Case Conference September 12th 2011

21-Sep-2011, Divisi ginekologi onkologi RSCM

Mrs. T/ 50 yo/ P6/jamkesda

 

HISTORY

 

September 6th 2011 : Patient came to Policlinic due to abdominal mass since 10 moths before admission. She didn’t have menstrual period since 10 months. Vaginal discharge (-). Defecation and micturition normal.

Married 1x, 17 years old

P6 : Smallest child was 9 yo

 

Physical examination on  September 6^th 2011 :

Gen status :

Dyspneu         

No enlargement of axilla, inguinal and supraclavicula lymphnodes

Pulmo : vesikuler +/- (left pulmo), ronkhi -/-

Abdomen : enlarged, shifting dullness (+) , palpated mass  as high as umbillicus.

 

Gyn status :

Io: portio normal

RVE : uterus difficult to identify,  nodulated and fixed mass  fulfilled the pelvic cavity to abdomen, smooth, ectum mucous, acites (+).

 

FM USG (September 6 2011) : Uterus anteflexed normal. Myometrium was homogen. Thin endometrium. Portio and endocervix normal. Solid mass cranially from uterus with irreguler shape and texture sized 153 x 184 mm (right) and 116 x 76 mm (left) originated from bilateral ovarian neoplasm. Spreading mass along peritoneum anterior (posteriorly from the bladder) and peritoneum posterior (Douglass pouch). Liver, spleen, and both kidneys normal. Bilateral pleural effusion. Massive ascites.   

Conclusion : Bilateral solid ovarian neoplasm correspond to malignancy. Pleural effusion, massive ascites and spreading mass on peritoneum (widespread). Adhesion between mass and sorrounding organs.

 

Roentgen Thorax  (September 6^th 2011) :

Suspected pleural effusion àConsult with thorax surgery : performed WSD and then did pleurofibrosis.

 

Roentgen Thorax  (September 9^th 2011) :

Compared with photo on September 6 2011 : Reduction of left pleural effusion. Now, left pneumothorax, pneumonia, and subcutis on left lateral chestwall.

 

BNO-IVP (September 9 2011) : Left kidney suspected being rotated and pushed to posterior. Soft tissue mass on lower abdominal cavity

 

Cytology of pleural fluid (September 13 2011) : No malignant cell tumor

Cytology of ascites (September 13 2011) : inconclusive, atipic cell

 

Tumor Marker :

September 7 2011 à Ca-125 : 409,7 U/mL

September 6 2011 à LDH 1203 U/L

 

ASSESMENT :

Solid ovarian neoplsm suspected malignancy (tendency non epithelial ovarian cancer)

 

 

PLAN :

NAC with non epithelial ovarian cancer vs primary laparotomy