Case Conference October 3rd 2012

03-Oct-2012, Divisi Ginekologi Onkologi RSCM

CASE CONFERENCE

October 3 ^rd 2012

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Mrs.S,  P3A2 52 years old , nrm 2661438  JAMKESDA

 

Recurrens Ovarian Carcinoma,  post laparatomy optimal de bulking (10/11/2003) ,Platinum sensitive with First line chemoterapy (Adriamycin and Platosin , March-July 2003), and with 2^nd  line chemotherapy (Cyclophospamide and platosin nov 2010-april 2011) and local radiation ( march-may 2012), due to costae metastasis  susp  liver and lung metastasis

 

RESUME

 

28/1/03

Reffered from OBGYN with ovarian cyst, abdominal pain since 5 months, decreasing body weight  4 kg (in 2 months )

O: Io : smooth portio

V/RT : uterus normal, left adnexal mass 5 cm

 

US  FM(28/1/3)

Uterus normal, cystic mass with solid part on posterior of uterus measuring 12,5x8,4x10,9 cm (RI : 0,40)

Conclusion : Ovarian neoplasma cystic with solid part

 

Ca 125 :

 

10/11/2003 performed complete surgical staging

pre op dx   solid –cistic adnexa tumor susp maligna

post op diagnosis : ovarian carcinoma

surgery report :

from the exploration there was  cystic mass  with solid part, multilobular, each measuring d.2-5 cm , from left and right   adnexa ,  filling douglas pouch, all  sized about 3 of adult fist,  half part was already rupture.

Uterus normal.

FS result : maligna

Performed TAH-BSO

Lymphadenectomy  pelvic bilateral, no LNDs enlargement

Omentectomy

Appendectomy

Right and left peritoneal biopsy

Tumor residu miliar in doglas pouch,  caused by adhesion of tumor

 

PA  result  (18/2/3):

Ovarium corespond to  endometrioid cel carcinoma , moderate-bad   differentiation

 

 

First Line of chemo (24/3/2003-24/7/2003)

Adriamycin  : 58,95 P:latosin :65,5

 

 

 

 

 

JUNE 10 ^TH 2010

 

S : patient controled with no complain

O : gyn state : Io: smooth of vaginal stump

                   RVT :palpated 2 cm mass on vaginal stump, smooth rectal mucosa

US (14/6/10) :

Right pelvic mass vol 4,64 cm³ ( 2,64x1,57x2,14)

Left pelvic mass vol 1,55 cm³  (1,86x1,237x1,25 cm)

Susp metastasis hepar ( an hypoechoic lession with halo appearance)

Ca 125 (10/6/10) : 35,4

 

A: Ovarian carcinoma stage IIIC residif with platinum sensitive

P: planning to perform chemo with CP

 

 

2 ^nd line of chemo (nov 30 ^TH 2010-april 26 ^TH 2011)

Cyclophospamid: 786 mg platosin 65,5

 

 

US (FM)19/5/11

There was echoic solid mass at right pelvic cavity , posterior of the bladder 24x12x16 mm, RI :0,8

Normal stump of vagina

Conclusion : residual mass ovarian carcinoma

 

 

25/5/2011

Case Conference

1.     From last US result : only 1 nodule à planning perfom CT-scan

2.     Be informed to the patient :

a.     Follow ip 3 months ( clinical examination), US, Ca 125)

b.     Laparascopy ( could be continued with laparatomy) for biopsy to de bulking.

 

 

January 24 ^th 2012

S : Patient controled with US result mass in costae

 

US  Oncology 24/1/2012

 

Hipoechoic area, irregular border on anterior costae VII linea axilaris posterior, pain (+) with largest diameter 12 mm.

Conclusion : no residive mass with mass on  anterior costae  VII

Suggestion : mass biopsy on costae

 

26/1/12 ( FNAB  no cytology 120194)

positive, carcinoma metastasis

Ca 125 :42,8,

Chest x-ray (30/1/12 ):

process specific, no metastasis

CT scan thorax (31/1/12 ):

susp  infected bronchiectasis on both lungs and lymphadenopaty left hilus, there was no nodule on right and left costae, no  lung metastasis . no nodul appearance on left costae

Assessment : Ovarian carcinoma stage IIIC residive on costae

Planning : Local radiation

 

27/3/12-2/5/12 :

performed local  external radiation

 

August 24 ^th 12:

 

S : Patient controled with pain in costae area

O: Gyn state : Io : smooth vaginal stump

RVT : mass (-)

 

ca 125:  45,3

Chest x-ray : Right  Lung TB dd/ metastasis

CT thorax (25/9/12):

Multiple mass and nodule : Segmen  III of left lung and segmen I,V of the right lung susp lung metastasis.

Fibroinfiltrat with ectasis on segmen I and II of right lung with segmen V oft left lung.

Lession on segmen V hepar, susp metastasis.

 

Assessment :

 

Recurrens Ovarian Carcinoma,  post laparatomy optimal de bulking (10/11/2003) ,Platinum sensitive with First line chemoterapy (Adriamycin and Platosin , March-July 2003), and with 2^nd  line chemotherapy (Cyclophospamide and platosin nov 2010-april 2011) and local radiation ( march-may 2012), due to costae metastasis  susp  liver and lung metastasis

 

Discussion with dr Hariyono, OBGYN (C)

Patient with lung metastasis à hematogene

Hepar metastasis à chemotherapy  is difficult  to reach  the metastasis,

Choice :

Chemotherapy

No treatment

Discussion in CC