Fellow Club » Interinstitue Conference » Interinstitute conference ครั้งที่ 107 จากกลุ่มงานสูติ-นรีเวชศาสตร์ โรงพยาบาลราชวิถี
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Interinstitue Conference
Written by Webmaster @ TGCSThai
01 พฤษภาคม 2558 10:49:22
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Interinstitute conference ครั้งที่ 107 จากกลุ่มงานสูติ-นรีเวชศาสตร์ โรงพยาบาลราชวิถี


Interinstitue conference ครั้งที่ 107

หน่วยมะเร็งนรีเวช  กลุ่มงานสูติ-นรีเวชศาสตร์

 โรงพยาบาลราชวิถี

********************

Clinical history

A 23-year-old Thai woman from Samut Prakan
Occupation: Student
First visit date: 15-05-2013

Chief complaint

Palpable pelvic mass for 1 month PTA
Present illness

1 month prior to the visit, she felt a palpated mass at mid-pelvis. She had abdominal pain, and it is uncontrollable with pain medication. She went to see the doctor at community hospital. The doctor found the pelvic mass. Ultrasonography was performed and showed huge lobulated pelvic mass, mixed echogenic content, 10x15x17 cm in size with deviated to the left. Then the patient was referred to tertiary hospital for appropriate management.
Past history

No underlying disease

History of sulfamethoxazole allergy

No history of previous surgery


Obstetric & gynecologic history

LMP: 10 August 2013 x 3 days

Para 0

Contraception: DMPA for 1 year

 

Physical examination

BW 52 kg, Height 162 cm, BMI 19.8 kg/m2

V/S: BP 110/60 mmHg, PR 74 /min, RR 16, T 36.4 °C

GA: A Thai woman with good consciousness

HEENT: Not pale conjunctiva, anicteric sclera, no palpable lymph nodes

Breast: No palpable mass

Heart: Regular, normal S1 S2, no murmur

Lungs: Clear

Abdomen: Midline pelvic mass size 15 cm., rubbery consistency, mobile, not tender, shifting dullness : positive.

No palpable groin node

Extremities: no edema
Pelvic examination :
    NIUB: Normal
    Vagina: Normal mucosa, minimal whitish discharge
    Cervix: No lesion, os closed
    Uterus: Normal size
    Adnexa: Midline pelvic mass about 15 cm., rubbery consistency, smooth surface, not tender, mobile
    RV: smooth rectovaginal septum, free parametrium

Tumor marker :  AFP ; 142 IU/ml                                   (0-5.8)

LDH ; 424 U/l                                               (240-480)

B-hCG ; 5.9 mIU/ml                                       (<25)



 

Provisional diagnosis

Ovarian germ cell tumor
Operative findings:

- Multiple seeding at diaphragm (largest about 3 cm)

- Left ovarian tumor size 15 cm with yellowish necrosis content with hair and cartilage

Operation:  Ascites collection, Lt. SO, OMT with Peritoneal Biopsy (suboptimal surgery)
Pathological diagnosis:

1. Left ovary :      -Immature teratoma of ovary

-Grade 1/3. Tumor size 15x11x7.5 cm

-Presence of capsule rupture and tumor necrosis

2. Peritoneal seeding biopsy : Implantation by immature teratoma (grade1/3)

3. Omentum : Implantation by immature teratoma (grade2/3)

Diagnosis : CA Ovary stage IIIC (Immature teratoma grade 1)
Management :

- Adjuvant chemotherapy: BEP regimen x 4 cycles

- FU CT whole abdomen after complete treatment 1 month
CT whole abdomen;     

- A soft tissue mass, arising at right subdiaphragmatic area, measuring about 11.6x8 cm, showing mixed soft tissue and fat component with calcification.

- 2 sites of soft tissue lesion at left subdiaphragmatic area 3.7x1.8 cm and tiny one abutting to the left peri-gastric region 1.08 cm with mild peritoneal thickening along lower right paracolic gutter.

Discussion point:
Differential diagnosis and plan of management in this patient




File Download :
  • case_study_107 _rajvithi.pdf


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