Case conference March, 28th 2012

29-Mar-2012, Divisi Ginekologi Onkologi RSCM

Oncology case conference march 25^th 2012

Mrs. Siti N, 49 yo

Post optimal debulking + 3x NAC and 3x adjuvant chemoth (carboplatin+paclitaxel) due to ovarian cancer (clear cell) advance stage

•       CC: bring lab result (Ca125 119)

•       8/5/11: came with cystic ovarian neoplasm susp malignancy (Ca 125 354.9)

•       19/5/11:Cytology ascitesà adenocarcinoma

•       8/6 until 28/7/2011:Chemoth/CP 3x, Ca 125 40.7

•       28/9/11: post NAC 3 series,

–      Stable disease

–      Resectable (+), plan for laparotomy

•       10/11/11: optimal debulking (TAH BSO, total omentectomy, right paracolic peritonectomy, tumor implant excision, appendectomy)

•       22/11/11: PA result shows clear cell carcinoma with poor differentiation

•       18/1/12: change chemoth/ with carbo-paclitaxel 3 series (25/1 until 7/3)

Physical exam

Compos mentis

BP 120/70 mmHg              Pulse 89x/min  

RR 18x/min         T 36.8

•       Conjunctiva        : not anemic

•       Heart/lung          : wnl

•       Abdomen            : wnl

•       Extremities         : edema -/-

Gynecological status

•       Inspection           : wnl

•       Inspeculo            : smooth vaginal stump, no mass

•       VRE                        :smooth vaginal stump, no palpable mass, TSMA wnl

US May 13 2011 (before NAC)

-          Anteflexed uterus with multiple intramural myoma size 28-38 mm. Regular endometrium.

-          Cystic mass on right adnexa with solid part, irregular shape and border, RI 0.28 could be originated from right ovarian neoplasm

-          Normal left ovary

-          Liver, spleen and both kidney normal

-          Ascites (+)

Conclusion :

Ascites and cystic mass with solid part of the right ovary, suspected malignancy

US August 22 2012( post NAC 3 series)

-          anteflexed uterus with multiple intramural and subserous myoma size 27-46 mm. Regular endometrium.

-          right adnexa : cystic mass with solid part, regular size and shape, size 182x110x184 mm (vol~1950 cc), neovascularization (+) RI 0.37 ~ right ovarian neoplasm.

-          Normal left ovary.

-          Ascites (-).

-          Normal liver, spleen, both kidney and bladder.

Conclusion :

-          Intramural and subserous myoma

-          Cystic neoplasm with solid part suspected malignancy (from previous ultrasound, mass volume is getting bigger).

US March 20 2012 (post Adjuvant chemotherapy 3x)

•       Conclusion: no new mass visualized

Ca 125 (March, 21 2012) : 119

Diagnosis

•       Post optimal debulking + 3x NAC and 3x adjuvant chemoth (carboplatin+paclitaxel) due to ovarian cancer (clear cell) advance stage

Problem

•       Post optimal debulking + 3x NAC and 3x adjuvant chemoth (carboplatin+paclitaxel) due to ovarian cancer (clear cell) advance stage, complete response

•       Increased ca 125 level ( 119) and no mass on US

Plan

•       Continue chemotherapy 3 series or observation??