Case Conference October 3rd 2012

03-Oct-2012, Divisi Ginekologi Onkologi RSCM

CASE CONFERENCE

October 3 ^rd 2012

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Miss.E, 17 yo, 3760674,JAMKESMAS

 

RECURRENS SINUS ENDODERMAL TUMOR WITH CKD

 

25/9/12

patient was reffered from RSUD Karimun with recurren ovarian tumor.

Came to ER RSCM with dyspneu since 1 day before admission.

 

20/7/2012 patient was performed the operation  with PA result : yolc sac tumor.

From the anamnesis of mother’s patient’s , the doctor taken out only the tumor outside uterus, with mass weight 500 grams.

Patient complained about abdominal enlargement since the operation . At the first, patient felt the lump in the abdomen  as big as chicken egg, and getting bigger until now.

Pain(+), nausea(+), vomiting(+). She had dyspneu that didn’t get worse during activity. Dismonerhea (+) since 10 yo. Difficult in mixturition and defecation. Vaginal bleeding (-).

During hospitalization in ERIA had HD 1 x .

 

History illness

-

Family illness

Hypertention and stroke –mother

 

Menarche 10 yo, regular, pain(-)

 

Clinical Examination :

BP : 100/60 mmHg,   Pulse : 110x/m  RR : 18 x/m  s : afebris

Eye : not pale or icteric

Cor and pulmo : wnl

Abdomen : distended with solid mass up to procecus xhyphoideus

Extrimitas : udema +/+

 

Gyn state :

I : v/u

RT : solid mass palpated from adnexa  filling the abdominal cavity up to procecus xhyphoideus

TSA normal, smooth mucosa

 

 

 

 

US (FM) 28/9/12

Uterus normal sized 4x1.9 cm

Right adnexa : in homogen solid lession, irreguler 7.9x4,8x6,3 cm³ vol 125 cm³, at cranial of this lession there is same lession that reached by the probe 16x12x15 cm vol 1500 cm³.

Free fluid (+) at doglas pouch

Abdomen:

Hepar, lien normal

Paraaortal LNds  couldn’t be evaluated, caused by ascites

Both kidneys are normal, no hydronephrosis

No  pleural efusion

Ascites massive

 

Corespond : right adnexal inhomogen solid lession  sized  7.9x4,8x6,3 cm^3.

On the cranial of the lession , there is same lession sized 16x12x15 cm³

 

Lab findings :

29/9/12  Na : 131  K : 4.00  Cl : 95,5

Hb: 8,1  L: 12.720  Trombosit : 499.000

Ur : 188  Cr : 4,60

AFP : 24.501.0

Ca 125 : 146.3

ALT : 48  AST : 27

PT : 11.5 ( 11.7
APTT : 28,6 (37,2)

 

Chest x-ray :

Normal cor and pulmo

Susp ascites

 

PA result (Dr.H.Soekimin, Sp.PA  28/7/2012): yolc sac tumor

 

Urology  consul result : no treatment because from US result there is no hydronephrosis ,

 

Assessment :

Advance stage tumor sinus endodermal post laparatomy outside, with CKD.

 

 

Planning :

 

IVFD : nacl 0,9% 500 cc/24 hrs

              Nacl : 3% /24 hrs

Diet 1500 kcal

Equal balance

Urine monitoring : 0,5-1 cc/kg/hour

 

Dissscussion with prof Andrijono :

Patient with tumor sinus endodermal, recurren, planning to have chemotherapy Discussion  in CC about the regimen for patien with tumor sinus endodermal with CKD