Case Conference November 28th 2012

28-Nov-2012, Divisi Ginekologi Onkologi RSCM

CASE CONFERENCE                  

 

MRS.K, 52 yo, P0A2,  INTRA ABDOMINAL TUMOUR SUSPECTED SARCOMA, UNRESECTABLE TUMOUR

 

Patient complained her abdominal lump  and spotting since August 2012,  Abdominal pain (+). Patient has been menopause since 2 years .Decreasing body weight 14 kg in 6 months. Normal mixturition and defecation

 

History of illness

History of CVD at 2003, hypertension (+)

DM (+)

 

Married since 22 years

P0A2

 

CLINICAL EXAMINATION

 

Gen state :

BP : 180/90 mmHg  P;90x/m

Eye : not pale conjungtiva

Cor/pulmo : within normal limit

Abdomen :solid ,intra abdominal mass,at level of umbilicus, fixed,

Extr : oedema -/-

 

Gyn state:

I : v/u normal

Io: smooth portio ,pushed to anterior

RVT :normal cervix, uterine corpus was fixed, especially to sacrum area and parametrium to retroperitoneal area

 

Chest x-ray (15/10/12)

Susp TB dextra –active

Cor within normal limit

 

 

US ( FM, ) 18/10/2012

Solid mass irregular, nodulated, 140x120x130 mm filled pelvic cavity and cavum douglasi.

The mass was union from solid tumour which came from both of adnexa and uterus, with severe adhesion ( adhered each others )

Uterus mass filled myometrium, uterine cavity until canalis cervicalis, with neovascularization (RI 0.48) which came from malignancy.

Normal ovary were difficult to be identified.

Other intra abdominal organs were normal

 

Conclusion: internal genitalia malignancy mass, from adnexa (ovary), uterine corpus, endometrium and endocervix. Difficult to evaluate the primary organ.

Adhesion with surounding organs.

 

 

US (oncology depart) 6/11/12

 

Uterus with round shape, 13x10x12 cm, AF,  inhomogen hyper-hypo echoic parenchim echostuctrue, nodulated, indistinguished border, vascularisation RI 0.67, endometriu 4 mm, no intra cavity fluid

Both adnexa were normal

There’s no free fluid in douglas pouch

 

Organ intra abdominal findings:

Hypoechoic homogen echoparencim liver; there was a nodule , 2 cm, on  the right lobe

Normal aorta abdominalis

There was enlargement of left parailiaca LNds, 5 cm

Dilatated renis pelvis of right kidney

No pleural nor peritonei cavity  free fluid

 

Conclusion :

Suspected liver hemagioma

Hydronephrosis dextra grade mild

Enlargement of left parailiaca LNds

Uterus Enlargment suspected myomatosus dd/ leomyosarcoma

 

 MRI whole abdomen (19/11/12)

 

Enlargement of utery corespond to uterus myomatosus

Mass on anterior wall, posterior,  right and left lateral of the uterus dd/ uterus myomatosus, adnexal mass ?

 

Assessment :

Intra abdominal tumour suspected leomyosarcoma, unresectable tumour

 

Discussion with dr.Sigit.OBGYN (C):

Patien with unresectable tumour, discuss in CC about next treatment.