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    RABAG Siti Bakiroh 19 Juni 2020

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    Ragam Pesona Simangunsong
    1) Mrs. Siti Bakiroh, age 55, presented with a 3 month history of abdominal enlargement and tenderness. Imaging showed a large cystic and solid ovarian mass. 2) Laboratory tests found anemia, elevated CA-125, and abnormal tumor markers. 3) Based on these findings, the diagnosis was suspected ovarian cancer. The patient was prepared for complete surgical staging with a blood transfusion to increase her hemoglobin level prior to surgery.

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    RABAG Siti Bakiroh 19 Juni 2020

    Uploaded by

    Ragam Pesona Simangunsong
    37 views23 pages
    1) Mrs. Siti Bakiroh, age 55, presented with a 3 month history of abdominal enlargement and tenderness. Imaging showed a large cystic and solid ovarian mass. 2) Laboratory tests found anemia, elevated CA-125, and abnormal tumor markers. 3) Based on these findings, the diagnosis was suspected ovarian cancer. The patient was prepared for complete surgical staging with a blood transfusion to increase her hemoglobin level prior to surgery.

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    RABAG Siti bakiroh 19 juni 2020 (1)

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    1) Mrs. Siti Bakiroh, age 55, presented with a 3 month history of abdominal enlargement and tenderness. Imaging showed a large cystic and solid ovarian mass. 2) Laboratory tests found anemia, elevated CA-125, and abnormal tumor markers. 3) Based on these findings, the diagnosis was suspected ovarian cancer. The patient was prepared for complete surgical staging with a blood transfusion to increase her hemoglobin level prior to surgery.

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    Download as pptx, pdf, or txt
    37 views23 pages

    RABAG Siti Bakiroh 19 Juni 2020

    Uploaded by

    Ragam Pesona Simangunsong
    1) Mrs. Siti Bakiroh, age 55, presented with a 3 month history of abdominal enlargement and tenderness. Imaging showed a large cystic and solid ovarian mass. 2) Laboratory tests found anemia, elevated CA-125, and abnormal tumor markers. 3) Based on these findings, the diagnosis was suspected ovarian cancer. The patient was prepared for complete surgical staging with a blood transfusion to increase her hemoglobin level prior to surgery.

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    Case Conference

    June, 19th 2020

    Mrs. Siti Bakiroh, 55 y.o, CM: B815793


    Department of Obstetric Gynecology
    Faculty of Medicine, Diponegoro University
    Kariadi Hospital, Semarang
    2020
    Clinical History
    Chief Complaint: Abdominal enlargement
    History of Present Illness: Patient complain have abdominal enlargement
    since 3 months ago and feel tender, Patient not complaint about pain or
    gynecology disorder before. Then Patient went to doctor at Salatiga Hospital
    than refered to obstetrician and gynaecologist, the doctor said she has ovarian
    cyst malignant suspected, than refered to RSDK. Weight loss (+), decrease in
    apetite (+), micturition and defecation normal. There are no fever, cought
    cold , throat pain, and shortness of breath.
    • History of Menstruation: Menopouse since 4 years ago
    • History of Marriage : 1 x ~ 35 years
    • History of Obstetric : P2A0 ~ Last Child’s age : 31 th
    • History of contraception : Not using Contraception
    • History of disease : asthma (-), Hypertension (-), Diabetes mellitus (-), heart
    disease (-)
    • History of surgery: denied
    General Status
    General condition : composmentis
    Vital sign :
    VS : BP : 130/80 mmHg RR: 18 x//m
    P : 90 x/mm T : 37 C

    TB : 149 cm BB: 40 kg BMI: 18,02 kg/m2(under weight)

    Eye : pale palpebral conjungtiva (-/-)


