Case Conference September 19th 2012

19-Sep-2012, Divisi Ginekologi Onkologi RSCM

CASE CONFERENCE

September 19 ^th 2012

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Mrs.HR, 41 yo, 3721076,SKTM

 

G3P2 16 WEEKS GA, STAGE II VULVAR CARCINOMA

 

 

CC: vaginal wound since 2 months before admission

 

History:

Patient is in  her 4 month pregnancy, LMP : 20/05/2012 à EDD : 27/02/2013.Did ANC in midwife, once performed US exam (RSCM), result was 14 weeks gestational age.

Pasien has been  had the woud in her vagina  since 2 months before admission, vaginal discharge (+), ithchy (+), smelly (+). Normal mixturition and defecation.. post coital bleeding (-).

 

Previous illness :-

 

Menarche 15 yo, married 27yo

LMP : 20/5/12

G3P2 :           I.spontan, midwife, 13 yo

                        II. spontan,midwife.8 yo

                        III. this pregnancy

Contraception : DMPA

 

Physical Exam :

 

No enlargement LN inguinal, pelvic and supraclavicula

I:  ulcerative lession seen as a process involved ½  right vulva  area and 1/3  distal ipsilateral. Area tumor sized 6x4 cm. border of lession is 1 cm above anus.

Io : process involved right vaginal wall up to right fornix lateral. Smooth portio. Fluor(+)

V/RT : uterus enlarge as big as 16 weeks pregnancy, smooth parametrium. process involved right vaginal wall up to right fornix lateral.

 

PA ( NO.1207089)

Histologis preview  corespond to adenocarcinoma vulvar, hard to assess the origin.

Comment : we though about tumor  origin, could be from endometrium or digest. How about the clinical ?

US FM (29/8/2012)

Fetal biometrics  corespond to 14 weeks gestational age, life singleton pregnancy. Normal activity.fetal anomaly (-)

 

Assessment :

 

G3P2 , 16 weeks gestational age, life singleton pregnancy

Stage II carcinoma vulva

 

 

Disscussion with prof Andrijono :

Planning :

Radical vulvectomy

Discuss in CC