Case Conference February 20th 2013

20-Feb-2013, Divisi Ginekologi Onkologi RSCM

CASE CONFERENCE                  

Mrs Y with  Cervical Carsinoma IIIB with Ovarian Cancer (Double Primer)

 

 

18-9-2012

CC : Vaginal bleeding since 3 years.

Reverred by Budhi asih hospital with cervical carcinoma.

Complain of vaginal bleeding since 2 years, getting worse, painless. Patient went to Budhi asih hospital, got blood transfusion and biopsy ® squamous cell carcinoma. Patient with no history of post coital bleeding, dyspareunia (-), getting lost weight , with loose of apetite. Patient felt abdominal mass, getting bigger (2009), but patient never control and went to alternative medicine.

Now patient feel the mass in abdomen getting bigger, pain (+) in the lower extremity, no complain in defecating n urinating.

Patient hospitalized due to DVT and CKD ® heparin and nefrostomy ® improve.

 

Married 1x , P3

Physical exam

BP 170/80 mmHg, HR 88 x/minute, RR 20 x/minute, a febrile

St gen : abd : abdominal mass until 3 fingers below navel.

St gyn : I: v/u within normal limit

Io: portio eksofitik until ½ distal vagina wall, fragile, easy to bleed.

RVT: uterus wnl, eksofitik mass palpated until ½ distal vaginal wall, stiff parametrium, no adnexal mass, TSA normal.

 

 

PA (2110107) Squamos Cell Carsinoma without keratin, poor differentiated, solid lymphosit

 

 

PA result from Budi Asih Hospital (1207525, September 18th 2012) Adenocarsinoma Mild Differentiated

 

 

USG (FM 18/10/2012)

Cystic neoplasm with Suspect malignant with carcinoma cervix spreading mass

 

 

Preoperative Diagnose :

Cervical cancer stage IIIB and cystic ovaroian neoplasm bilateral enlargement of left inguinal lymph node susp. Metastasis

 

Operation Procedure :

Laparotomy bilateral salphingoophorectomy

 

Post operative diagnose

Cervical cancer stage IIIB and bilateral cystic ovarian neoplasm

Enlargement of left inguinal lymph node susp. metastasis

 

PA result (26/11/2012):

Hystology appereance equal to: Malignant Branner Tumor, Poor differentiated already invade fallopian tube

 

What is the next appropriate treatment for this patient?

 

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