Case conference July 11th 2012

11-Jul-2012, Divisi Ginekologi Onkologi RSCM

Chief complain vaginal bleeding.

History

Patient was referred from Rangkas Hospital with uterus cancer. 1 year ago she suffered from vaginal bleeding followed with history of passing bloody stool. She admitted pain during voiding. She experienced post coital bleeding. She felt mass at lower abdomen and genital area during sitting position since 2 months ago with no pain. She had fouly odor discharge from vagina since 2 months ago. She seek treatment at Rangkas hospital and was referred to RSCM.

Pts was still on her regular cycle. Was married when she was 14 yo, P18(only 3 alive)A3, the smallest 14 yo.

Physical examination

Vital sign BP 110/60 HR 90 RR 12 T af BH 1.45 m² BW 39.5 kg

Gen st

Abd mass palpated at 1 finger below umbilicus, coming from symphisis, fixated, no tenderness.

No palpable lymph nodes.

Gyn st

I v/u wnl

Io exophitic mass, fragile, with diffuse bleeding was seen.

RVT uterus enlarged until 1 finger below umbilicus, adnexa was hard to evaluate, exophitic mass 6x6x4 cm extending until 1/3 distal of left vaginal and 1/3 proximal anterior vaginal wall, bilateral parametrium was involved, extending to pelvic side wall.

USG

Uterus is occupied with multiple (five) hypoechoic masses discrete margin 6.7 cm, 4.2 cm, 3 cm, and 2.4 cm in diameter correspond to intramural uterine fibroids. Enlarged cervix with hypervascularization, with irregular margin at parametrium 4.3x3.7x3.4 cm corresponds to cervical malignancy.

Normal liver and kidneys. No ascites.

PA result

PA Number 1205045

Cervical squamous cell carcinoma non-keratinized, well-differentiated. No LVI appearance.

Chest X-Ray

No abnormalities in heart and lungs. No metastasis to lungs.

BNO-IVP

Good excreting and secreting function of both kidneys.

Pelvic mass causing indentation of superior vesica wall.

No obstruction at both ureters.

Cystoscopy

Cystitis

Rectoscopy

No metastasis.

A: cervical cancer stage IIIB, multiple uterine fibroids.

Assessment by dr.Sigit P., OBGYN(C)

Consideration: cervical cancer stage IIIB, multiple uterine fibroids. Planning: radiation proceeded by subtotal hysterectomy.