A three-portal laparoscopic hysterectomy in a chimpanzee (Pan troglodytes) with a uterine manipulator and vessel sealing device.

OBJECTIVE: To report the treatment and outcome of a a captive chimpanzee (Pan troglodytes) undergoing 3-portal laparoscopic hysterectomy. Additionally, the technique used for successful urinary catheterization is described. ANIMALS: A 29-year-old female intact chimpanzee with uterine bleeding. STUDY DESIGN: Clinical case report. METHODS: Uterine changes consistent with adenomyosis and/or endometriosis were noted on abdominal ultrasonographic and computed tomographic examinations. A urinary catheter was placed before a 3-portal laparoscopic hysterectomy with a uterine manipulator (VCare) and a vessel sealer (Ligasure). The uterus was submitted for histopathology. RESULTS: Preoperative urinary catheterization was achieved with several modifications and prevented bladder protrusion into the surgical field. Laparoscopy provided excellent visualization of the pelvic structures and VCare effectively maneuvered the uterus for a safe and efficient dissection. The use of the vessel sealer was effective, and bleeding was minimal. Anesthesia and surgery lasted 240 and 150 minutes, respectively. No complications were encountered. Histopathological changes of the uterus were consistent with adenomyosis and myometrial hyperplasia. The chimpanzee recovered uneventfully and returned to normal behavior with no recurrence of uterine bleeding 5 months after surgery. CONCLUSION: The 3-portal laparoscopic technique reported here allowed hysterectomy without complication in this chimpanzee. Urinary catheterization was technically challenging but successful.

Diffuse Uterine Adenomyosis and Bilateral Ovarian Cysts in a Chinchilla Cat.

A 10-year-old female intact chinchilla cat was presented with intermittent vomiting and mild lethargy over the previous few months. Clinical signs and laboratory tests were unremarkable. Following an elective ovariohysterectomy, bilateral ovarian cysts and uterine adenomyosis were diagnosed in the patient. Because this cat had a long history of receiving low dose megestrol acetate for estrus suppression throughout her life (1.5 mg/cat, once during estrus, 2-3 times per year), it was suspected that the exogenous progestins increased her risk for disease. To our knowledge, this is the first report in cats demonstrating that even very low doses of megestrol acetate may increase the risk of developing uterine adenomyosis. Furthermore, uterine adenomyosis should be considered in the differential diagnosis of an intact female cat with a long history of unexplained vomiting.

Effect of ovarian steroids on vascular endothelial growth factor a expression in bovine uterine endothelial cells during adenomyosis.

BACKGROUND: Adenomyosis is a uterine dysfunction defined as the presence of endometrial glands within the myometrium. There is evidence that proangiogenic factors may play a role during the development of adenomyosis; however, exact mechanism remains unknown. The aim of the study was to determine the action of vascular endothelial growth factor A (VEGFA) in uterine tissue and uterine vascular endothelial cells during adenomyosis. RESULTS: Uterine tissues were collected and examined for the presence and extent of adenomyosis. Gene and protein expression of VEGFA and its two receptors (VEGFR1 and VEGFR2) was evaluated with quantitative polymerase chain reaction and Western blotting, respectively, in endometrium and myometrium during adenomyosis. Immunolocalization of VEGFA and its receptors within uterine tissues during adenomyosis was also determined. In an in vitro experiment, endothelial cells from non-adenomyotic bovine uteri were treated with media conditioned by non-adenomyotic or adenomyotic uterine slices treated with 17-beta-oestradiol (E2) or progesterone (P4). Both gene and protein expression of VEGFR2 were elevated in endometrium in stages 3-4 of adenomyosis. Protein expression of VEGFA and VEGFR2 as well as VEGFA secretion were increased in endothelial cells treated with media conditioned by adenomyotic uterine slices after E2 treatment. CONCLUSIONS: Results suggest that VEGFA signalling is an important component, next to E2, that enhances VEGFA action and participates in adenomyosis development in cows.

SURGICAL MANAGEMENT OF UTERINE LESIONS IN TWO CAPTIVE ORANGUTANS ( PONGO SPP.).

Uterine lesions in two orangutans were effectively managed with surgical intervention. A 26-year-old hybrid orangutan ( Pongo spp.) was diagnosed with uterine adenomyosis based on advanced imaging. Histologic evaluation identified multifocal myometrial endometriosis, a variant of adenomyosis. A 27-year-old Bornean orangutan ( Pongo pygmaeus) was diagnosed with a focal uterine fibroid based on histologic examination. The animals were housed at separate institutions and initially presented with dysmenorrhea and menorrhagia. Both animals were treated intermittently for episodes of dysmenorrhea, with recurrence of clinical signs after each treatment. Due to the lack of consistent response to medical management, an ovariohysterectomy in the hybrid orangutan and a myomectomy in the Bornean orangutan were performed and resulted in complete resolution of clinical signs. Surgical management of adenomyosis and neoplasia has previously been reported in nonhuman primates. These cases are the first known documentation of surgical management of multifocal myometrial endometriosis and a fibroid in orangutans.

Prolactin role in the bovine uterus during adenomyosis.

