Case Conference June 8th 2011

08-Jun-2011, Divisi ginekologi onkologi RSCM

Mrs. M/ 45 yo/ P / SKTM

 

16/09/2009 à Patient first came to CM Hospital with chief complain of abdominal enlargement. Patient diagnosed with ovarian cystic neoplasm with ascites and pleural effusion. We perfomed (CA-125, USG, pleural cytology).

16/09/2009 à USG FM à Cystic multiloculare mass, with no internal echo, size 13,5 x 9,0 x 9,5 cm (vol 600cc), RI 0,54

Cranial from the first mass, there were mass also size 7,0 x 5,5 x 5,0 mm (volume 100cc), ascites and pleural effusion (+)

 

Result : Bilateral cystic ovarian neoplasm with ascites and pleural effusion, suspect maligna

01/10/2009 à CA-125 à 3048

22/10/2009 à PA (092489) result adenocarcinoma

23/10/2009 à Consultant assessment à Ovarian cancer stg IV B (pleural metastases) à NAC

 

Performed NAC à CP 3 series (2/11/2009. 7/12/2009. 21/1/2010) à Partial response

04/02/2010 à USG Oncology

Left and right adnexa cant differentiate. There were cystic mass multiloculare size 18x12x17cm, septae 2-5mm, solid area (+) 25 x 19 mm, there were part with anechoic and echo internal.

 

Result : Ovarian cystic neoplasm malignant. Pleural effusion dextra

01/04/2010 à Consultant assessment à Debulking

11/05/2010 à CA-125 à 421,3

 

14/05/2010 à Performed optimal debulking

20/05/2010 à PA (1003397) result à Serous adenocarcinoma ovarii bilateral with poor differentiation and tumor implant at omental and paratube.

25/05/2010 à Consultant assessment à Adjuvant chemotherapy

Performed adjuvant chemotherapy (3/06/2010 / 28/06/2010 / 24/07/2010)

 

 

Follow up

12/08/2010 à USG result was normal pelvic, residue (-)

19/08/2010 à CA-125 à 14,1

10/01/2011 à CA-125 à 284,8

13/01/2011 à USG result was no residive mass

01/04/2011 à USG FM

At vaginal stump area and posterior peritoneum, there were hipoechoic mass, size and shape irreguler, 10-14 mm, might be came from residual tumor dd/ tumor relaps. There were free fluid

 

Result was free fluid and suspect residue tumour dd/relaps tumour

04/04/2011 à CA-125 à 2.764

13/04/2011 à Clinical Conference Oncology (Follow up 1 months ago à prepared for chemotherapy and informed consent family)

24/05/2011 à USG result was  residue tumour at vaginal stump and spreading mass at peritoneum and bowel. Massive ascites and pleural effusion.

Patient married 1x at 2005, with P0. There were no difficulties in defecation and micturition.

31/5/2011 à Pleural punction at pulmonology department

06/06/2011 à Consultant assessment brought to Clinical Conference.

 

Physical examination:

General states :

BP :120/80, P: 82, RR : 20 x/m, T : Afebris

·         Conj: anemies -/-

·         Abdomen: enlarged, shifting dullnes (+), no mass palpable

·         Extremities : warm, edema -/-

Gynecological status

I   : v/u normal

Io :  vaginal stump was smooth, mass (-), fluor (-)

RVT: no mass palpated  mass, parametrium was normal. Rectum mucous is smooth, mass (-). Ampulla rectum not collapses.

 

SUPPORTIVE EXAMINATION

24/05/2011 à USG FM

At vaginal stump area and posterior peritoneum, there were hipoechoic mass, size and shape irreguler, 10-14 mm, might be came from residual tumor dd/ spreading mass.

There were also mass at bowel and subhepatic peritoneum, suspect spreading mass.

There were massive ascites.

 

27/05/2011 Thorax PA

Bilateral pleural effusion

04/06/2011 Blood Count : Hb : 12,6, Leuco : 8.950, Trombo : 486.000

Ur/Cr: 5/0,5,  CCT : 125,22, Alb: 2,32, AST/ALT : 37/12

 

PROBLEM :

Ovarian cancer stg IV B (pleural metastastes) residive with platinum resistent

Post optimal debulking (PA : Serous Adenocarcinoma ovarii bilateral, poor differentiation)

 

PLAN:

Chemotherapy Second Line