Case Confrence 23 June 2010

23-Jun-2010, Oncology Gynecology Divison RSCM

1. Woman/18 yo 

Chief complaint:Follow up after 6 month laparatomy SOD, patient with no complaint.
                Defecation and mixturation within normal limit.
History:
Nov 11th 2009 : she came to oncology clinic x Hospital with chieft complaint abdominal enlargement since 5 mouth ago, referred from Pasar Rebo Hospital due to Ovarian neoplasm.
Physical exam : 
Abd: Revealed cystic mass with solid part in pelvic cavity, sized 20x15 cm, mobile, no ascites.
RT : Revealed cystic mass with solid part in pelvic cavity, sized 20x15 cm,
        Mobile, rectal mucosa was smooth.
Laboratory finding; Ca-125 : 50.10 U/ml
Dx : Cystic Ovarian Neoplasm.
Planned to perform laparatomy – VC.

Nov 11th 2009 :
US Onco:

Uterine: normal shaped, sized 5,9x2,0x3,2 cm, anteflexed, homogenic normal echostructure, endometrial line nor seen.
Cranial part of the uterine found cystic mass, fulfill whole abdomen cavity, sized 33x18x21 cm, intra locus echointernal was not found, 
 found solid area sized 5x3 cm with RI 0,28.
No free fluid at douglas pounch.
Other abdomen organs : wnl.

Conc : Cystic Ovarian Neoplasm suspected malignancy. 
Des 7th 2009   :  Laparatomy was done (Procedure: SOD + Omentectomy + Appendectomy + biopsy peritoneum at adhesion area).   
                  During operation :After peritoneum was opened, found adhesion of the tumor at anterior and both lateral side of peritoneum,
                                    perform adhesiolysis. Cytology was done. Further exploration: cystic mass from right ovary, sized 20x20x20 cm.
                                    Left ovary and uterine within normal limit.  Hepar was smooth.
                                    SOD was done (VC result : Cystic Ovarian Neoplasm with borderline malignancy) followed by infracolica omentectomy and appendectomy.
          
Des 11th 2009 :
Cytology Result (No.PA: 092918): no malignant cell
Histology Result (No.PA: 0907724):

MACROSCOPIC :
Received 4 kind of tissue with information :
I.Cystic mass. Consist of part of VC tissue and cystic mass sized 19x15 cm, already being cut, multicystic, white brownish, solid.
IA. Part of VC semcet 2 blocks, 2 cassette
IB. Cystic wall 8 blocks, 6 cassette
II.Appendix consist of 1 appendix tissue, sized 4x0,5 cm with faecalith  white bronish.
IIA. End part and middle part,  2 blocks, 1 cassette
IIB. Base point 1 blocks, 1 cassette
III.Peritoneum biopsy. Consist of small tissue sized 0,3 cm blackish, 1 blocks, 1 cassette
IV. Omentum. Consist of tissue sized 29x5 cm yellowish, no lymphnode, ,  2 blocks, 1 cassette

MICROSCOPIC
Parafin block concluded same diagnose with VC. Showed Ovarium multilocular cyst with fibrovascular  wall, showed tall columnar epithelium with lot of cytoplasmic.
Some part showed papillary growing with 2 layer of epithelium and mild atypic nucleus. Mitotic was not found. Fibrotic appendix with serous layer oedematous  and increased thickness slightly.
Omentum within normal limit. No sign of malignancy.
Conc : Ovarii papiliferum muscinous cystadenoma with mild atypic cell.

Des 17 th 2009: Controlled post operation.
                No complaint, Mixturation and defecation: wnl.
                Surgical wound in good condition.
                Dx : Ovarii papiliferum muscinous cystadenoma + post SOD
                     --> Suggested to controlled every 3 month to RSCM.

10th 2010: Follow up after 3 month laparatomy SOD, patient with no complaint.
Physical Examination :
Abd : Midline scar incision was found, no mass palpated.
RT : Uterine normal sized, no mass palpated at pelvic cavity, rectal mucosa was smooth.
Dx : Ovarii papiliferum muscinous cystadenoma + post SOD
     --> Suggested to controlled every 3 month to RSCM.

June 17th 2010 : Follow up after 6 month laparatomy SOD, patient with no complaint.  
Physical Examination :
Abd : Midline scar incision was found, no mass palpated.
RT : Uterine normal sized, no mass palpated at pelvic cavity, rectal mucosa was smooth.
Dx : Ovarii papiliferum muscinous cystadenoma + post SOD

June 17th 2010: US Onco : Uterus: normal shape, sized 4.9x2.3x2.8 cm, anteflexed, homogenic normal echostructure,
                                  no lesion and mass, regular endomentrium 9.9 cm.
                   Right adnexa : not seen
                    Left adnexa : revealed multilocular cystic mass, sized 4.1x3.3x3.4 cm, vol 25 cm3, septal thickness 12 mm, papil was found, no vascularization.
                                  Free fluid minimal at douglas pounch.
                                  Other abdomen organs : wnl
                           Conc : Cystic Ovarian Neoplasm , vol 25 cm3.

Problem :  Left Cystic Ovarian Neoplasm + Ovarii papiliferum muscinous cystadenoma + post SOD.

Problem solving :
1. Close of follow up.
2. Laparoscopy cystectomy.