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Dysgerminoma, Pyometra of the Stump and Mammary Carcinoma in a Female Dog with Ovarian Remnant Syndrome-Case Study

Faculty of Veterinary Medicine,Department of Clinics ,University of Agricultural Sciences and Veterinary MedicineIoana SFARTZ*, of Iasi, PetruAleea ROM. ŞSadoveanuCA, Iulian no.IBĂNESCU, 3, 700490, Ioana Iasi, CRIVEI, Romania Dan DRUGOCIU *Corresponding author: [email protected]

Bulletin UASVM Veterinary Medicine 72(2) / 2015, Print ISSN 1843-5270; Electronic ISSN 1843-5378 DOI:10.15835/buasvmcn-vm: 11401

Abstract

Ovarian remnant syndrome (ORS) represents the presence of functional ovarian tissue after routine castration of the bitch, caused either by surgeon error or the presence of anomalous ovarian tissue. The piece of that remains after the , may continue to develop and become functional, secreting hormones as estrogen and progesterone which cause signs of pro-estrus or estrus, even pseudocyesis. All those signs cause consternation among owners, who thought that the reproductive activity in their dog will be completely abolished. One mixed- breed, 6 years old bitch, 27.3 kg, spayed 8 months before, was presented with purulent vaginal discharge and mammary lumps, after the animal has been treated by her veterinarian with Proligestone to suppress the persisting estrus signs. Our investigations included vaginal cytology, vaginoscopy, the examination of the mammary chain, ultrasound, radiography, serum chemistry, blood count and histopathological examinations. The ultrasound revealed a filled uterine stump and the presence of a mass caudal the right kidney, which was suspected as an ovarian neoplasm. The examination of the mammary chain revealed masses in right M 3, M4, M5 glands and in the left M2 gland. The bitch underwent surgery, and the results of the histopathological examination were: dysgerminoma, pyometra, and the mammary masses were classified as carcinomas. In this paper we wanted to underline the fact that the Ovarian Remnant Syndrome may imply serious clinical consequences which can even lead to the death of the animal. We recommend as a method of treatment for this condition the surgical removal of the remnantKeywords tissue.: bitch ovarian remnant syndrome, pyometra, uterine stump

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INTRODUCTION

The ovary of the bitch can be often the seat In order to prevent these diseases, as well as of pathogenically entities development, such as other concerninget the al. reproductive system, the ovarian cysts or even neoplasia (Jones, 1983; owners are often advised to spay their female Drugociu, 2009).et al.Ovarian tumours can be of dogs (Runceanu , 2007). Surgical neutering germinal cells, epithelial cells or sex stromal in is one of the most common surgical interventions origin (Sforna , 2003). The most important in the veterinary practice. However, even the are the granulosa cell tumours, which can reach most experimented practitioners can face the very large sizes, sometimes they can even secret impossibility of fully removing the ovarian tissue, progesterone, triggering cystic endometrial caused either by poor visibility of the surgical hyperplasia and pyometra or persistent oestrus field, or because of improper application of clamps (Sforna, 2003; Drugociu, 2009). Germinal cells and ligatures, or sometimes, even because of the tumours, dysgerminomas and teratomas, are less presence of some adhesions or lesions that make common in the bitch (Greenlee, 1985). impossible to locate the (Chung, 2009). 284 et al

