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