Ovarian Fibrothecoma in a Holstein cow: A Case report

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1 Cse Report DOI: /veterinry.v9i Received: Accepted fter revision: Published online: 2017-Jun Jun Jn-20 Ovrin Fibrothecom in Holstein cow: A Cse report Ali Soleimnzdeh, RoozAli Btvni, Alirez Nourin, Bell Pshie b c Deprtment of Theriogenology, Fculty of Veterinry Medicine, Urmi University, Urmi, Irn Deprtment of Bsic Sciences, Fculty of Veterinry Medicine, Urmi University, Urmi, Irn Deprtment of pthobiology, Fculty of Veterinry Medicine, Urmi University, Urmi, Irn b c Keywords bovine; Fibrothecom; histopthology; Ovry; tumor Abstrct A 5-yer-old Holstein cow ws referred to the Veterinry Medicine Hospitl, Urmi University, Urmi, Irn, with bnorml estrous cycle. At rectl plption, the unilterl ovry enlrgement ws detected. On trnsrectl ultrsonogrphy view, the left ovry hd uniformly hyperechogenic res. The ffected ovry ws removed by ovriectomy nd sent for histopthologicl exmintion. Histopthologicl evlution reveled fibroblstic cells producing collgen fibers nd thec cells contining lipids. Bsed on histopthologicl fetures, dignosis of fibrothecom ws confirmed. This cse reports n extremely rre fibrothecom in cow. Abbrevitions MHz: Meghertz HCl: Hydrogen chloride GTCT: Grnulos-thec cell tumors WHO: Word Helth Orgniztion mg: Milligrm Kg: kilogrm IRANIAN JOURNAL OF VETERINARY SCIENCE AND TECHNOLOGY Tel: Fx: Web: ijvst.um.c.ir Emil: ijvst@um.c.ir Corresponding uthor: Ali Soleimnzdeh Assistnt Professor, Deprtment of Theriogenology, Fculty of Veterinry Medicine, Urmi University, Urmi, Irn Tel: Fx: Emil:.soleimnzdeh@urmi.c.ir 70 Ovrin Fibrothecom in Holstein cow

2 Introduction Ovrin tumors re uncommon in domestic nimls.however, they hve been reported more often in the mre, cow, bitch nd chimpnzee [1]. Ovrin tumors re clssified bsed on function, the histologicl fetures of tumor cells, similrity to norml cells, nd embryologicl origins of the predominnt cellulr constituents [1]. Bsed on embryologicl origins, ovrin tumors cn be relted to three cellulr subtypes: 1) the epithelium of the ovry consisting the surfce modified mesothelium, (lso clled rete ovrii), for exmple in ppillry nd cystic denoms nd ppillry denocrcinoms. These cellulr subtypes re less frequently involved in humn nd niml ovrin tumors; 2) the germ cells (dysgerminom nd tertom) nd; 3) the strom of the ovry tht includes the sex cords [1]. Ovrin fibrothecom is type of benign tumor of sex cord stroml cell origin, but it is rrely mlignnt nd includes both types of ovrin fibrom nd ovrin thecom cells [2]. Ovrin fibrom is mesenchyml cell tumor which consists of fibroblsts nd collgen. It seldom hs thecl cells or estrogenic production. Fibroms hs less cellulrity nd collgen content in comprison to fibrothecoms. Edem in orgns is one of the min consequences of fibroids cncer which hppens in more thn 50% of the ptients [3]. In comprison, ovrin thecom which is sex cord-stroml ovrin tumor, derives from norml cells constituting endocrine pprtus of the ovry. It contins lipid vcuoles with smll component of fibroblsts nd hs the cpcity to produce steroid hormones. Due to histologicl overlpping between fibrom nd thecom tumors, the term fibrothecom is used for describing neoplsm tht contins fetures of both thecoms nd fibroms [4]. The present study describes the pthomorphology nd ultrsonogrphy findings of fibrothecom in Holstein cow presented to the Veterinry Medicine Hospitl of Urmi University. Figure 1 Ultrsonogrphy picture of left ovry. Cyst, with the centrl nechoic re, covered by hyperechoic wll with 0.5 cm thickness. A 5-yer-old Holstein cow ws referred to the Veterinry Medicine Hospitl of Urmi University, Urmi, Irn being clved seventy-two dys go. The min complints were bnorml estrous cycle nd invisible estrus signs following two hormonl therpies. Perinel nd vulvr conformtion were exmined by trnsrectl plption nd visul evlution by vginoscope nd ultrsonogrphy (Pi-medicl 100LC, rectl liner probe 7.5 MHz). The routine procedures were pplied on the tissue nd it ws stined with hemtoxylin-eosin for histopthologicl exmintion. Moreover, immunohistochemicl exmintion ws performed with formlin-fixed tissue nd vrious ntibodies Cse Presenttion Figure 2 Ovrin fibrothecom ppers s solid mss with smooth surfce Soleimnzdeh/Btvni/Nourin/Pshie 71

