Skenario A Blok 24 Tahun 25

Mrs. Tari 37 yo, from middle income family comes to doctor at a public health venter with chief
complain of vaginal bleeding. She experienced post coital bleeding for 1 month. Since I year ago
she has been complaining about vaginal discharge with smelly odor and sometimes accompanied
by vulvar itchy. She already has 2 children before and the youngest child is 6 yo. Her husband is
a truck driver. She has never gone to the doctor related to her complain about vaginal discharge,
not using any medication, no history of pap smear examination, and no history of HPV
vaccination. She has a history of using intrauterine device ( IUD) as contraception for 5 years
since her youngest child birth and the IUD has been removed one year ago. Her older sister died
2 years ago caused by breast cancer.
In the examination findings :
Height : 155 cm weight 50 kg
BP 120/80 mmHg, pulse 80x/m RR x/m
Palpebral conjunctiva anemic
Breast there was no mass on both mammae
Abdomen flat and souffl, symmetric, uterine fundus is not palpable, there are no mass, no
painful tenderness and no free fluid sign
Internal examination
Inspection vulva and urethra was normal, there was no mass on the vulva, urethra, hymen and
perineum.
Speculum examination : mass on the portio size 2x2 cm, exophytic, fragile, easy to bleed, no
infiltration to the vagina, flour +
Bimanual examination cervix is soft, the external os is closed, no cervical motion tenderness,
exophtytic mass size 2x2x1 cm, fragile, easy to bleed, no infiltration to the vagina, uterine size is
normal, both adnexa and parametrium are within normal limit
Then you performes VIA, the result was you could define the external os, squamocolumnar
junction and there was thick acetowhite epithelium at the two oclock until 5 oclock position, so
you perform biopsy.
Laboratory result :
Hb 8,3 g/dL WBC 12.000/mm3 Trombosit 770.000/mm3 ESR 30 mm/hour.

The necxt week, the patient come with the histopathology result squamous cell carcinoma,
moderate differentiation, without limphovascular space invasion. You gave the inform consent
to the patient and family to refer her to the hospital, she asked you the diagnosed, kind of
examination that will be performed to her, and the possible treatment.
Klarifikasi Istilah
Coitus : senggama ; persetubuhan; penyatuan seksual antara laki-laki and pr yang melibatkan
penyisipan penis ke dalam vagina
Exophytic : tumbuh ke arah luar; pada onkologi istilah ini menunjukan proliferasi pada epitel
permukaan atau bagian luar organ tertentu atau struktur lainnya tempat pertumbuhan tersebut
berasal.
Squamo columnar junction : batas antara epitel yang melapisi ectoservix dan endocervix.
Pap smear : tes pap adalah tes yang melibatkan mikrokospik dari sel-sel yang dikumpulkan dari
leher rahim yang digunakan untuk mendeteksi perubahan yang mungkin kanker atau non kanker
seperti infeksi atau peradangan
IUD : AKDR; spiral; alat kontrsepsi atau kontrol kelahiran yang dimasukkan ke dalam rahim
yang terbuat dari plastic atau logam (biasanya tembaga)
Vaginal discharge : cairan vagina yang mengacu pada sekresi dari vagina, dan dapat bervariasi
dalam konsistensi (kental atau encer), warna (jernih, keruh, putih, kuning atau hijau), bau
(normal, tidak berbau ,berbau)
Acetowhite epithelium : warna putih pucat yang muncul pada zona transformasi berupa focus
focus perubahan epitel yang abnormal.
Indentifikasi Masalah
1. Mrs. Tari 37 yo, from middle income family comes to doctor at a public health center
with chief complain of vaginal bleeding. She experienced post coital bleeding for 1
month.
2. Since 1 year ago she has been complaining about vaginal discharge with smelly odor and
sometimes accompanied by vulvar itchy. She already has 2 children before and the
youngest child is 6 yo.
3. Her husband is a truck driver. She has never gone to the doctor related to her complain
about vaginal discharge, not using any medication, no history of pap smear examination,
and no history of HPV vaccination. She has a history of using intrauterine device ( IUD )
as contraception for 5 years since her youngest child birth and the IUD has been removed
one year ago. Her older sister died 2 years ago caused by breast cancer.
4. In the examination findings :
Height : 155 cm ; weight : 50 kg

