CASE REPORT OF ONCOLOGY

DIVISION
October 2nd,2017
CASE NO. 1
Mrs. A/ 68 years old/P3A0
Abdominal enlargement since a year ago
No vaginal bleeding
Menopause >10 years ago
Menarche at 12 years old
Menstruation : regular cycle, normal volume
Micturition is normal
Defecation is normal
No family history of cancer
 PHYSICAL EXAMINATION
General condition : good
Blood Pressure : 110/70 mmHg
Pulse : 78 bpm
RR : 20 times per minute
Temperature : 36.6 OC
Weight : 50 kgs
Height : 158 cm
BMI : 20.03 kg /m2
Karnoffsky : 80 %
 ABDOMINAL EXAMINATION

Palpable mass, cystic, mobile, size 15x15 cm

No pain with palpation
 VAGINAL EXAMINATION
Vulva : No abnormality found
Vagina : No abnormality found
Portio : smooth, no palpable mass
Uterus : anteflexi, regular surface. Mobile, no pain.
Adnexa : palpable mass on right adnexa, mobile, no pain
Parametrium : free/free
Cavum douglas : no mass found
Discharge : odorless white liquid
 DIGITAL RECTAL EXAMINATION

Tension Sphincter Ani was tightening

Smooth mucous
Empty ampulla
No palpable mass
 LABORATORY FINDING
Hb 12.9 gr/dl AFP : 1.35 IU/ml
WBC 6.100 /uL CEA : <0.50 ng/ml
Platelet 345.000/uL Albumin : 3.2 g/dl
SGOT 23 U/L
SGPT 13 U/L
UR 30 mg/dl Ca-125 : 6.96 U/ml
CR 0.83 mg/dl
GDS 67 mg/dl
BT 300
CT 800
 CHEST X-RAY

Pulmonary tuberculosis
lesions broad active
No signs of metastases in
both lungs
 ULTRASOUND

Cystic Adnexal Mass

 ABDOMINAL CT-
SCAN

Cystic Adnexal Mass

 ABDOMINAL CT-SCAN
Round cystic mass mass, regular border, no calsification with
size 10.5cm x 16.5 from adnexa
Liver: Normal size, density of parenchyma is in normal limit.
No dilatation of vascular system and bile duct intra/extra
hepatic appears. Metastasis in liver does not seem
Gal bladder: the walls do not thicken,no high density
appears like a stone
Pancreas : Size and density are in normal limit, no dilatation
of main pancreatic duct appears, there are no other
pathological lesions
 ABDOMINAL CT-SCAN
Spleen : Size and density are in normal limit. no metastasis
nodule appears
right Kidney : Contour is in normal limit, no dilatation of PCS
appears, cortex is well, no mass/cyst density appears
left kidney : : Contour is in normal limit, no dilatation of PCS
appears, cortex is well, no mass/cyst density appears
Bladder : the walls do not thicken, regular mucosa, no mass
density appears
No enlargement of the lymph nodes abdominal paraaorta
appears
There is free fluid in the peritoneal cavity
DIAGNOSIS
Neoplasm Ovarian Cystic Suspected Malignancy

MANAGEMENT
Laparotomy
Frozen Section
Surgical staging
CASE NO.2
Mrs. H/ 66 years old/P2A0
Abdominal enlargement since 3 years ago
No vaginal bleeding
Menopause >10 years ago
Menarche at 12 years old
Menstruation : regular cycle, normal volume
Weight loss
decreased appetite
Micturition is normal
Defecation is normal
No family history of cancer
History of gynecology surgery in 2015 without pathology result
 PHYSICAL EXAMINATION
General condition : Good
Blood Pressure : 110/70 mmHg
Pulse : 80 bpm
RR : 20 times per minute
Temperature : 36.8 OC
Weight : 46 kgs
Height : 153 cm
BMI : 19.65 kg /m2
Karnoffsky : 80
 ABDOMINAL EXAMINATION

Palpable mass, cystic consistency, sized 20 x 15 cm,

regular surface, immobile,
No pain with palpation
 VAGINAL EXAMINATION
Vulva : No abnormality found
Vagina : No abnormality found
Portio : No palpable mass
Uterus : anteflexi, mobile, no pain.
Adnexa : palpable mass, cystic, immobile, no pain
Parametrium : free/free
Cavum douglas : no mass found
Discharge : odorless white liquid
 DIGITAL RECTAL EXAMINATION

Tension Sphincter Ani was tightening

Smooth mucous
Empty ampulla
No palpable mass
LABORATORY FINDING
Hb 9.7 gr/dl
WBC 8.800 /uL AFP 0.59 IU/ml
Platelet 645.000/uL CEA 0.50 ng/ml
Albumin : 3.3 g/dl Ca 125 148.03U/ml
SGOT 18 U/L LDH 334 U/L
SGPT 11 U/L
UR 29 mg/dl
CR 0.79 mg/dl
BT 700
CT 300
CHEST X-RAY

no sign of metastases
Cor and pulmo normal
 ULTRASOUND

Cystic Adnexal Mass, hydronephrosis dextra

 ABDOMINAL CT-
SCAN

Cystic Adnexal Mass

Hydronephroureter
dextra
Hepatomegaly with
solitaire nodules right
lobes susp hepar
metastases
 ABDOMINAL CT-SCAN
Cystic heterogen dominant mass, septated, regular border,
no calsification with size 11.7cm x 12.4 cm x 12.3 cm from
adnexa
Liver: enlarged. lesions hipodens, the firm a round a thin
wall in lobes right did not look dilatationof vascular intra
system and extrahepatic biliary within the normal
Gal bladder: thin the walls reguler mucous, not seem any
density of rock/sludge in that.
Pancreas : Size and density are in normal limit, no dilatation
of main pancreatic duct appears, there are no other
pathological lesions
 ABDOMINAL CT-SCAN
Spleen : Size and density are in normal limit. no metastasis
nodule appears
Right Kidney : size was enlarged, dilatation of PCS appears,
cortex is well, no mass/cyst density appears, right ureter was
dilated
left kidney : Contour is in normal limit, no dilatation of PCS
appears, cortex is well, no mass/cyst density appears
Bladder : minimal urine (hard to evaluate)
Uterus : size and density of parenchyma are in normal limit
No enlargement of the lymph nodes abdominal paraaorta
appears
No density of free fluid in the peritoneal cavity
 DIAGNOSIS
Neoplasm Ovarian Cystic Suspected Malignancy

MANAGEMENT
Laparotomy
Frozen Section
Surgical Staging
THANK YOU