Case Conference January 9th 2013
09-Jan-2013, Divisi Ginekologi Onkologi RSCMCASE CONFERENCE
January 9 th 2013
Mrs.R, 31 yo, 354-50-19
Residif Ovarian Carcinoma Post Debulking (5-2012) and Lost Followup Chemotherapy (Carbo-Paclitaxel), Intake Difficulties, Cancer Pain, Hypoalbumin
3-4-2012
CC : Complaint about enlarged and full filled abdomen since 4 months ago. With decreased appetite. Decreasing of body wheight was noted ( 8 kg in 4 mo), also complaint about irregular bleeding outside her menstrual cycle. Went to Rangkas hospital, performed curretage 4 months ago( PA result: Endometrium : well differentiated mucinous adenocarcinoma). Abdominal pain (VAS: 5)
Married 1x at age 12.
P4 : olodest 18 yo, youngest 9 yo.
FP : coitus interruptus
St gen : abd : distended untill 1 finger bellow PX, cystic, mobility hard to
evaluate
St gyn : I: v/u within normal limit
Io : Fluxus +
RVT : uterus and both adnexa hard to evaluate due to abdominal
distension
USG Oncology (5-4-2012): Cystic ovarian neoplasm susp malignant ( due to size of the mass and ascites surrounding liver ), Endometrial cancer not clear
Thorax X Ray ( 11/4/2012) : Right pleural efussion with fibro infiltrate lession at basal region, suspected pneumonia dd pulmonal metastasis
BNO IVP : Excretion and secretion of both kidney wnl, no obstruction observed at both pelvicocalyces and ureters. Soft tissue pelvic mass pushing the vesica. Both ureter was pushed postero lateral
16/4/2012
DPL: 9,6/31,9/9340/617000
17/4/2012 à Pulmonal procedure room : not performing any procedure, pleural efussion was negative at both lung
30/4/2012 à PA Slide Review : Histologic : mucionous tumor borderline with intraepitelial carcinoma.
Lab (3/5/2012)
CBC: 8,8 / 28/ 12140/549.000 Alb: 2,38 Na/K/Cl : 133/3,95/93,7
OT/PT 14/13 Ur/Cr : 20/0,8 GDS : 131
Discusssion with dr Andi DP SpOG(K) à Repeat the USG to establish the uterine examination
USG Oncology (4-5-2012): Irregular endometrium, 3,2 mm thickness invading miometrium < 50%. Massive ascites with fibrin imaging, vol > 3000 cc. No liver metastasis.
Tumor Marker (4 – 5 -2012)
Ca 125: 107,3 CEA : 47,45
Lab (10-5-2012)
CBC : 9,6/30,6/13100/753.000 SGOT/SGPT : 37/37 Ur/Cr : 26/0,7 Na/K/Cl: 133/3,92/92,9
Pulmonal Tolerate: Mild
A: Cystic ovarian neoplasm susp malignant
Endometrial Ca stage IA
Hypoalbumin (2,29)
P: Laparatomy VC
14-5-2012 (Intraoperative report, dr Sigit P OBGYN(C), dr Andi OBGYN)
After peritoneum openned : cystic mass attached with whole peritoneum. Performed sharp adhesiolysis, during adhesiolysis, cyst was ruptured and cameout mucinous fluid. Upperborder of the mass could not identified since there was conglomeration between omentum and ileum. Impression clinically pseudomyxoma peritonii already involving upper and lower abdomen, diceded to perform palliative surgery (mass debulking). Post op diagnosis : Pseudomyxoma
PA Result : (22-5-2012)
Ovarian Cystadenocarcinomamucinosum intestinal papiliferum sub tiype, well differentiation.
31-5-2012
Patient was discharged from the ward
29-6-2012
Patient planned to perform 1st chemotheraphy carboplatin 528 mg and paxitaxel 255,5 mg
CBC: 12,7/39,6/8310/466.000
6-1-2013
Complaint about diarrhea and nausea. The stool was fluid like, vomitting frequently (15x per day). Abdminal Pain (VAS 5). The patient was a loss follow up chemotherapy for ovarian cancer
T: 90/80 FN : 98x/m
St gen : Abd : distended until 3 fingers above umbilicus, fixed,
St gyn : I: v/u wnl
Lab : 5-1-2013
CBC : 14,5 / 47,4 / 6170 / 360.000 Na/K/Cl : 128/4,6/102
Ur/Cr: 53/1,1 OT/PT : 22/25 Alb : 2,72 GDS : 105
A: Ovarian cancer (adenocarcinoma mucinous), post laparatomy paliative
surgery, 1 year ago, post 1st chemotherapy (carbopaclitaxel), lost
follow up
Intake difficulties
Cancer Pain
Hypoalbumin
P : Plan for USG
General improvement
Chemoterapy
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