Case Conference November 28th 2012

28-Nov-2012, Divisi Ginekologi Onkologi RSCM

CASE CONFERENCE                  

 

Mrs.H. 29 yo.3371765.SKTM,

 

Cervical Carcinoma stage IIB , complete

Chemo radiation (July 2012), reccurens with lung metastasis, hematometra with cervical stenosis

 

 

 

February 15 ^th  2010

Patient  came to policlinic, onco-gyn  refered by dr. Gatot OBGYN (C) with stage IIB  cervical carcinoma planed to perform ovarian transposision and chemoradiation.Patient

 complained  of vaginal bleeding and smelly white discharge 1 years before admission, came to  first OBGYN, and was diagnosed with stage I  cervical carcinoma , sugested to do operation but patient refused. Patient then had massive bleeding and came to Evasari Hospital, underwent biopsy with PA result : squamous cell carcinoma, unceratinzed , large cell type and refered to RSCM.

 

Menarche 14 yo

Married 27 yo, had history of sexual intercourse before.

History of laparatomy due to ectopic pregnancy 2006 at Jakarta Hospital.

 

Clinical Examination

Gen state :

BP : 120/80 mmHg  Pulse : 94x/m

No palpable inguinal, axilla and supraclavicula LNds

Gyn state :

I: v/u normal

Io : exophytic lession diameter 3,5x3,5X2 cm

V/RT : exophytic lession diameter 3,5x3,5X2 cm, invaded to posterior fornix, 1/3 left parametrium , normal right parametrium, smooth rectal mucousa.

 

PA : squamos cell carcinoma, unceratinized, large cell type, moderate differentiation.

 

Rectoscopy (17/2/10) : rectal metastasis (-)

Cystoscopy  (17/2/10): cystitis

Chest x-ray (19/2/10) : normal

BNO-IVP : normal seretion and excretion of both kidneys

 

US (22/2/10) –onco-gyn :

Cervix diameter  4,24 cm vol 27,27 (TAS)

Cervix diameter  4,09 cm vol 17,21 (TRS)

 

Assessment : Cervical carcinoma stage IIB

 

 

Planning :

·        Ovarian transposition

·        Chemo radiation

 

March 22 ^th 2010 ,

patient underwent laparatomy ovarian transposition dextra

 

April 16  ^th 2010-July 16^th 2010

Patient underwent complete radiation  ( external and internal radiation ) and got 3 series chemoterapy with platosin  at April 24^th, May 5 ^th and May 17 ^th 2010

 

 

August 22^th 2011

Patient control to policlinic with abdominal pain, from US finding (FM) corespond to hematometra and hematosalphing (dd/ piometra-piosalphing) ec. Cervical stenosis ( OUE area), internal genitalia adhesion (particularly left adnexa). Dilatation with busi was performed. Planed to evacuate hematometra  with busi until laparatomy  hematometra evacuation if she had severe pain. Discussed with patient and family, prefered to do regular intercourse first.

 

November 15^th 2012

S: Patient came to policlinic with complained of cough since 1 months before admission, still had  lower abdominal pain ( but already decreased) , now se’s been had diathermy therapy for the pain

O : 

Gen state :

No palpable inguinal, axilla and supraclavicula LNds

Gyn state :

I: v/u normal

Io : smooth portio (

V/RT : uterus with normal shape and size, loose parametrium, clinically NED

 

US (6/11/12)

Uterus normal 6,7x3,3x3,3 cm, AF, homogen echostructure of normal parenchim, no myometrial mass,  endometrium was unvisualized echointernal fluid intra cavum  1,4 cm

Intra abdominal organs were normal

Corespond to hematometra ec cervical stenosis.

 

Chest x-ray :  multiple nodular of both lungs , corespond to lung metatasis

 

 

Assesment :

Cervical Carcinoma stage IIB , complete

Chemo radiation (July 2012), reccurens with lung metastasis, hematoetra with cervical stenosis

 

Discussion with Dr.dr.laila.OBGYN (C)    `                  :

 

Patient is in phaliatif phase, length and quality of life, planning to have chemotherapy with cisplatin + Bleomycin.

Discussion in CC