Case Conference January 2th 2013

02-Jan-2013, Divisi Ginekologi Onkologi RSCM

CASE CONFERENCE

2nd January 2013

 

 

Mrs. B, 43 yo

 

Patient first came to Gynaecology outpatient clinic at 6/9/2012

CC lower abdominal pain and abdominal enlargement since 6 mo

Patient felt abdominal enlargement since 6 mo, already came to nearest hospital, there was tumor at her womb. No postmenopausal nor postcoital bleeding.

Miction and defecation wnl.

                  

Menarch 12 yo

Menopause 6 years

 

Married 2x

P2

Contraception DMPA and Implant

 

General status :

Abdomen: palpated cystic mass, mobile, until naevel

 

Gyn status : I v/u wnl

Io : smooth portio, ost closed, no fluor nor fluxus

RVT : CUT wnl, there was solid mass mobile sixe 15x1412 cm originated from left adnexa. Right adnexa wnl.

 

US FM 7/9/2012

Uterus RF size and shape wnl. Homogen myometrium, basal stratum of endometrium regular, thin 4mm portio and endocervix wnl. Right ovary size ans shape wnl, Left ovary there was cystic mass with inhomogen echointernal matter with rough lines size 200x120 mm no vasularization. No sign of malignancy

Liver, spleen and both kidney wnl. ~ left dermoid cyst.

 

Lab result 10/9/2012

Ca 125 359.4 U/mL

 

Chest X ray 20/9/2012

Cardiomgaly and aorta calcification, round lession multiple with calcification at it’s border, distinct border as high as diaphragm.

Suggestion : lateral chest xray

 

Echocardiography :

TR mild, diastolic dysfunction mild, LV and RV systolic function wnl.

 

Assesment : Left Dermoid Cyst (RMI 1078.2)

Performed Laparatomy VC  Total hysterectomy and bilateral salphingoophorectomy at 23/11/2012

VC result : Teratoma with malignant epitelial part, suggested a squamous cell ca.

 

Patient was discharged at 3rd day postop no complication

Histopathology result :

Mature teratoma with malignant transformation focuses suggested keratinized squamous cell ca, moderate differentiation, no lymphatic invasion.

 

Discussion with Oncology DPJP dr. Haryono, SpOG(K)

Discuss for treatment option : radiation

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