3 Figure 3 Mcroscopic imge of the cut of the ovrin fibrothecom, surrounded by thick nd firm consistency wll. (vimentin nd clretinin) were used to define the immune profile of the fibrothecom [5]. Results nd Discussion Figure 5 Fibrothecom tumor cells re positive for vimentin (A) nd Clretinin (B) (Immunohistochemistry, 400x). Vginoscopy indicted tht vulvr nd perinel regions were norml, however, the vulvr re- gion ws edemtous. Uterus nd right ovry were norml in size nd consistency nd no remrkble Figure 4 Microscopic exmintion of ovrin fibrothecom shows hypercellulrity, with two cellulr ptterns; s seen with higher mgnifiction in right corner (H&E; 400x), fibrom tht contined spindle-shped cells with longed nuclei in fibrocollgenous strom (white rrows), nd the thecom tht contined compressed ovl-round or fusiform cells with vcuolted cytoplsm (drk rrows); (H&E; 100x). Ovrin Fibrothecom in Holstein cow 72

4 structure (follicle or corpus luteum) ws recognized during trnsrectl plption. In contrst, the left ovry ws mssive nd smooth. On trnsrectl ultrsonogrphic imging, uterus (without edem) ws norml, but there were smll bcesses in the middle prt of the cervix. The left ovry hd uniformly hyperechogenic res on the ultrsonogrphy (Figure 1). Bsed on the rectl plption nd ultrsonogrphic findings, the left ovry tumor ws suspected. It ws removed with stnding lproscopic ovriectomy method. Left-flnk pproch in cudl re of prlumbr foss ws scrped, shved nd mde redy for opertion. L block nesthesi ws used nd inverted with 10 ml of lidocine HCl 2% (0.22 mg/kg; 5.5 ml/500 kg) (Psteur Institute, Tehrn, Irn) [6]. After ovry ws externlized on peritoneum cvity nd exposed to proper spce, the mesovrium ws ligted with 2 polyglycolic cid (Sup, Tehrn, Irn), by using sliding hlfhitch knotting technique. The ovry ws removed with myo scissors over the ligtedregion nd the bdominl wll ws closed with 3-pln suture in simple continuous pttern with 2 polyglycolic cid. In mcroscopic study, the tumor weighted 254 grms nd solid mss dimeter ws pproximtely cm 3. The outer surfce of the ovry ws smooth (Figure 2). After the tumor ws opened, we noticed tht it ws surrounded by thick, firm, nd consistent wll nd the interior section ws composed of solid mss long with necrosed nd hemorrhged prt (Figure 3). Histologiclly, benign neoplsm ws observed which consisted of two cellulr ptterns. The strom reveled dense fibromtous re tht ws composed of fibroblstic cells in n interwoven pttern (Figure 4). Results of immunohistochemicl stining delinetes tht the spindle-shped neoplstic cells were positive to vimentin (Figure 5A), while tumor cells were strongly positive for clretinin (Figure 5B). Discussion Fibroms nd Fibrothecoms re the sex cord-stroml origin tumors [1]. In ddition, ccording to WHO (World Helth Orgniztion) clssifiction of ovrin tumors, they re subgroup of grnulos-thec cell tumors (GTCT) which belong to the thecom-fibrom group [7]. In this study, fibrothecom ws detected fter ultrsonogrphy, histopthologicl exmintion, nd rectl plption. Conte nd collegues exmined 11 cses of fibrothecom nd suggested some dignostic sonogrphic ptterns [4]. The presence of homogeneous echogenic ptterns tht mrks the posterior coustic shdowing long with the lck of clcifiction, is highly suggestive tht fibrous ovrin fibrothecom exists. To the best of our knowledge, this is the first fibrothecom report in cow, but there were severl reports bout other nimls. Ovrin tumors in mres re lmost unilterl nd re present t n incidence of 5-6 % in comprison to other ovrin tumors nd the fibrothecoms is extremely rre in this sub-group [8]. Chnges in behvior will hppen in mres in cse of tumor s ctivity nd hormonl production, nd it should be noted tht high estrogen secretion by thecoml section of tumor leds to behviorl chnges. Abnorml clinicl signs such s defects in ovultion or implnttion my pper which led to infertility, prolonged nestrus, ggressiveness, msculine behvior, or nymphomni [9]. Azizi et l. reported n ovrin fibrothecom in 10-yer-old Arbin mre tht hd similr gross lesion nd microscopic feture s shown in the present study [10]. Jorritsm nd collegues hs reported grnulos-thec tumor in 2-yers-old cow [11]. The cse didn t show pregnncy fter rtificil insemintion nd enterd into estrus gin, but fter the blood nd histopthologicl exmintion thecom tumors ws dignosed. This cse nd nother similr cse reported by Tontis nd collegues hd nonspecific nd definitive dignostic clinicl signs similr to our report nd the tumor clssified s Thecoms fter histopthologicl exmintion [12]. Different types of solid benign ovrin cysts nd tumors, such s Brenner tumor, thecom, fibrom, nd fibrothecom, my mnifest similr echogenicity on ultrsonogrphy [13]. Thus, it is suggested tht other more specific tests such s, histopthologicl evlution nd immunohistochemicl exmintion [14] should be performed in order to obtin more ccurte dignosis [15]. Immunohistochemiclly, the tumor cells in this cse were strongly positive for clretinin nd vimentin. In conclusion, the cow in this report, with n enlrged ovry includes tumor tht hs metstsized to the ovry. To the best of our knowledge, it is the first ovrin fibrothecom reported in Holstein cow which ws confirmed by histoptholog- Soleimnzdeh/Btvni/Nourin/Pshie 73