BP 120/80 mmHg, pulse 80x/m RR x/m

Palpebral conjunctiva anemic
Breast there was no mass on both mammae
Abdomen flat and souffl, symmetric, uterine fundus is not palpable, there are no mass,
no painful tenderness and no free fluid sign
5. Internal examination
Inspection : vulva and urethra was normal, there was no mass on the vulva, urethra,
hymen and perineum.
Speculum examination : mass on the portio size 2x2 cm, exophytic, fragile, easy to bleed,
no infiltration to the vagina, flour +
Bimanual examination : cervix is soft, the external os is closed, no cervical motion
tenderness, exophytic mass size 2x2x1 cm, fragile, easy to bleed, no infiltration to the
vagina, uterine size is normal, both adnexa and parametrium are within normal limit
6. Then you performed VIA, the result was you could define the external os,
squamocolumnar junction and there was thick acetowhite epithelium at the 2 oclock
until 5 oclock position, so you perform biopsy.
The next week, the patient come with the histopathology result squamous cell
carcinoma, moderate differentiation, without limphovascular space invasion. You gave
the inform consent to the patient and family to refer her to the hospital, she asked you the
diagnosed, kind of examination that will be performed to her, and the possible treatment.
7. Laboratory result :
Hb 8,3 g/dL WBC 12.000/mm3 Trombosit 770.000/mm3 ESR 30 mm/hour.
Analisis Masalah
1. Mrs. Tari 37 yo, from middle income family comes to doctor at a public health
center with chief complain of vaginal bleeding. She experienced post coital bleeding
for 1 month.
a. Bagaimana anatomi dan histologi dari cervix dan vagina? (gambar) (Alif, Charita)
b. Bagaimana hubungan usia, sosial ekonomi, dan riwayat perdarahan post koitus
pada kasus? (Marlan, Azis)
c. Apa etiologi dan mekanisme dari vaginal bleeding? (Ulin, Ka Sandy, Ka Dul)
2. Since 1 year ago she has been complaining about vaginal discharge with smelly odor and
sometimes accompanied by vulvar itchy. She already has 2 children before and the
youngest child is 6 yo.
a. Apa etiologi dan mekanisme dari vaginal discharge dengan smelly odor pada kasus?
(Ulin, Ka Sandy, Ka Dul)
b. Apa etiologi dan mekanisme dan vulvar itchy pada kasus? (Marlan, Azis)
c. Apa makna klinis dari telah memiliki 2 anak dan riwayat persalinan pada usia 31
tahun pada kasus? (alif, Charita)
d. Apa makna klinis mengalami keluhan sejak 1 tahun lalu? (Marlan, Azis)
3. Her husband is a truck driver. She has never gone to the doctor related to her complain
about vaginal discharge, not using any medication, no history of pap smear examination,
and no history of HPV vaccination. She has a history of using intrauterine device ( IUD )

4.

5.

6.

7.

