Case Conference June 13th 2012

13-Jun-2012, Divisi Ginekologi Onkologi RSCM

CASE CONFERENCE

June 13th 2012

 

Mrs. Y, 43 yo, 354-97-13, SKTM

Cervical Cancer stage I B1

 

HISTORY

 

May 8^th, 2012

 

Patient was referred from PMI Bogor Hospital with cervical cancer post D/C. Patient complained of irregular bleeding and leucorea, then came to PMI Bogor Hospital à performed D/C à PA result was Cervical cancer.

 

Patient came with chief complain of irregular menstruation about 2 years.

Patient also complain of smelly leukorea and post coital bleeding since 2 month ago, decreasing appetite, body weight is stable, defecation and urinary within normal limit.

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

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

 

Menstruation history:

Regular menstruation, long of menstruation 7 day,  dismenorrhea (-), change pad 2-3x

Marital history:

She was married when she was 21^st years old

 

Obstetrical history : P4 ( the oldest child is 22 years old, the youngest 10 years old )

Family Planning history: IUD

Social history :Husband works as a driver  and the patient works as a housewife

 

PHYSICAL EXAMINATION on admission

 

General status, Compos mentis

BP 110/70 mmHg  Pulse 82x/min  RR 18x/min  T 36⁰ C

Height 158 cm           BW 61 kg      

 

Conjunctiva    : not anemic

Heart/lung     :wnl

Abdomen       : wnl

Extremities     : edema -/-

Lymph node   :no enlargement in supraclavicular, inguinal lymph node

 

Gynecological status

Inspection      :within normal limit

Inspeculo       : erotion portio, easily bleed, fluor (+), fluxus (-)

RVT                 :uterus slightly enlarged, retroflexed, closed ostium, tender    parametria,   adnexal mass (-), pain (-). Smooth rectum mucosal.

 

PA Result (D/C) on April 4^th 2012 à PMI Bogor Hospital

I.                    Mixed type of cervical carcinoma

-          Villoglandular adenocarcinoma well differentiated

-          Skuamous cell carcinoma without keratin moderately differentiated

II.                  Endometrial polyp

 

 

 

Oncology USG ( May 11^th 2012 )

Uterus size 6,5x5,2x5,1 cm, retroflexed, inhomogen echostructure, with solid lesion at the posterior corpus, irregular shape, size 5,9x3,9x4,8 cm, vol. 58 cm³

RI 0,65

Endometrial thickness 5 mm, regular

Homogeny cervix, no mass/lesion was seen, size 2x4x4 cm, vol 17 cm³, no vascularization.

Both adnexae and ovary were normal

No free fluid was seen in Douglas pouch

Normal liver, lien, renal and no ascites.

Conclusion : Uterine with solid lesion at the posterior corpus size 5,9x3,9x4,8 cm suspected adenomyosis; regular endometrium (thickness 5 mm). Homogen cervix, size 2x4x4 cm, no mass/lesion.

 

Review slide ( May 14^th 2012 )

I. Cervical adenosquamous carcinoma

    Mild lymphosit reaction, necrotic was found

    Limphovascular invasion was found

II.Endometrial in proliferation irregular with tumor pattern was same with point 

     I

 

 

                                                                                                                   

 

June 1^st 2012

Examination

Inspeculo   : Cervicitis like

RVT             : normal shape and size of the cervix

A/ Cervical cancer stadium IA?

P/ Planning for Laparoscopy Total Hysterectomy ( extended/extrafasial )

 

June 8^th 2012

Re-examination :

Inspection : wnl

Inspeculo  : ectopic portio with solid part at 11-13 o’clock suspected endofitic

                      mass

RVT                        : palpable endofitic mass at 11-13 o’clock size 1x0,5x0,5 cm. Smooth                 parametria, no palpable abnormal mass from both adnexae

 

A/ Cervical carcinoma stadium IB1

 

P/ Radical Hysterectomy