5 icl nd immunohistochemicl exmintion. Acknowledgements Authors would like to grtefully thnk Mr. Morvridi for his ssistnce in lbortory work. We lso thnk Mr. Mosiebzdeh for his technicl ssistnce. Author Contributions Conceived nd designed the experiments, performed the experiments, nd wrote the pper: A.S., R.B., A.N. nd B.P. Anlyzed the dt: A.S. Conflict of Interest The uthors declre tht they hve no conflict of interest. References 4. Conte M, Gurigli L, Pnici PB, Scmbi G, Rbitti C, Cpelli A, Mncuso S. Ovrin fibrothecom: sonogrphic nd histologic findings. Gynecologic nd obstetric investigtion. 1991; 32(1): Mittl K, Soslow R, McCluggge WG. Appliction of immunohistochemistry to gynecologic pthology. Archives of pthology & lbortory medicine. 2008;132(3): Brynt S. Ruminnt Anesthesi. Anesthesi for Veterinry technicins, Wiley-Blckwell, Ames, IA. 2011; pp Kennedy PC, Cullen JM, Edwrds JF, Goldschmidt MH, Lrsen S, Munson L, Nielsen S. Histologicl clssifiction of tumors of the genitl system of domestic nimls. Armed Forces Institute of Pthology; Kievitsbosch T, Prestes NC, Fbris VE, Slgdo LF, Alvreng MA. Ovrin Fibrothecom in Mre Cse Report. Journl of equine veterinry science Oct 31;33(10): comprison of methods for preopertive discrimintion between mlignnt nd benign dnexl msses: the development of new logistic regression model. Americn journl of obstetrics nd gynecology. 1999; 181(1): Ioffe OB. Ovrin stroml tumors. AJSP: Reviews & Reports. 2006; 11(1): de Pul Mrtins W, de Brros AC, de Abreu Brr D, Mud-Filho F. Ultr-sonogrfi n condução de msss pélvics. Femin. 2007; 35(6): McLchln NJ, Kennedy PC. Tumors of the urinry system. In, Meuten, DJ (Ed): Tumors in Domestic Animls. 4th ed., 2121 Stte Avenue, Ames, Iow 50014, USA, Iow Stte Press, A Blckwell Publishing Compny. 2002; pp Gündüz MC, Kşikçi G, Kilicrsln R, Ucmk M, Düzgün O, Tek Ç. Reproductive performnce following unilterl ovriectomy for tretment of ovrin tumors in 7 mres. Turkish Journl of Veterinry nd Animl Sciences. 2010; 34(3): Jung SE, Rh SE, Lee JM, Prk SY, Oh SN, Cho KS, Lee EJ, Byun JY, Hhn ST. CT nd MRI findings of sex cord stroml tumor of the ovry. Americn journl of Roentgenology. 2005; 185(1): Pldini D, Test A, Vn Holsbeke C, Mncri R, Timmermn D, Vlentin L. Imging in gynecologicl disese (5): clinicl nd ultrsound chrcteristics in fibrom nd fibrothecom of the ovry. Ultrsound in obstetrics & gynecology. 2009; 34(2): Azizi S, Nourbkhsh M, Kheirndish R. Ovrin fibrothecom in n Arbin mre: rre cse. Journl of Equine Veterinry Science. 2014; 34(2): Jorritsm R, Antonis AF, Stockhofe N, Kruip TA. Cse report of grnulos-thec tumor in cow. Tijdschrift voor diergeneeskunde. 2002; 127(9): Tontis A, König H, Luginbühl H. Grnulos nd thec cell tumors in cttle. (Observtions in 13 cses). Schweizer Archiv fur Tierheilkunde. 1982; 124(5): Timmermn D, Bourne TH, Tilor A, Collins WP, Verrelst H, Vndenberghe K, Vergote I. A Ovrin Fibrothecom in Holstein cow 74