Bilateral dysgerminoma in a senile bitch associated with nodular lymphoid hyperplasia in spleen and pyometra: a case report / Disgerminoma bilateral em cadela senil associado a hiperplasia nodular linfoide em baço e piometra: relato de caso

Ovarian neoplasms affect a low percentage of female dogs, and these tumors are classified according to their cellular origin and are considered rare. Dysgerminoma is a tumor derived from undifferentiated primordial ovarian germinal epithelium cells. In the male, this neoplasm is diagnosed as seminoma. Thus, dysgerminoma is not linked to the production of ovarian hormones such as estrogen and progesterone, which play a fundamental role in the establishment of pyometra. At Araujo Veterinary Hospital (HVA), a 15-year-old female Pinscher was admitted with mucopurulent vaginal discharge, abdominal enlargement, anorexia, polydipsia, and prostration clinical signs indicative of pyometra, radiographic and ultrasound examinations were requested, as well as a blood collection for hemogram and serum biochemistry. Ultrasound examination revealed uterine enlargement and hypoechoic content, in addition to bilateral ovarian cysts, measuring 7 cm in the right ovary and 3 cm in the left. The blood count revealed normal values in the erythrogram and the leukogram showed monocytosis and lymphopenia, in addition to macroplatelets. Biochemical examination revealed increased GGT values of 10 U/L. Ovariohysterectomy was performed and, in the trans-surgical period, nodules in the spleen were observed. So, the ovaries and a fragment of the lymphoid organ, were fixed and sent to the histopathology laboratory after surgical resection. Histopathology revealed ovarian dysgerminoma and lymphoid nodular hyperplasia. Ten days after the surgical procedure, the dog returned to the HVA for clinical evaluation and suture removal. However, three days after the return, the patient presented a convulsive condition evolving to death.

Neoplasias ovarianas acometem baixa porcentagem de cadelas, e estes tumores são classificados de acordo com a origem celular, sendo considerados raros. O disgerminoma é um tumor derivado de células do epitélio germinativo primordial ovariano, indiferenciado. No macho, essa neoplasia é diagnosticada como seminoma. Assim, o disgerminoma não está ligado a produção de hormônios ovarianos, como o estrógeno e a progesterona, que desempenham papel fundamental para o estabelecimento da piometra. No Hospital Veterinário Araújo (HVA), uma cachorra da raça Pinscher, com 15 anos, foi antendida apresentando, secreção vaginal mucopurulenta, aumento abdominal, anorexia, polidipsia e prostração sinais clínicos indicativos de piometra, solicitou-se exame de radiográfico e ultrassonografia, bem como a coleta de sangue para hemograma e bioquímico sérico. O exame ultrassonográfico revelou aumento uterino e conteúdo hipoecóico, além de cistos ovarianos bilaterais, com mensurações de 7 cm no ovário direito e 3 cm no esquerdo. O hemograma revelou valores normais no eritrograma e o leucograma apresentou monocitose e linfopenia, além de macroplaquetas. O exame bioquímico revelou valores de GGT aumentados, em 10 U/L. A ovariohisterectomia foi realizada e no trans cirúrgico observou-se nódulos no baço. Assim, os ovários e um fragmento do órgão linfoide, após a ressecção cirúrgica, foram fixados e encaminhadas para laboratório de histopatologia. A histopatologia revelou disgerminoma ovariano e hiperplasia nodular linfoide. Dez dias após o procedimento cirúrgico, a paciente retornou ao HVA para avaliação clínica e retirada da sutura. No entanto, três dias após o retorno, o animal apresentou um quadro convulsivo evoluindo ao óbito.

Diagnóstico e tratamento videoassistido de tumor de células de Leydig em cadela com síndrome do ovário remanescente / Videoassisted diagnosis and treatment for Leydig cell tumor in a bitch with remaining ovary syndrome

