ASYMPTOMATIC UNILATERAL OVARIAN LEIOMYOMA IN A GERMAN SHEPHERD BITCH

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1 Mcedonin Veterinry Review Mc Vet Rev 2017; 40 (1): Aville online t ASYMPTOMATIC UNILATERAL OVARIAN LEIOMYOMA IN A GERMAN SHEPHERD BITCH Alessndro Pecile, Deor Groppetti, Vleri Grieco, Griele Brell, Melni Moioli, Stefno Fverzni Deprtment of Veterinry Medicine, Fculty of Veterinry Medicine, Università degli Studi di Milno, vi G. Celori Milno, Itly Cse Report Received 20 My 2016; Received in revised form 19 Septemer 2016; Accepted 2 Octoer 2016 ABSTRACT This report shows for the first time clinicl imging (ultrsound nd computed tomogrphy), histologicl nd immunohistochemicl findings of n ovrin leiomyom, coincidentlly dignosed in n symptomtic unmted nulliprous ten yer-old Germn shepherd itch concurrently suffering from multiple mmmry tumors. A thorough exmintion llowed the differentition of ovrin leiomyom from other spindle cell tumors. An ccurte description of the dignostic procedures useful in the mnging of ovrin leiomyom could provide vlule informtion to veterinry prctitioners. Indeed, despite its rrity nd nonspecific symptoms, ovrin leiomyom my lso ffect the dog with n unknown potentil risk. Key words: dog, ovry, leiomyom, dignosis INTRODUCTION Ovrin leiomyom is very rre enign tumor minly occurring in women round their menopuse period, ut lso oserved in young nd pregnnt ptients, nd often ssocited with uterine leiomyom (1, 2). In dogs, leiomyoms commonly involve the vulv, vgin nd uterus (3) while they represent only 2% of the ovrin tumors whose incidence rnges from 0.5% to 6% (4). The cuse of cnine reproductive tumors is unknown, ut ovrin hormones re thought to ply strong role (5). Leiomyoms hve een reported in ssocition with chronic oestrogen stimultion minly in dogs lso ffected y cystic endometril hyperplsi nd mmmry glnd tumors, which re known to result from hormonl influence (5). Leiomyoms re slow growing, non-invsive, non-metsttic, smooth muscle msses (5) nd re mostly discovered incidentlly either during dominl exmintion, t surgery or t necropsy, oth in humns nd nimls (6). In symptomtic women, the presenttions cn vry from either dominl pin, mss per domen, hydronephrosis or polymiositis (6). To dte, few documented cses of ovrin leiomyom hve een reported in dogs. There is lck of knowledge out the clinicl impct of this rre tumor. Therefore, the present study offers descriptive dignostic procedure with rod term follow up of ptient suffering from ovrin leiomyom nd providing food for specultive thought out its prognostic expecttion. Corresponding uthor: Dr. Deor Groppetti, PhD E-mil ddress: deor.groppetti@unimi.it Present ddress: Università degli Studi di Milno Fculty of Veterinry Medicine Deprtment of Veterinry Medicine, vi G. Celori Milno, Itly Phone: Fx: Copyright: 2016 Pecile A. This is n open-ccess rticle pulished under the terms of the Cretive Commons Attriution License which permits unrestricted use, distriution, nd reproduction in ny medium, provided the originl uthor nd source re credited. Competing Interests: The uthors hve declred tht no competing interests exist. Aville Online First: 4 Novemer 2016 Pulished on: 15 Mrch CASE HISTORY AND DIAGNOSTIC PROCEDURES An unmted nulliprous ten yer-old Germn shepherd itch, weighing 36.6 kg, ws presented with history of multiple mmmry glnd msses. The owner reported regulr reproductive cycle (pproximtely every 6 months), the lst one occurring out 2 months efore, nd repeted pseudopregncies. No hormonl tretment for

2 Pecile A. et l. prevention or suppression of the het, neither ortifcient drugs hd ever een dministered. On physicl exmintion, the itch ppered helthy with no disese other thn mmmry glnd msses. In ddition, hemtologicl nd iochemicl prmeters were ll within norml vlues. Ovrin nomlies were coincidently dignosed during routine pre-surgicl investigtions. Adominl ultrsound exmintion performed with twodimensionl nd Doppler tool (Esote MyL 70, Genu, Itly) equipped with 4-8 MHz microconvex nd MHz liner trnsducer to stge the mmmry tumors, disclosed tht oth ovries incresed in volume with polycystic spect. The right ovry hd heterogeneous echogenicity due to multiple thin-wlled nechoic structures. Moreover, ptchy hypoechoic lesion mesuring up to 70 mm in dimeter with irregulr outer contours ws detected (Fig. 1 ). The left ovry ws 50 mm in size nd, s the right ovry, showed cystic with mny fluid-filled structures mesuring up to 20 mm, sometimes confluent, nd with distl enhncement (Fig. 1 ). The uterus nd other dominl orgns seemed norml. Figure 1. Sonogrphic ppernce of the ovry. Right ovry: nechoic structures (*) nd hypoechoic mss (rrows) (). Left ovry: nechoic structures (*) () Figure 2. Post-contrst CT scn. Cystic spect of oth ovries (right ovry *; left ovry ) (). A more cudl scn showing the right (#) nd the left (*) ovry (). 98