    Thorax : Heart : heart sound I-II regular
    Lung : vesiculer +/+ Ronchi-/-, wheezing -/-,
    Abdomen : enlargement, bowel sound (+)
    Extremity : oedema -/-
    -/-
    Gynecological Status
    Insp/VT : flx (-), fl (-)
    v/u/v : within normal limit
    6 Months Portio : smooth ~thumb
    Pregnancy C. Uteri : ~ Chicken’s egg
    AP : Cystic with solid mass ~ 6 months Pregnancy
    limited mobility
    CD : bulging (+)

    Chicken’s egg
    Patient Profile
    Laboratory 19/5/2020
    HEMATOLOGY
    Hb 9,3 gr%
    Leukosit 11.100 /mm3
    Trombosit 999.000 /mm3
    BG 94 mg/dl
    SGOT 27 U/L
    SGPT 11 U/L
    Ureum 21 mg/dL
    Creatinin 0.7 mg/dL
    Na 139 mmol./L
    K 4,1 mmol./L
    Cl 100 mmol./L
    PPT 13,4
    PTTK 30,0
    Laboratory 19/5/2020

    HEMATOLOGY
    Albumin 3,2
    Ca 125 >600
    Laboratory

    Dif Count
    Eosinofil 0%
    Basofil 0%
    Banded neutrophils 0%
    Segmented neutrophils 80%
    Limfosit 15%
    Monosit 5%
    CRP kuantitatif 5.39 mg/dL
    NLR 5.3
    Chest X – Ray

    • Heart is difficult to evaluate


    • No Infiltrate or nodul
    • Left Pleura efusion
    Electrocardiogaphy
    • Normo Sinus rhtym
    Gynecologic Ultrasound
    • Adequate bladder filling
    • Uterus size 5,28 x 3,08 x 5,22 cm, EL (+) 0.20 cm, regular
    contour, homogenous texture
    • Hypoechoic with hyperechoic mass at adnexa, size >10,15x
    13,24x 16,06 cm,wall thickness (0,24 cm), septum (-),
    Neovascularisation (+) Ri 0,24. STT score : 3/1/2/4: 10
    • Ascites (+)
    • Result : Ovarian Cyst With Solid Mass Neoplasm
    Gynecolgy Ultrasound
    Gynecolgy Ultrasound
    Gynecolgy Ultrasound
    Abdominal MSCT
    •  Massa solid kistik multilobulated pada
    adnexa kanan kiri hingga lower
    abdomen (Ukuran AP 7,7 x CC 15,4 x
    LL 15,5 cm) yang tampak menempel
    dan sulit dipisahkan dari uterus,
    cenderung neoplasma ovarium.
    • Multiple limfadenopati pada inguinal
    kanan kiri (Ukuran terbesar 1,6 x 0,8
    cm pada inguinal kanan
    • Penebalan irregular pada omentum
    yang membentuk gambaran omental
    cake pada hemiabdomen sisi kiri,
    cenderung peritoneal carcinomatosis
    Contras Abdominal MSCT

    •  Multiple lesi solid pada segmen 4 dan 8


    hepar (Ukuran sebesar 0,5 x 0,7 cm pada
    segmen 8)
    • Cholelithiasis (Ukuran 1,4 x 0,8 cm)
    • Infiltrat pada segmen 3 dan 6 paru kiri,
    cenderung bronkopneumonia
    • Efusi pleura kiri
    • Ascites massif
    • Spondylosis lumbal
    Contras Abdominal MSCT
    Contras Abdominal MSCT
    PAP Smear

    • Malignant cell not Visible


    • Atrophic smear
    HOGI Score : 10
    Weight loss :2
    Solid part :2
    Ascites :2
    Ca 125 (>600) : 2
    Ri :2
    RMI score : 3 x 3 x >600 = >5400
    Diagnose
    • P2A0 55 y.o
    • Susp Ca Ovary
    • Mild Anaemia
    Procedure

    • Complete Surgical Staging Preparation


    • Tranfusion PRC until Hb>10 before operation
    Thank You

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