Neoplasias ovarianas de origem primária são incomuns em cadelas, exigindo métodos diagnósticos e terapêuticos mais precisos. Fêmeas também possuem células intersticiais secretoras de esteróides, contudo o aparecimento do tumor de células de Leydig é considerado raro. Uma cadela sem raça definida e 12 anos apresentava sinais de estro após ovariohisterectomia pré-púbere. Na avaliação ultrassonográfica, foi identificada uma massa localizada na região abdominal lateral direita, sugestiva de ovário remanescente. Durante a inspeção laparoscópica foi identificada a massa distante caudalmente do coto ovariano direito, inserida em região de mesentério jejunal. O segmento intestinal foi apreendido e exteriorizado de maneira videoassistida, optando-se pela remoção do tumor associado à enterectomia do segmento afetado. A avaliação do coto ovariano esquerdo, revelou um cisto de 0,5cm de diâmetro que também foi removido. A análise histopatológica foi sugestiva de neoplasia de células intersticiais (tumor de células de Leydig) e um cisto epitelial ovariano. O tumor de células de Leydig é relatado com freqüência em machos, entretanto, sua aparição em fêmeas é considerada extremamente incomum acometendo principalmente animais não esterilizados. A neoplasia não aderida ao coto ovariano comprova ainda que resquícios de tecido ovariano que porventura fiquem livres na cavidade abdominal podem ser responsáveis pelo desenvolvimento da síndrome do ovário remanescente e neoplasias. O prognóstico para neoplasias ovarianas sem metástases é favorável, principalmente quando aplicada a intervenção cirúrgica como método terapêutico. O uso da videocirurgia para auxiliar no diagnóstico e tratamento demonstrou-se adequado para o caso descrito, mas que deve ser complementado pela análise histopatológica.

Primary ovarian neoplasms are uncommon in bitches, requiring more accurate diagnostic and therapeutic methods. Females also have steroid-secreting interstitial cells, however, the appearance of the Leydig cell tumor is considered rare. A 12-year-old mongrel bitch showed signs of estrus after prepubertal ovariohysterectomy. Ultrasound evaluation located a mass in the right lateral abdominal region, suggestive of a remaining ovary. During laparoscopic exploration, the mass was identified caudally distant from the right ovarian stump, adhered to the jejunal mesentery. The intestinal segment was apprehended and exteriorized by video-assisted technique, and removal of the tumor was performed associated with enterectomy of the affected segment. Evaluation of the left ovarian stump revealed a 0.5cm diameter cyst that was also removed. Histopathological analysis was suggestive of interstitial cell neoplasia (Leydig cell tumor) and an ovarian epithelial cyst. The Leydig cell tumor is frequently related in males, however, its appearance in bitches is considered uncommon, affecting mainly nonsterile animals. The mass non-adhered to the ovarian stump proves that remnants of ovarian tissue that may be free in the abdominal cavity and may be responsible for the development of the remaining ovary syndrome and neoplasms. The prognosis for ovarian neoplasms without metastasis is favorable, especially when surgical intervention is applied as a therapeutic method. The use of video surgery to assist in the diagnosis and treatment was considered appropriate for the case described, but it must be complemented by histopathological analysis.

Ocorrência simultânea de teratoma ovariano e hiperplasia endometrial cística com piometra em cadela Labrador Retriever / Simultaneous occurrence of ovarian teratoma and endometrial cystic hyperplasia with pyometra in a Labrador Retriever bitch

Background: Ovarian teratoma is a rare tumor that occurs in dogs. Its origin comes from embryonic cells of the notochord and it is a unipotent tumor. Pyometra is the accumulation of purulent content in the uterine lumen. Cystic endometrial hyperplasia is one of the factors predisposing a dog to the development of pyometra. The safest and most efficient treatment for pyometra is ovariohysterectomy. The purpose of this report was to describe a case of ovarian teratoma and cystic endometrial hyperplasia with concomitant pyometra in a Labrador Retriever Bitch. Case: A 10-year-old bitch Labrador Retriever, weighing 42 kg, was evaluated at Animal Care Barueri Veterinary Clinic, in Barueri, São Paulo. The patient was referred from another veterinary service to our clinic for an ovariohysterectomy and removal of an intestinal foreign body as previous ultrasonography (US) had indicated the presence of pyometra and a foreign body in the descending colon (she had ingested cloth according to the owner's report). Laboratory tests, complete blood count, alanine aminotransferase, alkaline phosphatase, urea, and creatinine levels did not show any significant changes. Upon examination, the clinical signs were mucopurulent vaginal discharge, 5% dehydration, rectal temperature 39.1°C, mild abdominal pain on palpation, normophagy, normodipsia, and normal defecation and urination. Laboratory tests and a new US were requested on which the uterus was observed with the presence of luminal anechoic content and increased uterine diameter (uterine horns 3.97 cm), an acoustic intestinal shadow supposedly from a foreign body, and on the leukogram, leukocytosis (23,600/mm3) due to neutrophilia with a right shift (20,532/mm3) was observed. Therapeutic ovariohysterectomy and exploratory celiotomy were chosen as therapeutic options. Celiotomy with caudoumbilical mid ventral access was performed. When the left uterine horn was identified, an attempt was made to pull it in order to expose the left ovary, but this maneuver was not successful. For this reason, the abdominal incision was enlarged cranially. At that point, a huge mass was observed in the ovary (which was supposedly the acoustic shadow of the foreign body in the descending colon/left ovary). The intestines appeared normal. Macroscopically, the mass had an irregular surface, round shape, firm consistency, and was 15 cm long x 10 cm wide. Once removed, the mass was incised in the transversal direction, purulent content, hair, and mineralized areas inside it were observed. Histopathological examination showed neoplastic proliferation, consisting of cells with elongated epithelioid shape that were arranged in long irregular bundles among well-differentiated adipose tissue. An exuberant eosinophilic matrix with extensive cystic areas filled with lamellar keratin and hairy stems covered by squamous epithelium was also observed. Extensive areas exhibiting nervous tissue with minimal atypia are shown. The morphological picture was compatible with teratoma. Discussion: The present report describes the concomitant presence of ovarian teratoma and pyometra in a dog. The diagnosis of pyometra requires complementary tests (laboratory and imaging). The intestinal acoustic shadow observed on the two US images obtained by two different professionals was suggestive of intestinal foreign body but was also a wrong diagnosis, which was confirmed after an exploratory celiotomy when the mass in the left ovary was identified. On the histopathological examination of this present case, epithelial, nervous, and cartilaginous tissues were observed. This differentiation of tissues corroborated the teratoma diagnosis. Thus, the importance of an accurate diagnosis contributes to the resolution of a surgical conditions that may have had a poor prognosis when the procedure took a longer time to perform.(AU)

