Case Conference September 12th 2012

12-Sep-2012, Divisi Ginekologi Onkologi RSCM

Carcinoma Ovary Post Second Look Laparascopy, Clinically NED

 

Identity

Miss. T, 33 yo, 3530931

 

28/6/2011

Patient was performed lap SOS and right cystectomy  at Karya bhakti Hospital, Bogor, with surgery report when peritoneum was opened, there was chocolate fluid 1000 cc in abdominal cavity. Cystic mass white grey-ish 8 cm from left ovary, rupture and  enlargement of right  ovary 4 cm. Patology  result was clear cell adenocarcinoma bilateral.

12/12/2011

Patient came to pliclinic with enlargement of abdomen as big as 5 months pregnancy.

Gen state : wnl

Gyn state :

RT : uterus as big as egg duck, AF, mass palpated at right adnexa, fixed, normal TSA, smooth rectal mucosa

Review slide (3530431)

bilateral clear cell carcinoma ovarian

 

US FM(16/12/11)

Adenomyosis uteri, cervix endometrioma ,non visual left ovary (post SOS ?), left adnexa adhesion.

 

CT-scan  pelvic (7/2/12)

Solid mass with cystic part at adnexa, adhered with uterine fundus and corpus , infiltrated the uterus, susp maligna (left ovarian)

Right cyst ovarian

No enlargement of lymph nodes

Thorax : normal

 

14/2/12

Ca 125 :18,4

AFP : 1,4

 

Discussed in case conference  22/2/12

considering of :

ü Operation 6 months before admission

ü No data about ca 125,  peritoneum and omentum from surgery report,

ü CT pelvis : mass in adnexa

 

Treatment :

Laparascopy à assessment of resectability, take out the mass if ressectable or chemotherapy if not ressectable

US (0nco-depart 27/3/12)

Cystic mass unilocular, irregular border, 22x15x23 mm

Susp endometrioma left ovarian

29/3/12

pre op diagnosis : susp reccurrence of clear cell ovarian cancer (post SOS and cystectomy dextra outside)

post op diagnosis :

susp endometriosis cyst

performes second look laparascopy (extirpation of left ovarian cyst and cystectomy dextra outside and biopsy peritoneal implant of chocolate implants)

surgery report :

ü Cystic mass at the left adnexa, adhered with pelvic wall just below round ligament 3x4x3 cm, normal uterus, no mass seen at right adnexa, right tube was  normal

ü Performed adhesiolysis : chocolate cyst was ruptured, chocolate fluid came out, decided to extirpate the mass, clinically look like endometriosis cyst

ü Susp endometriotic implants at right peritoneum and lateral pelvic – taken out for PA exam

PA result (no 1202642/ March 30^th 2012)

1.     Cyst with ovarian atipic cells with hemociderofag focus, susp maligna ( difficult to assess the depth wall infiltration of  the cyst

2.     Reactive peritoneum tissue

16/5/12

Discussion with dr;Hariyono, obgyn (C) :

Observation , control every month

4/9/12

patient came to policlinic , complain (-)

gen sate: wnl

gyn state :

RT : uterus normal, no adnexa mass

US (6/9/12)

Uterus 7x3x3 cm, RF,

Abdominal organs : normal

Pleural and cavum peritoneum free fluid (-)

No  new mass

Ca 125 (11/6/12) :18,5   ( 5/9/12 ):45,8

Discussion with Dr.Hariyono, obgyn (C) :
patient clinically : good condition

PA result 2nd look laparascopy : malignancy cell (-), chemotherapy option  will make decrease quality of life, now the treatment is  follow up.

Discussion in CC