Case Conference October 10th 2012

10-Oct-2012, Divisi Ginekologi Onkologi RSCM

CASE CONFERENCE

 

MRS.N. 49 YO.3494771

 

CA OVARIUM ADVANCE STAGE POST NAC CONTINUED WITH INTERVAL OPTIMAL DE BULKING

POST ADJUVANT CHEMOTHERAPY 3 SERIES,

ELEVATED TUMOR MARKER , SUSP PSEUDOCYST DD/RECURRENS

RENAL INSUFISIENSI

 

 

RESUME

 

CC: brought lab result (Ca125 119)

 

May  8 ^th   2011

Came with cystic ovarian neoplasm susp malignancy (Ca 125 354.9)

May 19 ^th   2011

Cytology ascitesà adenocarcinoma

US May 13 2011 (before NAC)

-         Anteflexed uterus with multiple intramural myoma size 28-38 mm. Regular endometrium.

-         Cystic mass on right adnexa with solid part, irregular shape and border, RI 0.28 could be originated from right ovarian neoplasm

-         Normal left ovary

-         Liver, spleen and both kidney normal

-         Ascites (+)

Conclusion :

Ascites and cystic mass with solid part of the right ovary, suspected malignancy

 

 

June 8^th – July 28 ^th  2011

Patient got chemotherapy 3 series with CP

Ca 125 40.7

 

US August 22 2012( post NAC 3 series)

 

-         anteflexed uterus with multiple intramural and subserous myoma size 27-46 mm. Regular endometrium.

-         right adnexa : cystic mass with solid part, regular size and shape, size 182x110x184 mm (vol~1950 cc), neovascularization (+) RI 0.37 ~ right ovarian neoplasm.

-         Normal left ovary.

-         Ascites (-).

-         Normal liver, spleen, both kidney and bladder.

Conclusion :

-         Intramural and subserous myoma

-         Cystic neoplasm with solid part suspected malignancy (from previous ultrasound, mass volume is getting bigger).

 

September 28 ^th 2011

post NAC 3 series,

Stable disease

Resectable (+), plan for laparotomy

November 10^th2011

Performed : optimal debulking (TAH BSO, total omentectomy, right paracolic peritonectomy, tumor implant excision, appendectomy)

Pre op diagnostic :advance stage ovarian cancer (stable disease)

Post op : optimally debulked advance stage ovarian cancer

November 22 ^h2011

PA result shows clear cell carcinoma with poor differentiation

January 25 ^th – March 7 ^th  2012

change chemoth/ with carbo-paclitaxel 3 series (25/1 until 7/3)

•       

US March 20 2012 (post Adjuvant chemotherapy 3x)

•      Conclusion: no new mass visualized

Ca 125 (March, 21 2012) : 119

 

Discussin CC à continue chemotherapy  6 series ( April 12 ^th – May 25^th  2012 )

 

 

September 14 ^th 2012

Patien controled to polyclinic with no complain

 

Clinical exam :

Compos mentis

BP 120/70 mmHg Pulse 89x/min     

RR 18x/min          T 36.8

 

Gynecological status

•      Inspection   : wnl

•      Inspeculo    : smooth vaginal stump, no mass

•      VRE           :smooth vaginal stump, no palpable mass.

 

Ca 125 : 722,1 U/ml

 

US (Sep 21 ^th ):

No pelvic mass, no metastasis on liver, spleen paraaorta and parailiac LNds, no hydronephrosis, pleural efusion (-)

 

CT abdomen September 28^th 2012

Lession with  HU density(fluid) at superoior of the vesica 4x6x4 cm

Conclusion : pelvic cystic lession at superior of the vesica 4x6x4 cm

Dd/ ascites, cystic lession

 

 

 

 

Patient with problems :

·        Ovarian carcinoma advance stage post NAC 3 series, continued with optimal de bulking and chemotherapy adjuvant 3 series

·        Elevated ca 125

·        Susp pseudocyst dd/ residive

 

Discussion :

Discussi0n with prof Andrijono, OBGYN.(C):

Now we can’t decided wether the mass is reccurrens or psuedocyst only. For further treatment we need to prove those things.

Last chemo : May 25 ^th 2012

It’s no use for exploration surgery

-->. Paliative SOL

 

 

 

	12.4	4/5	23/5	25/5	14/9	2/10
	Chemo IV	Chemo V		Chemo VI
Ca 125			341,4		722,1
USG			Mass(-)		Mass(-)
CT scan						Cystic lession 4x6x4 cm