Bilateral ovarian adenocarcinoma in a mare causing haemoperitoneum and colic.

CASE HISTORY: A 13-year-old Thoroughbred mare was presented with a history of mild colic over 3 days. This colic had acutely exacerbated and was unresponsive to analgesic treatment, and was referred to Massey University Veterinary Teaching Hospital. CLINICAL FINDINGS: On examination the heart rate was 100 beats per minute, and mucous membranes were pale and tacky. A large mass was detected on transrectal palpation in the caudal abdomen to the left of midline. Explorative laparotomy revealed severe haemoperitoneum and several masses that were associated with the reproductive tract. The mare was then subject to euthanasia. On post-mortem examination, adjacent and attached to each ovary were soft, lobulated dark red masses up to 200 mm in diameter. Similar masses were present in the omentum and on the peritoneal surface of the diaphragm and the serosa of the spleen and liver. Histopathology revealed that the neoplastic component of the masses comprised proliferating cuboidal to columnar cells forming disorganised acini and cords separated by dense collagenous stroma. Immunohistochemistry showed the neoplastic cells were positive for cytokeratin AE1/AE3 and vimentin, but negative for cytokeratin 7 and inhibin α. DIAGNOSIS: Bilateral ovarian adenocarcinoma with transcoelomic metastasis and terminal decompensation due to rupture of a neoplastic mass and consequent haemoperitoneum. CLINICAL RELEVANCE: To the authors' knowledge, bilateral ovarian adenocarcinoma has not been previously reported in a horse. Ovarian adenocarcinoma should be considered when horses present with haemoperitoneum and colic. Further research is required on the immunohistochemical differentiation of adenocarcinoma of ovarian and intestinal origin in the horse.

Investigation into the morphology of the third metacarpal bone in the horse.

AIMS: To describe key morphological attributes of the third metacarpal bone (Mc3) of horses and to determine whether or not the symmetry of the Mc3 varied significantly between limbs of the same horse. METHODS: Ten pairs of metacarpi were collected from slaughter facilities. The age and breed of the horses were recorded. Fixed points and axes that could be easily reproduced between bones were identified on high-quality photographic images of each bone. Using image analysis, three angles were measured. Angle gamma measured the rotation around the long axis of the diaphysis of Mc3, angle delta the angle between the dorsal long axis of the cannon bone and the surface of the condyle of Mc3, and angle theta the angle between the surface of the condyle and the long axis of the sagittal ridge of the condyle of Mc3. These angles represent some of the characteristic morphologic relationships within the equine Mc3. RESULTS: The coefficient of variation for angles gamma, delta and theta and were 1.2%, 0.2% and 0.5%, respectively. Angle gamma was larger in the left compared with the right limb (p=0.041). Angles delta and theta were larger in the right compared with the left limb (p=0.001 and p=0.003, respectively). There was a single outlier in a left limb for angle gamma. When this was excluded from the analysis, angle gamma in the left limb was still larger than in the right limb. Angle delta was consistently greater than 90° in 19/20 metacarpi. CONCLUSIONS: There were significant morphological differences in the Mc3 between the left and right limbs of the 10 horses examined. These findings provide some reliable reference data for future investigation. Further work is required to document these differences in a larger population of horses and to determine whether the morphology of the Mc3 is influenced by age or other factors such as use of the animal.

Multi-drug-resistant Enterococcus spp. as a cause of non-responsive septic synovitis in three horses.

CASE HISTORY: Three Thoroughbred horses, a 6-week-old filly (Case 1), a 15-year-old broodmare (Case 2) and a yearling filly (Case 3), sustained synovial sepsis secondary to trauma. CLINICAL FINDINGS: Case 1 presented with a heel bulb laceration communicating with the distal interphalangeal joint. Arthroscopic lavage was performed and treatment commenced using systemic and local broad spectrum antimicrobial drugs. A pure growth of multi-drug-resistant (MDR) Enterococcus gallinarum was cultured from samples of synovium and joint fluid. Antimicrobial treatment was changed according to the susceptibility results. Response to treatment was poor and despite repeat arthroscopic lavage and intra-osseous regional perfusion of antimicrobials the filly was subject to euthanasia 24 days after the initial injury. Post-mortem examination confirmed septic synovitis, cartilage degeneration and osteomyelitis. Case 2 sustained a full thickness wound to the carpus which was sharply debrided and closed. The wound dehisced with effusion within the tendon sheath. Drainage was established and treatment included systemic broad spectrum antimicrobials, topical lavage with povodine-iodine and manuka honey infusion. A mixed infection including MDR Enterococcus faecalis was cultured from the synovial fluid. Antebrachiocarpal joint effusion developed 21 days after initial injury and joint sepsis was confirmed. Arthroscopic lavage and tendon sheath debridement were performed, followed by treatment with systemic and local antimicrobials. The mare improved and was discharged. Three months later lameness recurred and corticosteroids were administered intra-articularly. The mare became non-weight bearing lame and was subject to euthanasia. Post-mortem examination confirmed joint sepsis of the antebrachiocarpal and intercarpal joint. Case 3 presented with a complete articular open fracture of the tibial crest. Under general anaesthesia the fracture was stabilised and the wounds debrided and closed. Systemic broad-spectrum antimicrobials were administered. Six days later the wound dehisced and a bone fragment was removed. Three weeks post-surgery the wound deteriorated with a purulent discharge. Culture of the discharge revealed a mixed bacterial infection, including a MDR Enterococcus faecalis. Femoropatellar joint involvement was confirmed, and treatment included joint lavage, local and systemic antibiosis, and manuka honey instilled into the wound. The filly initially improved, and then deteriorated such that euthanasia was performed. DIAGNOSIS: All three cases had synovial sepsis with MDR Enterococcus spp. CLINICAL RELEVANCE: Increased awareness of MDR pathogens in equine wound infections is essential. Prompt diagnostic testing, appropriate therapy, infection control strategies and on-going monitoring and management are vital to limit the clinical impact of these organisms.

Granulosa theca cell tumour in a pregnant mare: concentrations of inhibin and testosterone in serum before and after surgery.

CASE HISTORY: A 14-year-old Thoroughbred mare was presented for evaluation of a rapidly enlarging ovary at 73 days gestation. The mare's owner reported behavioural changes in the mare since she returned from stud, notably aggression towards other horses. CLINICAL FINDINGS: Transrectal palpation and ultrasonography of the reproductive tract revealed a viable pregnancy, an enlarged, multiloculated right ovary, and a normal-sized left ovary with a corpus luteum present. Concentrations of inhibin and testosterone in serum were 13.8 ng/mL and 1,150 pg/mL, respectively, being markedly higher than reference ranges. Concentration of progesterone was 4.5 ng/mL, consistent with the presence of functional luteal tissue. A presumptive diagnosis of a granulosa theca cell tumour (GTCT) was made, and the ovary was surgically removed. Histopathological examination of the removed ovary confirmed a benign GTCT. At 31 days after surgery concentrations of inhibin in serum had decreased 18-fold, and testosterone had decreased 10-fold. Pregnancy was reconfirmed at 115 days gestation by rectal palpation and transrectal ultrasonography. DIAGNOSIS: Granulosa theca cell tumour associated with elevated concentrations of inhibin and testosterone in serum. CLINICAL RELEVANCE: While ovarian enlargement and aggressive behaviour may be considered normal in some pregnant mares, a GTCT should be included as a differential diagnosis. Measurement of concentrations of inhibin and testosterone in serum are useful to support a presumptive diagnosis of GTCT in mares.