Case Conference October 24th 2012

24-Oct-2012, Divisi Ginekologi Onkologi RSCM

CASE CONFERENCE

 

Mrs.A, 36 years old .3723337

Soft tissue mass ec fibrous histiocytoma

 

 

Patient came to policlinic with chief complain vaginal bleeding 1 day before admission. Patient had been felt about lump in her vagina since April 2012 when she was going to use IUD, and didn’t know about the lump before. Pain (-), decreasing body weight and loss appetite (-). Patient went to Tangerang Hospital, had biopsy with the result :soft tissue tumor (low grade maligna), sugested to performe operation but the patient refused. Normal defecation and mixturition. She had alternative therapy with oxy water, but it wasn’t going improve the condition

 

Previous illness :-

Family history : -

 

P3 ( the youngest is 6 years)

Contraseption : DMPA

 

General state :

BP  130/80  pulse : 80 bpm  RR : 20 times/m  Body weight : 62 kg 

Eye : conj were not pale, sclera were not icteric

Cor and pulmo : normal

Abdomen : pain (-)

 

Gyn state

I : v/u were normal

V/RT : retroperitoneal mass diameter 9-10 cm, pushed bladder and vagina to left lateral and rectum to left lateral.

Clinical examination corelated to cystic dd/ soft tissue

 

 

PA 21/9/12 ( no 1207667)

Histologically corelated to fibrous histiocytoma

 

 

BNO IVP

Indentation at  right inferolateral of blader side, susp intra pelvic mass

 

Cystoscopy : cystitis and  blader indentation from mas outside the bladder

Rectoscopy: rectal metastasis(-)

 

Chest x-ray (5/10/12)

Cor and pulmo are normal

No lung metastasis

 

 

US 0ncology (October 2^nd 2012) :

Uterus normal 5x3x3 cm, RF to right side, endometrium 2.3 mm. cervix hypoechoic, homigen, distingush border.

Unvisualized right and left adnexa.

At left lateral vagina there is inhomogen hypoechoic solid mass, 9x9x9 cm, with envelope of the mass, no infiltration. Smooth vaginal wall

Other organs intraabdominal   were normal

Conclusion:

Solid mass with soft tissue at vagina left lateral

 

CT scan (17/10/12)

Solid mass with calcification 8.5x7.5x9.8 cm at left lateral cervix, pushing the bladder to right superolateral, pushing uterus to superior and pusing cervix to the right

 

Assessment :

Soft tissue mass ec fibrous histiocytoma

 

Discussion with dr.Hariyono.OBGYN (C) :

MRI exam àthe border between mass and bladder and urethra, bladder and vagina ,bladder  and rectum for extirpation procedure

If the result : the mass  actually is from vesica à urology case

For extirpation procedure : perabdominam or pervaginam

à discuss ini CC

 

 

 

Diagnostic planing:

ü MRI

ü Lab exam

ü Cardology-consultation

ü Anestesiology consultation