Case Conference February 6th 2013

06-Feb-2013, Divisi Ginekologi Onkologi RSCM

CASE CONFERENCE                  

Mrs.N, 33 yo, 357-60-33

 

Stage IIIB cervical carcinoma with bone metastasis

 

19-12-2012

CC : since 2 years before admission, the patient complained of vaginal discharge and bleeding. Then the patient was diagnosed with advanced cervical carcinoma. Radiotherapy and chemotherapy has been performed each of the 3 series. Patients already declared cured in anatomic pathology state at August 2012. Patient routinely control to obsgyn clinic at RSCM.

6 months before entering the hospital, the patient complained of lower back pain with no history of previous trauma. Both patient’s leg is weak. Patient felt tingling at lower limb. There’s no complaint of defecation and urination. Patient went to the Pelabuhan hospital as an orthopedic patient, and referred to the RSCM later.

 

Physical exam

BP 110/70 mmHg, HR 92 x/minute, RR 18 x/minute, afebrile

St gen : Lower limb pain and weakness (+)

St gyn : I: v/u within normal limit

 

Lab result (30-01-2013) shows anemia (Hb 9,6 g/dL; Normal MCV, MCH, MCHC; Erithrocyte 3,37). Leucocyte 13.710/uL. Low albumin (2,51 g/dL).

(26-01-2013) Hyponatremia (129 mEq/L), hypokalemia (2,91 mEq/L)

 

Whole body bone scan with Tc-99m Injection that conducted at 12-05-2012 showing possibility of bone metastases in lumbar vertebrae 2, 3, and 4.

 

MRI Thoraco-lumbal (sagital and axial) T1W1 – T2W1 and sagital fat sup and T2 Coronal, Myelogram, and Contrast that conducted at 12-11-2012 showing that tumor of left psoas muscle with destruction of third lumbar vertebral body (with suppression on left roots) and enlarged paraorta lymph nodes that referred to metastasis of a cervical carcinoma.

 

Abdominal USG that conducted at 30-11-2012 showing left hydronephrosis, with no sign of metastases

 

Pelvis imaging that conducted at 18-01-2013 showing no visible radiologic abnormalities in the pelvis. Internal fixation mounted in 4th and 5th lumbar spine.

 

The patient is diagnosed Stage IIIB cervical carcinoma post complete chemoradiation (February 2012), metastases to 2nd-4th lumbar spine with cancer pain

 

Discusssion with Prof.dr. Andrijono SpOG(K) à The patient is consulted to the radiotherapy department, whether there are still places/slot for palliative radiation to be done in the lumbar region.