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Intraabdominal Torsion of a Neoplastic Testicle and Prostatic Cyst in a Cryptorchid Dog

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Intraabdominal Torsion of a Neoplastic Testicle and Prostatic Cyst in a Cryptorchid Dog Fallbeschreibung Intraabdominal torsion of a neoplastic testicle and prostatic cyst in a cryptorchid dog G. Q. Mostachio, M. Apparício, W. R. R. Vicente, D. J. Cardilli, T. F. Motheo, G. H. Toniollo Department of Animal Reproduction, Faculty of Veterinary and Agriculture Sciences, São Paulo, Brazil Summary Intraabdominale Torsion eines neoplastischen Hodens und Prostatazyste bei einem kryptor- chiden Hund The present report describes a case of a nine-year Im vorliegenden Fall handelt es sich um einen 9- old male bilaterally cryptorchid boxer presented jährigen, beidseitig kryptorchiden Boxerrüden mit with testicular torsion and concurrent prostatic einer Hodentorsion und gleichzeitig vorhandener cyst. Clinical signs included anorexia, locomotor Prostatazyste. Klinisch zeigte der Hund Anorexie, difficulty and apathy. Abdominal palpation revealed Gehschwierigkeiten und Apathie. Bei der Palpation the presence of a hard and painful mass in caudal fiel eine harte und schmerzhafte Gewebsmasse im abdomen. Ultrasonographic findings were compat- kaudalen Abdomen auf. Im Ultraschall zeigte sich ible with testicular torsion and prostatic cyst, con- das Bild einer Hodentorsion und Prostatazyste, was firmed at surgery. Bilateral orchiectomy and omen- beides beim chirurgischen Eingriff bestätigt wer- talisation were performed. Histopathological den konnte. Es wurde eine beidseitige Orchiekto- examination of the torsed testicle revealed alter- mie und Omentalisation durchgeführt. Die histo- ations consistent with seminoma. pathologischen Veränderungen des befallenen Hodens wiesen auf ein Seminom hin. Keywords: testicular torsion, prostatic cyst, testicular neopla- Schlüsselwörter: Hodentorsion, Prostatazyste, Hodentumor, sia, cryptorchidism, dog Kryptorchismus, Hund Introduction To r sion is a twisting of the spermatic cord upon itself 1979). Clinical symptoms include: dysuria, intermit- that results in the obstruction of blood vessels supply- tent bloody urethral discharge, hematuria, fever, vom- ing the testis and epididymis. In dogs, spermatic cord iting, urinary infections not responsive to medical torsion is a rare condition and has been related to treatment, rectal tenesmus, dry or ribbon-like feces cryptorchidism. The undescended testicles may be and locomotor difficulty (Johnston et al., 2001b). The more frequently involved due to its greater mobility most common prostate disorder is benign prostatic inside the abdomen (Peduzzi and Carlson, 1980; hyperplasia followed by prostatic cysts and abscesses. Bartlett, 2002). Testicular torsion causes venous occlu- Prostatic cysts may be classified as either a prostatic re- sion, resulting in swelling and subsequent necrosis of tention cyst or a paraprostatic cyst. Prostatic cysts are the gonad. The clinical signs include: abdominal pain, defined as cavitating lesions with a distinct wall, con- anorexia, lethargy, vomiting, dysuria, locomotor diffi- taining fluid within the prostatic parenchyma (John- culty and pyrexia. In combination with testicular neo- ston et. al., 2001b). According to the same authors, a plasia symmetric alopecia and pendulous prepuce may paraprostatic cyst is defined as a fluid-filled cavity out- also be present (Johnston et al., 2001a; Bartlett, 2002). side the prostatic parenchyma. The pathogenesis of Presumptive diagnosis is based on symptoms and the cystic prostatic disorders is unknown although the presence of cryptorchidism. For definitive diagnosis, most accepted hypothesis is that prostatic retention an exploratory laparotomy is necessary. A condition cysts are caused by obstruction of ducts within the common among cryptorchid dogs due to its heredi- prostatic parenchyma and that paraprostatic cysts are tary nature, bilateral orchiectomy is the treatment of dilated embryonal remnants of Müllerian ducts (Bray choice (Johnston et al., 2001a; Feldman and Nelson, et. al., 1997) 2004). Bilateral orchiectomy is indicated as an additional Prostatic disorders as well as testicular torsion are treatment of prostatic disorders except in dogs with common in older dogs, and have effects related to the prostatic neoplasia (Rawlings, 1998). Surgical tech- urinary, digestive and locomotor systems (Chafraux, niques such as marsupialization, subtotal prostatec- Schweiz.Arch.Tierheilk. G. Q. Mostachio et al., Band 149, Heft 9, September 2007, 408–412408 ©2007 by Verlag Hans Huber, Hogrefe AG, Bern DOI 12.1024/0036-7281.149.09.408 Intraabdominal torsion of a neoplastic testicle tomy and Penrose drains have been used to remove or drain prostatic cysts and abscesses. However, pro- longed post-operative care and long-term complica- tions associated with these