Case Conference September 19th 2012

19-Sep-2012, Divisi Ginekologi Onkologi RSCM

CASE CONFERENCE

September 19 ^th 2012

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Mrs.JJ, 57 years old, 3721755,ASKES

 

Susp ovarian cancer advance stage with pulmonary metastasis, limphadenophaty para-aorta, paracava,  bilateral para iliaca with ascites and peritoneal seeding.

 

September 10 ^th 2012

CC :   lump in abdomen since 1 month

History:

Patients has been had lump in abdomen  and vaginal bleeding since 1 month. Also had swollen legs since 2 months. Once came to neurology depart, Bekasi Hospital, was said uric acid , just given drugs for drecreasing complains . swelling in legs  came again, had injection by GP, decrease the compain, but after that repeated swelling had occurred. It happened many times.

Then patient came to internal depart at Bekasi hospital,  done biopsy  the result : no malignancy cell,performed US exam at RSCM, with result ascites and  multiple malignancy mass and involve the uterus.

 

Previous illness:

DM,HT, allergy (-)

Family history :

DM (+) sister

 

Married 1x (1997)

P4, spontaneous.

OC history

Menopause 7 years.

 

Physical Exam

Body weight : 53 kg  Height : 146 cm

Conjungtiva : pale-/-, icteric -/-

Abd : cystic mass with solid part until 3 finger above umbilicus, fixed, pain (-), indistinguish border.

Extr : lower extrimity udem

 

Gyn state :

I: v/u normal,  smelly  redish discharge (+)

Io : portio was dificult to see (retracted to anterior), rectocele gr I (+), smooth vaginal wall

V/RT :portio  was retracted to anterior, uterus was hard to assess, fixed with solid mass from right and left adnexa until 3 finger above umbilicus,

Fistula vesico vagina was palpated at 1/3 proximal part of  anterior vagina

 

 

US (FM 28/8/12) :

 

Uterus enlarge with inhomogen solid mass filling uterine cavity to canalis cervicalis 130x70 mm. Hard to identify endometrium stratum basalis. Invasion mass to right corpus myometrium and connected to right solid adnexal mass, susp from malignancy.

There were right adnexa  solid masses, iregular,distinguish border,74x47 mm and  28x27 mm, neovascularisation (+), RI : 0.48, adhered to surrounding tissue ( bowel and perironeum), susp from malignancy and metastasis.

Left adnexa and douglas pouch, there was solid mass inhomogen, irregular, 100x70 mm, adhered to surrounding tissue (perironeum and right pelvic wall ), susp from malignancy and metastasis.

 

 

Conclusion :

Ascites and multiple malignancy involved the uterus (endometrium, endocervix and corpus), both adnexa (and ovarians) dan surround tissues. Hard to assess the origin (susp endometrium/endocervix).

Enlargement of paraaorta LN susp metastasis.

 

 

CT- whole abdomen (7/9/12)

Malignancy mass in pelvic-abdomen, irregular border , infiltration to anterior abdominal wall, rectum and uterus dd/ malignancy ovarian neoplasma

Limphadenophaty para-aorta, paracava,  bilateral para iliaca with ascites and peritoneal seeding.

Nodular lession at segmen X right lobus  à susp metastasis.

 

Chest-x ray ( 11/9/12):

Cardiomegaly with calcification aorta

Normal pulmo, no metastasis

 

CT-thorax  (11/9/12):

Nodul at segmen X right lobus, susp metastasis.

 

Rectoscopy : no metastasis

 

PA result ( RSUD Bekasi, no. 1201444, 28/8/12)

No malignancy

 

Lab findings (10/9/12):

Fibrinogen : 332,1

D-dimer : 2900 ( 0-300)3

AST/ALT : 39/9, alb : 3,29 ur : 38, cr : 1.00, Blood glucosa (fasting :76, 2 hrs PP:84)

AFP : 8,4  CEA : 2,43  Ca 125 : 712,3

 

 

 

 Assessment :

 

Susp ovarian cancer advance stage with pulmonary metastasis, Limphadenophaty para-aorta, paracava,  bilateral para iliaca with ascites and peritoneal seeding.

 

Discussion with prof Andriyono :

·        Review CT-scan

·        Discuss in CC about next treatment.