Case Conference September 19th 2012

19-Sep-2012, Divisi Ginekologi Onkologi RSCM

G3P2, 37 weeks gestational age, life  singleton  breech presentation

Cervical Carcinoma stage IB1

 

Identitas

Mrs. Ri, 33 yo, 3392173

 

14/9/12

Patient was refered from  Tangerang Hospital with G3P2  37 weeks gestational age with cervical carcinoma stage IB2

 

At 2010, patient was diagnosed cervical carcinoma st IB2 in Tangerang Hospital, , PA result : scuamos cell carcinoma and refered to RSCM, because financial problem patient didn’t came to RSCM( insurance :Jamsostek, not covering the malignancy disease).Then patient had alternative therapy. Discharge with smelly odour (+), post coital bleeding (+).

 

At April 2012, first knew about her  3 months pregnancy, last menstrual periode : January 2012. Did antenatal care at Husada Insani Hospital   and also ANC at midwife, planned to refer at aterm pregnancy.

 

Menarche 14 yo

Married 1 x , 19 yo

G3P2 : I, 13 yo, spontan

            II. 8 yo, spontan

            III. this pregnancy

Contraception :DMPA, OC

 

Previous illness : -

Family history : mother was cervical cancer, already passed away 2011

 

Physical exam :

 

Gen state :

No palpable LN ( inguinal, axilla, supraclavicula)

 

Obst state : Fut 31 cm, breech presentation, FHR + 140 dpm

Gyn state :

I : v/u normal

Io: endophytic mass 3,5x3,5x1 cm,

V/RT : endophytic mass 3,5x3,5x1 cm, limited in cervix, smooth  parametrium, smooth rectal mucosa, normal TSA.

 

USG (13/9/12)

 

Life singleton fetus, intra uterine , breech presentation, EFW : 3000 grams, anterior corpus of placental implantation

Fetal biometry corespond to 37 weeks GA,  normal activity and growth of the fetal, no anomaly. There’s no mass or  abnormal vascularisation of the cervix.

 

PA (RSU Tangerang, no 10T0935) March 27 ^th 2010

Scuamous Cell Carcinoma, unceratinized, on transformation zone.

 

Assessment :

 

G3P2, 37 weeks gestational age, life  singleton  breech presentation

Cervical Carcinoma stage IB1

 

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

·        Patient had been diagnosed cervical carcinoma stage IB1  since 2 years,

·        History of illness was quite slow  à clinically still cervical carcinoma IB1

·        à performed biopsy

·        planning : SC + radical HT + ovarecsis

·        if in partu à sc + ovarecsis,

·        discussion in CC