Upload
sukoco-hartono
View
217
Download
0
Embed Size (px)
Citation preview
CASE CONFERENCE APRIL 10nd , 2014
Mrs. YURIANI, 47 yo, BPJSCM : 446970
APRIL , 2014Division of Oncology Gynecology
Department of Obstetric Gynecology Faculty of Medicine, Diponegoro University
Kariadi Hospital, Semarang
APRIL 10th 2014• Chief complain : vaginal pain and contact bleeding
• Patient complained of having abdominal and vaginal pain the last 6 months. Contact bleeding (+). Leukorhea (+). She had the biopsy at RSDK : adeno carcinoma . Decrease in appetite/body weight (-), micturition/defecation disorder (-)
• History of Menstruation : menopouse 5 years ago• History of Marriage : 1 x 25 years• History of Obstetric : P2A1, youngest child aged 23 years• History of Contraception : -• History of Disease & operation : asthma(-), hipertension (-), DM(-),
cardiovacular disease (-) , surgery (-).
General status :• BP: 120/80 mmHg HR: 84 bpm• RR: 20 x/m temp: 36,5 C• Ht : 155 cm Wt : 59 kgAbdomen : Liver and spleen not palpable Gynecological status :
Insp/ VT : flx (-) flr (-) V/U : no abnormalities
Vagina : no infiltrate portio : infiltrate Ø 2 x 3x3 cm ant fornic (1 o’clock),
CUT : ~ goose egg AP : no infiltration CD : no abnormalities
RT : smooth mucosa, infiltrate -
goose egg’’’’’’
BIOPSY
• Adenosquamous carcinoma cerviks uteri
FRACTIONAL CURRETAGE
ENDOCERVIKS :• Small cell neuroendocrine carcinoma of cervixENDOMETRIUM:Endometritis kronik granulomatous
Laboratory Examination Result
Hb 14,6
L 11.000
Tr 259.000
GDS 106
UR/CR 24/0,69
OT/PT 25/33
Na/K/Cl 144 / 4.5 / 104
HbSAg (-)
VDRL / TPHA -/-
ELECTROCARDIOGRAPHY
• Normo synus rhytme
GYNAECOLOGY SONOGRAPHY
• uterine size > 10,21 x10, 81x8, 62cm unattainable transducer, regular contour and
texture inhomogen, looked a shadow of intra-uterine hipoekoik
• Not looked mass Hypo or hiperechoik on adnexa
• Free invisible intra-uterine fluid
GYNAECOLOGY SONOGRAPHY
ABDOMINAL SONOGRAPHY
• Thickening of the uterine cervix with structure inhomogen
• Enlarged uterus with fluid collection in the uterine cavity
• no nodules in the liver, spleen, and paraaorta suspicious of a metastasis
Chest x-Ray
• No heart enlarged• No appears on the pulmonary and bone
metastases
Chest x-Ray
PRODIAGNOSTIK
COLONOSCOPY
• Hyperemia of the distal rectum • There was no mass infiltration
CYSTOCOPY
• no infiltration ca
Analysis
• Cervical Small cell neuroendocrin stg IIA1
Management
• Radical hysterectomy • Bilateral pelvic lymphadenectomy
DISCUSSION
• Metaanalysis study between Januari 1987- September 2010 the efficacy of Neoadj chemotx before surgery ( NCS ) compared with primary surgical treatment
• NCS lower rate of large tumor size ‘n lymph node metast Reduced the need of adjuvant radiotx Reduced distant metastasis It failed to improve survival when compared with PST
Thank You