Case Conference November 14th 2012

14-Nov-2012, Divisi Ginekologi Onkologi RSCM

CASE CONFERENCE

 

Mrs.A  47 yo,3547973

Carcinoma ovarium, post incomplete surgical staging, post complete adjuvan chemoterapy 6 series (18/10/12),hepar metastasis

 

Patient came to policlinic with abdominal distended since 2 months before admission, getting bigger with decreasing body weight 11 kg in 2 months.

Difficulty in  defecation, (+) normal mixturition , spotting (+)

Menarche 13 yo, P1

Gen state: solid mass was palpated until ½ navel-px

Stat gyn : smooth portio, cut was difficult to identified

Cystic mass with solid part  came from adnexa , fixed at cranial uterus, smooth surface , smooth rectal mucosa.

US onco-gyn (26/4/12):

Cystic ovarian neoplasma susp maligna (RMI 1521)

Ca 125 : 507.8

 

May 28 th 2012

Pre op dx : cystic ovarian neoplasma RMI 1521

Post op dx : surgically ovarian neoplasma stage IIIC

Operation procedure : incomplete surgical staging ( BSO-HT, total omentectomy, extirpation of tumor nodule on bladder (lymphadenectomy was not performed, because the patient’s haemodynamic was not stabble)

There were no more tumor nodules found on the pelvic , peritoneal wall nor the intestines

 

PA  ( 28/5/12 no. 1204407): clear cell adenocarcinoma,  ovariian bilateral, well differentiated with metastase to omentum and vesica wall, external endometriosis et internal ( adenomyosis)

19/6/12-24/10/12

patient got chemotherapy with carboplatin 387 mg and paclitaxel 226 mg

 

 

After third  series chemotherapy , with discussion with prof.Andrijono,obgyn (C) : clinically : no new mass, respons (+), USG : no new mass , ca 125 increase (from 802.7à1220.0 )à  decided to continue chemotherapy

 

25/10/12

Patient controled to policlinic, after finished six series chemotherapy,

Clinical examination :

Gen state : no palpaple  inguinal/colie LNds

Abdomen : no mass nor ascites

Gyn state :

Io: smooth vaginal stump

RVT : no mass, smooth rectal mucosa

Chest x-ray (25/10/12) : cor and pulmo normal, metastasis (-)

 

US (25/10/12) :

Uterus and both adnexa couldn’t be visualized post BSO-HT, minimal free fluid anechoic  in pelvic cavity, no implant at pelvic wall.

Hepar : hipoechoic homogen , ecoparenchim. There are masses like noduls, look like bull’s eye, 1.7-3.2 cm, spread at lbilateral lobus liver, RLL 15.6 cm ; LLL 7.7 cm

Hepatomegali ec susp metastasis

 

Assessment :

Post incomplete surgical staging, post complete adjuvan chemoterapy 6 series (18/10/12), no respons, with increasing tumor marker, susp hepar metastasis.

 

Discussion with Dr. Sigit OBGYN (C) :

Discussion in CC

 

 

 

	Ca 125		USG
19/4/12	507.8
26/4/12			Hydronephrosis sinistra, cystic ovarian neoplam susp maligna
28/5/12	Incomplete surgical staging, incomplete surgical staging ( BSO-HT, total omentectomy, extirpation of tumor nodule on bladder (lymphadenectomy was not performed, because the patient’s haemodynamic was not stabble,
19/6/12		Chemo I
9/7/12	752.6
23/7/12		Chemo 2
30/7/12	802.7
16/8/12		Chemo 3
23/8/12	1220.0
30/8/12			Mass(-)
5/9/12		Chemo 4
24/9/12	936.8
26/9/12		Chemo 5
15/10/12	1304
18/10/12		Chemo 6
24/10/12	1559
25/10/12			Hepatomegaly ec metastase mass

 

CC Discussion 31/10/2012

 

 

q Probably tere was undetected liver micrometastasis and chemo was not respons for liver metastasis

q Metastatic liver appearance was still unclear à CT-scan

q Considering to use TACI for only  liver metastasis in  ovarium carcinoma

q Re-discuss after CT-result is present

 

 

CT-whole abdomen 7/11/2012

 

q Nodul multiple at bilateral lobus of  the liver

q LNds paraaorta,left  parailiaca and right obturator foramen  metastasis

q Other intraabdomen organ  are within normal limit

 

Assessment :

Carcinoma ovarium, post incomplete surgical staging, post complete adjuvan chemoterapy 6 series (18/10/12),hepar metastasis

 

Planning :

q use TACI for only  liver metastasis in  ovarium carcinoma