SUGAR

1
SUGAR

• Something in her ovary...
• Dr.Jose R. Castro
• July,2002

2
SIGNALMENT

• 6 years old
• Female
• T.W.H
• Bay

3
HISTORY

• Grass hay, Sweet Feed
• Foaled 2 years ago
• Didnt rebreed last year
• 3 months before presentation rDVM palpated a mass
  on her right ovary
• Becoming aggressive
• No other illness

4
REPRO HISTORY

• 1999 Foaled
• 2000 Reabsorbed fetus
• 2001 Continued cycling, signs of heat
• 2002 Ovarian mass incidental finding

5
PHYSICAL EXAM5/22/02

• T 100.4
• P 36
• R 20
• MM Pk

• CRT 1-2
• GS
• DP - - - -

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RECTAL

• Left Ovary Normal
• Right Ovary
• Soft mass
• Size of a cantalope
• Not painful
• Moveable

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U/S

• Capsulated, unilobular, globoid mass.
• Fluid like blood or pus.

8
CLINICAL PATHOLOGY

• CBC WNL
• Chem WNL
• Lytes WNL
• Fibrinogen WNL
• Hormones Not done

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DDx

• Not Cycling
• Adenoma Adenocarcinoma
• Dysgerminoma and Lymphosarcoma
• Arrhenoblastoma
• Hemorrhagic Follicules
• Granulosa-Theca Cell Tumor

• Cycling
• Hematoma
• Abscesses
• Teratoma
• Ovarian Cyst

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SURGERY5/23/02

• Right oblique paramedian laparotomy was performed
  to remove the right ovary.
• Mass cantalope size.
• Samples were taken and submitted to microbiology.
• Mass sent to Pathology.

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Incision
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Fixation
13
Exteriorized
14
Aspiration
15
Fluid Aspirate
16
Pedicle Ligation
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Closing Peritoneum
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Closing Muscle
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Closing SQ
20
Skin Staples
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Right Ovary
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Fluid Sampling
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Ovary Thickness Fluid
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POST-OP COMPLICATIONS

• Internal Hemorrhage, Sx day.
• Seroma on periincisional area.
• U/S (5/24/02) Hemoabdomen.

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MICROBIOLOGY

• No organisms seen.
• Microbiology
• UTCVM-LACS
• May 30,2002

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HISTOPATHOLOGY

• DIAGNOSIS
• Ovarian inclusion cyst.
• COMMENTS
• There is no evidence of neoplasia within sections
  of tissue examined. Excision should be curative.
• Dr. Robert L. Donnel
• 5/20/02

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DISCHARGE INSTRUCTIONS

• Monitor for E,D,U D
• The swelling will slowly decrease.
• Stall rest and handwalking for 2 weeks.
• Small paddock for 30 more days.

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DISCHARGE INSTRUCTIONS

• Hydrotherapy- 15 min. BID
• TMS tabs. BID
• Remove skin staples 14 days.

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AT PRESENT

• Owner was phoned on 7/22/02.
• Doing very well
• Progressively getting better
• Outside in a small paddock
• Seroma is gone
• Eating Drinking
• Gaining some weight
• Owner is happy with the outcome and the care that
  the mare got at UTCVM.

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ADENOMAS ADENOCARCINOMAS

• Rare
• Non secretory neoplasms
• Unilateral
• Unilobular or multilobular
• Hx weight loss, ascities, abdominal pain.

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Serous Cystadenoma
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DYSGERMINOMA /Ov. Lymphosarcoma

• Rare
• Highly malignant.
• Associated with hypertrophic osteopathy.
• Debilitation and visceral abdominal metastases
  are common.
• Abdominocentesis may reveal exfoliated tumor
  cells.

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Dysgerminoma (Bitch)
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Ovarian Lymphosarcoma (Cow)
35
ARRHENOBLASTOMA

• Rare
• Masculinizing ovarian tumors
• Increased concentration of testosterone
• Contralateral ovary Small and inactive
• DDx Histologic examination.

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HEMORRHAGIC FOLLICLE

• Size 60-90mm
• Infertility
• U/S Scattered free-floating echogenic spots
  within the follicular antrum that tend to swirl
  during ballottement of the ovary. bloody fluid
• Over time the contents begin to organize into
  fibrous bands.

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Hemorrhagic Follicles
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GRANULOSA-THECA CELL TUMOR

• Most common neoplasia in eq. ovary
• Benign
• Steroid producing Stallion like behavior.
• Anestrus, continuous or intermittent estrus.

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GRANULOSA-THECA CELL TUMOR

• Serum Testosterone 40-100 pg/dl is considered
  diagnostic
• Plasma estrogens below 100 pg/ml
• Increased Serum estrogens persistent signs of
  estrus or nynphomania.

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GRANULOSA-THECA CELL TUMOR

• Contralateral ovary small, supression of
  function and infertility due to production of
  inhibin and ovarian hormones.
• Size 4-40cm x 10-20cm
• Cut section multiple cystic structures.
• Content blood, blood-tinged fluid or
  straw-colored serum like fluid.

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GRANULOSA-THECA CELL TUMOR

• Treatment Surgery
• Prognosis Fertility is favorable

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Granulosa-Theca Cell Tumor -Mare
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Granulosa-Theca Cell Tumor - Foal
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Granulosa-Theca Cell Tumor - Foal
45
HEMATOMA

• Size 50mm to 50cm.
• Corpus Hemorrhagicum seen after ovulation.
• Normal cyclic ovarian activity.

• Persists 2 weeks to 6 months.
• Regress
• Mineralized ovary is devoid of follicular
  activity.

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HEMATOMA
47
ABSCESS

• Rare
• After needle puncture to aspirate contents of
  ovarian cysts or eggs for invitro
  fertilization.

• Mare cycle normally.

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TERATOMA

• Benign
• Nonsecretory
• Arises from germ cells
• Misplaced embryonic structures bone,
  skin,teeth,cartilage, nerves, blood vessels and
  hair.
• Mares continue to cycle.
• Do not interfere with fertility.

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TERATOMA (Cow)
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OVARIAN CYSTDoes not occur in mares!

• Large or multiple follicles.
• Ovarian hematomas.
• Prolonged estrus (8-12 days). Multiple follicles
  will ovulate at the same time.
• Paraovarian cysts.

• Germinal inclusion cyst
• Small 1-2 mm.
• Fibrous.
• Encapsulated.
• Occurs at the ovulation fossa.
• Contain serous fluid and may mechanically
  obstruct ovulation.

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Germinal Inclusion Cyst
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Hemorrhagic Cyst
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PARAOVARIAN CYST

• In tissues surrounding the ovary.
• Not clinically significant

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Paraovarian cyst
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Paraovarian cyst
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Something to remember...

• History
• Size
• Cycling
• Contralateral ovary
• Behavioral changes
• Endocrinology evaluation