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17 กันยายน 2562 14:26:10

Interinstitute conference ครั้งที่ 133 จากคณะแพทยศาสตร์ ม.ขอนแก่น






133th Interinstitute conference

Gynaecologic Oncology unit, Department of Obstetrics and Gynaecology

Srinagarind Hospital, Khon Kaen University

……………………………………………………………………………………

Patient identification:

A 76-year-old Thai woman

Occupation: Unemployment

Hometown: Kalasin province

Payment: Universal coverage scheme

 

Chief complaint:

Palpable mass at vulvar for 3 months PTA

Present illness:

3 months PTA, she palpated painless vulvar mass at left side of vulva. The lesion, situated on the left upper labia minora, had black-colored.

1 month PTA, she complained of increased in the size of vulvar mass and the mass developed superficial ulceration. She underwent tissue biopsy and the result suggested malignant melanoma.

The patient reported no other abnormal vaginal bleeding or vaginal discharge.

She has normal appetite and no weight loss.

Past history:

Underlying of essential hypertension

Current medication: Amlodipine (5) 1x1 p.o. p.c.

No history of food & drug allergy

No history of previous surgery

Obstetrics and Gynecologic history:

G5P4013, last child 36 years

Menopause at 53-year-old

Family history:

No history of cancer in family

Social history:

No smoking & alcohol drinking

Physical examination:

V/S: BT 37 °C,           PR 80/min,     BP 131/73 mmHg,     RR 16/min

BW: 60.1 kg,             HT 150 cm,    BMI 26.7 kg/m2

GA:                         Good consciousness

HEENT:                    Not pale conjunctivae, anicteric sclerae

CVS:                       Audible S1, S2, no murmur

Lungs:                     Equal breath sounds, no adventitious sound

Breasts:                   Impalpable mass

Abdomen:                Soft, not tender, impalpable mass

Liver and spleen impalpable

Lymph node:            No supraclavicular and groin node enlargement

Extremities:              No edema

Pelvic examination:

MIUB:                      Black color mass of 3x1.5 cm on left upper half of labia minora

Presented superficial ulceration

Non tender, not fixed to the deeper tissue and firm in consistency

Vagina:                    Atrophic mucosa, no lesion

Cervix:                              Os closed, no lesion

Uterus:                    Normal size

Adnexa:                   No mass

Cul-de sac:               Free

Rectal examination:

No rectal shelf

Smooth RV septum

Discussion:

What is the appropriate management?

- Metastatic work-up

- Surgical management (Vulva and groin lymph node)

- Role of adjuvant treatment









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