Case Conference October 3rd 2012

03-Oct-2012, Divisi Ginekologi Onkologi RSCM

CASE CONFERENCE

October 3 ^rd 2012

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Mrs.M, 65 yo.3700508

 

Ovarian Carcinoma Advance stage post NAC 3 series (stable disease)

 

May 23^th 2012

 

Patient  came to emergency theatre with complained of vomiting 1week before admission

Patient had lost appetitte 1 months before admission, epigastric pain (+).

She had another complain that had enlargement of her abdomen since january 2012-Marc 2012, and was hospitalized in Pringsewu Hospital, Lampung, performed the operation at April 2012. From anamnsesis with operator, patient only performed pungsion of the ascites, didn’t do tumor biopsy caused by fragile tumour and easily bleeding. With the cytology result positive adenocarcinoma.

Patient then reffered to Abdoel Moeloek than reffered to RSCM.Normal defecation and mixturition.

 

Previous illnes :

Hypertention (+)

 

Menarche 15 yo

Married 41 yo

P3 ( youngest 30 yo)

Menopause : 8 years

 

Gen state
Eye: conjungtiva not pale, not icteric

Cor /pulmo : normal

Abd :

Distended with massive ascites up to 2 finger below processus xhyphoideus

 

Gyn state :

I : v/u normal

Io : smooth portio

V/RT : uterus normal, pushed to anterior, loose parametrium, there is  solid mass filling pelvic cavity up to 2 fingers below the navel with massive ascites

 

PA result 19/4/12 (Bumi Waras Hospital )Adenocarcinoma

 

Ca 125 (25/5/12) :949,8

Chest x-ray : cardiomegali, metastasis(-)

 

US 25/5/12

Uterus normal  6.0x2,6x3,3 cm

Both adnexa couldn’t be identified

Solid mass with distinguished border at cranial uterus measuring 12,4x13,2x11,6 cm, volume 1004 mL, inhomogen hipoechoic, no vascularisation .

Anechoic Free fluid in douglas pouch

 

aorta abdominalis, pancreas, paraaorta  and parailiaca LNds couldn’t be identified caused by ascites.

Correspond to massive ascites, susp solid ovarian neoplasm, susp maligna

 

 

Assessment : low intake on solid neoplasma with massive ascites susp malignancy

 

Patient had been hospitalized for improvement of condition and  from prof Andrijono’s assessment decided to have NAC 3 times continued with de bulking

 

 

13/6/12

cytology :positive adenocarcinoma

 

15/6/12 - 14/8/12: 3 series chemo with carboplatin 450 mg Paclitaxel 300 mg

 

 

US (21/9/2012) post NAC III

Uterus normal 47x24 mm.

Solid mass with cystic part  measuring 17x14x15.6 cm  vol 1945 cm3, vascularisation (+), RI :0.33 the origin susp from right adnexa.

Massive ascites (+)

Conclusion :solid ovarian neoplasma measuring 17x14x15.6 cm  , bigger compared with US  29/5/12 (12.4x13,2x11,6 cm)

 

Ca 125 : 455,8

 

CT whole abdomen  27/9/12

There is heterogen mass 15,5x19x13,23 cm with necrotic component , in pelvic cavity,  the origin is from adnexa, pushing bladder posteroinferiorly.

Conclusion : ovarian mass with massive ascites, cholelitiasis, right nefrolithiasis.

 

 

	Ascites	Ca 125	Tumor mass
Pre NAC	+++	949	12,4x13,2x11,6
Post NAC	+++	455,8	17x14x15,6

 

 

 

 

Assessment :

Ovarian Carcinoma Advance stage post NAC 3 series (stable disease withj increasing of tumor mass and decreasing of Ca 125)

 

Discussion with dr.Hariyono, OBGYN ( C)

Planning to perform laparatomy interval de bulking, possibility of the stoma

Or no treatment

Cholelitiasis à consult to digestive depart

Discussion in CC