Case conference June 13th 2012

13-Jun-2012, Divisi Ginekologi Onkologi RSCM

CASE CONFERENCE

JUNE 13^th 2012

1 OUTPATIENT

 

Mrs. I, 49yo, 369-24-83, Jamkesmas

Cervical cancer stage IB1 post radical hysterectomy

 

 

HISTORY

 

May 14^th2012

CC: Vaginal bleeding since 1 month before admission (referred from M Jamil Padang Hospital with cervical cancer stage IB).

 

HOP: Patient complained of vaginal bleeding since 1 month before admission, consult to OBGYNà underwent fractional curettage with PA result: unceratinized squamous cell carcinoma with moderate differentiation, from cervix; endometrium does not contain tumor cells. History of post coital bleeding (+), odorous vaginal discharge (-), pain on lower abdomen (+).

 

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

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

 

 

Obstetrical  history:

 

Married 1x for both patient and husband, on age 25 (patient) and 28 (husband)

P3, all spontaneous, youngest child 20 years old.

Patient is a housewife, the husband is a merchant

 

PHYSICAL EXAMINATION on admission

 

General status: good, compos mentis,

BP 110/80 mmHg Pulse 80x/min RR 18x/min T 36,8⁰ C

 

Conjunctiva    : not anemic

Heart/lung     :wnl

Abdomen       : wnl

Extremities     : edema -/-

Lymph node     :no enlargement in supraclavicular, axillar, inguinal lymph node

 

Gynecological status

Inspection      :wthin normal limit

Inspeculo       : portio enlarged sized 4x3x2 cm, smooth, rough/lobulated surface, with fragile mass on squamocolumnar junction area à biopsy

 RVT    :  portio palpated sized 4x3x2 cm, lobulated, smooth; CUT within normal limit, no adnexal mass, both parametrium were smooth, rectal mucous was smooth

 

PA  RS Harapan Bunda  Batam (18/05/2012):

1.      Unceratinized squamous cell carcinoma with moderate differentiation, from cervix

2.      Endometrium does not contain tumor cells

 

 

Gynecology Oncology US (15/05/2012)

Uterus: normal shape , sized 9x5x4 cm, anteflexed,   parenchymal echostructure was normal homogen , there was myoma on posterior subserous with largest diameter 2.1 cm; endometrium 7.9 mm; no intracavum fluid. Left and right adnexae were unidentified, no free fluid on Douglas’ pouch,

Liver: no nodul, homogenous hypoechoic echoparenchim

Abdominal aorta: normal caliber, no paraaortal and parailiacal lymp node enlargement.

Kidney: no enlargement on bilateral pelviocalyces system

No free fluid on pleural space and peritoneal cavity

Conclusion : Correspond to cervical cancer stage I

                       Subserous myoma

 

 

PA Review RSCM

Cervical unceratinized squamous cell carcinoma. Moderate-poor differentiation. Hard lymphocyte reaction. Mild necrosis.

 

Chest X ray: within normal limit

BNO IVP : within normal limit

Cystoscopy : Sistitis ringan

 

LABORATORY RESULT

DPL: 12,9/38/6490/316.000//94/31/33

LED : 20

PT/aPTT : 0,9x/1,0x

SGOT/SGPT : 14/10

Ur/Cr : 13/0,7

Alb : 4,2

GP/2JPP: 97/127

Na/K/Cl : 141/4,34/103

 

 

May 28^th 2012:

Patient underwent radical hysterectomy +BSO, bilateral pelvic lymphadenectomy

 

PA  conclusion from operation specimen (May 29^th 2012):

·         Cervical squamous cell carcinoma with minimal ceratinized

·         Lymphatic invasion was seen

·         Moderate lymphocyte reaction, no necrosis was found

·         Vaginal incision margin 1,3 and 5 mm free of tumor

·         Deepest invasion exteriorly ± 2 cm

·         Uterine leiomyoma

·         Right ovarian hemoragic follicle and simple cyst

·         Left ovarian hemoragic lutein and endometrial cyst

·         Left salphyngitis

·         From right pelvic lymph node: 15 lymph nodes was found, and from left pelvic lymph node: 17 lymph nodes (total 32 lymph nodes); all was free from tumor.

 

ASSESMENT

Cervical Cancer stage IB post radical hysterectomy

 

CONSIDERING:

·         Tumor sized 2 x 2 x 2 cm

·         LVSI (+)

·         Deep invasion (2 cm)à exteriorly

 

GOG score 179

 

PLAN

Adjuvant radiation