Case Conference November 21st 2012

21-Nov-2012, Divisi Ginekologi Onkologi RSCM

CASE CONFERENCE

 

 

Miss. SH , 24 yo. 3726999,JAMKESMAS

 

Progresive ovarian carcinoma post laparatomy outside (Agst 2012), with multiple intra abdominal organ metastasis, left Hydronephrosis

 

 

 

Patient was refered from Purwodadi Hospital with ovarian carcinoma stage IIIC

And  underwent laparatomy at August 2002, with PA result cystadenocarcinoma ovarium serosum papiliferum. Right after the operation , she experienced abdominal enlargement, with decreasing body weight. She complained of nausea and vomiting and had been hospitalized at ERIA RSCM  for condition  improvement

 

Clinical examination :

 

Gen state :

Cachexia, vital sign within normal limit

Eye : not pale conjunctiva

Cor and pulmo : normal

Abdomen :ascites (+), solid mass , undistinguished border, ½-navel-symp. Peri-umbilical redish mass , diameter 3 cm

gyn state :

I: v/u normal

RT :solid mass , intra pelvic, sized until ½-navel-symp, smooth rectal mucous

 

Suportive data :

Ca 125 : 560,4

LDH : 773 U/l

 

US (FM -30/10/12):

solid ovarian neoplasma suspected malignancy

 

Cest x-ray: (29/10/12)

right lung fibrotic

left pleural efusion dd/ left pleuritis

 

BNO-IVP  (29/10/12):

Susp soft tissue at level S1

secretion and excretion function  of right kidney was normal; susp partial obstruction at level L4-5 right ureter

non visualized left kidney

 

CT-whole abdomen (13/11/12)

 Malignan mass with solid and cystic part in pelvic cavity with massive ascites , peritoneal and omental metastasis

Lession multiple in hepar, spleen and bowel with para-aorta and para iliaca  limphadenopaty  , with metastasis lession impression

Bilateral pleural impresion with multiple nodule at inferior lobe or right lung

Left hydronephrosis

 

Assessment :

 

Progresive ovarian carcinoma post laparatomy outside (Agst 2012), with multiple intra abdominal organ metastasis, left Hydronephrosis

 

Discussion with prof .Dr.dr.Andrijono.OBGYN (C):

·        With hepar  metastatic lessions are  quite big (  largest diameter :7.1 cm) à poor condition, succesfull rate is low , considering no treatment

·        Or : undergo chemotherapy

à discussion in CC