Case conference Dec 30th 2009

30-Dec-2009, Oncology Gynecology Division RSCM

Mrs. S W /21 yrs

She had already underwent optimal debulking on Dec 4 th 2008 in RSCM o/i stage III C Ovarian carcinoma  (cystic and solid mass 30x23x20 cm from right ovarian, nodul-nodul at peritoneum, cavum douglass, and bowel ). The pathologic report showed teratoma with real immature component, has already spread to around area, with high grade. She was planned to have adjuvant chemotherapy PVB 6 courses. After 3 courses chemotherapy, she discontinued chemotherapy on reason of sick. About two months after 3 courses PVB, she complaint of  abdominal swelling, amenorea.  She has any weight loss, she deniad of gynecological or urologic symptoms. There was no family history of gastrointestinal or gynecological disorders.

Physical examination revealed a thin female with clear breath sounds and a over  distended abdomen. Pelvic examination was remarkable for an erlaged pelvic mass. Ultrasound demonstrated a cystic tumor approximately 22x21x24 cm in size with solid components and papillary growth inside, no vascularisation. No ascites on douglass cavity, there is also cystic and solid mass beneath diafragma with size 13x18 cm

Complete blood count, serum electrolytes, and liver enzyme  were unremarkable .

Problems

1.     Progressive ovarian cancer after 3 courses PVB

Problem Solving : 

1.     Laparotomy debulking, or

2.     Continue chemotherapy