procedures inspired the de- velopment of a new technique using the omentum (Apparício et al., 2004) which has been shown to have angiogenic, immunogenic, dead-space filling and ci- catricial repair properties. Taking this into account, White and Williams (1995) suggested that the omen- tum could be used as a physiological drain for pro- static cysts and abscesses. The aim of this report is to describe the clinical-surgical condition of a dog with concurrent intra-abdominal spermatic cord torsion and prostatic cyst. Case History Figure 1: Sonogram of an intraabdominal testicle of a Boxer. A A nine-year old male boxer was referred for investi- wellcircumscribed structure with a central hyperechoic area (arrow) gation of anorexia, locomotor difficulty and apathy. surrounded by an anechoic structure can be seen. On physical examination, the dog was markedly apa- thetic and cachectic, and the absence of both testicles from the scrotum was noticed. (bilateral cryp- torchidism). Abdominal palpation revealed the pres- ence of a hard and painful structure in the caudal portion of the abdomen. An ultrasonographic exami- nation of the abdomen was carried out and revealed a well-circumscribed structure with a central hypere- choic area surrounded by an anechoic structure, find- ings compatible with testicular torsion and infarction (Fig. 1). In addition, a large anechoic area (> 8 cm in diameter) was found in the prostate gland suggesting the presence of a cyst (Fig. 2). The hematological eval- uation and serum chemistry analysis were within nor- mal limits. Based on our findings and on the animal’s condition an exploratory laparotomy was performed. Both tes- ticles were located in the caudal abdomen. The right testicle was enlarged, firm and hemorrhagic (Fig. 3). Figure 2: Sagital ultrasonographic image of the prostate gland (pt) There was > 360º (torsion of the spermatic cord, with and the urinary bladder (bx). An anechoic area (> 8 cm in the twist located about 1 cm proximal to the testicle. diameter) is visualized within the prostatic parenchyma (arrow), representing the prostatic cyst. The left testicle and the sublumbar lymph node did not present macroscopic alterations. A cyst measuring about 12 cm in diameter connected to the prostatic parenchyma (prostatic cyst) was found in the caudal abdomen (Fig. 4). Gonads were removed by standard procedure and the prostate was omentalised as de- scribed by Apparício et al. (2004). The prostate gland was packed off with Weitlaner retractor and the cyst was identified. Suction of about 300 ml of sanguinous content was performed to avoid abdominal contami- nation. Stab incisions were made in the ventral aspect of the gland, in both lobules, and the cavities were dig- itally dissected adjacent to the urethra. Prostatic omentalisation was then performed by introducing the omentum through the cavities but it was not passed around the prostatic urethra as described by Figure 3: Testicular torsion and prostatic cyst in an adult Boxer. G. Q. Mostachio et al., Band 149, Heft 9, September 2007, 408–412409 Schweiz.Arch.Tierheilk. ©2007 by Verlag Hans Huber, Hogrefe AG, Bern Intraabdominal torsion of a neoplastic testicle only the right testis presented histopathologic charac- teristics of neoplasia, even though the dog was a bilat- eral cryptorchid. Reif and Brodey (1969) have re- ported that the right testis is more frequently affected by tumors than the left one, but up to date there is no explanation for this incidence. Testicular torsion is also observed in dogs with both testes in the scrotum, but this appears to be very rare (Hulse, 1973; Zymet, 1975; Young, 1979). On the other hand, testicular torsion is not rare in humans, usually affecting children and newborns that present intrascrotal testicles (Pinto et al., 2001). Zymet (1975) speculated that excessive sexual and physical aggres- Figure 4: Macroscopic appearance of the right testicule and spermatic cord. Note the deformity and hemorrhage of the sion may be a contributing factor of intrascrotal tes- testicular and spermatic cord (arrow). ticular torsion in dogs. The most common clinical signs of testicular torsion are abdominal pain, anorexia, lethargy, vomiting, dy- White and Williams (1995). After sufficient omentum suria, locomotor difficulty and pyrexia (Johnston et was placed to fill the entire space within the prostatic al., 2001a; Bartlett, 2002) which, however, may also be cavities, it was anchored in place with simple contin- present in dogs with prostatic cysts. In our case, the uous sutures of 3/0 Vicryl, engaging both the omen- dog displayed some of the symptoms referred to in the tum and prostatic capsule. The abdomen was closed by literature (apathy, anorexia and locomotor difficulty) standard procedure in three layers. Histopathologic which, together with our clinical observations and ul- examination of the twisted testicle
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