Case Conference May 9th 2012

09-Mei-2012, Divisi Ginekologi Onkologi RSCM

CASE CONFERENCE

MAY 9^th 2012

1 OUTPATIENT

 

 

Mrs. LM., 27 yo, 3364850, Jamkesmas

Residive ovarian carcinoma, post conservative surgery and chemotherapy 2x, gravid G2P1 5 wga

 

 

January 28th, 2010

•         Patient was referred from RSUD Bekasi with suspected ovarian carcinoma+ascites

•         CC: abdominal mass

•         3 months before: surgery at M. Jamil Hospital Padang à only biopsy and ascites citology à benign

•         PA (PJ-1411-09): ovarian cyst biopsy, fibrocollagen tissue. No evidence of benign or malignant epithel from cyst wall

 

October 23th, 2010

•         RSCM: performed laparotomy conservative surgical staging à ovarian carcionoma clinically stage IC

•         PA result:

•         cystadenocarcinoma musinosum well differentiated of right ovary

•         invasion of lymph vessel

•         no lymph nodes metastase

•         Sitology result : inconclusive, atypical cells tend to neoplasm

 

CC Result February 2^nd, 2010

•         Chemotherapy CP 6 series

 

Patient refused à want to continue medication in Padang

 

At Padang à Chemotherapy only twice, loss of folloe up due to financial problem

 

 

April 30^th, 2012

•         Back to RSCM

•         CC: abdominal mass

•         LMP 2 months ago

 

Social and Obstetrical Status:

Married       : 1 x

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       : vulva, uretra wnl

              Io                  : portio smooth, pushed right-posteriorly

              RVT              : portio pushed posteriorly, palpable cystic mass size 20x20x20cm with limited

                                     mobility

Oncology US May 1^st, 2012

Uterus normal size and shape, size 12x5cm, parenchym echostructure homogen, no mass, GS intra uterine with YS and embrionic pole with positive heart motion.

Left adnexa à multilocular cystic mass size 17x13x14cm=1834mL, septa 2mm, anechoic echointernal, no solid part

è Left cystic ovarian neoplasm progresive?

Bilateral hydronephrosis

Amenorhea due to gravid

Ca-125: 12,2

Pregnancy test: positive

 

Discussion with Consultan Prof.Andrijono OBGYN (C)

è Bring the case to Clinical Conference at May 9^th, 2012

 

Problems:

-          Residive ovarian carcinoma, post conservative surgery and chemotherapy, G2P1 5wga

-          Induced abortion continue with chemotherapy 3x à evaluation?