Loobani AcademyAbstract
Vaginal tumor is a common tumor in the reproductive organs of female dogs. It obstructs the birth canal, affects the growth and breeding performance of dogs, and even causes the loss of mating and breeding ability of female dogs. A vaginal tumor, also known as a vaginal polyp, is a common tumor in female reproductive organs, accounting for about 64% of genital tract tumors in dogs. Uterine prolapse and vaginal neoplasms are challenging to distinguish from vaginal prolapse/hyperplasia. The most common vagino-vaginal tumors are fibroleiomyoma, lipoma leiomyosarcoma, squamous cell carcinoma, and metastatic tumors. Most public vaginal tumors occur in older (≥10 years) unneutered females. Benign vaginal-vaginal tumors are most common and are subject to local excision. Fibroleiomyoma is the most common benign tumor. Fibroleiomyomas originate around the urethral process and are usually pedicled, smooth, firm, and pale. The most common malignancies are infectious ones. These tumors tend to be broad, irregular, brittle, and bleed easily. Malignant vaginal-vaginal neoplasms are usually locally invasive and metastasize to local lymph nodes at an early stage. Non-neoplastic differential diagnoses include vaginal cysts, hydrocolloids, and septum or congenital malformations.
Keywords: Vaginal tumor; Fibroma; sterilization
Basic information
Name: DU DU
Breed: Mixed
Sex: Female (castrated)
Age: 6 years old
Body weight: 3.8kg
History: outdoor activities, complete vaccination, no deworming, vaginal bleeding one year ago
The owner fed her at home this year. Not playing outdoors during this time. Three days ago, the dog started to appear lethargic and weak. The owner found it walking in an incoordinate post and bleeding from the ass. So decided to take her to the hospital. Vaccinate history is completed.No deworming this year.
Physical examination
Body weight 3.8kg, temperature 38.6℃, respiratory rate was 20/min, heart rate: 126 beats/min. No prominent murmurs in breathing and cardiophony. Mouth mucosa was pink, capillary refill time（CRT）<2s, body condition score（BCS）was 5/9, which can touch the ribs in palpation. The patient presented with depression. Abdominal palpation was no obvious abnormal finding in the abdomen. There were mild dental calculus and gingivitis in an oral examination. Multiple areas of skin were soft. Obvious dehydration was not found. The vaginal was found with a type of bright red mass, like a ball; the size of it was about 5cm*3cm*3cm, with perineal distension. The overturned mucosa may protrude from the vulva or be touched with the fingers in the vagina.
Laboratory examination
Complete Blood Count (CBC) examination
Project | Result | Reference Range |
WBC | 7.0×109/L | 5.5~19.5 |
RBC | 7.0 x 1012/L | 4.6~10.0 |
HGB | 165g/L↑ | 93~153 |
HCT | 50.5%↑ | 28.0~49.0 |
MCV | 71 fL↑ | 39.0~52.0 |
MCH | 23.3pg↑ | 13.0~21.0 |
MCHC | 327g/L | 300~380 |
PLT | 557×109/L | 100~514 |
LYM% | 16% | 12.0~45.0 |
OTHR% | 77.3% | 45~86 |
EO% | 6.7% | 2~10 |
Interpretation: No obvious abnormality was observed in the leukocyte line. Mild highs with HGB, MCV, MCH, and HCT indicate dehydration, and we can not ignore the possibility of anemia in the patient because of the bleeding.
Idexx Catalyst biochemistry CHEM15
Project | Reference Range | Result |
ALT | 12-130 | 84U/L |
ALKP | 14–111 | 34U/L |
TBIL | 0-15 | 6umol/L |
AMYL | 500-1500 | 542U/L |
BUN | 2.5-9.6 | 5.5mmol/L |
CREA | 44-159 | 70umol/L |
ALB | 25–46 | 32g/L |
PHOS | 1.0-2.42 | 0.78mmol/dL |
TP | 57-89 | 71g/L |
GLU | 4.11-8.4 | 5.89umol/L |
GLOB | 28-51 | 38umol/L |
Ca | 1.95-2.83 | 2mmol/L |
Interpretation: There was a normal result of the biochemistries, so the further case of this disease had to find by the other examination.
The result of the CRP testing
Project | Result | Reference Range |
CRP | 18.6mg/L | <20mg/L |
Interpretation: The result of CRP was normal; the inflammatory should be evaluated in conjunction with another examination outcome.
