Case Conference January 2th 2013

02-Jan-2013, Divisi Ginekologi Onkologi RSCM

Mrs.  GS

17/12/2012

Patient came to policlinic with abdominal lump since 1 month before admission, LMP February 2012, pregnancy test (-). The lump was in lower abdomen, getting bigger every day. Pain (+) in lower abdomen. Patient referred from tangerang hosp due to suspected invasive mola.

History curettage in September 2011 at Dinda Hosp tangerang ec Mola hydatidosa, after curettage, controlled 4x (only did USG). Bleeding (-). P3A2 (twice mola hydatidosa)

 Physical examination

BP 120/90;  RR 20; P 90

Abd = Fundal height ~ half symp- 

           umbilical, shifting dullnes (+)

Gyn St : CUT ~ half umbilical-symp

 

CT Whole abdomen non contrast (03/12/12)

Susp Peritonitis TB, asites (+), Myomatosis uteri.

 

Cytology of CX (5/12/12)

 ~ no malignancy

         

USG (18/12/12)

TGD mass, invasif through fundal & posterior corp. Haematochel &  haematoperitoneal(+) due to actife perforation of the mass.   

 

US  and Direct Observation (18/12/2012) by DR.dr.Noroyono W OBGYN (C) :

-         Mioma uteryi intramural with ascites and adhesion on omentum susp TB

à Increased of B HCG due to false positife due to liver damage

à Acut abdomen (-), defans musculer (-)

à exploration laprotomy was cancelled.

 

Discussion with DR.dr. Laila OBGYN (C) :

- Patient with high risk TGD (score 8) sugested start chemo treatment

Lab (29/12012)

-Ur/Cr = 64/1,3 ; CCT44,14; Alb 1,68

 -OT/PT 325/118

Consulted to Hepatology ~ Posponed chemotherapy 

Discussion à Patient with high level of SGOT/SGPT with high rish TGD à which chemotherapy    

                         treatment sugested given to the patient