CASE CONFERENCE

APRIL 10nd , 2014

Mrs. YURIANI, 47 yo, BPJS
CM : 446970




APRIL , 2014
Division of Oncology Gynecology
Department of Obstetric Gynecology
Faculty of Medicine, Diponegoro University
Kariadi Hospital, Semarang

APRIL 10
th
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 kg
Abdomen : Liver and spleen not palpable
Gynecological status :
Insp/ VT : flx (-) flr (-)
V/U : no abnormalities
Vagina : no infiltrate
portio : infiltrate 2 x 3x3 cm ant fornic (1 oclock),
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 cervix
ENDOMETRIUM:
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