Case Conference November 1st 2012

01-Nov-2012, Divisi Ginekologi Onkologi RSCM

CASE CONFERENCE

 

Mrs. M, 41 yo,376-24-11, SKTM

Invasive Mole , Vaginal Metastasis.

 

21/10/12

patient  came to emergency theatre at  3^rd floor RSCM, with vaginal bleeding since 3 hrs before admission , with BP 90/60, was assessed with hypovolemic schock, got resussitation and transfusion.

(patient was refered from Tangerang Hospital with  susp invasif molle ,choriocarcinoma)

 

One month before admission, patient was diagnosed with hidatidiform mole with b-hcg (>1 .000.000) and performed curretage at Tangerang Hospital.  Post  curretage evaluation , uterus was normal, b-hcg quantitative ( 2 weeks after curretage ) was 17.000

One week before admission , patient c omplained about her vaginal bleeding and performed  total hysterectomy at Tangerang Hospital, and had no complain after the surgery.

Three hours before admission patient complained of heavy vaginal bleeding.

History illness :

Hypertention (+)

 

P4,

Cntraseption : DMPA

 

Gen state :

BP : 180/90 mmhg  Pulse :110  RR: 20 x/m

Conj pale

Cor/pulmo : normal

abdomen :  pain(-), mass(-)

 

Gyn state ;

I : v/u normal

Io : smooth vaginal stump, there was a mass 3 cm at anterior wall of vagina, actve bleedingà byopsy

V/RT : mass was palpated at anterior vagina wall 3x3x1 cm, fragile, , bleding, smooth vagiinal stump

 

Adnexal mass :-/-, smooth parametrium

 

US  (emergency theatre ):

Right kidney : 6.25x3.05 dan left kidney 6.18x3.46 m, hepar normal

Conclusion :kidneys and hepar within normal limit

 

 

US FM (29/10/12) :

post total hysterectomy appearance and SOD,  normal stump of vagina – granulation tissue

 

Lab findings :

Hb : 12.5/Ht :36.5%/ E: 4.33.!0⁶,/L:13.060/ tr. 322.000

Na/K/Cl : 142/3.3/113

Ur/cr : 22.4/0.52

AST : 7/ALT :7

Alb : 3.43

Beta-HCG : 4034

Assessment :

History of hypovolemic shock ec vaginal bleeding ec susp invasive mole , vaginal metastase

Hypertention

 

FIGO scoring (modified WHO prognostic scoring system as adapted by FIGO): score 3 à low risk

 

Discussion with prof Andrijono : patient with  vaginal metastasis  à low risk ,planning  got chemo with Mtx + Etoposide

 

Now patient is already in the ward, from discussion with DPJP   (dr.Hariyono, OBGYN (C)) ,plan to have just methotrexat ( single agent), discussion in CC.