Case Conference October 3rd 2012

03-Oct-2012, Divisi Ginekologi Onkologi RSCM

CASE CONFERENCE

October 3 ^rd 2012

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Mrs. SM, 38 yo, P2, 372 00 25,

Stage II A with PA result HGSIL

August 14^th 2012

 

Patient  came to Policlinic RSCM. She was referred from Pasar Rebo Hospital with suspected squamous cell carcinoma. Patiet  complained about her vaginal bleeding since 1 month ago. Fluor  albus (+) with no smelly and itchy. Post coital bleeding (-), pain (-), weight loss (-). Normal defecation and mixturition.

Patient came to  PHC à referred to YKI for Pap’s test exam. The result (PA no 1206765)  was positif, there were hard dysplasia cells, with possibility of  squamous cell carcinoma. She was suggested to perfomed colposcopy, but since there’s no colposcopy at Pasar Rebo Hospital, the patient was refered to RSCM.

 

Menarche 12 yo, P2 (the youngest is 10 yo)

Contraseption : IUD from 2011 until now

Husband : private employee, patients is housewife

 

Gen state : wnl, no palpable lymph node (inguinal,axila and supraclav)

Gyn state :

Io: erosive portio, easily bleed, IUD filament (+), at  posterior part there’s thickened mass Ø 2 cm, acetowhite (+)

VRT : uterus normal size and shape, palpated mass at posterior fornix Ø 3 cm, buldging to the right parametrium. Left parametrium was loose. No mass at both adnexas.

From RT : the mass was palpated at anterior part size 3x2 cm, buldging to right. Anal sphincter normal, smooth mucosa

 

Supportive data :

US  FM  (August 15^th 2012) :

Uterus RF normal size and shape. Homogeny miometrium.  Endometrium regular, with IUD inside the uterine cavity, good position.

IUO, endocervix and EUO normal.

At posterior part of cervix (posterior fornix), there’s hypoechoic mass with inhomogen texture, undistinct border, size 19x12x16 mm. mass wa contained arterial type vascularization.

Both ovaries normal size and shape.

No enlargement of paraaota dan parailiac LNDs

Liver, spleen, both kidneys, bladder and rectm normal.

No ascites

è IUD insitu. Irregular mass in posterior fornix, malignancy cannot be excluded

 

Assessment :

Suspected Cervical carcinoma II B

 

Planning : colposcopy and targeted biopsy

 

August 16^th 2012

The patien had Colposcopy exam with the result ;

IUD filament (+), IVA test à acetowhite (+) at whole area of cervix and the mass. It seem that the mass awas fragile and easily bleed.

Performed targeted biopsy.

 

Discussion with dr. Hariyono W, OBYGN (C ) :

From the colposcopy, the IVA tes (+) with fragile and easily bleeing mass  à clinical staging stage II A cervical cancer.

If the biopsy result (+) plan for another supportive examination.

 

August 27 ^th 2012

PA (no 1206783) result :

Chronic cervicitis with mild dysplasia metaplastic epithelial cervix ( NIS II = HGSIL)

Discussion in CC the method to  diagnose pre cancer lesion

                                                                                                                   

Disscussion in Case Conference (12/9/12)

·        From the first colposcopy : unsatisfactory colposcopy,not representative, sample macroscopic 0,3 cc , not adequat

·        Unclear lession

·        Re-colposcopy : clear cervix, explore columnar junction and transformation zone

·        Performed LLETZ

 

14/9/2012

performed colposcopy à Assessment : HGSIL

with PA result :

histologycally corespond to hard dysplasia- SCC incsitu with focus ‘ early stromal invasion(less than 1 mm)

asseesment : cervical carcinoma IA ( microinvasive)

planning : Conization diagnostic for excluding of invasif  possibility

 

Discussion with dr.Sigit OBGYN (C):

From PA result : hard dysplasia- SCC incsitu with focus ‘ early stromalinvasion(less than 1 mm)

But from macroscopic, specimen was not reprecetative (sample was only 0.3 cc)

Discussion in CC