VETERĞNER CERRAHĞ DERGĞSĞ 23

ile do₣rulandı. Ğdrar kesesinin trigon bölgesinden alınan örneklerin muayenesinde, epitelde hiperplazi veya The Diagnosis of hipertrofi, hemoraji, lenfosit ve plazma hücre infiltrasyonu ve epitel hasarı görüldü. Sonuç olarak, Trigonitis in Cows noninvazif bir metot olan ultrasonografi ve idrar sediment analizinin, trigonitis tanısı için do₣ru ve Using Transrectal güvenli bir de₣erlendirme sa₣ladı₣ı kanısına varıldı. Anahtar Kelimeler: Histoloji, idrar sedimenti, inek, Ultrasonography and trigonitis, ultrasonografi. Biochemical and INTRODUCTION Trigonitis describes hemorrhagic and proliferative inflammation including apparent hypertrophic or Histological hyperplasic changes that occur at the trigone of the urinary bladder (8-10, 16, 21). This lesion has essentially Techniques been described in humans. Heymann (8) described the lesion as trigonitis in 1905 firstly and Cifuentes (5) (Sı₣ırlarda Trigonitis’nin Transrektal reported it as true trigonal membranes in 1947 in human Ultrasonografi, Biyokimyasal ve Histolojik patients. These changes of the trigone are observed in as Tekniklerle Tanısı) many as 40% of adult woman (13). Similar lesions are less common in men (5, 14, 19). The etiology of trigonal hypertrophy or metaplasia is unclear. This condition is DURGUT, R.1, GÖNENCĞ, R.2, referred to more properly as trigonal nonkeratinizing ğ ¾ 3 squamous metaplasia (7, 9, 19, 21), and has minimal ATE O LU, E.Ö. morbidity or mortality unless it evolves into squamous

1 University of Mustafa Kemal, Faculty of Veterinary carcinoma (3, 4, 15, 17). The aim of the present study Medicine, Department of Internal Medicine, was to describe clinical, ultrasonographic, biochemical and histological findings of trigonitis in cows. 2 Department of Surgery, 3 Department of Pathology, 31040 Antakya/Hatay MATERIALS and METHODS Veteriner Cerrahi Dergisi (2003), 9 (1-2), 23-26 In the present study, 300 Holstein and Southern Anatolian crossbreed cows, aged between four to seven SUMMARY years old, admitted to Antakya Slaughterhouse, Turkey, In the present study, a total of 300 cows, aged four to were screened in Fall 2001. At the anamnesis, it was seven years old, presented to the Antakya Slaughterhouse understood that the owners of the animals had been were evaluated, and lesions at the trigone of the urinary adding giant fennel (Ferulla communis) to the animal bladder were detected in 60 cows. The diagnosis of rations. The animals were subjected to clinical, trigonitis was based on ultrasonography, cytological biochemical, histological and transrectal examination of the urine and by using urine dipstick test ultrasonographic examinations. In 60 of the 300 cows, stripes and definitive diagnosis has confirmed by trigonitis cases were observed. histologically after postmortem examination. After clinical examination, urine samples were obtained Examination of the samples taken from the trigone of the by catheterization from urinary bladder for testing and urinary bladder revealed hyperplasia or hypertrophy, the samples were then labeled. Urine analyses were lymphocyte and plasma cell infiltrations with performed within 15 minutes after the collection. The hemorrhagic areas and epithelial damage in the epithelial screening urinalysis tests were measured by a reagent test cells. It is concluded that, ultrasonography, which is a strip. The urine samples were centrifuged at 3000 rpm non-invasive method, and analyses of the urine sediment for 10 minutes. After decanting, the supernatant provide reliable and safety evaluation for the diagnosis of sediments were resuspended in physiological saline. trigonitis. Urine cytology was performed to search the existence of Key Words: Cow, trigonitis, histology, ultrasonography, abnormal cells under the microscope. The bladder, urine cell sediment. kidney, and ureter were examined by transrectal ultrasonography using a scanner 100 LC Vet ultrasound ÖZET machine (Pie Medical Equipment B.V., Philipsweg 6227 AJ Maastricht, The Netherlands) with a 6.0/8.0 MHz LA Bu çalıİmada, Antakya kesimhanesine getirilen, yaİları DF Vet TRD (401670, 401811) ultrasonic probe. 4-7 arasında de₣iİen 300 sı₣ır araİtırıldı ve 60’ında idrar After urinary bladders were collected following kesesinin trigon bölgesinde lezyonlara rastlandı. slaughtering of the animals, macroscopic evaluations Trigonitis’in tanısı ultrasonografi, idrarın sitolojik were performed and then bladder samples were fixed in muayenesi ve idrar dipstick test çubukları kullanılarak 10% neutral buffered formalin solution and embedded in yapıldı ve tanı kesim sonrası yapılan histolojik muayene 24 VETERĞNER CERRAHĞ DERGĞSĞ paraffin-wax. They were then processed by routine abundant in the large cell in 15 animals. There were no histological methods. Sections were cut at 6 µm and abnormal cells detected in 240 animals. stained with haemotoxylin and eosin (H&E) and Periodic Morphologically, at postmortem examination of 60 cows, acid Schiff (PAS) for histological to examinations. trigone was swollen and became large and increased size, measuring 1-5 cm with a mean of 3.4 cm in thickness, RESULTS and focal petechial hemorrhagic areas were detected on the trigone (Fig. 2). The rest of the 240 animals, there Physical examinations of the animals revealed no was no changes in trigone macroscopically. evidence of any diseases, except that in the 60 animals, lifting of their back dorsally or hypersensitivity in bladder palpations were observed. In ultrasonography, irregular structures with echogenic focal filling defects arising from mucosal surface of the urinary bladder neck which extends into the urinary bladder lumen were detected. The echogenicities of the bladder mucosa were changing gradually with no clear boundaries. The trigonal areas around the urinary bladder neck, whose sizes ranged from 3 to 5 cm in diameter, were readily and consistently detected in 60 cows ultrasonographically (Fig. 1). No trigonal abnormalities were detected in the 240 animals in ultrasonograpic examination.