as contraception for 5 years since her youngest child birth and the IUD has been removed
one year ago. Her older sister died 2 years ago caused by breast cancer.
a. Apa makna klinis dari riwayat diatas? (alif, Charita)
b. Kapan dilakukannya vaksinasi HPV? (Rani, Amel)
c. Bagaimana cara melakukan pemeriksaan pap smear? (video) (Bayu, Ekik)
d. Jelaskan jenis jenis IUD beserta keuntungan dan kerugiannya? (Dinda, Panek)
In the examination findings :
Height : 155 cm ; weight : 50 kg
BP 120/80 mmHg, pulse 80x/m RR x/m
Palpebral conjunctiva anemic
Breast there was no mass on both mammae
Abdomen flat and souffl, symmetric, uterine fundus is not palpable, there are no mass,
no painful tenderness and no free fluid sign
a. Apa interpretasi dan mekanisme abnormal dari pemeriksaan fisik diatas? (Bayu,
Ekik)
Internal examination
Inspection vulva and urethra was normal, there was no mass on the vulva, urethra, hymen
and perineum.
Speculum examination : mass on the portio size 2x2 cm, exophytic, fragile, easy to bleed,
no infiltration to the vagina, flour +
Bimanual examination cervix is soft, the external os is closed, no cervical motion
tenderness, exophytic mass size 2x2x1 cm, fragile, easy to bleed, no infiltration to the
vagina, uterine size is normal, both adnexa and parametrium are within normal limit
a. Apa interpretasi dan mekanisme abnormal dari pemeriksaan inspeksi vulva dan
spekulum diatas? (Marlan, Azis)
b. Apa interpretasi dan mekanisme abnormal dari pemeriksaan bimanual diatas? (Alif,
Charita)
c. Bagaimana cara melakukan pemeriksaan dalam diatas? (video)
- Inspeksi vulva dan speculum (Marlan, Azis)
- Pemeriksaan bimanual (Alif, Charita)
Then you performed VIA, the result was you could define the external os,
squamocolumnar junction and there was thick acetowhite epithelium at the 2 oclock
until 5 oclock position, so you perform biopsy.
The next week, the patient come with the histopathology result squamous cell
carcinoma, moderate differentiation, without limphovascular space invasion. You gave
the inform consent to the patient and family to refer her to the hospital, she asked you the
diagnosed, kind of examination that will be performed to her, and the possible treatment.
a. Bagaimana interpretasi dari hasil diatas? (Dinda, Panek)
b. Bagaimana gambaran histopatologi pada kasus? (Dinda, Panek)
c. Bagaimana gambaran makroskopik acetowhite? (Rani, Amel)
d. Bagaiana gambaran makroskopik kanker cervix? (Bayu, Ekik)
Laboratory result :
Hb 8,3 g/dL WBC 12.000/mm3 Trombosit 770.000/mm3 ESR 30 mm/hour.

a. Bagaimana interpretasi dan mekanisme abnormal dari pemeriksaan lab di atas? (Rani,
Amel)
8. Analisis Aspek Klinis
a. Bagaimana cara penegakkan diagnosis pada kasus? (Alif, Charita)
b. Apa diagnosis banding pada kasus? (Dinda, Panek)
c. Apa working diagnosis dan definisi pada kasus? (Dinda, Panek)
d. Apa etiologi pada kasus? (Bayu, Ekik)
e. Bagaimana epidemiolog pada kasus? (Rani, Amel)
f. Apa faktor resiko pada kasus? (Rani, Amel)
g. Bagaimana patofisiologi pada kasus? (Marlan, Azis)
h. Bagaimana pathogenesis pada kasus? (video) (Ulin, Ka Sandy, Ka Dul)
i. Bagaimana manifestasi klinis pada kasus? (Bayu, Ekik)
j. Apa SKDU pada kasus? (Rani, Amel)
k. Bagaimana tatalaksana pada kasus? (algoritma) (Ulin, Ka Sandy, Ka Dul)
l. Bagaimana pencegahan dan edukasi pada kasus? (Alif, Charita)
m. Apa saja komplikasi pada kasus? (Bayu, Ekik)
n. Apa prognosis pada kasus? (Dinda, Panek)
Hipotesis
Ibu Tari, 37 tahun mengalami perdarahan vagina akibat kanker servix.
Learning Issues
1. Vaginal bleeding (Ulin, Alif, Marlan, Ka Sandy, Ka Dul, Azis, Charita)
2. Kanker Servix (Rani, Amel, Bayu, Ekik, Dinda, Panek)