Case Conference May 30th 2012

30-Mei-2012, Divisi Ginekologi Onkologi RSCM

CASE CONFERENCE

May 30^th, 2012

1 OUTPATIENT

 

 

Mrs. G., 54 yo, P3, 3576108, Jamkesda

Residive high risk endometrial cancer stage IB post TAH-LSO

Mixed Mullerian Tumor (MMT)

 

 

August 8^th, 2011:

•         Patient was referred to RSCM by Tugu Ibu Hospital with pedunculated submucosum uterine fibroid.

•         CC: vaginal bleeding since 3 months

•         Already menopause for 5 years

•         History of previous illness: DM type II

•         Married 1x

•         Obstetrical status :P3

•         Gynecology status : ~ pedunculated submucosum uterine fibroid

•         Diagnosis: pedunculated submucosum uterine fibroid

 

August 11^th, 2011:

•      FM US : endometrial cancer with pedunculated submucosum uterine fibroid

•      Plan to consult to oncology division

 

August 12^th, 2011:

•      Oncology division : biopsy vaginal mass àPA

•      Plan to TAH - VC

•      Ro Thorax : wnl

 

August 23^rd, 2011:

•      PA result (no.1106315)from vaginal mass’ biopsy: leiomyoma uteri

 

September 30^th, 2011:

•         Operative: TAH – VC + LSO ( right ovary couldn’t be identified) + omentectomy + pelvic lymphadenectomy

•         VC result: uterus specimen shown positive malignant epithelial cell, probably adenocarcinoma.

 

November 8^th, 2011:

•         PA result (no. 1107552) :

Ø  Endometrial endometrioid adenocarcinoma well-moderate differentiated, infiltrative with emboli lymphatic, less than 50% myometrial thickness.

Ø  Uterine carcinofibroma (mixed mullerian tumor/MMT).

Ø  No metastase on omentum, pelvic lymph node, and peritoneal mass biopsy.

 

 

Patient control in Hermina hospital, suggest to undergo chemotherapy but she refused.

 

 

May 7^th, 2012

•         Patient was came to RSCM with CC: mass on vagina since 1 month

•         Vaginal bleeding since 1 month

•         Difficulty in urinating, defecation wnl

•         General status: abd: there was solid mass until ½ umbilicus – symphisis

•         Gynecology status:

                       I: mass was came out until introitus vagina

                       VT: mass on vagina size 6x4x4 cm, fragile

•      WD/ endometrial carcinoma intermediate risk with MMT component, residive.

•      Plan to do cystoscopy, rectoscopy, CT scan

 

 

May 21^st, 2012:

•      CT scan: Uterine mass size 12.15x11.6x14 cm

                               No sign of metastase

•      Disscussion with consultant: Plan to evaluate by another consultant whether this patient operable or not

•      Informed consent to patient and family.

 

May 22^nd, 2012:

•         Assessment by consultant on duty: this patient was inoperable and plan for chemotherapy

•         Bring this case to clinical conference

 

CC result May 23^rd, 2012:

•      Plan for chemotherapy with Cisplatin-Ifosfamid

 

May 29^th, 2012:

•      Hemoglobin : 9,6/ leucocyte 12.290/alb 3,21/SGOT 61/SGPT 83

•      Ur/Cr: 22/0,5

•      CCT: 49,26

•      Disscussion with consultant:

o   Repair renal function, with insertion of DJ stent or

o   Give chemotheraphy non toxic to the renal

 

Assesment:

Residive high risk endometrial cancer stage IB post TAH-LSO

Mixed Mullerian Tumor (MMT)

 

 

Consideration:

Which treatment should be given to this patient?