Case conference Nov 16th 2011

17-Nov-2011, divisi ginekologi onkologi RSCM

CASE CONFERENCE

November 16^th 2011

1 OUTPATIENT

 

Mrs. A/ 44yo/P3A1/343-69-93/JAMKESMAS

 

 

 

HISTORY

 

October 25th, 2010

 

Patient came to RSCM with chief complain abdominal tumor since 3 month before admission. Abdominal pain (+) since 1,5 month before admission. Menopause (+) 10 month before admission.Difficulties in micturition and defecation (+) Decreasing BW (+) 6 kg for two month.

Married 1x, 15 yo. P3A1, youngest child 10yo

FP : DMPA injection

Housewife

 

PHYSICAL EXAMINATION on admission

 

General status, Compos mentis

BP 130/80 mmHg     Pulse 89x/min           RR 18x/min   T afebrile

Height 150 cm           BW 48 kg

Conjunctiva    : not anemic

Heart/lung     : wnl

Abdomen       :  acute sign (-)

Extremities     : edema -/-

 

Gynecological status

Inspection      : wnl

Inspeculo       : smooth portio,closed OUE, Fluor (-) ,fluxes(-)

RVE                 : Uterus retroflexi, enlarge with mass size equals to egg on the anterior corpus,parametrium was stiff , adnexal mass -/- , portio motion pain (-), SAT good, ampula didn’t collapse. Smooth rectal mucosa(+),mass pushing the rectum(+)

 

 

FM USG 27^th October 2010

Uterus anteflexi, size and shape wnl, homogen myometrium, endometrial thicknes was 7 mm with reguler stratum basalis. From both adnexa until Douglas pouch there’s mass attached to the uterus and surround tissue(the gut).Right mass with papillary growth, contains inhomogen echointernal with sediment mass, fixed size 66x35x38 mm,47 cc from the right ovarii neoplasma. Left mass, solid with irregular border, fixed size  52x47x50 mm vol 58 cc, contain neovascularization with RI 0.45, from the left ovarii neoplasma. Liver and both kidneys were normal, no ascites.

Conclusion : Bilateral ovarian neoplasm suspected malignant attached to the gut in Douglas pouch dd/ Colon neoplasm.

 

3^rd  November 2010 :

BNO –IVP: Mass in pelvic minor. Secretion and Excretion function wnl. No blocking on ureter or kidney. No stone on urinary tract, lumbalspondylosis.

Thorax Rontgen: Within normal limit, no sign of metastases

 

9 th November 2010,

Patient assessed as Cystic Ovarian Neoplasm suspected malignant with malignancy score 6  (RMI: 21.088) and planned to have Laparotomy VC ,then the patient consulted to the cardiology, anesthesiology and digestive surgery.

CA 19-9 28.2 (high)

CEA 2.43

 

Abdomen CT Scan on 2^nd December 2010 :

Lobulated Solid and Cystic mass in pelvic ,after contrast the solid mass become clear suspected malignant, the mass infiltrated  the gut and rectum,others organ wnl.

 

17^th December 2010 :

Cardiology consult :mild-moderate risk, agree to operate

Anesthesiology consult : ASA II ,agree to operate

Digestive Surgery consult : agree to joint operation

 

20^th December 2010 :

Performed laparotomy VC, optimal debulking, adhesiolysis, totalhysterectomy, bilateralsalphingo-oophorectomy, debulking para aortic lymph nodes, rectum resection with Hartman procedure. VC result: carcinoma ovarii

Assesment after surgery was : Carcinoma ovarium st IIIC, Colostomy

After the surgery the patient went the ICU in good condition and came out one day after surgery to the ward.

 

PA 19^th January 2011:

Bilateral Ovarian  Cyst adenocarcinoma mucinous with bad differentiation,the mass has reached the rectum and mecentrium and paraaorta lymph nodes.

 

17^th  February 2011:

Consult to dr. Sigit Purbadi, OBGYN (C) à should be performed adjuvant chemotherapy with CP for 6 series, after 3 series of therapy ,patient was being asked to control to Oncology Clinic and to have USG examination.

 

19^th April 2011:

Patient has completed 3 series of chemotherapy

 

 

 

FM USG 19^th April 2011 :

There were no uterus, ovaries, vaginal stump wnl, there’s no abnormal mass and metastatic mass inside the abdomen and pelvic, there’s no paraaorta lymph node enlargement, no ascites, liver and both kidneys wnl,

Conclusion : there’s no new mass growth or metastatic mass on abdomino-pelvic.

 

19^th October 2011:

Patient came to oncology clinic with incomplete chemotherapy, suggested to consult to the oncology consultant and performed FM USG .

 

FM USG 19^th October 2011 :

No new mass growth or metastatic mass on abdomino-pelvic

 

25^th October 2011 :

Prof.Dr.drAndrijono, OBGYN ( C ) suggested the patient to have whole abdomen CT Scan

 

10^th November 2011 CT SCAN :

CT scan Abdomen- pelvis wnl, no mass or lymph nodes enlargement.

 

15^th November 2011 :

Patient came to the oncology clinic , after discussion with Prof.Dr.drAndrijono, OBGYN ( C ) decided that the patient with this certain condition (no development of new mass) should be followed up every three months, repair colostomy could be done à suggest to CC