Laboratory predictors of survival in ovarian cancer

SUMMARY OBJECTIVE To relate disease-free survival and overall survival with type I and type II ovarian cancer and preoperative laboratory parameters biomarkers. METHODS A retrospective study was carried out based on the collection of data from medical records of patients with ovarian tumors. Kaplan-Mayer curves were drawn based on the statistical analysis of the data and were compared using the Log-rank test. RESULTS Disease-free survival in type I ovarian cancer was significantly higher than in type II (p=0.0013), as well as in those with normal levels of CA-125 (p=0.0243) and with a platelet-lymphocyte ratio (PLR) lower than 200 (p=0.0038). The overall survival of patients with type I ovarian cancer was significantly higher than in patients with type II, as well as in patients with normal CA-125 serum levels (p=0.0039) and those with a preoperative fasting glucose of less than 100 mg/dL. CONCLUSION CA-125 levels may predict greater overall and disease-free survival. PLR < 200 may suggest greater disease-free survival, whereas normal fasting glucose may suggest greater overall survival.

RESUMO OBJETIVO Relacionar a sobrevida livre de doença e sobrevida global com câncer de ovário tipos I e II, assim como com parâmetros laboratoriais pré-operatórios biomarcadores. MÉTODOS Estudo retrospectivo realizado com base na coleta de dados de prontuários de pacientes com tumor ovariano. As curvas de Kaplan-Mayer foram realizadas em relação à análise estatística dos dados, sendo comparadas pelo teste de Log-rank. RESULTADOS A sobrevida livre de doença nas pacientes com câncer de ovário tipo I foi significativamente maior do que nas pacientes com câncer de ovário tipo II (p = 0,0013), bem como maior naquelas com níveis normais de CA-125 (p = 0,0243) e com relação plaquetas-linfócitos (RPL) inferior a 200 (p = 0,0038). A sobrevida global de pacientes com câncer de ovário tipo I foi significativamente maior do que em pacientes com tipo II, maior em pacientes com níveis séricos normais de CA-125 (p = 0,0039) e naquelas com glicemia de jejum pré-operatória menor que 100 mg / dL. CONCLUSÃO Os níveis de CA-125 podem predizer uma sobrevida global e livre de doença. A RPL < 200 pode sugerir uma maior sobrevida livre de doença, enquanto uma glicemia normal de jejum, uma maior sobrevida global.

Ovarian dysgerminoma causing multifocal metastases in young bitch / Disgerminoma ovariano causando metástases multifocais em cadela jovem

The ovarian neoplasias are unusual in canine species, mainly originated from germinative cells. Among these, dysgerminoma is a rare neoplasm in bitches, predominantly affecting senile and small and medium breeds. They are large, rounded, smooth surface, painless and firm in consistency. The clinical signs commonly demonstrated by patients with this neoplasia are abdominal distension and secondary signs of hyperestrogenism. The diagnosis should be based on the association of history, clinical signs, radiographic, ultrasonographic, cytological, histopathological and immunohistochemical exams. The treatment is the surgical castration and metastases are uncommon. Due to the rarity in bitches, specifically the young animals, this study aimed to describe a case of left ovarian dysgerminoma, of considerable size and adherence in adjacent organs, in a Brazilian Fila, whose showed considerable increase in abdominal volume and progressive weight loss. The diagnosis was confirmed by means of complementary x-ray, ultrasound, histopathological and immunohistochemical tests. Even with the recommended surgical treatment (castration), the patient demonstrated severe respiratory symptoms and increased abdominal volume after two months, and the complementary exams suggested pulmonary and multifocal metastases and the tutor chose euthanasia. As presented by the results, although rare in bitches, dysgerminoma should be included in the differential of ovarian neoplasias, including the young ones.

