Case Conference

March 29th , 2023

Mrs. Siti Aslamiah, 46 y.o, C990478

Department of Obstetric Gynecology
Faculty of Medicine, Diponegoro University
Kariadi Hospital, Semarang
2023
 Clinical History
Chief Complaint: Abdominal enlargement
History of Present Illness:
Patient complaints of abdominal enlargement since 2 months ago. She felt that the mass is
getting bigger and painful sometimes. She later checked up to Demak hospital and was
diagnosed ovarian cyst malignancy suspected, then she was referred to Kariadi Hospital.
Patient had loss of appetite and 8 kg weight loss during her illness, There are no complaints
about urinating and defecating.
• Menstrual history : last menstruation March’17 2023
• Marriage history : once – 15 years (divorce)
• Obstetric history : P0A0
• Past contraceptive history : (-)
• Past medical history : hypertension (-), diabetes mellitus (-), heart disease (-) allergy (-)
• Family medical history : female organ malignancy (-)
• Prior surgery : (-)
 General Status
General condition : compos mentis
Vital sign :
BP : 129/90 mmHg RR: 20 bpm
HR : 80 bpm T : 36,5 C

Height : 145cm Weight : 43 kg BMI: 20.4kg/m2

Facies ovarica (-)

Eye : pale palpebral conjungtiva (-/-) icteric sclera (-/-)
Neck : no palpable mass
 General Status
Thorax Abdomen
Cor Inspection : distention, ~ 7 months
pregnancy
I : ichtus cordis (-)
Pa : palpable ichtus cordis on 5th of left ICS on Auscultation : bowel sound (+) normal
midclavicular line Palpation : cystic mass, ~7 months pregnancy,
Pe : normal cor configuration limited mobility
A : S1S2 regular, murmur (-), gallop (-) Percussion : shifting dullness (-)

Lung Extremities:
I : symmetrical thoracic wall movement
CRT < 2 s
Pa : similar bilateral vocal fremitus
Edema - -
Pe : sonor (at bilateral lungs)
- -
A : vesicular sound (+/+) rh (-/-) wh (-)
 Gynecological Status
Inspection : Flx (-), flr (-)
Vulva / Urethra : No abnormalities
cystic mass ~ 7 months pregnancy Inspeculo
• Vagina : No abnormalities
• Portio : smooth, ~thumb, pushed to right
lateral
• Sondage : 6 cm,retroflexion
Vaginal Toucher
• C. Uteri : difficult to identify
• AP : cystic mass ~ 7 months pregnancy,
limited mobility
• CD : bulging
Patient Profile
 Laboratory
HEMATOLOGY HEMATOLOGY
Hb 11.2 gr% PPT 16.9(16.2)
WBC 13200 /mm3 PTTK 31.5(30.5)
Platelet 242000 /mm3 CA-125 179.6
Glucose 86 mg/dl
ALT 32 U/L Urinalysis
AST 48 U/L Protein negative
Ureum 21 mg/dL Nitrite Negative
Creatinin 0.6 mg/dL Bacteria 114
Sodium 134 mmol/L
Potassium 4.4 mmol/L
Chloride 100 mmol/L
HBsAg Negative
Chest X – Ray
• No heart enlargement
• No infiltration or nodule at lung
 Gynecologic Ultrasound
Transabdominal
• Adequate bladder filling
• Uterus difficult to assessed
• Hypoechoic mass with hyperecoic part , measurement: 19.3x13.4x21.4 cm, volume 2914.53 ml, septal (+), wall thickness
0.33 cm, neovascularization (+) Ri: 0.25 STT score : 3/2/2/3 = 10
• free fluid on morison pouch

Transvaginal
• Inadequate bladder filling
• Uterus, measured 8.51x3.78x4.57 cm, Volume 76.973 ml, EL 0.99 mm ,regular contour, homogeneous texture
• Conclusion : Ovarian cystic neoplasm with solid part
Gynecologic Ultrasound

ff
Gynecologic Ultrasound

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Gynecologic Ultrasound

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Gynecologic Ultrasound

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Papsmear (21/3/23)
• Negative for intraepithelial lesions
or malignancy
• Non specific inflamation
 Electrocardiography
• Normal sinus rhythm
HOGI score
Weight loss :2
Solid part :2
Ascites :2
CA 125 (179.6) :2
Ri (0.25) :2
Total : 10

RMI 3 score : 1x 3 x 179.6 = 538.8

 Diagnosis
• P0A0 46 y.o
• Ovarian cystic neoplasm with solid part, malignancy
suspected
 Procedure

• Unilateral salpingooophorectomy + frozen section

with complete surgical staging preparation
Thank You