Case Conference September 12th 2012

12-Sep-2012, Divisi Ginekologi Onkologi RSCM

Endometrial Carcinoma advance stage post laparatomy  sub optimal de bulking at March 2012 (TAH,BS), omentectomy, appendenctomy,bospy of the tumor nodules, left common iliac lymphadenectomy, sampling of paraaortic nodes),hepar metastasis

 

Identity

Mrs.UK,  38 yo, P1.  SKTM

 

January 11 ^th 2012

Patient came to policlinic, refered from Puskesmas Senen with susp endometrial carcinoma.Complained of vaginal bleeding since october 2011, went to puskesmas senen then RSI Jakarta, performed d/c with result endometrial carcinoma, clinically ?. Because of financial problems patient was refered to RSCM.

Previous illness: DM (-), HT (-)

Gen state :

Vital signs : wnl, Body weight :61 kg, height : 146 cm

Gyn state :

Io:smooth portio

VRT : enlargement of uterus, loose parametria, no adnexal mass, smooth rectal mucosa

 

US result (11/1/12)

Abdominal : abdominal organs are normal,enargement paraaortic  and paracava lymph nodes (-), ascites (-)

TV :uterus RF, a little bit enlargement of the utery with irregular mass 1,70x4,30, infiltrated > ½  parametria, neovascularisation (-),RI : 0.4,both ovarian were normal.

Susp endometrial carcinoma.

 

Review slide (18/1/12, no pA :1200485)

Adenoscuamosa carcinoma, .... diferentiation, still dificult to assess tumor origin,

Comment : what  kind of tissue ,the specimen come from, biopsy or curretage ?

 

20/3/12

performed :

Laparatomy  sub optimal de bulking,(TAH,BS), omentectomy, appendenctomy,bospy of the tumor nodules, left common iliac lymphadenectomy, sampling of paraaortic nodes)

Pre op diagnosis : Endometrial carcinoma

Post op diagnosis : advance stage of endometrial carcinoma

Surgery report :

ü Cystic mas 8x8x10 cm, smooth surface, multilocular, originated from riight ovary

ü Uterus enlarge as big as adult fist, left ovary was normal size, with miliary tumour nodul on its surface. There were tumor nodules at the right pelvic side wall as high as uterine artery crossing the ureter ( 3 cm) at rectosigmoid part(1 cm a)t douglas pouch, 1 cm.Milliary tumor nodules at omentum, appendix, intestines, posterior vagainal wall.

ü SOD à FS result : ovarian cystadenocarcinoma

ü Performed total omentectomy,appendectomy, biopsy at tumor mass originated peritoneum, rectosigmoid and douglas pouch

ü No enlargement pelvic and paraaortic lymphnodes, performed paraaortic sampling

ü Milliary nodul at mesentriumm intestine, rectum, douglas pouch, couldn’t be optimally debulk

PA result (20/3/12 no. 1202361)

Endometrial adenocarcinoma tipe I (endometrioid), moderte differentiated with invasion >1/2 myometrium and infiltrated to endocervix.

Metastasis on both ovarian, periapendix, omentum,left ommon iliac, caecum, cavum douglas, right pelvic peritoneum, right ureter

 

Discussion with dr.Sigit obgyn (C) :

Planning to perform  radiation and chemotherapy three weekly, with carboplatin and paclutaxel.

5/9//12

S : Patient was lost follow up, financial problems, SKTM C.omplain of abdominal pain and  vaginal bleeding.

O: gyn state :

Tumor mass seen  filling  vaginal cavity up to 1/3  vaginal part, firm vaginal wall

VRT :

Lobulated tumor filling up to 1/3 part of vaginal, orginate fromleft vaginal stump, sized 5x5x4 cm

 

US (7/9/12):
Solid pelvic mass, irregular, at the stump of vagina 5,2x4,9x5 cm with  hepar  metastasis multiple lession, hydronephrosis right kidney, ascites (+)

 

Assessment : Endometrial Carcinoma, Advance Stage  post sub optimal de bulk March 2012, hepar metastasis

 

Planning :

Discusion with dr.Hariyono,obgyn (C)

Vaginal bleeding à paliatif radiation

Liver metastasis à no treatment

Discussion in CC