As neoplasias ovarianas são de ocorrência incomum na espécie canina, principalmente as originadas de células germinativas. Dentre estas, o disgerminoma é uma neoplasia rara em cadelas, acometendo predominantemente fêmeas senis e de raças pequenas e médias. Apresentam-se como massas grandes, arredondadas, de superfície lisa, indolores e de consistência firme. Os sinais clínicos comumente demonstrados por pacientes com este tipo neoplásico incluem distensão abdominal e sinais secundários de hiperestrogenismo. O diagnóstico deve ser baseado na associação do histórico, sinais clínicos, exames radiográficos, ultrassonográficos, citológicos, histopatológicos e imunohistoquímicos. O tratamento de escolha é a castração cirúrgica, sendo que as metástases são incomuns. Perante a raridade em cadelas, em específico as jovens, este relato teve como propósito discorrer um caso de disgerminoma ovariano esquerdo, de tamanho considerável e aderência em órgãos adjacentes, em uma Fila Brasileira, cuja sintomatologia incluiu considerável aumento de volume abdominal e emagrecimento progressivo. O diagnóstico foi confirmado por meio de exames complementares de raios-x, ultrassom, histopatológico e imunohistoquímicos. Mesmo com a instituição dotratamento cirúrgico preconizado (castração), a paciente demonstrou grave sintomatologia respiratória e aumento de volume abdominal após dois meses e, como os exames complementares foram sugestivos de metástases pulmonares e multifocais, o tutor optou pela eutanásia. Diante dos resultados, pode-se admitir que apesar de raro em cadelas, o disgerminoma deve ser incluído no diferencial das neoplasias ovarianas, incluindo as jovens.

Perfil epidemiológico dos casos de neoplasias de ovário diagnosticados em um laboratório de patologia do sul do estado de Santa Catarina no período de julho de 2008 a julho de 2011 / Epidemiological profile of ovarian cancer cases diagnosed laboratory in southern Santa Catarina between july 2008 and july 2011

O câncer de ovário é considerado a neoplasia ginecológica mais letal e ocupa a sétima posição entre as causas de óbito em mulheres. Tem como dificuldade para seu tratamento o fato de o diagnóstico ser tardio, por apresentar sintomas inespecíficos e ainda não possuirmos um método de rastreamento abrangente e eficaz. O presente artigo traz como objetivo estimar o perfil epidemiológico das neoplasias de ovário diagnosticadas em um laboratório de anatomia patológica no sul do estado de Santa Catarina no período de julho de 2008 a julho de 2011. Se trata de estudo transversal, documental, descritivo e de abordagem predominantemente quantitativa. Foram encontrados 268 casos de neoplasias de ovário com idade média no momento do diagnóstico de 43,20 anos. O tamanho médio do ovário foi de 8,27cm havendo significância entre o tamanho do ovário e a malignidade do tumor. Os tipos histológicos mais encontrados foram o mucinoso benigno 22,0%, o teratoma maduro (cisto dermóide) 28,6% e o seroso benigno 36,3%. O câncer de ovário participa, a cada cinco anos, com cerca de meio milhão de mulheres afetadas. A literatura mostra os tumores epiteliais como os mais prevalentes, seguidos pelos tumores das células germinativas e do cordão sexual-estroma, coincidindo nossos dados, 68%, 29% e 3% respectivamente. A região de Criciúma mantém os padrões encontrados na literatura no que se refere às neoplasias ovarianas e os parâmetros avaliados neste estudo. Destacamos características locais que poderão contribuir para futuros estudos, a fim de desenvolver ações preventivas e diagnósticas.