SFARTZ

Ovarian remnant syndrome represents the to males) the possibility of failing to completely persistence of functional ovarian tissue after remove one of the ovaries because of the presence routine spaying of the female dogs (Feldman, of some adhesions. On medical advice, the owners 2004; Runceanu, 2007; Drugociu, 2009). The have opted for a contraception with Proligestone ovarian cortex portion remaining after the injections. When the animal started to present surgery continues to grow, becoming functional, mammary enlargements, the currant veterinarian secreting hormones, progesterone and oestrogens interpreted this as canine lactatio sine graviditate, (Feldman, 2004), just as the intact ovary, exerting without performing additional exams. effects on genital tract, mammary gland and the When the owners brought the dog to our central nervous system, depending on the phases clinic, there was already a tennis ball-sized mass of the sexual cycle in which the animal is (Miller, in theRESULTS right M3 ANDgland. DISSCUSION 1995; Feldman, 2004). According to Sorenmo (2013), there is a general agreement that the greatest benefit on On physical examination, it was found that the mammary tumor prevention is seen if the dog animal was spirited, with no signs of discomfort. is not allowed to go through any heat cycles, The respiratory, cardiac frequencies as well as the suggesting that the pivotal and irreversible effects rectal temperature were within normal limits. The of ovarian hormones on the mammary glands in patient was clinically examined by inspection and terms of risk occur early in life, likely during palpation, ascertaining the evident increase in puberty when the mammary gland develops and the abdomen. Abdominal palpation revealed the mature, thus, the best way to prevent mammary presence of a hard, large, movable mass in the mid cancer is the early spaying of the female dog. Also, abdomen, but the patient did not show any sign of exposure to exogenous or pharmacologic doses pain during this procedure. Palpation of mammary of hormones (both progestins and estrogens), chain revealed the presence of some hard, with however, has been found to increase the risk for irregular contours, immovable masses in the right developing mammary tumors in dogs. Thus, dogs M3 (2 cm diameter), M4 (1cm diameter) and M5 treated with progestins are more likely to develop glands (8cm diameter) and the left M2 gland (3,5cm tumors and are younger when they do. According diameter). The size and consistency of the reginal to the Norwegian Canine Cancer Registry, dogs lymph nodes were within physiological norms. treated with progestins to prevent estrus had a Following this examination, it was suspected the 2.3 times higher risk for mammary tumors when presence of mammary tumors, therefore radiologic compared to dogs not receiving such treatment examination was performed to verifyet al. the presence (Stroving, 1997). for metastases, particularly of the lungs, common Our study presents the ovarian remnant in mammary neoplasia (Kealy , 2011). The syndrome in a 6 years old mixed breed bitch, result was negative (Fig.1 (a,b)). diagnosed with ovarian dysgerminoma, pyometra On gynecological examination, it was found of theMATERIALS stump and mammary AND METHODS carcinoma. the presence of malodorous purulent vulvar discharge. With the vaginal speculum and a light source it was observed the light edema of the The patient, a 6 years old, mixed breed female vaginal mucosa and the presence of the purulent dog, weighing 27,3kg, was presented in our clinic 8 discharge. The vaginal smear cytology performed months after she was castrated in a private clinic. by Diff-Quick staininget al.revealed a high number of The female had only one litter, 3 years before being large superficial cells, characteristic in estrogenic spayed and received progestogens several times secretion (Noakes , 2001; Feldman, 2004), (4-5 times) before the surgical spaying. The owners also numerous bacteria and neutrophils. have reported the presence of some mammary The ultrasound examination, performed lumps that have significantly increased in volume with a 7.5MHz sectoral transducer, showed the in a relatively short time (several months). The presence of a large heterogeneouset al. mass, caudal doctor who operated the animal later admitted (3 to the right kidney (Fig. 2), which was suspected months after the surgery, when the owners were as an ovarian neoplasm (Kealy , 2011). Also, surprisedBulletin UASVM Veterinaryto find Medicine that their72 (2) / 2015pet is still receptive there was a distended, convoluted, thin-walled 285

