Case Conference 9th March 2011

19-Mei-2011, Divisi Ginekologi Onkologi RSCM

Mrs.T/49 yo/P2

(4/3/11) Patient controlled to policlinic brought USG result.

History

Patient first came to RSCM in 02/09/09, referred by RSUD (SpOG) with cervical cancer  and history of surgery (in 2007) due to chocolate-cyst.She also suffered from DM from 2 years ago without regular check upà consult to metabolic endocrine department.She was married for 2 times: 2 children from 1^st marriage (divorced) and no children from 2^nd marriage.

Then we performed USG (09/09/09) with result cervix inhomogen with size 4,67 x 4,78 x 5,09 cm  and mass at intrauterine cavity susppolip size 6 mm. We also performed biopsy of cervix.

(14/9/09) (PA: 0905775) result Adenosquamouscarcinoma “clear cell” focus, moderate differentiated.

Consultant staging (2/10/09): mass with size 4x 5 x 4cm, endophytic lesion. Rightparametrium was rigid, leftparametrium was smooth. à cervicalcancer stage IIb + DM type II àPlan : Chemoradiation.

Treatment performed: Chemoradiation: Platosin 4 series (03/11/09, 19/11/09, 01/12/09, 09/12/09) and external radiation (05/11/09 – 16/12/09), internal radiation  (13/01/10, 20/01/10, 27/01/10).

Follow up à11/12/09 à USG, with result cervix inhomogenvol 9,3 cm3 (decreased than USG result at 09/11/09). Patient performed pap smear (05/05/10 and 04/11/10) with result negative.

14/12/10à Patient complained of having a mass in her abdomen. à USG (FM)à result wascystic mass at the right adnexa suspected as neoplasm.

15/12/10àCA-125: 163,4

18/01/11 àUSG (Onco) à  result was right cyctic ovarian neoplasm with papillary and solid part (9,2 x 8,9 x 9,0 cm), uterus with solid part at the posterior corpus (3,7 x 2,4 x 3,6 cm) suggesting fibroid, inhomogenous cervix (1,8 x 1,0 x 1,2 cm), left pelvic with pseudocyst 9 x 7 x 8 cm, right hidronefrosis grade 1. à Discuss with consultant à plan for laparotomy.

19/01/11 à Case Conference à decided to perform laparotomy, if mass not resectableà biopsy.

25/01/11 à Performed Bilateral salpingoophorectomy.

07/02/11 à PA (1100645) à result Cystadenocarcinomaendometriod type ovary (Right ovarian) and cystadenoma mucinous ovary (Left ovarian).

23/02/11 à Patient controlled to polyclinic with PA result. à CA-125 & USG

25/02/11 à CA-125 : 857,5. 

04/03/11 à USG à result Frozen cervix, hematometra, and suspect endometrial neoplasm

Now :

General status: Conscious CM, BP 100/80 mmHg, HR 88x/minutes,  RR 18 x/minutes.

Conjunctiva :anemic

No enlargement of supraclavicular/axilla/inguinal limphnodes

C/Pwnl

Abdomen: normal, no mass palpated,

 

Gynecologicalstatus :Inspeculo: portiowas atrophy, smooth. no mass,

RVT: Uterus was enlarged size as a duck egg,anteflexion.  no mass palpated, left parametrium is smooth, rightparametrium was rigid/fixed. Rectum mucous is smooth, mass (-). Ampulla rectum not collapses.

 

Lab(25/02/2011)Hb11,5 g%, WBC 8.130 /uL, PLt  313 10³/µL, AST/ALT 13/08, Alb 4,47. Ur/Cr 26/0,6.CCT : 72,17,  Glucose : 214, Glucose PP : 404.

 

Tumour marker

25/02/11 à CA-125 : 857,5

 

USG (FM) (04/03/11)

Uterine enlarged with uterine cavity opened with diameter 3,5 cm contain sonoluscen , possibility originated from hydrometradd/ hematometra

Endometrial most of them thin and regular, except at posterior wall near OUI, there is irregular appearance and papiler, suspected malignancy.

Cervix with inhomogen texture, canaliscervicalis can’t be identified (fibrosis post radiation?)

No abnormal mass at both adnexa

Hepar, both kidney and vesica normal. Ascites (-)

Impression : frozen cervix, hydrometradd/hematometra, suspect endometrial neoplasm.

 

 

PROBLEM :

Ovarian cancerpost bilateral salphingoovorectomy, post complete chemoradiationoi cervical cancer stage IIB.

DM type II

 

PLAN :          

Chemotherapy