Case Conference October 31st 2012

31-Oct-2012, Divisi Ginekologi Onkologi RSCM

CASE CONFERENCE

 

MRS.PR, 42 YO. 3310265,SKTM

Stage IV B Cervical carcinoma ( lung and liver metastasis )massive ascites

 

 

 

At May 2009 patient was diagnosed with cervical carcinoma stage IB1 and planned to performed radical hysterectomy but patient refused the procedure because of financial problems. Patient had alternative therapy then. But the complains of spotting, white smelly odour dischage and post coital bleeding was still present.

Patient has been felt about abdominal enlargement and abdominal pain since Septembe 22^th 2012 and controled to policlinic.

 

Clinical Examination :

 

Gen state :

 

BP : 150/100   height : 150 cm  weight : 50 kg

No enlargement of inguinal, axilla and supra clavuculla LNds.

Eye : conjungtiva not pale, icteric -/-

Cor/pulmo : normal

Abdomen : ascites (+)

Extrimitas : edema-/-

 

Gyn state :

Io :  endophytic mass 5x6x5 cm

VRT :  endophytic mass 5x6x5 cm was palpated, parametrium was nodular until pelvic wall, smooth rectal mucous

 

Lab findings :

Hb 10.9 d/dL, Ht 32.4  L:12.980  Tr. 50.000

AST/ALT : 52/10  Alb : 3.27

Ur/cr 28/1.20

Blood glucosa : 102

 

 

PA biopsy (7/5/2009)

Skuamo cell carcinoma unceratinez, poor differentiation,

 

BNO-IVP (8/10/12)

Indistinctness  of abdominal cavity dd/ ascites

Left kidney secretion and excretion  are normal, no congestive signs

One of right kidney, unvisualized right renal function until  examination ends

Chest x-ray (9/10/12)

Lung metastasis

 

 

 

Cystoscopy (10/10/12)

Cystitis

 

Rectoscopy  (11/10/12):

No rectal metastasis

 

US oncology ( October 12^th 2012 )

Enlargement  of the cervix is present size 49.7 x 73.6 x  69.9 mm susp maligna, susp adhered to surrounding tissue.

There’s no  uterine focal lession , intracavum filled susp hematometra 10 cc

Solid lession with cystic part 119x112x116 mm susp from left ovarian

Hepar multiple metastasis lession (+)

Sludge gall bladder (+)

Grade II- Right kidney hydronephrosis

Right pleural efusion

Massive ascites (+)

 

Discussion in CC (17/10/12)

·        Phaliative phase , considering for   giving chemotherapy, (Length of life)

·        Waiting for cytology result

·        Ct scan abdomen and thorax,  re-discussion with those results

 

 

Cytology ascites ( no.122621)

Microscopic : ascites specimen cytology is containing mesotel cels and leucocyts.

No malignan  tumor cells

 

 

 

CT-thorax (23/10/2012)

Multiple nodule on both of lungs, corelated to metastasis

Right pleural efusion

Multiple nodule on liver with ascites, coulld be metastasis

 

CT-Abdomen (23/10/2012)

Malignant mass in cervical uteri , spread to bladder and right parametrium with massive ascites.

Multiple nodule on liver with ascites, coulld be metastasis

Right hydroureter and hydronephrosis solitary stone in inferior calix at right kidney.

Right pleural efusion

 

Assessment

Stage IV B Cervical carcinoma ( lung and liver metastasis )massive ascites

 

Discussion with Prof . Dr. dr.Andrijono  OBGYN (C) (policlinic )

No treatment à no need for having chemo, paliative phase , quality of life

 

Dr. dr. Laila, OBGYN  (C) : the possibility for giving the chemo , for length/ quality of life in paliative phase.

 

Discussion in CC.