Case Conference Dec 7th 2011

07-Dec-2011, Divisi Ginekologi Onkologi RSCM

Clinical Conference December 7^th 2011

Mrs N/49 th/P1A0/3520703/jamkesda

CC : Lower abdominal pain since 3 months before admission.

History :

Lower abdominal pain since 3 months before admission. Palpable mass in abdomen since 3 months ago. Decreasing bodyweight since 1 months , decreasing appetite. Difficulty defecation, micturition wnl. She underwent ultrasound by Obgyn and being told as ovarian neoplasm. She went to  PMI hospital and being told cervical cancer. She had vaginal bleeding and leukorrhea since 3 months. Postcoital bleeding (-),

P1A0, married  2x in year 74 dan 84.  KB : -

Physical examination on admission

St gen:

TD: 100/60 mmHg.  N: 92x/m. P: 18x/m S:36,5

St.gen:

Abd : palpable solid mass until 1 finger under navel and mobile.

St gin (consultant)

I  :  v/u tenang

Io: portio with exofitic mass, fragile, easy to bleed, diameter 4 cm, pada lateral vagina.

RVT : fragile exofitic mass  diameter  4 cm in portio, both parametrium smooth. Palpable solid mass suspected from uterus until 1 finger under navel,mobile. Adneksa mass -/- Rectum mucous smooth,massa(-),feses(+), blood(-)

 

USG FM  (12/10/11):

Uterus cavity filled hyperechoic mass with unclear border (stratum basalis ireguler) and irreguler form with hyperplasia  16 mm, probably from neoplastik endometrium DD/ hiperplasia. Cervix hiperechoic mass with irreguler form and border, size 68x35x50 mm, from malignancy.

 

Conclusion:

Cervical malignancy. Invasion until parametrium. Malignancy endometrium DD/ hiperplasia endometrium,  ascites and solid ovarian neoplasm bilaterally suspected malignancy, not clear whether single or multiple primer.

 

PA ( 29-09-11) :

Squamous cell carsinoma  keratinized, poorly diferentiated DD/  adenoskuomosa carcinoma , poorly diferentiated .

 

BNO-IVP ( 06/10/11)

Function secretion and excretion both renal wnl. No signs of hydronefrosis.

 

RO thoraks (06/10/11) :wnl

Rektoscopy: no metastase

Sistoscopy : sistitis

 

21-11-2011 :

Dx pre op: solid ovarian neoplasm susp. Malignancy (susp meta cervix dd/ double primer)

Perfomed laparomy frozen section, myomectomy and radical hysterectomy.

Dx  post op: Cervical cancer IB2, uterine myoma, ca ovarium, suspect ca endometrium

 

PA ( 1109182):

Histology correspond to :

-          Adenocarcinoma endometrioid moderate diffrentiation at the cervix and ovarium. Dd/ Neuroendocrine

-          Endometrium showed the same cell type. Myometriumshowed proliferation muscle with clear border correspond to Leiomyoma.

-          Lymph node pelvic bilateral and paraaorta infiltrated with the same cell type tumor.

-          Vagina border and parametrium free of tumor.

 

 

 Assesment :

-          Ovarian cancer advance stage ( not yet omentectomy)

-          Neuropati atoni bladder

Plan:  Chemotherapy.