Case Conference July 18th 2012

18-Jul-2012, Divisi Ginekologi Onkologi RSCM

Identity

Mrs. EH 28 years-old 3697669 , SKTM

 

Chief complain

Lump at abdomen and neck.

 

History

Patient 28 years-old lady, P3, was referred from RSU Tarakan with squamous cell carcinoma dd/ lymphoma. In February 2011, she had vaginal spotting for a month. She had no significant other symptoms. She went to a doctor at Tarakan Hospital at was diagnosed as pedunculated submucous fibroid protruding to vagina. She went through currettage and was diagnosed sarcoma dd/lymphoma. She was advised for surgery. In June 2011 she had another episode of vaginal bleeding (Hb dropped until 3 g/dl), had a hysterectomy, did not know what the result.

In June 2012 she complained of an abdominal lump and another lump at her neck. She was then told to go to RSCM.

P3 --> youngest 2 years-old.

Previous Illnesses --> no hypertension, diabetes, heart, or lung disease.

Familly History --> no history of malignancy in family.

 

Physical Examination

BW: 42 kg   BH: 150 cm            BP: 120/80           

HR: 80                      RR: 20                      T:  afebrile

Eye no pale conjunctiva, no icteric sclera

Normal heart/lung

Abdomen mass palpated at 3 fingers above symphysis, solitary, smooth, firm, limited mobility, no tenderness

Extremities no edema

Lymph nodes enlargement at left supraclavicular nodes, sized 3x2 cm.

 

Gynecological status

I           : normal vulva and urethra

Io        : smooth vaginal stump

RVT a 10x10x9 cm mass was palpated with limited mobility. Rectal mucosal layer was smooth.

 

Currettage Result (T 1100120 28 Feb 2011 RS Tarakan)

Histologically corresponded to malignancy. Dif diagnosis/ endometrial stromal sarcoma ; lymphoma.

 

Immunohistochemical staining corresponding to T 1100120 slide (2110401 24 Mar 2011 RSCM)

Neuroendocrine tumour.

 

Operation report (26 Jul 2011)

Total hysterectomy, porridge-like substance came out of the cervix. Both ovaries were normal and not taken out.

 

Post hysterectomy histology Result (T 1100515 14 Jul 2011 RS Tarakan)

Cervix histologically corresponded to malignancy susp. Burkitt Lymphoma. DD/ neuroendocrine tumour.

 

Supraclavicular lymph nodes biopsy (121701 9 Jul 2012 RSCM)

Positive for malignancy. DD/ round cell sarcoma ; malignant lymphoma non-Hodgkin

 

Ultrasound (6 Jul 2012)

Uterus and both adnexa were unrecognisable. A solid inhomogenous hypoechoic mass with cystic area at center 11x8x6 cm in size was found at pelvis area.

Enlargement of 2 paraaorta lymph nodes.

Pelviocalixes dilatation of bilateral kidneys.

Free fluid in peritoneal cavity, right subhepatic and around vesica felea.

 

Conclusion:

Mass of unknown origin (uterus/ adnexae), paraaortal lymphadenopathy, minimal ascites, bilateral hydronephrosis grade moderate.

 

Chest X-Ray (6 Jul 2012)

Cardiomegaly. No sign of pulmonary metastasis.

 

Lab (29 Jun 2012)

CBC 10/31/6,600/296,000/82/27/33

AST/ALT 26/19 Ur/Cr 32/2 RBG 72

 

Assessment :

·        Progressive cervical cancer (post hysterectomy in 2011)

·        Multiple lymphadenopathy with dd/round cell sarcoma or malignant lymphoma non-Hodgkin

 

Planning : Next therapy ????