Case conference May 16th 2012

16-Mei-2012, Divisi Ginekologi Onkologi RSCM

CASE CONFERENCE

MAY 16^th 2012

1 OUTPATIENT

 

 

Ms. M., 28 yo, 3443484, Gakin

Dysgerminoma post SOS + chemotherapy PVB (6 series)

 

December 22th, 2010

•         Patient was referred from RSUD Koja with pelvic mass (dysgerminoma) suspect residive

•         CC: abdominal mass since 1 year

•         11 months before: surgery at RSUD Koja Jakarta à left salphingoovorectomy à lost of follow up (2x visits after surgey).

•         PA Sukanto Hospital (k 2100059): dysgerminoma

•         Abdominal mass again since 2 months before.

 

January 5th, 2011

•         Review slide result: dysgerminoma of ovary

•         US: Solid ovarian neoplasmwith vol>3400cm3 susp maligna. Metastases lesion on hepar (-), paraaortic lymph nodes (-), bilateral hydronephrosis grade 2, pleural effusion (-), ascites minimal.

 

CC Result January 12th, 2011

•         Patient should be hospitalized because there was renal impairment

•         Discuss with urology department for the possibility of having URS, nefrostomy, or double G.

•         Evaluation after procedure to make better renal function, wheter we will give chemotherapy or chemoradiation.

 

January 17th, 2011

•         Urologist: bilateral DJ stent insertion

 

February - October, 2011

•         Chemotherapy Carbo/Vinblalstin/Bleomysin 6 series

 

Jully 13^th, 2011

•         FM US: post left oovorectomy, no sign of uterine abnormality, right adnexal adhesion, no sign of new mass nor metastases.

 

November 18th, 2011

•         FM US: right adnexal mass, adhesion mass (right adnexal inflammation) compared to previous US: hydrosalphing and adhesion on the right adnexa à advise: cautious on the right adnexa mass, seromarker check and US in 3 months

•         Discussion with consultant dr. Andi D., OBGYN(C)

•         Suspect residive à discuss in CC

•         CT scan

•         Discussion with consultant dr. Hariyono OBGYN(C)

•         Considering LDH before chemo 2084 à 440 (respon), eventhough (post chemo 3x 361)

•         Clinically no mass

•         US: small mass 2,5cm, pseudocyst before 4,8cm

 

 

November 24th, 2011

•         Discussion with consultant dr. Sigit P., OBGYN(C)

            Considering

•         residual mass on previous operation à seems no residu

•         LDH 2084 à 440 à respon, but there’s increasing after chemo 3 series (360)

•         Patient already stop chemo quite long (last chemo 5/10/11)

à evaluate LDH, perform CT scan if possible

 

December 21st, 2011

•         CT scan: right adnexal mass size 3,1x2,7x2,3cm, non spesific hepatomegaly, no sign of lymph node enlargement or metastases

 

January 2nd, 2012

•         Discussion with Dr. Laila, SpOG(K)

•         Two option: closed observation for 2 months, tumor marker exam+US

•         Laparoscopy biopsy

•         Patient and family choose to have observation first

 

March 6^th, 2012

•         No complain, already menstruating for 2 months

•         Physical exam: wnl

•         Oncology US:

New mass: negative

Right mass: stqa

(still on the same size with CT scan result 27/12/11 by dr. Arman,SpRad)

•         Control every 2 months, check tumor marker (AFP, LDH), US

 

May 10th, 2012

•         No complain

•         Physical Examination:

General status: wnl

Gynecological status

I     : vulva, uretra wnl

              Io  : portio smooth, pushed right-posteriorly

RT : uterus normal size and shape, no palpable mass

•         Oncology US :

New mass: negative

Right mass: stqa

(still on the same size with CT scan result 27/12/11 by dr. Arman,SpRad)

	LDH	AFP
27/12/10	2084	3,3
13/07/11	361	3,1
17/11/11	447	3,1
23/02/12	342	2,2
04/05/12	326	2,2

 

Discussion with Consultan Dr. dr. Laila Nurana, OBGYN (C)

è Bring the case to Clinical Conference on May 16^th, 2012

 

Discussion:

-          Dysgerminoma post SOS + chemotherapy PVB (6 series)

-          Next plan for this patient, observation only or operative?