Case Conference January 9th 2013

09-Jan-2013, Divisi Ginekologi Onkologi RSCM

CASE CONFERENCE                  

Mrs.R, 31 yo, 354-50-19

 

Residif Ovarian Carcinoma Post Debulking (5-2012) and Lost Followup Chemotherapy (Carbo-Paclitaxel), Intake Difficulties, Cancer Pain, Hypoalbumin

 

3-4-2012

CC : Complaint about enlarged and full filled abdomen since 4 months ago. With decreased appetite. Decreasing of body wheight was noted ( 8 kg in 4 mo), also complaint about irregular bleeding outside her menstrual cycle. Went to Rangkas hospital, performed curretage 4 months ago( PA result: Endometrium : well differentiated mucinous adenocarcinoma). Abdominal pain (VAS: 5)

 

Married 1x at age 12.

P4 : olodest 18 yo, youngest 9 yo.

FP : coitus interruptus

 

St gen : abd : distended untill 1 finger bellow PX, cystic, mobility hard to  

                         evaluate

St gyn : I: v/u within normal limit

              Io : Fluxus +

              RVT : uterus and both adnexa hard to evaluate due to abdominal   

                        distension

 

USG Oncology (5-4-2012):  Cystic ovarian neoplasm susp malignant ( due to size of the mass and ascites surrounding liver ), Endometrial cancer not clear

 

Thorax X Ray ( 11/4/2012) : Right pleural efussion with fibro infiltrate lession at basal region, suspected pneumonia dd pulmonal metastasis

 

BNO IVP : Excretion and secretion of both kidney wnl, no obstruction observed at both pelvicocalyces and ureters. Soft tissue pelvic mass pushing the vesica. Both ureter was  pushed postero lateral

 

16/4/2012

DPL: 9,6/31,9/9340/617000

 

17/4/2012 à Pulmonal procedure room : not performing any procedure, pleural efussion was negative at both lung

 

30/4/2012 à PA Slide Review : Histologic : mucionous tumor borderline with intraepitelial carcinoma.

 

Lab (3/5/2012)

CBC: 8,8 / 28/ 12140/549.000      Alb: 2,38    Na/K/Cl : 133/3,95/93,7

OT/PT 14/13   Ur/Cr : 20/0,8    GDS : 131

 

Discusssion with  dr Andi DP SpOG(K) à Repeat the USG to establish the uterine examination

 

USG Oncology (4-5-2012):  Irregular endometrium, 3,2 mm thickness invading miometrium < 50%. Massive ascites with fibrin imaging, vol > 3000 cc. No liver metastasis.

 

Tumor Marker (4 – 5 -2012)

Ca 125: 107,3   CEA : 47,45

 

Lab (10-5-2012)

CBC : 9,6/30,6/13100/753.000   SGOT/SGPT : 37/37   Ur/Cr : 26/0,7   Na/K/Cl: 133/3,92/92,9

 

Pulmonal Tolerate: Mild

 

A: Cystic ovarian neoplasm susp malignant

     Endometrial Ca stage IA

     Hypoalbumin (2,29)

 

P: Laparatomy VC

 

 

14-5-2012 (Intraoperative report, dr Sigit P OBGYN(C), dr Andi OBGYN)

After peritoneum openned : cystic mass attached with whole peritoneum. Performed sharp adhesiolysis, during adhesiolysis, cyst was ruptured and cameout mucinous fluid. Upperborder of the mass could not identified since there was conglomeration between omentum and ileum. Impression clinically pseudomyxoma peritonii already involving upper and lower abdomen, diceded to perform palliative surgery (mass debulking). Post op diagnosis : Pseudomyxoma

 

PA Result : (22-5-2012)

Ovarian Cystadenocarcinomamucinosum intestinal papiliferum sub tiype, well differentiation.

 

31-5-2012

Patient was discharged from the ward

 

29-6-2012

Patient planned to perform 1^st chemotheraphy carboplatin 528 mg and paxitaxel 255,5 mg

CBC: 12,7/39,6/8310/466.000

 

 

6-1-2013

Complaint about diarrhea and nausea. The stool was fluid like, vomitting frequently (15x per day). Abdminal Pain (VAS 5). The patient was a loss follow up chemotherapy for ovarian cancer

 

T: 90/80   FN : 98x/m

St gen : Abd : distended until 3 fingers above umbilicus, fixed,

St gyn : I: v/u wnl

 

Lab : 5-1-2013

CBC : 14,5 / 47,4 / 6170 / 360.000  Na/K/Cl : 128/4,6/102

Ur/Cr: 53/1,1  OT/PT : 22/25   Alb : 2,72   GDS : 105

 

A: Ovarian cancer (adenocarcinoma mucinous), post laparatomy paliative 

     surgery, 1 year ago, post 1^st chemotherapy (carbopaclitaxel), lost 

     follow up

     Intake difficulties

     Cancer Pain

    Hypoalbumin

 

P : Plan for USG

     General improvement

     Chemoterapy