Case Conference September 14th 2011

14-Sep-2011, Divisi ginekologi onkologi RSCM

Mrs. S/ 33 yo/ P3/ Jamkesda

 

HISTORY

 

July 15th 2011 : Patient came to Policlinic Cipto Mangunkusumo Hospital due to vaginal discharge since 2 months before admission. Referred from OBGYN from Tanjung Pinang due to cancer. She had vaginal bleeding since 2 weeks before admission and post coital bleeding. No complain of micturition and defecation. Never done papsmear before.

Married 1x, 19 years old

P3, the smallest child was 6 years old

 

Physical examination on  July 27^th 2011 :

 

Gen status :

No enlargement of supraclavicula and inguinal lymphnodes

 

Gyn status :

I : vulva, urethra wnl       

Io: Exophitic mass on the portio sized 4x4x2 cm, not infiltrated vagina

RVE : Exophitic mass on the portio sized 4x4x2 cm, anterior and posterior fornices were infiltrated by tumor, involvement of right parametrium and upper third of the pelvic sidewall. Uterus  normal, no adnexal mass, smooth rectal mucous.

 

FM US (July 28 th 2011) : Uterus enlarged and nodulated. There was hypoechoic and inhomogen mass in the cervix that widen to the both of parametrial sized 46x27 mm. Canalis cervicalis and endocervix was normal. There was echogenic mass around the uterus and both parametrial, with no find  border and the mass was connected with the mass in the cervix and uterus. Both of ovaries were normal. No adnexal mass of both adnexa. No enlargement of para aorta and para iliaca lymphnodes. No ascites. There was hyperechoic mass on the vesica felea come from cholelitiasis. Liver, spleen, and both of kidneys were normal.

Conclusion : Malignancy of cervix with bilateral parametrial invasion. Cholelithiasis.

 

PA Biopsy (July 22^nd 2011) no. 1105447 :

Histologically appropriate with non keratinized squamous (small) cell carcinoma, poor differentiation.

Mild lymphocytic reaction and broad necrosis.

Probably neuroendocrine tumor.

 

Cystoscopy (July 27^th 2011): Cystitis

Rectoscopy (July 22^nd 2011): no spreading to rectum mucose

 

US of Whole Abdomen (August 8^th  2011):

Cholelithiasis. Uterine myoma with calsification. No tumor spreading to intra abdominal organs.

 

BNO-IVP (July 25^th 2011) : Secretion and excretion of both kidneys were good. No sign of obstruction.

Thorax Photo (July 25^th 2011) : No abnormality of cor and pulmo. No metastatic sign.

 

Lower Abdominal CT-Scan (August 12^th 2011) :

Mass with inhomogen density which enhanced by contrast size 5.53x3.19x5.7 cm in the cervix suggestive to  cervical tumor suggestive malignant which infiltrate retrouterine soft tissue.   Suggestive bilateral ovarian cyst

 

Laboratory finding

July 19, 2011 :

CBC : Hb 11,0/Ht 30,9%/T 327.000/L 6.330

OT 16/ PT 9/ Alb 3,98. Ur 15/ cr 0,8. Fasting BG 75. Post pandrial BG 136

Na/K/Cl : 142/3,71/102,3

 

August 8, 2011 :

Total Bilirubin o,35. Direct bil 0,10. Indirect bil 0,25

 

Staging perfomed by dr. Sigit Purbadi, OBGYN (C) : Cervical cancer IB polypoid

Plan for Radical hysterectomy

 

August 22^nd 2011 : Performed Radical hysterectomy, Bilateral pelvic lymphadenectomy, Right ovary transposition, nerve sparing, and cholecystectomy

 

PA no. 1106565 : Histologically appropriate to neuroendocrine tumor of cervix, small-cell carcinoma with lymphovascular invasion

PA no. 1106566 : Chronic cholecystitis

 

PROBLEM :

Neuroendocrine small-cell cervical cancer is a rare malignancy, representing less than 5% of all cases of cervical cancer. These tumors provide a therapeutic challenge for the clinicians, as they are characterized by frequent and early nodal and distant metastases and they appear to have the poorest prognosis of the various small cell cancers. Therefore, we need discussion for the next therapy and consideration to give radiation for this patient.