Page 1445 - Cote clinical veterinary advisor dogs and cats 4th

734 Ovarian Tumors

ASSOCIATED DISORDERS aided by abdominal imaging and is confirmed ○ Germ cell tumors: dysgerminoma is rare;
Persistent estrus, hyperestrogenism (anemia by surgery and histopathologic exam of tissues. teratoma reported at a rate of 50% in one
VetBooks.ir cystic endometrial hyperplasia are sometimes Differential Diagnosis ○ Sex cord tumors: granulosa cell tumors
study; teratocarcinoma is common.
and thrombocytopenia), pyometra, and/or
in up to 20% of cases
• Estrus
associated with sex cord tumors.
Clinical Presentation • Pyometra • Feline sex cord: granulosa cell tumor with
• Gastrointestinal or other intraabdominal
metastasis to the lung, liver, and spleen has
DISEASE FORMS/SUBTYPES disease been reported.
• Epithelial tumors (adenoma, adenocarci-
noma, carcinoma, cystadenoma, cystad- Initial Database Recommended Monitoring
enocarcinoma): 5% of all pathologic exam • Routine lab tests (CBC including platelet • In dogs, abdominal enlargement and estrous
reports, no case reports count, urinalysis, and serum chemistry cycle abnormalities (e.g., prolonged estrus,
• Sex cord tumors (granulosa cell tumor, panel): generally unremarkable unless vaginal discharge, vulvar enlargement) should
Sertoli, Sertoli-Leydig): 31% of all patho- estrogen myelosuppression is present be monitored.
logic exam reports, 50% of case reports • Vaginal cytologic exam • In cats, estrous cycle abnormalities (e.g.,
• Germ cell tumors (dysgerminoma, teratoma, ○ Confirmation of estrus persistent estrus) should be monitored.
teratocarcinoma): 15% of all pathologic exam ○ Assessment for pyometra or other infection • In either species, evidence of anemia,
reports, 50% of case reports hemorrhage, or opportunistic infection
Advanced or Confirmatory Testing warrants consideration of estrogen-induced
HISTORY, CHIEF COMPLAINT • Abdominal radiographs myelosuppression.
Dog: • Abdominal ultrasound
• Abdominal enlargement and ascites • Abdominocentesis (p. 1056) and fluid PROGNOSIS & OUTCOME
(adenomas, adenocarcinoma, granulosa analysis (cytologic evaluation for ovarian
cell tumor, dysgerminoma, teratoma, carcinoma) • Excellent if benign and no metastasis has
teratocarcinoma) • Thoracic radiography for metastasis occurred
• Depression (dysgerminoma, teratocarcinoma) • Exploratory surgery • Poor if distant metastasis or carcinomatosis
• Estrous cycle abnormalities such as prolonged • Histopathologic exam of tissue is present at the time of diagnosis
estrus (granulosa cell tumor)
• Vulvar enlargement and discharge (adeno- TREATMENT PEARLS & CONSIDERATIONS
carcinoma, granulosa cell tumor)
• Incidental finding during ovariohysterectomy Treatment Overview Comments
or necropsy (adenomas, teratoma) Surgical excision is the most common treat- • May be unilateral or bilateral
• No common findings (Sertoli and Sertoli- ment; chemotherapy has been used in some • Ovarian tumors are possible in animals after
Leydig cell tumors) patients. ovariohysterectomy if an ovarian remnant
Cat: remains.
• Estrous cycle abnormalities such as persistent Acute General Treatment
estrus (granulosa cell tumor) Ovariohysterectomy or unilateral ovariectomy if Prevention
• Depression (granulosa cell tumor) owner desires to preserve fertility. A small litter Ovariectomy or ovariohysterectomy
• Incidental finding during ovariohysterectomy has been reported after unilateral ovariectomy
or necropsy (cystadenoma, dysgerminoma, of an ovarian tumor. Technician Tip
teratoma) Avoid cystocentesis in pets with abdominal
Chronic Treatment effusion.
PHYSICAL EXAM FINDINGS • Chemotherapy should be considered if there
• Estrus (vaginal smear for cytologic exam) is histologic evidence of vascular or lymphatic Client Education
• Vulvar discharge invasion or evidence of metastasis in the peri- Ovariohysterectomy eliminates the risks of
• Abdominal enlargement/effusion toneal cavity during surgery (carcinomatosis). ovarian and uterine tumors.
• Palpable abdominal mass (cats) ○ Cisplatin (not in cats) or cyclophospha-
• Fever, pallor, weakness, and heart murmur mide and chlorambucil and nitrosourea SUGGESTED READING
possible if pancytopenia secondary to have been used for treating metastatic Arlt SP, et al: Cystic ovaries and ovarian neoplasia
estrogen myelosuppression carcinomas in a few dogs, resulting in a in the female dog—a systematic review. Reprod
median 9-month survival. Domest Anim 51:3-11, 2016.
Etiology and Pathophysiology ○ Additional chemotherapeutics that can be
Clinical signs can be related to hormone considered include doxorubicin, carbo- AUTHORS: Jose A. Len, DVM, MS, PhD, DACT; Bruce
E. Eilts, DVM, MS, DACT
production by sex cord tumors; the signs can platin, and 5-fluorouracil. Intracavitary EDITOR: Michelle A. Kutzler, DVM, PhD, DACT
also be related to organ impingement by space- chemotherapy may be indicated for
occupying masses or metastasis for other types. effusions.
Abdominal distention can occur secondary to ○ Consultation with an oncologist is
carcinomatosis (abdominal effusion). recommended.
DIAGNOSIS Possible Complications
Metastasis:
Diagnostic Overview • Canine
The diagnosis is expected if an older intact ○ Epithelial tumors: adenomas and adeno-
animal has persistent estrus, vulvar discharge, carcinoma in 50% of cases according to
or abdominal enlargement. The diagnosis is pathologic exam reports

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