Case conference October 19th 2011

19-Oct-2011, Divisi ginekologi onkologi RSCM

Mrs. K/58^th/P2

 

HISTORY

Agt 8^th 2011

Patient is referred to Ciptomangunkusumo Hospital with suspek melanoma maligna dd/ ca cx st 3 B. Normal micturition and defecation. P2 (alive child 1). Menopause 5 th.

 

PHYSICAL EXAMINATION :

General status :

• Still within normal limit
• No enlargement of supraklavicular or inguinal lymph node

 

Gynecological Status (staging consultant):

•      Insp v/u : normal

•      Inspeculo : exophitic dark mass, fragile in the vagina  size 7 x 5 x 5 cm (LL-AP-CC). Portio is hard to identify.

•      VT and RT : exophitic mass from vagina, both parametrium were loose. Retal mucous was smooth.

 

SUPPORTIVE EXAMINATION:

Melanoma maligna

Chest X-Ray ( august 8^th 2011)

No signs of metastase.

BNO-IVP (august 12^th 2011)

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

US  (August 19th 2011):

CUT AF, shape and size wnl à atrophy. Canalis cervicalis normal. Echogenic mass size 83x53x52 mm fullfilled in the vagina. The border is irreguler. No hipervascularitation ( probably necrotic mass). Vagina wall is reguler and the mass is no adhere with the vagina (sliding sign positif). The ovarium are normal. Both parametrium are free of tumor.

There are lymphnode enlargement parailiaca bilateral.

Correspond to Melanoma vagina dd cervix.

 

Cystoscopy : polipoid mass

PA VU biopsy (no PA 1106260) :

Sistitis polipoid

 

 

Assessment  :

Melanoma maligna vagina

 

PLAN :

MRI

Exenteration