Case Conference June 6th 2012

06-Jun-2012, Divisi Ginekologi Onkologi RSCM

CASE CONFERENCE

JUNE 06^th 2012

3 INPATIENTS

 

Mrs. S, 45yo, 354-55-05, Jamkesda

Ovarian cancer (clear cell carcinoma) post  SOD + myomectomy (2008)

postchemotherapy 2x

 

HISTORY

 

19/4/2012

CC: Abdominal enlargement since 6 months

HOP: Patient underwent SOD+myomectomy on 13/12/2008 at RSUD Tangerang, with result of malignant tumor (clear cell) à referred to RSCM, had chemotherapy 2 times (2009). Patient didn’t continue the chemotherapy due to financial reason àl oss of follow up. Since 6 months ago patient complained abdominal reenlargement, with loss of appetite, and difficulty of defecation, tough micturition was still normal.

 

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

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

 

 

Obstetrical  history:

Patient is never married, no history of sexual intercourse.

Menopause after chemotherapy (2009)

 

 

PHYSICAL EXAMINATION on admission

 

General status: cahexic, compos mentis,

BP 120/70 mmHg Pulse 82x/min RR 16x/min T 36,5⁰ C

Height 150 cm           BW 35 kg       BMI: 15.5

 

Conjunctiva    : not anemic

Heart/lung     :wnl

Abdomen       : median scar (+).  enlarged, cystic mass until navel

Extremities     : edema -/-

Lymph node     :no enlargement in supraclavicular, inguinal lymph node

 

Gynecological status

Inspection      :wthin normal limit

Inspeculo       : not performed

 RVT    : uterus was hard to evaluate, palpated cystic mass until two fingersabove navel, suggestive from left adnexae, pain (-), limited mobility, rectal mucous was smooth, TSA wnl, ampulla was not collapsed, feses (+)

 

PA RSUD Tangerang (22/12/2008): clear cell carcinoma, leimyoma

Ro toraks 16/02/2012: wnl

 

 

Gynecology US (19/04/2012)

Uterus: normal shape , sized 33 x 13 x 6 mm, anteroflexed,   parenchymal echostructure was normal homogen , no mass , endometrium not seen , no intracavum fluid. Left and right adnexae were unidentified, on cranial of the uterus there was mass massa sized 157 x 127 x 166, cystic unilocular, with positive echointernal and solid area sized 6 x 3 cm, septum thickness 2 – 3 mm, no RI

Ascites around liver (+).

Left hydronefrosis

Conclusion : Suspected progressive cystic ovarian neoplasm

 

May 1^st 2012: Outpatient clinic

Assesment by consultant: dr Sigit, OBGYN (C) àPlan to do laparotomy debulking

 

June 1^st 2012: Oncology ward

Weak condition, edema on right lower extremity

 

Ward round by dr. Fitriyadi, OBGYN,

·         patient with ascites àdo ascites cytology, and metastases work up

·         rediscuss with DPJP to evaluate operation possibility à operation was cancelled to improved patient condition

 

Lab:  Hb 6.2, Alb 2.98 à PRC transfusion 750cc, 1800 kal diet, peptisol 3x200cc

Ascites puncture: 2000cc/24 hour

 

June 4^th 2012

Ward round by consultant Prof. dr. Andrijono, OBGYN (C) : perform CT scan à chemotherapy 3x

 

 

ASSESMENT

Residive ovarian cancer, post SOD-myomectomy and chemotherapy 2 series

 

PLAN

Chemotherapy 3 series àreevaluate