Case Confrence 24 March 2010

24-Mar-2010, Oncology Gynecology Division RSCM

1. Woman, 57 yo
Chief complaint: lower abdomen pain

History of complaint:
12/11/07 :   
S : Reffered by Sutoarjo Hospital Jogjakarta. Came to out patient clinic, diagnosed with cerxix ca III B with cervix biopsy PA : adenosquamosa Ca. She was admitted to hospital for tranfusion. 
O : Physical exam : normal.
On gynaecologic exam no mass in the abdomen.
Inspekulo : mass exophytic, 5x4x3 cm, VT: infiltration to left and right pelvic wall. Rectal mucose is normal.

19-11-07 
thorax PA : normal, BNO IVP normal, cystoscopy, rectoscopy normal. C cardio : CAD
PA : carsinoma adenosquamosa poor-moderate differensiated.(13/11/07).
A : Ca Cx IIIB
P : Chemoradiation

She was given Ekternal radiation since 12/12/07 – 5/2/08 with accelerator linier and internal radiation on 24/2/08-6/3/08-14/3/08 with high dose rate after loading ( total dose was 50Gy + 3x700Gy)
She also given 50 mg platosin on 11/12/07-17/1/08.

She went for regular follow up for 6 times. With no evidence of malignancy cell.

2/3/10
She came for regular follow up and complaining about pain in the lower abdominal. No bleeding and leukorhea.
O : Physical exam : normal.
On gynaecologic exam mass palpable in the lower mid abdomen ½ away from the navel.
Inspekulo : mass (-) RVT: uterine size ~to 14-16 weeks GA. Rectal mucose is normal.
US (3/3/10)
Uterus enlarge size 13x7x7 cm,  uterine cavity 6 cm filled with anechoic fluid. Thin regular Miometrium. Cervix can not evaluated due to shadowing of the corpus.
Adnexa normal
Other abdomen organ normal
con : uterine enlargement suspect ec hematometra
Lab : Hb 12,2. WBC 6,55. PLt 171. BS 110

A : Ca Cx IIIB , with hematometra
P : dilatation end evacuation with narcosis

12/3/10 Dilatation in operating theathre. No blood/liquid flow.

18/3/10 Control in out patient clinic
S : pain
O : Physical exam : normal.
On gynaecologic exam mass palpable in the lower mid abdomen ½ away from the navel.
Inspekulo : mass (-) RVT: uterine size ~to 14-16 weeks GA. Rectal mucose is normal.

US : (22/3/10)
Uterus : rounded, size 14,12x7,76x10,59 cm, axial, thin myometrium, homogen. Endometrium regular. Thickness 1,9mm uterine cavity volume 449ml. Internal echo(+), no solid part. Elongated servix : size 4,82x2.82x2.85cm, vol 20,28ml. Inhomogen. No vascularization.
Adnexa:no mass
Limphnodes on right pelvic 5,35x3,16x3,35cm
Liver : no metastasis lesion. No enlargement of paraaortal Limphnods . no HN, no ascites
Impression : cervix vol 20,28ml. Hemato/pyometra 449ml. Limphnodes on right pelvic.

A: Ca CX IIIB hematometra.

Problems : hematometra persist
Problem solving : follow up .
Abdominally evacuated