Case Conference Dec 28th 2011

28-Dec-2011, Divisi Ginekologi Onkologi RSCM

Case Conference

December 28th 2011

Mrs. F/27 yo/G2P1/ASKES

 

 

CC: Referred by Obgyn with ovarian neoplasm suspected malignancy

history :

Patient was in 2 months pregnancy, she forgets her last period. Test pack (+) in October and ultrasound by Obgyn confirmed 9 weeks pregnancy with ovarium cyst and ascites then reffered to RSCM.   No abdominal enlargement , right abdominal pain  (+), no body weight decreasing  (-), vomitus/naussea  (+)

Difficulties in defecation and micturition since 2 weeks before admission

Married 1X in 23 yo, G2P1

 

Physical examination

St gen:

Abd: palpated abominal mass until navel. Shifting dullness (+)

St obs:

I: v/u wnl

Io: portio smooth, flx(-), flr(-)

RVT: CUT was difficult to identify. Palpated mass suggested from right adnexa.

 

Lab  (7/11/11): Hb 11,2 Leko 12.700/uL. Trombo 350K/uL. OT/PT 15/12  Ur/Cr 10/0,48 Alb. 3,6  HBSAG non reaktif

CA 125 120,4  LDH 650   AFP 3137

 

USG FM :

7/11/2011 :  9 weeks prenancy with ascites, ovarian neoplasm cystic with solid part from right ovarium

12/12/2011 :  14 weeks pregnancy with ascites, ovarian neoplasm cystic with solid part from left ovarium (correction from  the last US )

 

Assesment:

G2 P1 14 gest weeks with ovarian neoplasm suspected malignancy.

 

15/12/2011 : Laparotomy salphyngoooforectomy + peritoneum biopsies and cytology.

18/12/2011: palpated mass at the left supraclavicula. She felt the mass since 1 weeks before admission, then getting bigger. The mass size 8 x 6 x5 cm with pain (+) in the area sternocleidomastoideus à FNAB.

Patology Anatomy result (113186) :

Positive, metastase tumor mass from germ cell tumor.

 

Patology Anatomy result (1109908):

Yolk sac Tumor (sinus endodermal tumor) . Peritoneum biopsies are free of tumor cells.

Assesment:

Yolk sac tumor stage IV B in pregnancy

Problem:

Chemotherapy for sinus endodermal tumor in pregnancy