Ovarian cancer is considered the most lethal gynecologic cancer and ranks seventh among the most common causes of death in women. One thing that complicate its treatment is the fact that the diagnosis is usually late, since the symptoms are nonspecific and still not having a screening method comprehensive and effective of tracking it. To estimate the epidemiological profile of ovarian cancer diagnosed in a pathology laboratory in southern Santa Catarina between July 2008 and July 2011. A transversal, documental, descriptive and addressing predominantly quantitative study. We found 268 cases of ovarian cancer with an average age at diagnosis of 43.20 years old. The average size of the ovary was 8.27 cm with a significant association between the ovarian size and the malignancy of the tumor. The prevalent histological types found were benign mucinous 22.0%, mature teratoma (dermoid cyst) 28.6% and benign serous 36.3%. The ovarian cancer affects about half a million women every five years. The literature shows epithelial tumors as the most prevalent, followed by germ cell tumors and sex cord-stromal, coinciding with our survey, which were 68%, 29% and 3% respectively. The region of Criciúma maintains the standards found in the literature referring to ovarian tumors and the parameters evaluated in this study. We emphasize local characteristics that may contribute to future studies, in order to develop preventive and diagnostic strategies.

A relação entre os níveis séricos de CA 125 e o grau de diferenciação em neoplasias ovarianas / The relationship between serum levels of CA 125 and the degree of differentiation in ovarian neoplasms

Introduction: Primary ovarian neoplasms exhibit a wide range of histopathological aspects, and tumors with epithelial differentiation are the most frequent. Among the malignant tumors, the most common histological type corresponds to serous adenocarcinoma, whose diagnosis is established in advanced stages of the disease in approximately 75% of the patients. Tumor marker CA 125 represents a glycoprotein synthesized mainly by neoplastic cells with epithelial differentiation, and its serum level seems to be associated with the biological potential of these lesions. Objective: To estimate the association between serum levels of CA 125 and the degree of differentiation in primary ovarian neoplasms. Method: Sixty distinct cases of primary ovarian tumors were selected, previously analyzed at the Laboratory of Pathology of the Hospital Complex of Universidade Luterana do Brasil (Ulbra), between 2005 and 2010, from patients undergoing concomitant analysis of CA 125. In each case, age, tumor size, histological type, degree of differentiation, presence of necrosis and tumor invasion of the albuginea or extraovarian tissues, pathological stage and serum CA 125 were determined. Results: A statistically significant relationship between CA 125 levels and histological grade (p = 0.001), age (p = 0.009), biological behavior of the tumor (malignant or benign - p = 0.002) and extraovarian invasion (p = 0.005) was found. No relationship between CA 125 levels and tumor size (p = 0.1006) and pathologic stage (p = 0.1) was determined. Histologic grade was associated with the presence of necrosis (p = 0.001), extraovarian invasion (p = 0.009) and tumor size (p = 0.008). Conclusion: In the present study, serum levels of CA 125 were associated with histological grade in primary ovarian neoplasms, especially in high-grade malignant tumors, suggesting that high levels of this glycoprotein are associated with lesions of more aggressive biological behavior...

Introdução: As neoplasias primárias de ovário apresentam uma ampla variação dos aspectos histomorfológicos; sendo os tumores com diferenciação epitelial os mais frequentes. Entre os tumores malignos, o tipo histológico mais comum é o adenocarcinoma seroso, cujo diagnóstico é determinado em estágios avançados de doença em aproximadamente 75% das pacientes. O marcador tumoral CA 125 corresponde a uma glicoproteína sintetizada pelas células neoplásicas com diferenciação epitelial principalmente, e seu nível sérico parece estar associado ao potencial biológico dessas lesões. Objetivo: Estimar a associação entre o nível sérico de CA 125 e o grau de diferenciação em neoplasias ovarianas primárias. Método: Foram selecionados 60 casos distintos de tumores ovarianos primários, previamente analisados entre 2005 e 2010, de pacientes submetidas à dosagem sérica concomitante do marcador CA 125. Em cada caso foram determinados tamanho tumoral, tipo histológico, grau de diferenciação, presença de necrose tumoral, invasão neoplásica da albugínea ou tecidos extraovarianos, estadiamento patológico e nível sérico de CA 125. Resultados: Foi encontrada uma relação estatisticamente significativa entre nível de CA 125 e grau histológico (p = 0,001), idade (p = 0,009), comportamento biológico da neoplasia (maligno ou benigno - p = 0,002) e invasão extraovariana (p = 0,005). Não foi observada relação do nível de CA 125 com o tamanho tumoral (p = 0,1006) e o estadiamento patológico (p = 0,1). O grau histológico esteve associado à presença de necrose (p = 0,001), invasão extraovariana (p = 0,009) e ao tamanho tumoral (p = 0,008).Conclusão: Os níveis séricos de CA 125 estiveram associados ao grau histológico em neoplasias primárias ovarianas, principalmente nos tumores malignos de alto grau, sugerindo que os níveis elevados dessa glicoproteína estejam associados a lesões de comportamento biológico mais agressivo...