Case conference May 9th 2012

09-Mei-2012, Divisi Ginekologi Onkologi RSCM

CASE CONFERENCE

MAY 9^th, 2012

1 OUTPATIENT

 

Mrs. E, 31 yo,3690730, JAMKESMAS

Vulvar carcinoma with cystic ovarian neoplasm susp.malignant (RMI 732.6)

Bilateral hydronephrosis on cystostomy

 

 

HISTORY

 

April 10^th, 2012

 

•      Referred by RSUD Bekasi with cervical cancer post cystostomy

•      Chief complain: mass on genital since 1 year ago, enlarge and fragile, pain (+)

•      Vaginal discharge (+), foul odor.

•      Difficulty in urinating àcystostomy in RSUD Bekasi

 

Previous history                    : DM (-), HT (-), cor/pulmo disease (-)

                                                History of tumor /cancer(-)

Previous history in family    : DM (-), HT (-), cor/pulmo (-)

Marital history                       : 1x

Obstetrical history                : P2, youngest 10 yo

 

PHYSICAL EXAMINATION

 

General status

Compos mentis

BP 120/80 mmHg Pulse 86x/min RR 18x/min T 36.7⁰ C

 

Conjunctiva    : pale -/-

Heart/lung     : wnl

Abdomen       : Palpable cystic mass with until 2 finger above umbilicus, cystostomy: no obstruction

Extremities     : edema -/-

Lymph node   : no enlargement in supraclavicular and inguinal lymph node

 

 

Gynecological status

Inspection      : Vulva with exophitic mass, fragile and easily bleed à     biopsy

Inspeculo       :  can not be done due to vulvar mass.

RVT                 :Vaginal wall was rigid with exophitic mass, cervix was smooth, uterine size was normal,there was abdominal mass fixed seems unite with mass at the vagina.

 

Laboratory :

CBC        : 12.6/39.3/9420/370000/89/28/32

OT/PT : 17/7

Ur/Cr    : 21/1.1

Alb         : 3.87

Cr (urine) 24 hr: 0.81

Volume urine:2170

CCT: 60.14

Na/K/Cl: 135/ 4.59/ 93.9

Ca-125:244.2
Urinalysis: wnl

 

PA (no.1202991),April11^th,2012:

Adenocarcinoma mucinosum vulva

 

CXR, April 23^rd, 2012:

Wnl, no sign of metastases

 

Gynecology US, April 24^th, 2012:

Intra abdominal mass susp.malignant ovarian cyst neoplasm

Urinary retension

Bilateral hydronephrosis

Minimal free fluid in fossa splenorenal

Vaginal cancer cannot be assessed.

 

 

 

Assessment by consultant on April 26^th, 2012:

Patient was diagnosed as vulvar carcinoma with malignant cystic ovarian neoplasm susp synchronize.

Plan to perform NAC with (Carboplatin AUC 5 and Paclitaxel).

If response àPelvic exenteration.

 

Laboratory on May 07^th, 2012

CBC        : 12.8/39.3/9950/408000/88/28/32

OT/PT : 18/7

Alb         : 3.86

Ur/Cr  : 16/1.1

Volume urine:5250 ml

CCT: 49.32

Na/K/Cl: 139/4.24/97.6

 

 

ASSESMENT

Vulvar carcinoma with cystic ovarian neoplasm susp.malignant (RMI 732.6).

Bilateral hydronephrosis on cystostomy

 

Assessment by consultant: Prof. Dr. dr.Andrijono, OBGYN (C)

Next plan for this patient will be discussed in case conference

 

Consideration:

Vulvar carcinoma with malignant cystic ovarian neoplasm susp synchronize, with hydronephrosis bilateral on cystostomy and low CCT (49.32),

 

Which therapy we should give to the patient ?