Figure 2. A macroscopic view of a urinary bladder with oedematous and hypertrophic changes in trigone (arrows)

Histologically, trigonal urothelium consisted of three cell layers, which were basal, intermediate, and superficial in 240 cows. On the other hand, trigonal urothelium of 60 cows, there were about four folds thickening due to hyperplasia in epithelial cells in intermediate and Figure 1. Ultrasonographic appearance of the trigonal area of the urinary bladder. The ventral wall of the urinary bladder is irregularly superficial layers (Fig. 3, E). Glycogen storage cells in thickened, bulging into the lumen (arrows) the epithelial cells of superficial layer (Fig.3, G) were observed. The structure of basal lamina was normal (Fig.3, L). Vacuolization was seen in trigonal epithelial In macroscopic examination, urine was yellowish or light cells (Fig. 4, V). The normal structure of the trigonal pink in color. In 5 of 60 animals, the color of the urine epithelium was disorganized to varying extents (Fig. 4, appeared normal, whereas, in the rest of the animals, D). Focal mononuclear cell infiltrations, including small number of erythrocytes (about 50 per µl) was lymphocyte and plasma cells in the lamina propria (Fig. detected with urine test stripe was used, revealing 4, M) with oedematous (Fig. 4, O) and hemorrhagic areas haematuria and slight inflammation. In urine cytology of of trigonal region of the urinary bladder were detected. the 60 cows, an increased cellularity was the major finding with a relatively clean background. The cells were predominantly appeared in isolation, although DISCUSSION and clusters were present in 19 of 60 animals. In the cells, CONCLUSION nuclear enlargements and some other alterations including a moderate amount of well-defined minimal In the present report the authors describe trigonitis in cytoplasm, hyperchromatic nuclei, irregular nuclear cows diagnosed by ultrasonography and postmortem contour, and angular irregularity were observed in 21 examination. For the first time ultrasonography is often animals. Chromatin was uniformly increased in density, recommended as the first diagnostic tool in patient with nucleoli were infrequent and, cytoplasm was more hematuria or dysuria, as it is more sensitive and specific VETERĞNER CERRAHĞ DERGĞSĞ 25 in detecting urinary bladder disorders (2, 15). In recent Urine cytology is still the most commonly used years, transrectal ultrasonography has been proved as a noninvasive test to diagnose bladder masses and bladder useful non-invasive technique to evaluate the urinary mucosal abnormalities at early stages, although cytology bladder abnormalities (17). There are several entities that is highly subjective; does not distinguish with any degree may mimic the ultrasonographic appearance of urinary of success between moderate; well differentiated cancers bladder masses, such as bladder tumors, urinary polyps, and sometimes overdiagnose a tumor (12). In spite that blood clots, hemorrhagic cystitis and granulomatous urinary cytology yields poor results for trigonitis in cystitis (21). The use of ultrasonography was the major voided urine sample (19), absence of neoplastic cells and tool for diagnosis of trigonitis. In the present study, existence of atypical cells in the urine may possibly therefore, in urological examinations of cows, transrectal indicate bladder mucosal abnormalities in this study. ultrasonography was considered as a first step. In the present study, the common laboratory finding was the blood in the urine detected by urine test stripe. Existence of blood in urine is generally used, but not only, as an index for inflammation (6, 11). The inflammation of the bladder may be caused by kidney diseases, benign tumors, or bladder stones. It has to be noted that when small amount of blood is seen in urine, for the differential diagnosis, the disorders given above have to be considered. The etiology, morphology and clinical significance of trigonitis are poorly understood (7, 9, 18, 20). It has been reported that in human naturally occurring tumors are mostly located in the trigone of the urine bladder. No bladder tumor in the present study was detected in the animals with trigonitis. On the other hands such lesions usually are referred to as leukoplakia (3). Benson et al (3) reported that 21% of human patients with urothelial leukoplakia progressed to malignancy. Therefore, it should be noted that animals with trigonitis may be prone to subclinical bladder lesions, including bladder tumors Figure 3. Thickening of the epithelial cells (E), glycogen storage cells (G) and basal lamina (L) in trigone. PAS., x600 and urethral obstruction. In the present study, the histological work revealed that lamina propria of the trigon was invaded by lymphocyte and plasma cell, and showed hypertrophy. The present authors believe that trigonitis should reflect mobilization of the humoral immune response to various factors, such as subclinical diseases or allergens, which possibly leads to disorganized urothelial architecture. Alternatively, underlying cause for the disorders given here might be Ferulla communis, which is given to the cows by the farmers in this area for the belief of that this plant may have estrogenic effect. There have been many reports about this plant’s estrogenic effect ferutinin, which is fitoestrogenic agent (1). These hyperplasic changes in the recent plants appearing to include cows, as reported previously (10, 22). The present authors acknowledge that this is, at this stage with the presented evidence, speculative statement. So the effects of Ferulla communis need further investigations. It is concluded that, ultrasonography, which is a non- invasive method, and analyses of the urine sediment provide reliable and safety evaluation for the diagnosis of trigonitis. REFERENCES 1. Appendino, G., Cravotto, G., Sterner, O., Ballero,

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