Blood agglutination test
Project | Result | Reference Range |
APTT | 16.8 | 15-43 |
PT | 10.2 | 5-16 |
Interpretation: The result of the blood agglutination test was normal; the function of blood coagulation may be normal, and the outcome should be evaluated in conjunction with another examination result.
Microscope of the cytology with the mass
Interpretation: Multiple nucleated red cells and inflammatory cells were seen at high field, which was an indicator of inflammatory hyperplasia with the mass. More examinations were suggested to have a more precise diagnosis.
The result of the pathological examination
Interpretation: Vaginal mass is original with fibroma. Cell-derived tumors are common in the lower reproductive tract. These tumors form stiff nodules in the lumen structure, narrowing and twisting the lumen. Leiomyoma and fibroma are common vaginal tumors in female dogs. Fibroma is a benign tumor, primarily hard to the touch, white and spherical in appearance, and composed of fibrous cells and a rich connective tissue matrix. This specimen has a well-differentiated pattern, representing benign tumor behavior.
Diagnosis
Vaginal fibroma
The diagnosis methods in Canine Vaginal tumors usually used in clinical consist of the complete blood count, urinalysis, cytology of vaginal smear, serum biochemistries, abdomen ultrasound, needle aspirate, cytology of mass or tumor, biopsy and histopathology of mass or tumor, vaginal examination. The evidence of the cytology was not found, obviously, so it was necessary to take the histopathology of the group to make a diagnosis. However, it was expensive and a waste of time sometimes. Luckily, the tumor was benign.
Treatment
1. Surgical therapy: surgically excised the benign fibroma tumors
2. Cefotaxime 50mg/kg i.v q 12h
3. Meloxicam 2mg/kg s.c on the first day, then the dosage changed to 1mg/kg
4. 0.9%Nacl + LRS 1:1 get 40mL/kg/d
Prognosis varies by tumor type. Benign tumors usually have a good prognosis because most are cured with surgery. Malignant tumors require more extensive surgical resection than benign tumors for local control, but the risk of metastasis remains low. In one report, the average survival time for dogs with benign tumors was 18 months, compared with 11 months for those with benign tumors—a dog with a malignant tumor. However, no dogs with benign tumors died, and only 1 in 17 dogs with malignant tumors died from tumor-related causes. The reported recurrence rate was 14%; However, when ovaries and hysterectomies are performed simultaneously, the recurrence rate of benign tumors is close to zero. A study of five dogs with clitoral tumors treated with prednisolone, surgery, or surgery plus carboplatin reported a survival time of 100-500 days. One survived 420 days, and the other 500 days. One of the dogs that did not receive treatment stayed for only seven days.
In this case, the prognosis is good after therapy, and the monitoring of the vaginal bleeding is needed monthly for tumor recurrence.
Conclusion
Erythrocytes(Red blood cells) can be found in normal canine vaginal cytology and are associated with postestrus, estrus, and early diarrhea arrest. The persistent fever with pink to reddish-brown estrus vaginal discharge usually lasts 5 to 10 days, but estrus can last up to 3 weeks. It has been reported that female dogs that are generally pregnant give birth. Postpartum rufous lochia is more common at 2 to 3 weeks postpartum. Lochia should be odorless and decrease in number during the first few weeks after pupping. Most uterine remodeling, including the loss of collagen clumps associated with the placenta site, is completed at 6 to 8 weeks postpartum. Vaginal discharge beyond this stage is uncommon. Normal regeneration and repair of the endometrium are conducted at 12 to 14 weeks postpartum.
Reproductive Tract Disorders
For any dog with persistent vaginal bleeding, a reproductive history should be obtained, including all previous thermal cycles and the timing of breeding. Systemic or non-reproductive tract diseases (as described above) should be assessed. Blood counts, biochemical data, and urine analysis constitute a minimal database for these patients. A colposcopy should be performed to help locate bleeding and assess visible lesions in the vulva and vestibule. Vaginal swabs should be collected to determine if the peel vaginal cytology is consistent with the phase of the estrus cycle expected from the reproductive history. Hormonal analysis (estrogen levels, progesterone assay) may be helpful in further determining the reproductive status of the bitch.
