3713970,Jamkesda

 

Anamnesis (July 25^th, 2012)

Patient was referred from RSUD Karawang with gestational trophoblastic neoplasia.

April 2012, patient had currettage due to molar pregnancy, after currettage she was told to have a complete abortion, fetus was found, and no histology examination was done. No history of bleeding since then. However she experienced difficulty in voiding and defecation.

At June 2012, she had abdominal pain and was examined by doctor who told her she had blood clot inside her womb. No vaginal bleeding occurred. She had high B-HCG blood result and was then referred. No dyspneu.’

Previous illness à no significant illness.

Was married at 17 yo.

A1 à molar pregnancy.

 

Physical examination

BP 120/80 HR 80

Gen st

normal heart/lung

Abd enlarged uterus 2 finger below umb

Gyn st

Io retracted portio

RVT enlarged uterus 2 finger below umb, mobile, no adnexal mass

 

USG result

Enlarged uterus size measurable 15x5x9 cm. anteflexion. A heterogenous lesion image occupied the entire uterus, with merely normal part, hypervascularized with RI 0.3. at cervical area, lesion extruding to the vesica, the vascularization penetrated the vesica.

No abnormal mass at adnexa.

No free fluid.

Normal liver and spleen.

Grade I right hydronephrosis.

No pleural effusion.

 

Conclusion:

Trophoblastic gestational neoplasia with susp. bladder metastases.

Right hydronephrosis grade I.

 

Chest X Ray

Cardiomegaly with early lung congestion

 

Lab result

CBC 9.5/32/6,900/117,000/73/21/29

AST/ALT 12/5

Ur/Cr 6/0.4

RBG 87

HbsAg Non reactive

B-HCG 13 July 2012 : 37,425 mIU/mL

 

Assessment

WHO-FIGO scoring : High risk TGN

Hammond scoring : High risk TGN

 

Planning

ME chemotherapy.

 

Discussion with Dr.dr.Laila obgyn(C) :

Discussion about  Chemotherapy guidelines for high risk TGN, bring it to CC.