Case conference June 8th 2011

08-Jun-2011, Divisi ginekologi onkologi RSCM

Mrs. K/ 55 years old/  P1A1

 

January 24th 2011

Chief complain

Chief complain from this patient is abdominal enlargement since 4 years before admission. Since 3 months more bigger and hard consistency. Decreasing body weight (+), fecal and micturition normal. Dyspnea (-). There is no history of vaginal discharge and post coital bleeding. Already menopause since 2 years ago. She was married for 35 years, with P1A1

 

General status:

Abdomen: palpated mass ½ umbilicus – processus xipoideus, Pain (-), immobile

Ginecological status:

I          : v/u within normal limit.

Io        : smooth portion, closed OUI, fluxus (-), fluor (-)

RVT   : uterine corpus cant identified, mass palpable until ½ umbilicus – processus xipoideus fullfil

  abdominal cavity

             Smooth rectal mucouse

 

January 25th 2011

FM ultrasound

Uterus retroflexion, Normal size and shape

In cranial uteri there is a solid mass with cystic part with inhomogen texture and unclear border, size 138x148x145 mm, vol.1359 cc, from right ovarian neoplasm

In douglas pounch there is a solid mass with inhomogen texture and irregular border, size 81x84 mm, RI 0.59, from left ovarian neoplasm

Massive Ascites è Bilateral Solid ovarian neoplasm with cystic part susp Malignancy

 

February 24th 2011

Oncology ultrasound

Uterus anteflexion, normal size and shape

Both adnexa cant identified

In cranial uteri there is a solid mass with cystic part, size 12.7x8.8x11 cm, with cystic septum 3-14mm, RI (-).

Massive Ascites

Enlargement of Paraaorta and Parailiaca lymph nodes è Solid ovarian neoplasm susp Malignancy

 

Ca 125                                    : 1318

Ro thorax and BNO IVP      : normal

Sitologi ascites fluid   : Adenocarcinoma

 

Assesement:  Solid ovarian neoplasm susp Malignancy with MS 8

Planned for NAC CP 3 series

 

March 2nd, 2011  à 1st NAC

March 24th, 2011 à 2nd NAC

April 20th, 2011   à 3rd NAC

 

April 29th, 2011

Ca 125 : 1.305

Oncology ultrasound

Multiloculare cystic mass, size more than 18.2x11.6x14.3 cm, vol. 1600cm³ ,septum 6mm, with papil and solid part, RI 0.72.

Massive Ascites

Enlargement of Paraaorta lymph nodes, size 4.7x2.2x4.4cm

Endometrium menebal 10mm

Bilateral pleural effusion à Solid ovarian neoplasm susp Malignancy

 

CT Scan (May 30th, 2011)

Solid-cystic septal mass with calcification in pelvic cavity to abdominal cavity with origin suspect from ovari, size 9.91x9.84x9.38 cm with massive ascites, suggestive malignancy

 

Assesement:  Solid ovarian neoplasm susp Malignancy post NAC CP 3 series

 

 Discussion:

After chemotherapy there is no significant improvement, the next plan :

1.      Laparatomy Debulking

2.      2nd Line Neoadjuvant