Dysgerminoma, Pyometra of the Stump and Mammary Carcinoma in a Dog with Ovarian Remnant Syndrome tubular stump in the caudal abdomen, chemistry results were also within physiological dorsal to the urinary bladder, containing etfluid al. limits. (Fig. 3,4). All other structures seemed unmodified Linking the anamnestic data with the clinical in the abdominal cavity (Barr, 2011; Kealy , and laboratory findings, the presumptive diagnosis 2011). of ovarian remnant syndrome, ovarian tumor, Results were completed by a complete uterine stump pyometra and mammary neoplasia blood count that revealed a hemoglobinemia was established. (7,89mmol/l), a hematocrit of 39 l/l, leukocytosis It has been decided to intervene surgically, (20G/l), neutrophilia (81,2%), lymphopenia urgently, to remove the abdominal mass, the (4,32%), monocytosis (8,98%), an increased uterine stump, and to perform total mastectomy value of basophil granulocytes (2,22%), other of the right mammary chain (being more than 3 values were within species normal limits. Blood glands affected) (Sorenmo, 2013) and a partial

a) b) Fig. 1. (a, b)

Thoracic radiography, lateral decubitus position (right (a) and left (b)); lack of visible lung metastases in a mixed-breed, 6 years old female dog

Fig. 2. Fig. 3. Neoplasia caudal to right kidney-ultrasound Distended uterine stump-ultrasound aspect in a aspect in a 6 years old mixed breed female dog 6 years old, mixed breed female dog Bulletin UASVM Veterinary Medicine 72 (2) / 2015 286 et al

SFARTZ

Fig. 4. Fig. 5.

Uterine stump diameter-ultrasound aspect in a Distended uterine stump, filled with a purulent 6 years old mixed breed female dog fluid- aspect during surgery in a 6 years old mixed breed female dog left mammary chain mastectomy, being one single was dysgerminoma, uterine stump pyometra and gland affected. mammary carcinoma. The ovarian tumor mass was completely The patient made an uneventful recovery after removed, submitted in 10% formalin and sent to the surgery, the medication she received post- the laboratory for histopathological examination, surgery was: Metacam, Synulox, Meloxicam and along with the uterine stump, that was highly Lymphomyosot N. At the 12 days check-up consult enlarged and filled with a purulent fluid (Fig.5). the general state of the animal was very good, she After checking for the metastasis presence in the only presented a small surgical wound infection abdominal cavity, the abdominal wall was sutured that was properly treated (with local disinfection in continues thread, and then the mastectomies and antibiotic ointment (Sorenmo, 2013). were performed. The neoplastic mammary masses One month postoperatively, the bitch was have been completely removed up to healthy submitted at our clinic with bulky new operative tissue, being also stored in 10% formalin and sent wound infection, purulent discharge and pain on to the laboratory along with the other samples for palpation of the mammary chain. By palpation, histopathologic differentiation. a rice grain-sized mass was found in the left M3 The histopathologic examination results have gland, another one of 10x10x4 cm, hard, immobile showed: in the right M3 gland- focal hyperplasia in the left M4 gland and a 1 cm in diameter one and ductal epithelium sclerosis; in the right in the left M5 gland. The complete blood count M4 gland- development of strong infiltrating revealed a leukocytosis (15,7G/l). The dog was carcinoma process; in the right M5 gland (the sent back home with an analgesic and antibiotic biggest among the mammary masses) - partially treatment, and should be presented in a few days tubule-papillary complex, partially carcinoma to a new consultation. Three days later, the patient extensive necrosis and purulent infiltration in the was brought in a critical condition, presenting central portion-mixed tumor process, granulation metastases in the entire mammary chain, the tissue. In the left M2 gland-cystic papillary impossibility of taking the stern-abdominal carcinoma. The abdominal ovarian mass was decubitus position because of the serious pain, differentiated as dysgerminoma. In the uterine thus, along with the owners, the decision of stump, numerous neutrophilic granulocytes could euthanasiaCONCLUSION was taken. be observed in the lumen, also an endometrial squamous metaplasia and cell residues of placental trophoblasts insertion. Thus the final diagnosis This case demonstrates that the remaining portion of the ovary after incomplete castration Bulletin UASVM Veterinary Medicine 72 (2) / 2015 287

Dysgerminoma, Pyometra of the Stump and Mammary Carcinoma in a Dog with Ovarian Remnant Syndrome

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Bulletin UASVM Veterinary Medicine 72 (2) / 2015