Indentiy

Mrs. S, P2, 43 yo, 3528634, JAMKESDA 

Chief Complain

Abdominal swelling

History

Pts referred from Medistra (Prof Farid A, OBGYN(C) with diagnosis susp. Ovarian Ca (CA 125 1,810, ascites adenoCa) and she was planned for NAC followed with surgery.

A year before, she felt abdominal pain sometimes, after consulting to internist and surgeon she had CT Scan that showed susp. ovarian malignancy, after that she came to Prof Farid. She was referred to RSCM because financial problem. She had loss of appetite, 5 kg weight loss in 6 mos.

P2, youngest 19 yo.

No hypertension, no diabetes.

28 Nov 2011

Clinical assessment by dr Sigit P., OBGYN(C): CA 125 1,800 and fixed tumour extending to side pelvic wall.

Agree to perform NAC with 3 series of carboplastin-paxus

29 Nov 2011

After first chemotherapy was done, the slide review result came out with a conclusion glandular neoplasm suggestive to borderline adenoma. Decided to continue chemotherapy

17 Jan 2012

Third chemotherapy was done. From clinical consideration of pelvic tumor extending to rectosigmoid area and increase of CA 125 decided to have a surgery.

12 Mar 2012

An optimal debulking was done (TAH-BSO, total omentectomy, appendectomy), post operative diagnosis was advanced stage ovarian cancer.

Physical examination before surgery

St gen: (before surgery 2 Feb 2012)

BP       : 110/ 70 mmHg.  HR: 94 x/m .RR: 16 x/m.

Abd     : cystic mass palpated until half of umbilicus-symphysis level. Limited mobility. No pain.

St gin:

I           :  normal vulva and urethra

Io         : smooth portio

RVT     : smooth portio, adnexal mass wass palpable 10x8 cm size with suspicion of adhesion to rectum.

 CT SCAN (29 Oct 2011 Medistra)

Multiloculated complex cystic masses (conglomeration of multiple cysts) located at pelvic cavity surrounding right lateroposterior and uterine fundus.

The largest cyst reached 86x69 mm in diameter, while some other were smaller around 3-5 cm.

Solid part were found in few cystic tumor and omentum was suspiciously thickening at those area suggestive appearance for malignant cystic tumor  of ovary (mucinous type) with partial omental seeding and massive ascites reaction in abdomen.

No enlargement of paraaortal or pelvic lymph nodes.

Cytology result (14 Oct 2011 Medistra)

Reactive mesothelial due to acute-chronic inflammation.

dd/adenocarcinoma with well differentiation.

Cytology slide review at RSCM (29 Nov 2011)

Glandular neoplasm, suggestive of borderline adenoma.

Ultrasound post NAC (26 Jan 2012 RSCM)

Normal uterus. At cranial part of uterus found multiloculary cystic mass 10 x 8 x 11 cm = 478 ml. Septal thickness 2 mm. Some locus are anechoic, others are with positive echointerna. Solid area was found. RI 0.67.

Free fluid was found at Douglas pouch.

Found anechoic free fluid intraperitoneal until subhepatic cavity.

No enlarged lymph nodes.

Operation report (12 Mar 2012) 

-Yellowish ascites 300 cc.

-Complex mass adhered to part of the omentum, rectum, and uterus.

-Partially ruptured cystic mass originating from left ovary on top of the uterus.

-Normal uterus.

-Cystic mass originating from the right ovary 10 cm in diameter below the uterus.

-Omentum was soft and no nodules were found.

Post-operative Histology Result 26 Mar 2012 (PA 1202102)

Histologically corresponded with bilateral borderline tumor serosum papiliferum ovarii with endometriosis. Uterus with adenomyosis, adenomatoid, and leiomyoma. Omental microimplant was non-invasive.

28 Jun 2012

 Post operative CA 125 = 78.9

Assessment

Bilateral borderline tumor serosum papiliferum ovarii.

Discussion

 Are there any further therapy needed in this case???