Preoperative Conference

IDENTIFYING DATA

D. J
44 Y/O
Married
Roman Catholic
Naga City, Cam Sur
Government
Employee
Informant- Patient
 CHIEF COMPLAINT

Elective Surgery for

Endometrial Carcinoma
 HISTORY OF PRESENT
ILLNESS
5 Years PTA
Patient noted to have
amenorrhea, with no associated
symptoms
1 Year PTA (Feb 2022)
Patient tested (+) HPV
2 Months PTA (March 2023)
Patient still (+) HPV, and checkup
revealed cervical polyps
2 Months PTA
Ultrasound was requested which
revealed thickened endometrium.
Patient underwent Endometrial biopsy
on 29 March.
Revealed multiple foci of well
differentiated endometroid carcinoma
arising in a predominantly atypical
hyperplasia/endometrial
intraepithelial neoplasia.
HISTORY OF PRESENT
ILLNESS

Interim

Patient visited BMC OPD where work

up was done and patient was then
scheduled for surgical intervention.
PAST MEDICAL • (+) HTN, 5 years on Nebilet 0.5mg/tab OD

HISTORY • (+) DM, since Nov 2022 on Metformin OD

FAMILY •
•
(+) HTN, Maternal
(+) DM, Maternal

HISTORY
• (+) CKD, Maternal
• (+) Cervical cancer, Maternal grandmother

PERSONAL & • Non-smoker

SOCIAL • Occasional alcoholic beverage drinker
• Government employee
HISTORY
 Obstetric History G5P5 (2123)
Gravida Year Term Preterm Abortion Manner of Place of Delivered
Delivery Delivery by
1 2002 ✓ Hospital

2 2002 ✓ Hospital

3 2003 ✓ CS Hospital OB

4 2004 ✓ CS Hospital OB

5 2007 ✓ CS Hospital OB
Gynecologic History
Menarche 12 years old

Interval Irregular (every 3 Regular

months)
Duration 2 Weeks 5 - 7 days

Amount 3 - 4 PPD 3 PPD

Symptoms (-) Dysmenorrhea (-) Dysmenorrhea

 PHYSICAL EXAMINATION
General: Awake, Conscious, Coherent,
Not in distress
Abdomen: soft, flabby, non tender
Vital signs: BP - 110/80 mmHg, HR - abdomen
88 bpm, RR - 20, T – 36.2°C
Speculum exam: Cervix is pinkish, no
BMI: 32 Kg/m2 (obese) erosions, no lesions, no bleeding

HEENT: Anicteric sclerae, pink
palpebral conjunctivae, no neck vein
distention, no cervical
lymphadenopathy
Chest/Lungs: Symmetric chest
expansion, no retractions, Clear breath
sounds
Cardiovascular: Adynamic precordium,
normal rate, regular rhythm
IE: Cervix closed, smooth uterus small
no adnexal mass nor tenderness,
Minimal vaginal bleeding
RVE: Tight sphincteric tone, empty
rectal vault
Extremities: No edema, Full equal
pulses, CRT < 2 seconds
REVIEW OF SYSTEM
General: (-) weight loss (-) appetite (-) irritability (-) weakness
Skin: (-) color changes (-) sores (-) itchiness
HEENT: (-) Headache (-) blurring of vision (-) loss of hearing (-) nasoaural
discharge (-) colds (-) hoarse voice (-) dysphagia
Respiratory: (-) cough (-) hematemesis (-) hemoptysis
Cardiovascular: (-) palpitations (-) chest tightess/pain (-) easy fatigability
(-) orthopnea
Gastrointestinal: (-) watery stools (-) melena (-) nausea/vomitin
Genitourinary: (-) dysuria (-) oliguria (-) hematuria
REVIEW OF SYSTEMS
CNS: (-) loss of consciousness (-) seizure (-) behavioral change (-)
balance or gait abnormality
Musculoskeletal: (-) paralysis (-) painful joints (-) frequent muscle aches
(-) bipedal edema
Hematologic: (-) easy bruising (-) bleeding episodes
Ancillary Tests • WBC: 6.74 NEU: 64.8
• RBC: 4.79. LYMP: 28.0
CBC (05/23/2023) • HGB: 137.00 MONO: 5.0
• HCT: 0.417 EOS: 1.8
• PC: 327 BAS: 0.5

• Multiple foci of well differentiated endometroid carcinoma

arising in a predominantly atypical hyperplasia/endometrial
Endometrial Biopsy intraepithelial neoplasia, Fragments suggestive of endometrial
polyp.
(03/29/2023) • Two microscopic foci show cribriform and/or glandular fusion
consistent with beginning invasion.

• HPV DNA 16: Negative

HPV DNA PCR Test • HPV DNA 18_45: Negative
(03/29/2023) • Other HR HPV DNA: Positive
Ancillary Tests
Na: 141.75 K: 3.80
Crea: 59
BUN: 4.02
Blood Chemistry BUA: 376.51 (H)
(05/23/2023) LDH: 246.18 (H)
ALT: 37
AST: 25

Color: Straw
Character: Clear
pH: 6.0
SG: 1.005
Urinalysis (05/23/2023) Protein: Negative
Glucose: Negative
WBC: 0.72
RBC: 0.36
UTZ
The anterior cervix measures 2.5x1.2cm
and the posterior measures 2.4x0.8cm,
homogeneous stroma and distinct
endocervical canal. The endometrium is
hyperchoic with multiple cystic spaces
extending to the endocervical canal.

IMPRESSION: Normal sized uterus,

Thickened endometrium consider
endometrial pathology extending to the
endocervical canal, Normal ovaries
CXR
SALIENT FEATURES
• 44/F
• Gravida 5 Para 5 (2123)
• Irregular Menstrual Periods
• HPV Infection: One year prior to admission, in February 2022, the
patient tested positive for human papillomavirus (HPV)
• Thickened Endometrium: An ultrasound examination performed two
months prior to admission revealed a thickened endometrium.
• Past medical History: (+) HTN 5Y, (+) DM 6mos
SALIENT FEATURES
• Family history: (+) HTN, (+) DM, (+) Cervical cancer
• Endometrial biopsy on 29 March 2023 revealed multiple foci of well
differentiated endometroid carcinoma arising in a predominantly
atypical hyperplasia/endometrial intraepithelial neoplasia
DIFFERENTIAL DIAGNOSIS
Polycystic ovary syndrome (PCOS)
Uterine Fibrosis
Endometrial carcinoma
RULE IN RULE OUT
(+) Amenorrhea, (+) T2 Diabeties (-) Ovarian cyst, (-) Weight gain, (-)
Mellitus, (+) HTN Fatigue, (-) Acne
(+) Prolonged periods for 2 weeks (-) Pelvic pain, (-) Frequent
urination, (-) Constipation, (-)
Dysmenorrhea
Endometrial carcinoma: The Cannot be completely ruled out
endometrial biopsy revealed well-
differentiated endometroid
carcinoma
(+) Family history of cervical cancer
(+) HPV for 1 year
(+) Minimal vaginal bleeding
 ADMITTING DIAGNOSIS

Gravida 5 Para 5 (2123) Endometrial

Carcinoma Uterus, Human
Papillomavirus (HPV) Deoxyribonucleic
Acid (DNA) Persistence; Hypertension
Stage II, Type 2 Diabetes Mellitus;
Status Post Endometrial Biopsy
(03/29/2023)
 PLAN

Exploratory Laparotomy,
EHBSO with Planned Function
Class Identification and
Bilateral Lymph Node
Dissection