Clinical Conference 07.01.2009

This week there are 2 cases we would like to post,

Case 1

• Ms. I, 30 yo, P2
• Referred by Obgyn in Cilegon with GTN




• Gen St: conj anemic, Neck : thyroid enlargement 3x3x2cm,

• Gyn st : there is no mass in the posterior vaginal wal; uterus 3 fingers above simf, cytic mass in the right adnx

7x5cm and left adnx 6x4cm

• USG 4/12/08 : uterus 10x6x6cm w/ small cystic masses in the Corpus size

3x4cm . Right adnx : multiloc cystic mass 6,5x4,3x4,9cm

left adnx : multiloc cystic mass 6x4,2x6,3cm. Ascites(-), hepar (N)

Result : GTN w/ teca lutein cyst bilateral

• bHCG 3/12/08=15.200

• 15/12/08: TSH=0,013 FT4=3,96

• 2/12/08 Thorax : multiple nodul in both lung à lung meta

• 5/1/09  vaginal bleeding à emergency ward

– CBC : 6,8/9100/385000

• Problem

GTN w/ lung metastasis

• Suggestion

Improved general condition w/ transfusion and

straight to do chemoth w/ MTX+Etoposide

If there were massive bleeding àhisterectomy

Discussion

• This patient is Stadium II-III (FIGO). The treatment of

patient with GTN metastatic, is a combination 2 regiment

chemotherapy, Methotrexate and Dactinomycin. Or other

combination regiment, Methotrexate and Etoposide.

(Evidence based level III-C). Other treatment, single

regiment only, such as Metothrexate, can be used also for

treating GTN metastatic. (Evidence based level III-C).

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Case 2:

• Ms 18yo

- abdomen enlargement since 2 months ago

- regular menstrual periode

- BW ↓ 4 kg in 2 mo

• Gen.state: wnl

• Gyn.state:

Abd: abdomen enlarged, solid mass until 2 finger

above umbilicus, limited mobility, ascites (-)

Rt: solid mass fullfilled Douglas pouch until 2 finger

above umbilicus

• USG 28/11/08:

- uterus normal,

- On Douglas pouch: inhomogen solid mass with

cystic part size 8,8 x 6,3 x 5,0 cm, came from right

ovary (there is still healthy tissue of ovary),

neovascularization with RI 0,3

- On left cranial: inhomogen solid mass with cystic

part size 136 x 90 x 132 cm, neovacularization with

RI 0,45

- Ascites (-)

--> bilateral solid ovarian neoplasm susp.malignancy

Tumor marker 1/12/08 :

– Ca-125: 106,1

– LDH: 2403

– AFP: 0,9

– ß-HCG: 13,1

Problem

Solid Ovarian Neoplasm

suspected Malignancy

on Very Young Woman

Discussion

• Actually it is not necessary to do VC in cases of ovarian neoplasm in young woman, because it doesnt change the modality of treatment -->conservative

• Because most of the solid ovarian neoplasma in this age is likely to be Dysgerminoma, and it is very responsive to chemotherapy