Case conference April 25th 2012

25-Apr-2012, Divisi Ginekologi Onkologi RSCM

CASE CONFERENCE

APRIL 25^th 2012

1st OUTPATIENT

 

Mrs AR, 48 yo, 3535118, Askes

Cervical carcinoma IIIB post complete radiation with partial response, Type II Diabetes Mellitus

 

January 11th, 2012:  

Patient was referred to RSCM from Manado with cervical carcinoma st IIB, bulky tumor (>4cm)

2  years before vaginal discharge (+), post coital bleeding (+)

August 2011: vaginal bleeding à biopsy PA: clear cell carcinoma

Married 1x, P3

 

February 6th, 2012:

St Gyn:   

•      I: vulva /urethra wnl

•      Io: exophytic cervical mass size 7x5 cm, vaginal wall smooth

•      RVT: exophytic cervical mass size 7x7x5 cm, until both parametrium, and left pelvic wall

 

Lab:

CBC: 8.6/29.1/29600/367.000

FBG: 398 mg/dl, PP 570 mg/dl

OT/PT: 11/7 Ur/Cr: 22/0.4

HbA1C: 12.5%

 

September 24th, 2011 PA no.PDPA 1053, Manado:

Clear cell carcinoma

 

Histopatology January 11th, 2012, slide No. 1200306:

Squamous adenocarcinoma, poor differentiated

Lymphovasculer invasion (-), moderate necrosis, mild lymphocyte reaction

 

US Fetomaternal:

Cervical malignancy (bulky tumor), invasion until OUI, both parametria, posterior bladder wall

Paraaorta lymphnode enlargement and suspected metastatic on both parailiac lymphnodes.

 

Rectoscopy: no rectal metastase

Cystoscopy: cystitis

Chest X-ray: no sign of metastase

BNO-IVP: suspected right hydronephrosis grade I, both renal function wnl

 

 

Metabolic endocrine consultation:

Regulating blood glucose

Metformin 3x850 mg, Glurenorm 2x1

 

 

 

 

 

 

 

February 24 th, 2012- April 6th, 2012:

Performed external radiation

 

March 16th, 2012- April 9, 2012:

Performed internal radiation

Total dose 73 Gy, partial response radiation, with cervical residual mass

 

April 24th, 2012

Both legs swelling, defecation and mixturition wnl, vaginal bleeding (-)

 

Physical examination:

St gen :

•      No enlargement of supraclavicular, axillar, or inguinal  lymph node

•      Lower extremities: oedema (+/+)

St gyn:

•      I: vulva /urethra wnl

•      Io: mass size 3x3x3 cm on portio, fluor (+), fluxus (-)

•      RVT:palpated portio mass size 3x3x3 cm, no infiltration on both parametrium

 

    

 

 

Oncology US April 24th, 2012:

Cervical size post radiation 30 mm

Enlargement left inguinal lymphnode

Bilateral pleural efusion

 

Assesment:

Cervical carcinoma IIIB post complete radiation with partial response, Type II Diabetes Mellitus

 

Discussion with consultant (Prof.Andrijono, OBGYN (C)) :

will be discuss further in clinical conference

cervical carcinoma IIIB partial response post complete radiation with residual tumor 3x3x3 cm

à needle radiation?