Case Conference November 28th 2012

28-Nov-2012, Divisi Ginekologi Onkologi RSCM

CASE CONFERENCE                  

 

MRS. N, 28 yo,P3, nrm  3729199, Stage II B Cervical Carcinoma, HIV (+)

 

Patient was refered from OBGYN, Bogor with  stage  IIA cervical carcinoma . She complained vaginal bleeding for 6 months before admission, with smelly white discharge (+). She also experienced of post coital bleeding for 6 months. Normal mixturition and defecation. Once she came to OBGYN and refered to RSCM.

First sexual intercourse at junior high school.

She’s married twice, first husband died in prison ( husband was criminal and drug user, no data of cause of death ), married at 2000-2002

Married with second husband at 2007-now.

No history of contraseption

Patient recently discovered that she’s HIV (+) when  she controled to policlinic

 

CLINICAL EXAMINATION

 

Gen state :

No palpable LNds

Eye : not pale conjunctiva

Mouth : oral trush (-)

Cor and pulmo : normal

Abdomen : mass(-)

 

Gyn state ;

I : v/u normal

Io : endophytic mass, easily bleeding , 4x5x3 cm

V/RT: endophytic mass was palpated, 4x5x3 cm, process involved left sacrouterina, smooth rectal mucousa

 

PA (no.1208886) : histologic appearance corespond to cervical mucinosum adenocarcinoma.

 

BNO –IVP (13/11/12): renal secretion and excretion function were normal,

 

Chest x-ray (13/11/12) :no lung metastasis

Rectoscopy (6/11/12) : no rectal metastasis

Cystoscopy (7/11/12): cystitis

 

HbsAG : non reactive

 

 

 

Anti HIV : reactive

CD 4 :

Sel T (CD4+) : 17%

Sel T (CD4+) : absolut : 244 sel/uL

 

US (onco-gyn) 23/11/12:

Cervical enlargement  41,2x48,6x42,3 mm suspected maligna.

 

Staging Dr.dr.Gatot,OBGYN (C) :

Cervical carcinoma stage II B

 

Assessment :

Stage II B, cervical carcinoma with HIV (+)

 

Planning to perform laparascopy ovarian transposition,

Patient with HIV (+),  Laparascopy must be a high risk procedure , discussion in CC whether the procedure is tolerable  or not