Case Confrence 24 February 2010

23-Feb-2010, Divisi Onkologi Ginekologi RSCM

1. Mrs. L M/ 27 yo / P1A0

Chief complaint: Patient came to oncology clinic at RSCM for follow up after conservative complete surgical staging on Feb 4th 2010.

History:
Des 29th 2010 :   Dx:  Solid ovarian mass
Feb  4th 2010 :   Laparotomy surgical staging, operation prosedure :
-Cytology
-SOD + Left ovarian biopsy
-Omentectomy
-Appendectomy + Paraapendix lymph biopsy
-Bilateral Pelvic Lymphadenectomy
-Paraoarta biopsy
-Peritoneal : Paracolica bilateral biopsy
-Peritoneal prevesical biopsy
-Peritoneal cavum douglas biopsy
-Peritonealsubdiagfragmatica biopsy
                                   
                                 
Durante operation :
-There was cystic mass sized 30 x 40 x 40 cm, severe adhesion between mass with peritoneum, omentum and bowel „³ adhesiolysis, and the mass was exteriorated (from the right ovary)
-Ruptured of the cystic mass, came out 11.000 cc seromucinous reddish fluid
-The uterus and left ovary were macroscopically normal.
-Right salpingoovorectomy (frozen section examination„³ malignant) was done and adhesiolysis with appendix, palpated enlargement paraappendix lymphe  (2x3x2 cm) „³  appendectomy, Parapependix lymph biopsy
-On exploration, surface of the  spleen, liver, and diaphragma are smooth
-Perform complete surgical staging: left ovarian Biopsy  , bilateral pelvic lymph node dissection, paraaortic lymp node dissection, omentectomy, , Peritoneal: Paracolica bilateral Biopsy,Peritoneal prevesical, Biopsy, Peritoneal cav. Dauglasi Biopsy,  Peritoneal subdiafragmatica biopsy

           
Feb 16th 2010 Histopathologycal result:
- Well differentiated Cystadenocarcinoma mucinosum on right ovary
- Lymphovascular space invasion (+)
- No lymphnode metastase
- Pseudomixoma ovarii on tumor mass and omentum
    
Dx : Ca ovarium st.I C (Adenoca ovarii St IC)

Planning : Adjuvant chemotherapy CP 6 cycle

Discussion  : 
What is the  effect of  Lymph¡VVascular Space Invasion for epithelial ovarian cancer?

 

2. Mrs. J L / 50 yo / P5A0

Chief complaint: Patient came to oncology clinic at RSCM for follow up after NAC CP 3 cycle.

History:
1989 : patient underwent laparotomy at Kupang due to cystic ovarian mass with no histopathology result.
2003 : patient underwent 2nd laparotomy at Kupang due to uterine mass with no histopathology result.
July 27th 2009  : refered to RSCM due to abdominal enlargement
                 Gynaecology examination : found cystic with solid part fulfill abdominal cavity, distal part until cavum douglasi.
                             US onco : Suspect residual cystic mass with peritoneal implantation, acites, Right  hydronefrosis dan hernia incisional.
                             Ca-125 : 1528 mIU/L
August 13th 2009 : Dx : Ca ovarium unresectable
August 28th 2009 : Cytology from acites : Adenocarcinoma
Sept 1st  2009 : patient underwent neoadjuvant chemotherapy for 3 cycle (1/9; 30/9; 29/10/2009)
Nov 25th 2009 : Ca-125 : 1160 mIU/ml
Nov 30th 2009 : Re-evaluation by consultant; conc: partial respons, decided to perform:laparatomy debulking.
Feb 2nd 2010  : patient came to oncology clinic for preparing laparatomy debulking.
                Gynaecology examination : found solid mass measuring 10 x 15 x 15 cm limited in mobility, suggested mass from retroperitoneal side.

Feb 5th 2010 CT Abd. Result : Adnexa cystic mass with solid part on pelvic cavity until lower part of the abdomen.
                              Hydronefrosis grade II ¡V II and right hidroureter.
                              Acites
                              Left inguinal hernia and abdominal ventral hernia on level L4-5
                
Feb 18th 2010 :US onko : Cystic mass (15x12x11 cm) bigger than US result on July 2009
                         Acites, Right Hydronefrosis grade I
                         Hernia incisional.
Re-evaluation by consultant : Gynaecological exam: retroperitoneal mass, fixed Unresectable

Problem treatment option due to clinically  unresectable tumor; should be:
-  Laparatomy debulking ?
- Continue chemotherapy ?