Proestrus/Estrus
The symptoms of over three weeks of male attractiveness, receptivity to erections, and menstrual bleeding are not typical. Vaginal exfoliation cytology during estrus should show mainly large intermediate and keratinized epithelial cells. Occasionally, dogs, especially female dogs in development, will show “split estrus,” which may be a sustained estrus for pet owners or a shortened interval between estrus. During early follicular development, these dogs may show evidence of estrogen effects, including swelling of the vulva and serological discharge that may last for several days. These signs weaken for 1 to 3 weeks and then resume during “true” estrus. Ovulation usually occurs during the second half of the division fever, and fertility seems normal if the dog is bred. Uninterrupted, the persistent estrus with behavioral signs and the preponderance of superficial epithelial cells on the cytology of the vagina for more than three weeks requires a complete diagnostic evaluation. Constant vulvar discharge during heat may result from inflammation, infection, or structural lesions similar to urinary incontinence or neutered bitch. Female dogs with genital tract inflammation often attract male dogs but are rarely receptive to being mounted unless they are in heat. Copulation-related trauma can cause persistent vaginal bleeding. Prolonged estrus can occur in dogs treated with estrogen or progesterone to prevent or terminate unwanted pregnancies. Ovarian cysts and tumors are occasionally associated with persistent estrus. Non-productive cysts (such as reticulum of ovary cysts, subsurface epithelial structure cysts, or parafollicular cysts) are more common than cystic or luteinized follicular cysts that secrete hormones. The blisters and voids in the developing corpus luteum are typical cystic structures in the canine ovary. Most dogs with cystic follicles show a decreasing frequency of initiation rather than persistent estrus or nymphomorrhea. Huskies and golden retrievers may be susceptible to prolific ovarian cysts (7 of the 13 female dogs found at Colorado State University in 1982-1986 belonged to these two breeds and were in constant estrus). The animals ranged in age from 7 months to 9.5 years, with a median age of 16 months. Ovarian tumors usually occur in older dogs (median age 10-12 years), but ovarian teratoma often occurs in dogs younger than five years (median age = 4 years).
Both sex cord-stromal tumors (granulosa cell tumor, sertolystromal cell tumor) and germinal cell tumors (germinal cell abnormal tumor, teratoma) showed increased estrogen. In the 71 primary ovarian tumors studied at the Animal Medical Center, epithelial tumors (adenomas, adenocarcinomas) were more common (46%) than sex cord-stromal tumors (34%) or germ cell tumors (20%). Granulosa cell tumor (GCT) is dogs’ most common hormone-producing ovarian tumor. GCT may be unilateral or bilateral, and 10-25% have metastasis or local invasion at diagnosis. Hormone-active tumors may be less evident on examination of the affected ovaries or may grow to a considerable size (up to 4,000 cm3) at the time of diagnosis. Ovarian tumors should be suspected when an elderly female dog continues to be in estrus. Abdominal ultrasound is beneficial for evaluating the uterus and ovaries in dogs with persistent estrus. Normal follicles rarely exceed 0.5 cm in diameter. Cysts were found on ultrasound in 9 of the 11 dogs described by the report.
The concentration of sex hormones in the serum is helpful in the case of prolonged estrus. Estrogen peaks at 60-70 pg/mL late in estrus and begins to decline before LH surges. Estrus levels are usually 8 to 15 pg/mL. Progesterone levels rise before estrus at 0.5-1.0 ng/mL when LH peaks and grow after ovulation. Peak progesterone (15-90ng /mL) was reached 15-30 days after peak LH. Progesterone levels drop to 4-6 ng/mL during the last third of pregnancy and fall below 1-2 ng/mL just before delivery. In non-pregnant female dogs, progesterone gradually returns to estrus levels <1.0 ng/mL at 60 to 110 days. Serum estrogen levels exceeded estrus levels in 6 out of 11 dogs with reproductive ovarian cysts and 5 out of 5 dogs with ovarian tumors. Mildly elevated progesterone levels were found in 3 of 13 dogs with reproductive ovarian cysts and 1 of 7 with ovarian tumors (2.0-6.0 ng/mL). Aspiration (ultrasound-guided or laparotomy) of cystic areas within ovarian cysts or ovarian tumors revealed high levels of estrogen +/- progesterone in several dogs with persistent estrus, including some animals with serum values in the normal range. In many patients, exploratory laparotomy and ovariohysterectomy may be necessary for a definitive diagnosis.
