Case Confrence 31 March 2010

31-Mar-2010, Oncology Gynecology Division RSCM

Woman, 38 YO.G8 P5 A2, 37-38 weeks GA. Ca Cx IB1

Chief complaint: vaginal bleeding during pregnancy 

History of complaint:

3/3/10 : referred by family clinic with G8 P5 A2 Gravid 34 weeks GA , susp Ca Cx IB2

29/3/10 :
S: scanty vaginal bleeding about 2 weeks with profuse lechorrhea.
   LMP : 10/7/09. PNC midwife since the 6th month pregnancy. There is no evidence of malignancy during vaginal examination.
   History of contact bleeding happens since 3 years ago.
   Lechorrhea since 15 years ago.
   She had married for 4 times. --> I at 17 YO with 1 child. 20 YO.
                                                     II at 24 YO with 2 children 12 and 11 YO, and 1 abortus
                                                     III at 28 YO with 2 children 9 and 4 YO, and 2 abortus
                                                     IV this pregnancy

   She is housewife. Husband is jobless.
O : CM
    Anemic -, icteric –
    Supraclavicule limphnodes enlargement -/-
    Abd : UF 3 finger BPx (31 cm)
    Head press. FHB (+). Uterin contraction (-)
    V/V. Livide
    Insp : Portio livide . friable nodule Ǿ 0,5 cm on left posterior cervix near OUE
    RVT : Head press. Right and left adnexa mass (-), nodule (-)
    Rectal mucose smooth, and no nodule palpable on parametrium.

 

   Biopsi PA : (1001945)(22/3/10)
              Squamous cell ca non keratinizing moderate differensiation. With limphatic invasion. Highly limphocyt reaction. No necrosis.

   US : 5/3/10
       Head pressetation. Singleton, life fetus
       Biometri : BPD 81mm, AC 293 mm, FL 63 mm ~ 33 weeks GA, EFW 2000g. No major morfology anatomy.
       Placenta on posterior corpus.
       AF normal.

   Chest XR : (29/3/10)  normal
   Lab : Hb 10,6 g%, WBC 5,76K.uL, Plt 223 K/uL

A: G8 P5 A3 37-38 weeks GA. Ca Cx IB1

Problem :

Clinical Staging and surgery prochedure during pregnancy

Problem solving : Staging under anesthesia after CS :Followed by Radical HT