Case Conference September 12th 2012

12-Sep-2012, Divisi Ginekologi Onkologi RSCM

ADVANCE STAGE OVARIAN CARCINOMA POST  NAC 3 SERIES CONTINUE WITH LAPARATOMY OPTIMAL DE BULKING COMPLETE RESECTION (AGST 2012)

 

Identity

Miss. M, 19 yo, 3675637,GAKIN

 

Anamnesis

March 2012,

patient came to RSCM at Gynecology Clinic  with complained of abdominal enlargement since 6 months.  Lost of appetite (+). Decrease of body weight (+). Micturition within normal limit. Constipaton (+).  Dyspneu (+), abdominal discomfort (+). Once came to Koja Hospital, performed US with result ovarian cyst, was suggested done the operation. Patient came to Internal Department RSCM, and refered to  gyn depart ,was diagnosed with solid ovarian neoplasm suggestive malignan with massive ascites then refer to onco gyn depart.

Gen state : wnl

Gyn state :

RT : solid mass palpated  in adnexa 13x12x12 cm

 

US(March 9 ^th  2012)

Right solid ovarian neoplasma 15,5x10,3x14,7 cm susp maligna

 

CT-scan (19/3.2012)

 solid mass with hipodens multiple lession(necrotic) with massive ascites à  ovarian neoplasm susp malignancy. Bilateral pleural efusion . abdominal organs wnl.

 

Tumor marker :Ca-125 2290, AFP 0,6; LDH 16 ,hCG 418.  CEA 0.46 and Ca19.9 : 41,7

 

Chest X-ray revealed pleural effusion, a pleural punction was done and the cytology  (29/3/12) confirm metastase of adenocarcinoma.

 

Assessment : advance stage ovarian carcinoma

( 19/4-9/5 and 30/5/2012)

Got NAC with CP 3 series

 

June 19^th 2012

Control post NAC

General status: good, compos mentis,

BP 110/70 mmHg Pulse 80x/min RR 18x/min T 36,8⁰ C 

Gynecological status

RT: uterus wnl, palpated mass on left adnexa sized 5 x 4 x 4 cm, mobile.

 

BNO-IVP

Normal renal excretion and secretion function  

 

Gynecology Oncology US (21/06/2012)

Decreased right solid ovarian neoplasm, 6 cm ( compared to March 19 ^th 2012:15 cm)

	PreNAC	Post NAC
Ca-125	2290	58
Mass	15x10x14 cm	6,1 x 3 x 5,5 cm
Pleuran Effusion	++	Minimal
Ascites	++	-

 

Assessment :

Advance stage ovarian cancer post NAC (CP) 3 series, partial respons

27/6/12

 

Disscussed in case conference :

Planning : laparascopy + VC, waiting  for parafin block result for concervative management

 

Discussion in  Pre op Parade (1/8/12):

Planning to perform laparatomy without VC , initial plann: conservative if possible according to operator. Chemo continue with CP

6/8/12

performed : laparatomy optimal de bulking complete resection ( TAH-BSO, total omentectomy,lymphadenectomy of mesenteric lymph node, resection paravesival and pararectal nodules)

pre op diagnosis : ovarian carcinoma stage IV

post op diagnosis : ovarian carcinoma stage IV

Surgery report :

ü Serohaemorrhagic ascites 500 cc

ü There was solid mas nodulated on right ovary 6 cm,there was also a solid and cystic mass on left ovary, nodulated 3 cm. uterus normal

ü Since planned to conserve the uterus, but there was suspected process on contralateral ovarian, decided perform FS

ü There was no nodule at liver and lien, but there was nodule at paraaortic region àresected àmesentric lymph node

ü  FS : ovarian carcinoma from left ovary, continue with total hysterectomy and SOS

ü resected 2 cm nodule in cavum douglas, 0.5 cm paravesical

 

PA result (7/8/12):

ü Right ovary disgerminoma  ( bilateral) with luthein cyst and left follicle cyst

ü Nodul at vesica,pararectal and omentumà metastase (-)

ü Cervicitis

 

Discussion with Dr.Laila, OBGYN (C)

ü Change regiment of chemo to BEP

Discussion in CC