case conference october 19th 2011

19-Oct-2011, Divisi ginekologi onkologi RSCM

Mrs. S/55 yo/P8A1/Jamkesmas

 

Agt 10^th 2011

Patient came to RSCM due to vaginal bleeding since 1 months

Defecation & micturition were normal.

Married three times at age 18 yo, P8A1, youngest child 8 yo.

 

Physical Examination

General status:

     BP 110/80           

     HR 88    

     RR 18    

     No supraclavicular, inguinal or   axilla  lymph nodes enlargement.

Eye         : pale conjungtiva -/ -

Lung      : rhales -/-

Heart     : normal Heart Sound, murmur   (-), gallop (-)       

Extremity: edema -/-

Gynecological status: (consultant)

Io            :  endophytic mass, size 5x5x4 cm

RVE        : uterus normal, exophytic mass size 5x5x4 cm, infiltrated lateral fornix,  both 1/2  parametrium were noduler reached pelvic wall, rectal mucous was smooth  

 

Supportive Laboratories

Pathology Result no 1005659 ( Agt 10^th 2010)

Squamous cell carcinom of cervix, moderate differentiated. Dd/ adenosquamous carcinom

 

Chest X-Ray ( August  23^rd 2010)

Within normal limit

 

BNO-IVP (August  23^rd 2010)

Both kidney secretion & exretion were normal. No sign of obstruction.

 

Cystoscopy 

Cystitis

 

Rectoscopy

No metastasis to rectum

 

 

03/09/10-15/12/10 : chemothearapy + external radiation

 

2/12, 9/12, 15/12/10 : internal radiation

 

25/3/11 + 07/06/11 + 29/07/11 : regular control after radiation therapy.

General status and ginecological status were within   normal limit.

 

August 11th 2011 : she came to policlinic with edema  leg.

Diagnosed as lymphedem. dd/DVT.

Plan : rehabilitation + doppler US.

 

Sept 9th 2011 :  palpable mass at cruris dx regio.

Plan : Roentgen  cruris dx

 

Roentgen Cruris (sept 13th 2011) :

 rarefaksi 1/3 distal diafisis os tibia dextra disertai reaksi periosteal, kemungkinan lesi metastasis belum dapat disingkirkan.

è Discussion with dr Arman Sp Rad : Not clear bone involvement at cruris regio, at this time suspect metastasis at soft tissue from this area . Plan : FNAB guided USG.

 

Sept 20th 2011 :

complain about multiple masses at Vulva.

Gyn status : multiple nodul at right Vulva.

Plan : FNAB

 

FNAB  26/09/11 (no sitologi 112429): correspond to  metastasis squamoous cell ca cx.

FNAB 28/09/11 (no sitologi 112456): correspond to  metastasis squamoous cell ca cx.

 

 

Analysis

Cervical cancer st IIIB post chemoradiation  recidive bone and vulva meastases.

 

Management

Radiation for bone metastase or consult orthopaedi  for amputation or radiation the bone metastases.

Consult radiotherapy for possibility radiation the vulva, cause the last radiation less than 1 year.