Case Conference August 1st 2012

01-Aug-2012, Divisi Ginekologi Onkologi RSCM

Endometrial Carcinoma Residif, Post HR( May 2012 ) and Complete Radiation

Identity

Mrs.N, 62 YO,3390333

Anamnesis ( July 17^th 2012)

Chief complain  : abdominal pain

In March 2010 patient came to RSCM with chief complain vaginal bleeding after menopause 15 years.The result of ultrasound (  FM :30/3/10) : anterior corpus uteri mass susp  endometrial malignancy  with myometrial invasion .Oncology US (13/4/2010) :endometrial thickness vol 15 cm³ , infiltrated >1/2 myometrium anterior corpus

Performed endometrial sampling with result : (PA 14/4/10 :adenocarcinoma endometrioid endometrium, moderate differentiated).

Thorax foto (31/3/10): soliter nodule in right lobus perifer susp metastasis and had confirmed with CT-thorax (reviewed) : throrax was normal

In May 20^th 2010, performed  Laparatomy surgical staging (Procedure : Panniculectomy, total hysterectomy, bilateral salpingoophorectomy, omentectomy, pelvic lymph nodes sampling, and paraortal lymph nodes sampling)

Pre operative diagnosis          : Endometrial cancer

Post operative diagnosis         : Endometrial cancer IB

Operation report

Findings:

1.     Uterus and both ovaries within normal limit, peritoneum, omentum, liver, spleen, no enlargement of pelvic and paraaortic lymph nodes.

2.     Decided to performe : panniculectomy, total hysterectomy, bilateral salpingoophorectomy, omentectomy, pelvic lymph nodes sampling, and paraortal lymph nodes sampling

3.     Postoperative incision : porridge like tissue at endometrium, smooth portio.

 

Histopathology Result (21/5/2012):

Macroscopic speciments:

1.Uterus

2.Omentum, no lymph nodes were found.

3.2 right pelvic lymph nodes, 1 left pelvic lymph nodes

4. paraortic lymph nodes specimen : no lymph node

 

Microscopic findings:

 

1.Endometrial tumor mass extending to cervix area less than ½ cervical wall.

2.Tumor had infiltrated more than ½ thickness of uterine wall.

3.Tumor was found in  lymph vessels and perineural area.

4.Normal tuba and ovaries.

5.Parametrium was normal.

6.Pelvic lymph nodes showed no abnormalities.

7.Paraortic  lymph node specimen showed no lymph node

 

 

Conclusion :

Endometrioid adenocarcinoma, well differentiated to moderate endometrium.Grade 2.

·        Tumor had infiltrated servix area, superficial and infiltrated < ½ cervical wall

·        Tumor had infiltrated myometrium > ½ uterine wall

·        Lymph node and perineural invasion

·        No metastasis in both parametrial, adnexa, omentum and pelvic lymph nodes

June 23^th – July 27^th  2010 : External radiation continue with

Augst 2^th – 9 ^th 2010  : internal radiation

 

Follow Up

1^st  visited :

US FM (Sept 26^th 2011) :

No mass or abdomino-pelcic metastasis

 2^nd  visited (April 4^th 2012) :

Gyn state : mass(-)

3 ^rd  visited (July 17 ^th 2012)

S       : abdominal pain

O       : BP : 140/80 mmHg

            No palpable lymph nodesin supraclavicula laxilla and inguinal

            Gyn status : Io : vaginal stump was smooth

                               V/RT : mass (-)

 

USG (July 17 ^th 2012)

Suspected paraaorta limphadenophaty

Susp left CKD

 

CT scan abdomen ((July 23^th 2012)

Paraaorta lymph nodes enlargement, L3, susgestif metastasis

A : Endometrial Carcinoma Residif ,susp metastasis paraaorta lymph node

 

Discussion with Dr.Sigit.P.OBGYN (C)

à Case management , bring it to CC