parade onkologi ny yuriani final hotland
TRANSCRIPT
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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
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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 (-).
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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’’’’’’
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BIOPSY
• Adenosquamous carcinoma cerviks uteri
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FRACTIONAL CURRETAGE
ENDOCERVIKS :• Small cell neuroendocrine carcinoma of cervixENDOMETRIUM:Endometritis kronik granulomatous
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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 -/-
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ELECTROCARDIOGRAPHY
• Normo synus rhytme
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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
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GYNAECOLOGY SONOGRAPHY
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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
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Chest x-Ray
• No heart enlarged• No appears on the pulmonary and bone
metastases
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Chest x-Ray
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PRODIAGNOSTIK
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COLONOSCOPY
• Hyperemia of the distal rectum • There was no mass infiltration
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CYSTOCOPY
• no infiltration ca
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Analysis
• Cervical Small cell neuroendocrin stg IIA1
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Management
• Radical hysterectomy • Bilateral pelvic lymphadenectomy
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DISCUSSION
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• 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
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Thank You