Case Conference August 8th 2012

08-Aug-2012, Divisi Ginekologi Onkologi RSCM

Cervical Carcinoma  with Inguinal Limphadenopathy Susp Residif  , Post NAC  ( 2 series)with PVB Continue with Radical Hysterectomy (May 2012) and Complete Radiation.

 

Identity

Mrs.S, 41 years old

Private patient

 

 

April 12  ^th 2011

patients was diagnosed with cervical carcinoma IIA2, with PA :  adenocarcinoma , well differentiated (medistra).Physical examination :cervix enlarge 4X4X3 cm, infiltrated in left fornix. SCC was 9,5.

 

May 6 ^th  - June 3 ^rd  2011

Patient was given PVB chemotherapy ,after 2 series chemotherapy, still bleeding , response(-)

 

June 25 ^th 2011,

was performed radical hysterectomy with PA result :adenocarcinoma cervix, well differentiated, deep invasion 12 mm, with metastase in obturator lymphe node, continued with complete  radiation  (August 15 ^th -September 20 ^th external radiation, sept 16 ^th - October 10 ^th brachitherapy).

 

At May 16 ^th 2012 patient controled with chief complain left leg swollen , performed Doppler US ( June 11 ^th ) : there was a lymphe node at left inguinal 2 cm

 

Lab Findings :

 

Biopsy - PA result (12/4/2011, Medistra Hospital, No.1104120065)

adenocarcinoma , well differentiated

 

Rontgen thorax  (28/4/2011)

Cor and pulmo  :normal

 

CT-scan whole abdomen  (28/4/2011)

Cerviks more thick, lobulated, mass 4,7X4,5 cm,not homogen at right side corpus. Cycstic mass 2,2 X2 cm, in left adnexa with   bilateral parametrial lymph. Uterus with IUD, parenchim was not homogen, cavum uteri filled with fluid/blood. Sugesting malignancy from cervix, staging IIb

Hepar, lien,pancreas, kidneys normal, no ascites. Paraaorta and retroperitoneal lymph nodes were normal

 

 

After radical Hysterectomy

 

PA result (25/6/2012, Medistra Hospital, No.RI1106240017)

Macroscopic :

Uterus+ cervix 11X8X4 cm, cervix 5X3X2 cm, myoma 3 cm

Right obturator Lymph nodes :4

Left obturator Lymph nodes :4

Right pelvic Lymph nodes :2

Left pelvic  Lymph nodes :4

 

Microscopic :

Cervix : adenocarcinoma, well differentiated, depth invasion 12 mm

One of right obturator Lymph nodes : metastasis (+) adenocarcinoma

 

MRI whole abdomen  (12/4/2012)

Post hysterectomy status,pelvic  pathologic mass (-), ascites(-), no enlargment retroperitoneal lymph nodes, hepar , pancreas and renal normal,lien a little bit enlarge, focal lession (-)

 

Doppler US left leg (11/6/2012)

There’s no accute deep veins trombosis on left leg

Subcuttan oedem on left leg, especially on femur, susp inflamation process or selullitis ?

There was a lymph node in leftinguinal area (2 cm) , focal lymphadenitis.

 

Lab findings

2/7/2012

CBC 12,1/36/5410/244.000

AST/ALT 21/23

 

 

(21/7/2012)

CBC 11,3/4800/249.000

CEA : 0,3

SCC : 1,2

AST/ALT 12/5

Ur/Cr 6/0.4

RBG 87

 

Assesment :

Cervical carcinoma post NAC  ( 2 series)with PVB continue with Radical Hysterectomy (May 2012) and complete radiation, inguinal limphadenophaty susp residive

 

Discussion with DR.dr.Laila,N,obgyn (C)

Discussion about patient management in CC