1.Patient, female, 81 years old, 11 months post-operative for ovarian cancer decompensation and 10 days of abdominal distension.
2.The patient was diagnosed with ovarian cancer in March 2014 at the Union Hospital due to pain in the right lower abdomen, and underwent tumor cell reduction surgery (total uterus + bilateral adnexa + greater omentum + appendix + pelvic and abdominal lesion resection + adhesiolysis) under general anesthesia on March 21. Postoperative pathology showed (right) hypofractionated plasmacytoid papillary carcinoma involving (uterine rectal fossa, sigmoid surface and greater omentum), with no significant left ovary and left fallopian tube No significant abnormalities in the left ovary and left fallopian tube. Immunohistochemistry: CK20-,CK3+, ER weak+, PR focal+, Vimentin+, WT-1 weak+, p53+. Postoperative chemotherapy was refused. He was admitted to our department 10 days before admission with lower abdominal distension and loss of appetite for further treatment. He was admitted to our department for further treatment. His symptoms were: abdominal distension grade 4, lower abdomen predominant, fatigue grade 3, dry mouth without desire to drink, no appetite, normal night sleep, 1-2 stools/day, still formed, urine acceptable.
3. Past: history of hypertension for more than 10 years, used to take niskindipine and coxsartan, discontinued in the last 4 months, blood pressure control is still good, denied history of diabetes, coronary heart disease and cerebrovascular disease.
4.Physical examination T 36.5℃ P 96 times/min R 20 times/min BP 135/85mmHg
Height 140cm Weight 40kg Body surface area 1.28m2 KPS: 70 points
Normal development, moderate nutrition, walk-in ward, and cooperative body check. There was no yellowish staining of the whole body skin and mucous membranes, and no enlargement of superficial lymph nodes was palpable. There was no deformity of the five senses of the head, the lid conjunctiva was pale, the sclera was not yellowish, the eyes were flexible, the pupils were equal in size and round, and there were no abnormal secretions from the ears and nose. The lips and mouth were not cyanotic, the pharynx was not red or swollen, and the tonsils were not enlarged. The neck was soft and non-resistant, the trachea was centered, the thyroid was not large, and the jugular vein was not angry. The thorax was generally symmetrical and the spine was anteriorly curved. The breath sounds of both lungs were clear, and no dry and wet rales were heard. The heart rate was 96 beats per minute, the heart borders were not large, and no murmurs were heard in the auscultation areas of the valves. The abdomen was distended, and healing of the surgical scar was seen in the midsection. There was no pressure pain and rebound pain, the liver and spleen were not detected under the ribs, mobile turbid sounds (+), no percussion pain in the kidney area, and both lower limbs were not swollen. Physiological reflexes were normal, pathological reflexes were not elicited, the tongue was dark red with yellow coating, and the pulse was stringent and slippery.
5. Auxiliary examinations.
Blood routine, urine routine, stool routine, coagulation did not show any significant abnormalities.
Biochemical albumin (ALB) 28.80 (g/L) glucose (GLU) 6.07 (mmol/L) normal liver and kidney function and electrolytes.
Swollen standard serum osteoglycan (CYFRA) 8.61 (ng/mL) Neuron-specific enolase (NSE) 16.59 (ug/L) Glycoantigen CA-125 (CA-125) 203.70 (U/mL) Glycoantigen CA-153 (CA-153) 38.18 (U/mL)
Glycosylated hemoglobin: 6.60%, blood glucose 9.8 mmol/L 2h after lunch.
Abdominal ultrasound: normal liver morphology and size, parenchymal echogenicity was not uniform, portal vein trunk was not wide, several string-like strong echogenicity 0.6 cm with acoustic shadow was seen in the left lobe of liver, proximal bile duct was not dilated. The gallbladder was normal in size, with a wall thickness of 0.33 cm, gross, and no clear abnormal echogenicity was seen internally, and the intra- and extra-hepatic bile ducts were not dilated. Gastrointestinal gas was abundant, and the pancreas and retroperitoneal lymph nodes were poorly visualized. The spleen was normal in thickness and homogeneous in echogenicity. The splenic portal vein was not wide. Both kidneys were normal in morphology and size, with clear dermis and no dilatation of the renal pelvis. No clear occupying lesions were seen in both kidneys. Color flow showed no significant abnormalities. A large amount of free fluid was seen in each abdominal cavity interstitial space, with a deeper depth of about 11 cm. The fluid echogenicity was not clear and a large number of star-like echogenicity was seen. Conclusions: (1) intrahepatic calcified foci or bile duct stones; (2) mild thickening of the gallbladder wall; (3) ascites (massive).
Cardiac ultrasound: (1) tricuspid regurgitation (small amount); (2) left ventricular hypo-diastolic function.
Pelvic MRI scan + enhancement: uterus and bilateral ovaries are not shown. Multiple nodular slightly long T1 slightly long T2 signals with partial fusion are seen in the presacral area, the longest diameter is about 5.4 cm, with moderate more uniform enhancement. The bladder was full with no significant wall thickening. A large amount of watery signal shadow was seen in the abdomen. Conclusions: (1) enlarged anterior sacral multiple lymph nodes with partial fusion, consistent with metastatic manifestations; (2) uterus and bilateral ovaries were not shown, consistent with postoperative manifestations; (3) large amount of peritoneal fluid.
Western medical diagnosis: post-operative reduction of plasmacytoma papilloma of the ovary (stage T3cN1MX IIIc)
pelvic lymph node metastasis
abdominopelvic fluid accumulation
Hypertensive disease
abnormal glucose tolerance
Treatment after admission: diuresis, albumin supplementation, anti-tumor with compound Zebra, Conlet and Addy injections, and topical application of Si Miao San to reduce water retention and swelling.
(1) Oral tonics to dredge the liver and strengthen the spleen, dispel blood stasis and resolve phlegm.
Raw Astragalus 30 Radix Angelicae Sinensis 10 Radix et Rhizoma Polygonati 15 Poria 15
Radix Codonopsis pilosulae 15 Rhizoma Atractylodis Macrocephalae 15 Radix et Rhizoma Glycyrrhizae 6
Radix et Rhizoma Polygonum Multiflorum 15 Radix et Rhizoma Bupleurum 10 Neem 6 Stir-fried Sanxian 30
Jiao betel nut 10 fried grain bud 10 chicken internal medicine 10
Take one dose daily with water decoction
(2) Formula for the first week of chemotherapy
Radix et Rhizoma Ginseng 30 Fried Atractylodes Macrocephala 10 Poria 10 Roasted Licorice 6
Ginger and Semen 10, wide peel 10, black plum 6, sandy sage 6
Mu Xiang10 Jiao San Xian30 Nei Jin10 Su Stem10
Stir-fried Huanglian 6 Ginger bamboo rhizome 10 Roasted astragalus 30
The above formula is given in 4 doses with 100ml of concentrated decoction, one dose a day.
(3) Chemotherapy regimen
Paclitaxel 80mg ivgtt d1 8 15
Carboplatin 100mg ivgtt d1 8 15
q21 days
After 2 cycles, ascites disappeared and blood glucose fluctuated, changed to albumin paclitaxel + carboplatin.