Case Conference November 7th 2012

07-Nov-2012, Divisi Ginekologi Onkologi RSCM

CASE CONFERENCE

 

MRS.T, 47 YO.3724124

Suspected endometrial cancer advanced stage , vaginal  and liver metastasis DD/ synchronous primer tumour, endometrial and vaginal carcinoma

 

 

ANAMNESIS

 

Patient was refered from Fatmawati Hospital with cervical carcinoma and vaginal carcinoma.

At 2010 pasien complained about heavy vaginal bleeding especially when she had her periode. Then patient came to the midwife, without vaginal examination, just given the medicine for bleeding, the complain stoped but after a while the bleeding came again .

White discharge(+) since 7 months before admission, post coital bleeding (-)

Menarche 12 yo, married 20 yo, P1

 

ClINICAL EXAMINATION :

BP ; 130/80 mmHg   pulse : 82x/m  RR: 20x/m  height : 150 cm  height : 58 kg

Gen state :

Eye : not pale conjunctiva

Cor/pulmo : normal

Abd: pain (-)

 

Gyn state :

I;:v/u normal

Io : smooth portio, ex-excision was seen at left lateral vaginal wall

V/RT : nodulated tissue was palpated at anterior vaginal wall, 1/3 distal, not easily bleeding., sized 5x4x3 cm .The tissue was retracted inside

Uterus was enlarge as big as adult’s fist, smooth parametrium, smooth mucosa recti, norma TSA

 

PA result (Fatmawati Hospital, PA no:PA 12-2990)

Scuamosa cell carcinoma , poor differentiation, ( probably from the cervix)

 

PA (1207729) (review slide)

Histologic  shows malignant tumour, prone to small cell neuroendocrine carcinoma, moderate differentiation.limvovascular invasion (-).

DD/ adenoscuamos moderate differentiation

Suggestion ; IHC for diagnosis

 

Cystoscopy (26/9/12) : cystitis

Retoscopy (28/9/12): no metastasis

BNO (5/10/12)

Normal excretion and secretion kidney function

Congestion (-)

Chest-x  ray (5/10/12)

Elongation and calcification aorta

US  (12/10/12)

Vagina with solid lession 2,5x1,8x2,4 cm,  hard to evaluate bladder infiltration

Uterus with intracavum hyperechoic solid lession 6,5x5,4x6,3 cm, vol 120 cm3, vascularisation with RI 0.59, normal cervix.--> susp submucous myoma

No metastasis in liver, ien, paraaorta and parailiac LNds.

No hydronephrosis, pleural efusion and ascites.

 

 

 MRI abdomen  (15/10/12)

Malignant solid  tumor on vaginal anterior without  involving rectum nor cervix.

Endometrium Irreguler solid mass with undistinc border with myometrium especially at fundus.

Is there any possibility of  malignancy double primer

Right parailiaca and presacral  LNds enlargement with soliter nodul-S2 on liver suspected metastasis

Bilateral kidney cysts

No bladder nor rectal metastasis

 

PA 1208513 ( from endomerial sampling)

Histoogically corelated to endometrioid adenocarcinoma with scuamous defferentiation gr 2-3.

Compared with last PA result ( from vagina no. 1207729), same appearance  except scuamous differentiation is more dominant.

 

Assessment :

Suspected endometrial cancer advanced stage , vaginal  and liver metastasis DD/ synchronous primer tumour, endometrial and vaginal carcinoma

 

Discusion with dr.SigitOBGYN (C)

After have  the result of   endometrial sampling à discuss in CC  and CPC if there are any difference between PA results