Case Conference August 10th 2011

10-Aug-2011, Divisi ginekologi onkologi RSCM

Mrs. N/ 32 th/ P1

 

HISTORY

 

May 4^th 2009

She was referred by RL Hospital, Bekasi.

March 20th 2009 : spontan delivery (baby girl 2500 gr), after delivery still big stomach andwent to Obgyn and diagnosed as cyst ovarian tumor.

April 15th 2009 laparotomy left Salphingoophorectomy and omentectomy was performed due to ovarium cyst permagna. Pathology result revealed malignancy, tend to cystadenocarcinoma ovarii  moderate – poor differentiated. Normal micturition and defecation.

 

Physical examination on  May 4^th 2009 :

Gen st : within normal limit

Gyn status ; not done

 

USG examination May 13th 2009 :

Uterus wnl. Right adnexa 2,9x1,3x2,2 cm wnl. Hepar,lien, kidney wnl. Left adnexa (-).

 

Review PA May 13th 2009(0903119) :

Adenocrcinom endometrioid type ovarii well differentiated.

 

May 14th 2009 – March 29th 2011 : loss of follow up

 

March 29th 2011:

Patient came with cc: enlarged stomach.

 

PHYSICAL EXAMINATION on March 29th 2011

General status :

• Still within normal limit
• No enlargement of supraklavicular or inguinal lymph node
• Abdomen: solid mass palpated, mobilitation was limited. Size 30 x 30 cm

 

Gynecological Status :

•      Insp v/u : normal

•      Inspeculo : Portio smooth.

•      VT and RT : solid mass with limited mobilisation. Mucosa recti smooth.

 

LABORATORY FINDING

 

30/3/2011       

CBC : 12,0/10.920/306000/4,28/37    Na/K/Cl : 144/3,7/102 

albumin 5,09   Ur/Cr : 23/0,6 SGOT/SGPT : 16/07 

Ca 125 : 233,8

18/4/2011       

CBC : 11,3/34,1/9.900/288.000 Ur16/Cr 0,50 CCT 106,49 ml/mnt.

13/6/2011       

CBC : 10,1/30,8/ 5.440/304.000

OT 22 /PT20/ Alb 4,14/ Ur 24/

Cr 0,90/CCT 96,9 ml/mnt

 

USG Examination March 29th 2011:

Cystic mass with solid part and papiller part,  filled the whole abdomen cavity, irreguler form and side. Neovaskularisation (+) RI 0,41.  

 

Summary : Acites and cystic neoplsm with solid part ovarii malignancy suspected.

 

Thorax X-Ray : within normal limit

BNO IVP : Function and secretion ofboth kidney are normal.

April 15th 2011:

Discussion with Consultant : decided to give NAC with Cyclophosphamid an Carboplatin 3 cycles.

April 26th 2011 : CP 1^st cycle

May 24th 2011 : CP 2^nd cycle

June 14th 2011 : CP 3^rd cycle

 

LABORATORY FINDING

21/6/2011      CBC : 10,3/ 31,6/11.900/243.000  Ca 125 :397,0

 

USG examination june 23th 2011:

Cystic mass with solid part and papiller part,  filled the whole abdomen cavity, irreguler form and side. Neovaskularisation (+).

Summary : Acites and cystic neoplsm with solid part suspected malignancy.

 

CT scan abdomen july 27th 2011 :

Cystic mass with solid part from right ovarii with masif acites correspond to ovarii neoplasm suspected malignancy

 

Assessment :

•      Ovarian cancer progressive disease during treament.

 

Management

•      Second line chemotherapy .

•      Laparotomy with high risks maximal  only biopsy.

•      No treatment.