Case Conference December 26th 2012

26-Dec-2012, Divisi Ginekologi Onkologi RSCM

CASE CONFERENCE                  

 

 

Mrs.N, 65 yo, 3724187

 

18/10/2012

 

Patient came to policlinic with abdominal lump.               .

 

Patient has been felt abdominal lump since 1 years before admission with no pain nor decreasing body weeight. There were difficulties in mixturition and defecation. Patient came to Tarakan Hospital, was diagnosed with solid ovarian neoplasm \ refered to RSCM

 

 

Hypertension (+)

 

P4, married 40 years

menopause 15 years

 

Clinical Examination:

 

Gen state :

BP : 130/90 mmHg

 

Abdomen : abdominal enlargement ,cystic mass with solid part was palpated filling abdominal cavity

 

Gyn state :

I : v/u normal

Io : portio couldn’t be evaluated

RVT : cut was hard to be evaluated, ostium was retracted to anterior, cystic mass with solid part was palpated filling whole abdominal cavity, smooth parametrium, smoooth rectal mucousa.

 

US (25/9/12-FM)

Retroflexed uterus, atrophy, was pushed by mass to anterior. Homogen myometrium, endometrial stratrum basalis was thin and reguler.

There was cystic mass filled almost whole abdominal cavity-pelvic, with sonolusen particle. The mas consisted solid part –papiler, 220x206 mm, no vascularization, suspected from ovarian neoplasm.

 

 Conclusion : permagna cystic ovarian neoplasma with solid part-papiler

Suspected maligna stilll couldn’t be excluded

 

Ca 125 (24/9/12); 7.0

 

19/10/2012 underwent (optimal debulking,complete resection

 

Pre-operative diagnosis  :

Cystic ovarian neoplasm with solid part, suspected malignancy,  with RMI ; 63

 

Post-operative diagnosis:

Ovarian Cancer, clinically stage III C

 

Operation Procedure  :

Laparotomy Total  Abdominal Hysterectomy, Bilateral Salpingo-oophorectomy, Omentectomy (optimal debulking,complete resection

 

Surgery findings :

-         After the peritoneum was opened, à no ascites. 200 cc of Normal Saline was poured for peritoneal washing, àcytology examination

-         There was a cystic mass, adhered to the peritoneum, omentum and intestines.

-         Adesiolysis à cystic mass, originated from the left ovary. àthe mass was taken for FS.

-         uterus, the righ ovary and tube were within normal limit.

-         The FS resultà adenocarcinoma of the ovary”.

-         Performed total hysterectomy and right salphingoophorectomy.

-         On exploration, the omentum was thickened and there was suspected a nodule at the left part of the omentum, diameter, 2 cm à suspected IIICà decided to perform omentectomy,

-         there was no enlargement of the pelvic nor para aortic lymphnodes

-         The liver , appendix and lien ,were within normal limit,

-         Blood loss 500 cc, urine 500 cc clear

PA result (no PA:1208539)

 

Specimen from left ovarian revealed to adenocarcinoma pattern with pleomorphyc cell and hyperchromatic nucleus. There was also cystic tumor with fibrovascular wall and hing columnar epitel.

Right ovarium revealeddouble endosalphyngiosis. Uterus with no abnormality, thin atrophyc endometrium, normal servix and omentum

 

Conclusion

Left ovarian carcinoma

Left ovarian Ccstadenoma mucinosum papiliferum

 

Cytology  (no. 122694)

No malignan cells

 

Assessment :

Ovarian carcinoma stage IA

 

Disscussion with dr.Sigit OBGYN (C):

·        Operative report –clinically stage IIIC , from PA result : minimalà Stage IA( without data cytology )

·        Cytology result : no metastase

·        Discussion in CC

 

Patient  with stage IA ovarian carcinoma ( from PA and cytology result) àobservation, clinically and tumor marker