Case Conference August 29th 2012

29-Aug-2012, Divisi Ginekologi Onkologi RSCM

Reccurence Tubal carcinoma, Hystory of SOB-HT nov 2010

History of Unconsious Due to Septic Shock, Improvement

Bilateral Pleural Effusion on Bilateral WSD, Post Right Pleural Fibrosis, Hypoalbuminemia,DIC

 

Identity

Mrs.S, 49 yo,P3,3717976,jamkesmas

 

Refered from Abdul Moeloek Hospital Lampung with ovarian ca recurens

 

At November 1 st 2010 performed SOB-HT  and adhesiolysis with  dx pre op :ovarian cyst, post op dx : neoplasma ovarian cystic susp maligna ( operation findings :  uterus normal, cystic mass from right ovary 20x25 cm, adhered with rectum and uterine fundus, left ovary and tube were normal).

After the operation, patient didn’t control to hospital although the doctor said that the result was cancer and wanted to refer to RSCM.

PA result (PA.1101-10)

 cystadenoma serosum ovary in one side, and adenocarcinoma tuba in other side

 

July 25 ^th 2012

Patient came to Abdul Moeloek with distended abdomen. decreasing body weight (+), patient refered to RSCM

 

PHYSICAL EXAMINATION

Gen State :

Body weight : 35 cm  Height :150 cm

Eyes : pale conj -/-, icteric -/-

Thorax: WSD bilateral

Abd: ascites (+), with solid part in superficial susp omental cake

 

Gyn state :

Io: mass  filling the vagina

RVT : Solid mass filling  the vagina

Good TSA, smooth rectal mucous, solid mass palpated extra lumen, pressing the rectum.

 

LAB FINDINGS:

BNO : Soft tissue filling pelvic cavity, Until hemiabdomen

Bilateral pleural efusion

 

Ultrasound (31/7/12)

solid mass filling pelvic abdomen,hypoechoic,inhomogen,7X10X7 cm, RI : 0,54,free fluid anechoic (+),nodul hepar 36 mm
Coclusion : ascites, susp hepar metastases, moderate bilateral  hydronephrosis

 

 

cytology pleural efusion :

10/8/12 : Pleura  : eksudat
13/8/12: mesotel reaktif

 

cytology ascites : no malignan cells

 

 DPL :8.9/21730/293.000 ur/cr : 61/0,5

Albumin : 1.07

 

Thorax photo :

Pleural Effusion	Right	Left
27/7/12	+	+
1/8/12	++	++	WSD
22/8/12	-	++, Collapsed lung	WSD

 

Follow up (28/8/2012)

S: weak, history of apneu during right pleuro fibrosis yesterday

O: CM, BP: 90/40 mmHg  N:88x/m, regular, smooth,RR:18x/m

    C/P: bilateral WSD, serous

     abd: ascites 9-), pain (-)  

     gyn state: bleeding-

 

Assessment :

·        Reccurence Tubal carcinoma, hystory of SOB-HT nov 2010

·        History of unconsious due to septic shock, improvement

·        Bilateral pleural efusion on bilateral WSD, psot right pleural fibrosis

·        Hypoalbuminemia

·        DIC

 

Planning :

Albumin corection

Tienam 2X1 gr

Levofloxasin 1X 500 mg

Balance

Chest physiotherapy

•         Heparinisation

•         IVFD : TE: aminofluid = 1;2

•         Nacl 0.9%

 

Discussion (dr.Rudd Bekkers)

Planning to get chemotherapy with carbo  AUC 2, weekly, 3 series,informed choice with the family