3 Asymptomtic unilterl ovrin leiomyom in Germn shepherd itch The dog underwent pre- nd post-contrst computed tomogrphy (fourth-genertion single-slice scnner mod. PQ2000S, Philips MS, Eindhoven, Hollnd) study of thorx nd domen tht confirmed ilterl increse of the ovrin volume (right ovry 32 x 37 x 69 mm; left ovry 53 x 48 x 92 mm). After i.v. dministrtion of 600 mgi/kg Omnipque TM 350 (GE Helthcre AS, Oslo, Norwy) contrst medium, oth ovries showed severe nd heterogeneous uptke shrpening, rounded hypodense res with irregulr nd thin hyperdense mrgins (Fig. 2 ). This spect ws suggestive of cystic nture. In the right ovry (Fig. 2 #), solid highly vsculrized component (45 x 51 x 40 mm) showing heterogeneous nd severe contrst uptke ws evident nd suggestive of lrge spce-occupying lesion. In the left ovry (Fig. 2 *), hypodense cystic res coexisted with n irregulrly shped re expressive of norml lutel ovrin tissue. After performing ovriohysterectomy in routine mnner (7), we proceeded with totl unilterl mstectomy for the removl of mmmry tumors (8). At surgery oth ovries were surrounded y the ovrin urse nd were enlrged in size with extensive cystic degenertion (Fig. 3 ). The uterus ppered norml. On dissection, the right ovry showed tht it completely chnged into solid whitish mss with shiny smooth outer surfce nd firm consistency (Fig. 3 ). The cut surfce of the mss displyed whorled pttern. Grossly, there ws no recognizle norml ovrin tissue (Fig. 3 c). Provrin cysts were lso detected (Fig. 3 c). The left ovry showed lutel ppernce nd mny provrin cysts were lso detected (Fig. 3, c). The surgiclly removed tissues were then sumitted for pthologicl exmintion. After fixtion in 10% neutrl uffered formlin nd emedding in prffin wx, 5 μm thick sections were otined from ll surgiclly removed tissues nd stined with hemtoxylin nd eosin (HE) for histologicl exmintion. Immunohistochemicl stining ws performed s in previous report (9) on deprffinized sections of the ovrin neoplstic mss with the vidin-iotin-peroxidse complex (ABC; Vector Lortories, Burlingme, CA) technique (10). Histology identified the mss t the right ovry level s tumor, composed y interlcing undles of spindle cells chrcterized y moderte mount of eosinophilic cytoplsm nd elongted sophilic nuclei. Neoplstic cells showed miniml cellulr typi nd low mitotic ctivity (< 1 HPF). Necrosis ws sent. The left ovry showed corpor lute without ny pthologicl feture. Bilterl provrin cysts were thin wlled structures lined y simple cuoidl epithelium. A slight cystic endometril hyperplsi ws recorded. Due to gross nd histologicl similrities etween ovrin leiomyom nd other spindle cell tumors such s thecom nd firom, n pproprite immunohistochemicl test ws performed to llow differentil dignosis (2). Immunohistochemicl stining showed neoplstic cells s positive for desmin nd α-smooth muscle ctin (Fig. 4,). These results, together with the histologicl ppernce, confirmed the dignosis of ovrin leiomyom. c Figure 3. Mcroscopic spect of the ovries. Right (R) nd left (L) ovry still enclosed within the urse (), fter dissection of the urse (), nd fter incision (c). 99

4 Pecile A. et l. Figure 4. Immunohistochemicl spect of the neoplstic mss in the right ovry. The cytoplsm of neoplstic cells ws strongly stined for the nti-desmin monoclonl ntiody () nd the nti-α-ctin (smooth muscle) monoclonl ntiody (). Avidin-iotin peroxidse complex (ABC). Br = 100 µm. Multiple findings from hyperplsi to ppillom nd denocrcinom were oserved in the whole mmmry chin. Inguinl lymph nodes showed mild folliculr hyperplsi. Aout one yer fter surgery, splenectomy ws necessry for removl of low grde myxoid liposrcom. Six months lter the dog ws euthnized due to the onset of pulmonry metstses. DISCUSSION The histogenesis of ovrin leiomyom is uncertin. This tumor could rise from smooth muscle cells of the ovrin hilr lood vessels wlls, ut other possile origins include cells in the ovrin ligment, smooth muscle cells or multipotentil cells in the ovrin strom, undifferentited germ cells, or corticl smooth muscle metplsi (6, 11). Ovrin leiomyoms re considered s enign tumors, including those which re mitoticlly ctive, nd re treted conservtively (12). However, no definitive criteri to distinguish etween enign nd mlignnt smooth-muscle tumors of the ovry hve een estlished in humn nd the criteri used for uterine smooth-muscle tumors hve usully een pplied (2). Ovrin leiomyom often co-exists with uterine leiomyom nd hs een recently reported together with n ovrin myxoid liposrcom in dog (13), suggesting common etiology or identicl hormonl stimultion (6). In the present cse, either cystic endometril hyperplsi, mmmry glnd tumors, ovrin leiomyom nd splenic liposrcom, 100 were dignosed in ten yer-old Germn shepherd itch who died s result of lung metstses. Clinic, ultrsonogrphic, computed tomogrphy, histologicl nd immunohistochemicl spects of the ovrin leiomyom descried in this study were similr to the humn counterprt (12). Indeed, ovrin leiomyom ws chrcterized y well-circumscried soft tissue mss with n internl swirling pttern nd vrile echogenicity (determined y extent of degenertion nd firosis) (1). The tomogrphic spect ws consistent with ovrin leiomyom descried in humns s heterogeneous mss with severe contrst enhncement (14). CONCLUSION This report highlights n extremely unusul entity descriing its clinicl nd dignostic spects, nd the ssocited neoplstic events throughout lifetime follow-up. The expnsion of shred cse studies cn contriute to deeper knowledge of this rre disese in dogs, which is essentil to dignose nd mnge ovrin leiomyom tht, however, my occur in clinicl prctice with n unknown potentil risk. CONFLICT OF INTEREST STATEMENT The uthors declred tht they hve no potentil conflict of interest with respect to the uthorship nd/or puliction of this rticle.

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