Case Conference August 15th 2012

15-Aug-2012, Divisi Ginekologi Onkologi RSCM

Progresive Endometrial CA Stage III Post Optimal Debulking and Incomplete Chemotherapy Intrabdominal Mass Susp Omental Cake dd/ LN Enlargement

 

Identity

Mrs O, 52 yo 3502351, JAMKESDA

 

Patient was Referred by Karawang Hospital at May 2011  due to endometrial Carcinoma with histopathology result from curretage : adenoca endometrium, complained post menopausal bleeding and discharge from vagina. Physical examination : uterus  was enlarge as adult fist. Ultrasound : Endometrium irregular , volum lession 86mm3 susp maligna , infiltrated almost all of myometrium  thicness (>1/2)

Slide Review PA(4/5/2011 no 1103158 ) Papilary adenocarcinoma with origin hard to asses, comment:  suspected from cervical. Clinically?

31/5/2011

performed Total Hysterectomy and BSO, LN debulking, with pre op diagnostic : endometrial cancer susp high risk, post op diagnostic : optimally debulked advance stage endometrial cancer

 

PA (1/6/2011 no 1104178 )

Adenocarcinoma endometrium, endometrioid type, moderate diferentiated

Lymphatic invasion

Servicitis

Deepest invasion more than ½ miometrium

Right ovari: cystadenoma serosum ovarii

Right pelvic LN (1 LN), left pelvic LN (4 LN) consist of tumor

4 Paraaortic LN from 6 LN, consist of tumor cell

 

Discussed in CC (June 15 ^th  2011)  andd CPC ( june 26 ^th  2011)) :

discrepancy from hystophatology result ( pre operative : Papilary adenocarcinoma and post op : Adenocarcinoma endometrium) à morphologycally : papiler with type cell : Adenocarcinoma endometrioid type), the origin  was from endometrium.  No marker for paraaorta LN. ERBT as high as renal vein, and decided to  have chemotherapy :platinum based and adryamycin, no radiotherapy.

Lost follow up (her sister  who accompanied her was  also sick )

28/12/2011

patient came to piliclinic  with abdominal pain. Had been planed chemotherapy, but didn’t came. Clinically NED. US findings : no growth mass in pelvic regio, paraaortic LN erlargement susp active spreading ( sized 40x25 mm)

Assessment with dr Laila, there was no choice except chemoà continue  treatment with chemotherapy.

26/1/12-14/4/12

Patient had chemotherapy then, with Adriamycin and carboplatin 4 series, with US oncology result (5/4/2012) paraaortic LN ( same as last examination desember 2011)-enlargement 4  paraaorta à discussion with dr laila, continue chemo IV

6/8/2012

patient came to policlinic with abdominal discomfort, mass intraabdomen. Finished only 4 series of chemotherapy because of her sister was sick again.

Physical exam :Abdomen: solid mass, fixed in umbilical regio diameter 10 cm

Gyn state;

Vaginal stump smooth, loose parametrium, no mass

 

US oncology (7/8/12)

Unvisualized uterus and both adnex, no free fluid

Bowel adhesion surround blader

Hepar wnl, no parailaiac LNs enlargement

4 paraaortic LN enlarged,

 

 Conclusion

Compared with april 2012, increasing of size and amount of LN

A: Progressif endometrial Ca stage III post optimal debulking and incomplete chemotherapy

    Intrabdominal mass susp omental cake dd/ LN enlargement

 

Discussion:

Patient with post BSO-HT/ de bulking on endometrial carcinoma stage III

Post chemotherapy 4 series (incomplete)

Now the diseasse is progressif ( mass, lymph nodes)

Pain (+)

ànot respons with chemotherapy

planning : paliatif  phase à discussion in CC