Case Conference April, 4th 2012

05-Apr-2012, Divisi Ginekologi Onkologi RSCM

CASE CONFERENCE

APRIL 4^th 2012

1 OUTPATIENT

 

Mrs N, 51 yo, 3248562, Jamkesmas

Residive vulvar carcinoma, post adjuvant radiation, post radical vulvectomy and inguinal lymphadenectomy

 

January 12th, 2005

•         Patient was referred to RSCM Pasar Rebo with suspected varicous carcinoma

•         CC: Mass in vulvar region, redness (+), itchy (+), vaginal discharge (+)

•         PA Pasar Rebo Hospital (10/10/08): verrucous carcinoma

 

October 23th, 2008

•         RSCM: diagnosed vulvar carcinoma st II

•         slide review: squamous cell carcinoma keratinizing, well differentiated

 

April 30th, 2009

•         Operative: radical vulvectomy, bilateral inguinal lymphadenectomy

 

June 9th, 2009

•         PA (No.PA 0902819): well differentiated vulvar squamous cell carcinoma with keratinization with macroscopically free margin 1.2 mm from the edge of tumor

•         CPC: 1,2 mm àobservation

 

December 27th, 2010

•         CC: new vulvar mass

•         àResidive vulvar carcinoma

 

December 29th, 2010

CC result:

•         if bone scan (+) à radiation, if (-) à under narcose exam

•         if MRI metastase (+) à radiation, if (-) àunder narcose exam

•         resectable: surgery

•         non resectable: radiation

 

27/06/11      MRI: metastase to parametrium, no inguinal lymph node enlargement

13/06/11      Bone scan: no bone metastase

 

June 30th, 2011

Assesment by consultant (dr Sigit P, OBGYN (C):

RT : tumor mass infiltrate right musc bulbocavernous

A: residive vulvar carcinoma, unresectable

P: radiation

 

August 4th – September 30th, 2011

•         external radiation

 

October 11th, 2011

No complain, follow up in 3 months

 

 

January 4th, 2012

CC: pain in mixturition

Gyn St: I: tumor mass (-)

à follow up in 3 months

 

March 13th, 2012

CC:  pain in vulvar region

 

Social and Obstetrical Status:

 

Married       : 1 x, P5 with the youngest child is 18 years old

Occupation : housewife

 

 

Physical Examination:

 

General status, Compos mentis

BP 120/80 mmHg     Pulse 80x/min  RR 18x/min               T afebrile

Conjunctiva   : not anemic

Heart/lung    : wnl

Abdomen       : wnl

Extremities    : edema -/-

 

Gynecological status

Inspection     : hyperemic fourchette, swelling (+)

              RVT                  : not performed due to pain   

 

Discussion with Consultan Prof.Andrijono OBGYN (C),

Biopsy on suspicious lession:

If (+)à niddle radiation

If (-)à follow up

 

March 16th, 2012

Biopsy perineum (suspicious lession)

PA result (16/03/12): well differentiated residive vulvar squamous cell carcinoma with keratinization

 

Assesment:

Residive vulvar carcinoma post adjuvant radiation, post radical vulvectomy and inguinal lymphadenectomy

 

Consideration:

Vulvar carcinoma residive, post adjuvant radiation:

Is it necessary to give either chemotherapy or repeat radiation?