Spayed bitch in persistent estrus

RE: Spayed bitch in persistent estrus

Andrew Kent — Fri, 29 Sep 2017 22:16:31 GMT

Thanks for the update Dave - hope the dog is getting on well!

RE: Spayed bitch in persistent estrus

Beats — Fri, 29 Sep 2017 13:44:53 GMT

[quote user="Andrew Kent"]Do let us know what you find![/quote]

"In this tissue sample consisting primarily of well-vascularized fibrous connective tissue, there is a localised, encapsulated nodule, measuring 4.7mm in diameter. This nodule consists primarily of a multilobulated mass. The mass consists of proliferation of plump polygonal cells, resembling cells of the corpus luteum. These cells have abundant, variably vacuolated cytoplasm and round large nuclei, with prominent single nucleoli. There is mild anisocytolosis and mild anisokaryosis, but mitoses are not frequent (2 per 10 hpf's). A delicate fibrovascular stroma is present. Along the periphery, in subcapsular tissue, there are a few small glandular structures, lined by well-differentiated cuboidal epithelium. No recognisable ovarian follicles are seen. In the adjacent tissue there is a localised thin-wall cyst, lined by a single layer of variably attenuated, cuboidal epithelial cells. Within the connective tissue are multifocal remnants of collagen suture material.

DIAGNOSIS

Luteoma.

Parovarian cyst.

COMMENT:

The nodular mass has appearance of remnants of an ovary, with occasional subsurface epithelial structures recognisable. Most of the ovary has been expanded by a mass lesion, with morphological features most consistent with a luteoma. As far as can be ascertained, this tumour appears to be benign and contained within the ovarian tissue. These tumours may occasionally be hormonally active. The prognosis is likely to be favourable following ovariohysterectomy.

There is also evidence of a parovarian cyst. These cysts develop from the vestigial embryonic remnants. These are benign lesions and are not thought to be hormonally active."

MMedVet(Path)

RE: Spayed bitch in persistent estrus

Andrew Kent — Thu, 31 Aug 2017 08:44:53 GMT

[quote user="Beats"]Anti-mullerian hormone would (probably) confirm the presence of ovarian tissue then? (i.e. wouldn't be elevated if adrenal source of hormone?) Where do you get this tested directly? [/quote]

Yep should show ovarian tissue. As Rob says run at the lab formerly known as Cambridge Specialist Labs.

[quote user="Gillian Mostyn"]I have no idea of what the quoted statistics are for this test, but we had a case of ovarian remnant syndrome last year (spayed elsewhere I must add ) and the anti-mullerian hormone test came back 'normal' ...but ex lap confirmed both remnant and stump pyo.[/quote]

The reported sensitivity is 90% so can always miss some, specificity reported at 100% (some of the studies have relatively low case numbers so interpret with caution). But still likely the best we have.

Andy

RE: Spayed bitch in persistent estrus

Rob Loxley — Wed, 30 Aug 2017 22:38:44 GMT

We had a recent case - ran antimullerian hormone at NWL (Cambridge) Specialist Lab; exlap and removal of remnant followed and was surprisingly easy to identify

RE: Spayed bitch in persistent estrus

Gillian Mostyn — Wed, 30 Aug 2017 20:42:52 GMT

[quote user="Beats"]Anti-mullerian hormone would (probably) confirm the presence of ovarian tissue then?[/quote]

I have no idea of what the quoted statistics are for this test, but we had a case of ovarian remnant syndrome last year (spayed elsewhere I must add ) and the anti-mullerian hormone test came back 'normal' ...but ex lap confirmed both remnant and stump pyo.

RE: Spayed bitch in persistent estrus

Beats — Wed, 30 Aug 2017 20:38:14 GMT

That's fantastic, thanks Andy!

My ultrasound skills aren't up to much, so will probably just open up and have a look.

Owners want to wait few weeks to more convenient time, so I'll check cytology again then before opening.

Neoplastic ovarian tissue would certainly be a logical explanation.

Anti-mullerian hormone would (probably) confirm the presence of ovarian tissue then? (i.e. wouldn't be elevated if adrenal source of hormone?) Where do you get this tested directly?

RE: Spayed bitch in persistent estrus

Andrew Kent — Wed, 30 Aug 2017 20:19:20 GMT

Hi Dave,

There are reports in the literature of long delays between spay surgery and onset of signs with ovarian remnant so I would still have this top of my list. The delayed ones are often reported to be associated with the development of neoplastic transformation in the retained tissue so can be a concern.

I tend to use anti-mullerian hormone as my first line for diagnosis as more reliable than stimulation testing but that is another option. Ultrasound or another form of imaging may also be helpful.

If its not ovarian than perhaps another source of hormone production (e.g. adrenal).

Do let us know what you find!

Andy