Case Conference December 5th 2012

05-Dec-2012, Divisi Ginekologi Onkologi RSCM

CASE CONFERENCE                           

 

Mrs.N, 45 yo.3683034, ASKES

 

RECCURRENS OVARIAN  CARCINOMA, HISTORY OF LAPARATOMY OUTSIDE,  POST LAPARATOMY SUB OPTIMAL DE BULKING ( JUNE 2012) WITH CEMOTHERAPY 4 SERIES, NON RESPONS , RENAL IMPAIRMENT

 

 

Patient was refered from RSUD Dr.Adji Darmo, Kabupaten Lebak with solid ovarian tumor.History of laparatomy due to benign ovarian tumour at Juni 2011 at RS.Banten, and just taken out the fluid caused of severe adhesion

At the beginning , the lump was as big as  orange fruit and after 6 months after the operation, the abdomen was getting bigger and reach as big as aterm pregnancy. Pain (+), decreasing body weight 13 kg (4 months). Normal mixturition but there was defecation problems,vaginal bleeding(-).

Menarche , 14 yo, P3

 

Gen state  on admission

BP : 180/120  N:98  P;22  weight : 52 kg  Height: 160 kg

Gyn state :

Abdomen : distended, solid mass was palpated  until ¨ö navel-proc xyphoideus, scar mediana incision below umbilicus, fixed

RVT :cut was hard to be  evaluated, the mass was palpated filling douglas pouch untill ¨ö navel-proc xyphoideus, smooth rectal mucous

 

US (FM):

Uterus normal, pushed to right posterior with cystic mass and solid part which filled almost a half part of abdominal cavity, RI : 0,52, ascites(+)

major calyses  dilatated both of kidney

Patient was hospitalized at internal medicine with problems : CKD, hypertension and DVT,underwent nefrostomy and condition improvement.

 

PA :14/5/12( no.121166: adenoma borderline)

PA (11.1483-PA.454-RKS): simplex cyst

Review slide (1203971): possibility of ovarian cyst

 

 

 

 

At June 1 st 2012 Laparatomy sub optimal de bulking  was performed.

 

Pre op diagnostic : neoplasma ovarian cyst suspected malignancy

Post op : ovarian cancer , clinico surgically stage IIIC, post sub optimal de bulking

with residu on transversum colon 2x2x0.5 cm

Operative procedure ;

Lap suboptimal de bulking TAH-BSO, total omentectomy, appendectomy

 

PA (1204604)

Clear cell Adenocarcinoma, moderate diferentition, bilateral.

LNds and omentum metastasis

Foci of Adenomyosis uterus

 

Patient with low CCT, planning undergo chemotherapy

Discussion with prof Andrijono :  chemotherapy with taxotere

 

 

11/9/12- 21/11/12

patient got

After3 series  chemo , ca 125:86,2

 

¡¦..

S: Patient controled in policlinic, after 4 series  chemotherapy

O : Gen state :

Abd : metastasis at subcutis- sub umbilical area 2-4 cm

Gyn state :

Io: smooth vaginal stump

VRT : solid mass was palpated 4x5x3 cm , fixed,at vaginal stump

ca 125:86,2

 

US onco-gyn :

 Multiple mass on hepar and lien

Para aorta lymphadenophaty

Pelvic mass susp progresive disease

 

Progresive ovarian carcinoma, history of laparatomy outside (june 2011), post sub optimal de bulking (1/6/12), continue with 4 series chemotherapy with taxotere, renal impairment on nefrostomy

 

Discussion with Dr.dr.Gatot OBGYN (C):

planning second line chemotherapy with Gemcitabine, discuss in CC.

Refering to previous case, Gemcitabine was uncovered by the insurance.