Case Conference July 25th 2012

25-Jul-2012, Divisi Ginekologi Onkologi RSCM

Ovarian  Cancer  St IIIC Progresif Post Suboptimal Debulking with history of  Partial Obstructive Ileus due to pelvic mass suppression, inguinal metastasis, paliatif phase,

 

Identity

Mrs.J, 49 YO, 3698561

 

CC

A lump protuding from navel has been felt since 2 months.

 

History :

A lump protuding from navel has been felt since 2 months, bleeding (-)

 

November 24^th 2011

Patient was performed the suboptimal debulking ( HT-SOB, omental biopsy, peritoneal biopsy) due to  ovarian carcinoma advance stage

Residual tumor size 3,5x1x1 cm at rectum  with PA result :

Malignant Mesodermal Mixed Tumor (MMMT) and emboly lymph  was found

 

At the first , planed to have chemotherapy with Carbo-Pacli but the CCT result  were still low after 3x checked ( I. 1/12/2011 64,28 ; II. 27/1/2012 52,83 ; III 22/2/2012 20,55) à not given chemotherapy.

 

March 9^th

Patient came to policlinic with  constipation and pain in the abdomen. Physycal examination found  bluish mass, came from top of vagina, bleeding, 6x5x3,6 cm with solid pelvic mass, 8 cm, suppress the rectum

CCT: 9/3/12:27,21

 

Already disscussed in CC March 14^th 2012 :

Ocarian Carcinoma IIIC  Progressif post suboptimal de bulking

With  ileus obstructive( defecation dificulty)

à paliatif Phase :QOL (pain control,sleep disorders,Intake,obstruction,psichologys approach)

 

 

PHYSYCAL EXAMINATION

 

General Status :

Abdomen : tumor mass protuding from navel, bluish, diameter 5 cm, palpate the mass on pelvic cavity with diameter 10 cm,  fixed,pain (+)

 

Gynecological Status :

I : v/u wnl,

Io : Bluish mass filled full of vagina

RVT : Palpate mass at vagina size5x5x4 cm came from top of vagina, vagina smooth, supress to the rectum, fixed, smooth rectum mucose, recty ampulla was empty

 

A:

 

Patients with :

·        MMMT Ovarian Carcinoma st III C  progresif post Suboptimal debulking ,with umbilical  metastasis

·        History of Low CCT

·        Paliatif Phase

 

 

Discussion with Dr.Hariyono,OBGYN(C)

 

àshoud we perform radiation for decreasing size of umbilical mass ? disscuss in CC

 

Surgery report (November 24^th 2011)

 

Pre Op Dx :

Endometrial Cancer & Solid Ovarian Neoplasma susp Metastasis dd/ sinchronous Ovarian Cancer

 

Post op Dx :

Ovarian cancer Advance Stage +  submucous myoma

 

Performed

Suboptimal debulking ( HT-SOB, omental biopsy, peritoneal biopsy)

 

·        Residual tumor size 3,5x1x1 cm at rectum

·        Serohaemorrhagic ascites  500 cc

·        uterus enlarged  15X10X10  and solid tumour mass size 20X10X5 cm originated from right ovary, irreguler surface, lobulated, fragile,easy to bleed, the mass was severe adhere to anterior pelvic wall and entrapted at douglas pouch. Multiple cystic part of tumour, diameter 2-3 cm

·        Solid tumour 8x5x7 cm from left ovary,irregular surface,lobulated à performed SOS FS : granulosa cell tumour

·        Implant on bowel,peritoneum and omentum 1-3 cm

·        removed solid mass from ovary, left tumor mass 5x2,5x1 on the rectum, looks like bone tissue easy to bleed

·        Nodule  on the descenden colon and paracolica 2-3 cm, removed

·        Resection tumor of the rectum, left residu 3,5x1x1x1 cm, tumor implant in omentum 2 cm, omentectomy partial

·        Bleeding already 1700 cc, difused bleeding àabdominal packing à aff after 24 hrs.