Adenomyosis is uterine dysfunction defined as the presence of endometrial glands within the myometrium. It is suggested that adenomyosis is estrogen-dependent pathology, and prolactin (PRL) also affects its development. In the uterus of ruminants, PRL stimulates gland proliferation and function. We hypothesized that in the bovine uterus, the expression of PRL and its receptors (PRLRs) during adenomyosis is disturbed and modulated by estradiol (E2). Uterine tissues were collected postmortem from cows; epithelial, stromal, and myometrial cells were isolated; and cultured and treated with E2. Material was divided into 2 groups: control (nonadenomyotic) and uteri with adenomyosis. In adenomyotic uterine tissue, PRL and its long-form receptor protein were increased, as determined by Western blotting. Immunohistostaining showed that during adenomyosis, PRL and its receptors are highly expressed in adenomyotic lesions. In cultured myometrial cells, protein expression of PRL and its receptors was increased during adenomyosis. Estradiol decreased PRLRs protein expression in nonadenomyotic stromal cells and in adenomyotic myometrial cells, and increased PRL secretion by adenomyotic myometrial cells. Moreover, PRL secretion was increased in untreated epithelial and stromal cells during adenomyosis. On the other hand, in stromal cells, PRLRs messenger RNA and protein expression was decreased, as determined by real-time PCR and Western blotting, respectively. Obtained results show that significant changes in PRL and PRLRs expression are observed in uterine tissue and cells during adenomyosis, which were also affected by E2. These data suggest involvement of PRL in adenomyosis development and the link between PRL and E2 actions during the dysfunction in cows.

Adenomiose uterina em gata associada à piometra / Uterine adenomyosis in a queen associated to pyometra

Adenomyosis, a non-neoplastic myometrial proliferation, is a rare pathologic condition in domestic animals, of unknown etiology. There is a lack of information about the clinical and pathological features of this disease in cats, therefore just a few reports in that species. The study describes a case of adenomyosis in a feline female. A cat, six years old, undefined breed, not spayed, had abdominal swelling history and vaginal discharge. Clinically, upon abdominal palpation, a diffuse increase suggesting a uterine change was found. The vulva had sanguine-purulent exudates. The choice was for the neutering surgical. Uterine macroscopy revealed cystic endometrial hyperplasia/pyometra in uterine horns, and the presence of a diffuse mass on uterine corpus. Fragments of the mass were sent for histopathological analysis, which revealed adenomyosis of the uterine corpus. The patient exhibited adequate post-operative recovery. The adenomyosis should be considered as a differential diagnosis of uterine neoformation in domestic cats.(AU)

Estradiol Reduces Connexin43 Gap Junctions in the Uterus during Adenomyosis in Cows.

Adenomyosis is defined as the presence of glandular foci external to the endometrium of the uterus, either in the myometrium or/and perimetrium, depending on the progress of this dysfunction. To date, we showed that steroids secretion and prolactin expression and proliferative processes are disturbed during uterine adenomyosis in cows. During endometriosis in eutopic endometrium in women, gap junctions are down regulated. The transmembrane gap junction protein, connexin (Cx43) is necessary for endometrial morphological, biochemical and angiogenic functions. The aim of this study is recognition of adenomyosis etiology by determination of the role of Cx43 in this process. Immunolocalization and comparison of Cx43 mRNA and protein expression in healthy (N=9) and adenomyotic uterine tissue (N=9), and Cx43 mRNA expression (real time PCR) in uterine stromal - myometrium co-culture under 24-hour stimulation with 17-beta estradiol (10-7M) isolated from healthy (N=5) and adenomyotic (N=5) cows were determined. Cx43 was localized in healthy and adenomyotic uteri. mRNA and protein expression was down-regulated in uterine tissue in adenomyotic compared with healthy cows (p<0.05). Estradiol stimulated Cx43 mRNA expression in myometrial cell culture and co-culture of stromal and myometrial cells in adenomyotic compared with healthy cows (p<0.05). In summary, down-regulation of Cx43 expression in the junction zone might play an important role in pathogenesis of adenomyosis. Estradiol modulates gap junctions during adenomyosis.

UTERINE ADENOMYOSIS AND AN ENDOMETRIAL POLYP IN A ROCK HYRAX (PROCAVIA CAPENSIS).

An 8-yr-old nulliparous, female rock hyrax ( Procavia capensis ) had intermittent mucoid to bloody discharge late winter-early spring for two consecutive years. Fragments of necrotic tissue, suspected to be vaginal or rectal in origin, were passed on two occasions. Physical examination, radiographs, and ultrasound did not identify the source of the tissue. Exploratory laparotomy and ovariohysterectomy were performed. On histopathology, a diagnosis of adenomyosis with a uterine polyp was made. Postsurgical complications included incisional infection and renal compromise that were medically managed and resolved. No further vaginal discharge was observed. This is the first report of uterine adenomyosis and endometrial polyp in a rock hyrax.

Is adenomyosis a problem in reproduction and fertility?

Adenomyosis is defined as the presence of glandular foci beside the endometrium of uterus: in the myometrium and/or perimetrium depending on the progress of the disorder. So far, adenomyosis has been diagnosed in women and rodents, and studies conducted on cows have been rare. In this review we: (1) summarize the knowledge regarding adenomyosis, (2) compare the symptoms and aetiopathology between women and cows, (3) describe angiogenic uterine processes related to adenomyosis development and (4) outline the influence of adenomyosis on proper fertility processes in cattle (conception and fertility rates).

Uterine adenomyosis in southern three-banded armadillos (Tolypeutes matacus).

Uterine adenomyosis was diagnosed in five southern three-banded armadillos (Tolypeutes matacus) from four different zoological collections in North America between 1995 and 2012. Two cases were diagnosed after ovariohysterectomy and histopathologic evaluation of the uteri, and the remaining cases were identified incidentally at the time of postmortem examination. Animals ranged from 5 to 14 yr of age at the time of diagnosis. Of armadillos diagnosed before postmortem examination, clinical signs included weakness, collapse, anemia, and vulvar discharge. Histopathologic evaluation of the uteri revealed well-developed, irregular endometrial glands extending into the myometrium and occasional hemorrhage within these glands. The two cases diagnosed antemortem were successfully treated with ovariohysterectomy. To the authors' knowledge, this condition has not been previously reported in Xenarthra, including armadillos.