Page 521 - Equine Clinical Medicine, Surgery and Reproduction, 2nd Edition

496 CHAPTER 2

VetBooks.ir the perineum or adjacent muscles, leading to distor- ulcerated can be surgically excised, especially on the
Hamartomas present as large growing masses in
vulval labia or vestibule. Other treatments include
cryotherapy, topical 5-fluorouracil daily for 3 weeks,
tion of the normal anatomy.
BCG local infiltration and radiotherapy. Melanomas
Diagnosis are rarely treated, but ulcerated or especially large
Leiomyomas may be detected on rectal palpation lesions can be surgically excised. Intralesional cis-
as firm spherical masses in the uterine wall. On platin (or alternative chemotoxic agents) has been
ultrasonography these are hyperechoic, solid and used in large lesions not amenable to surgery. Oral
spherical. The histopathological appearance on cimetidine therapy has been reported to reduce the
biopsy (endoscopic or hand-guided) is distinctive. size of the tumours if used over several months.
Papillomas/polyps have a distinctive appearance on Repeat therapy can be used if the tumours begin to
vulval/vaginal examination and can be differenti- enlarge again. No treatment is required for hamar-
ated from leiomyomas on biopsy. SCCs are typical tomas and surgical resection is difficult because of
in gross appearance and on biopsy. The draining their poorly defined borders.
local lymph nodes in the inguinal/iliac region
should be palpated. Melanomas are also typical Prognosis
in gross appearance and multiple lesions in the Leiomyomas can be difficult to remove completely
perineum and elsewhere around the body are com- and fertility may be affected. Papillomas/polyps are
mon. Excisional biopsy may confirm the diagnosis easily removed and have a good prognosis for return
and malignancy. Hamartomas on biopsy reveal to fertility. SCCs have a variable prognosis depend-
normal tissue types. ing on the type and extent of the lesion (worse in
ulcerative types, large lesions, local lymph node
Management spread). Melanomas generally carry a good progno-
Pedunculated leiomyomas can be removed by a sis, but large or multiple lesions may cause difficul-
snare passed via an endoscope, or with a CO :YAG ties in defecation and urination as well as affecting
2
laser. Papillomas/polyps are easily removed by ligat- mating and parturition. Hamartomas carry a good
ing or surgically severing the pedunculated neck. prognosis unless they enlarge enough to interfere
SCCs that are small, localised and not extensively with normal defecation, urination or breeding.

DISEASES AND DISORDERS OF THE UTERUS

ENDOMETRITIS immunological (production and secretion of immu-
noglobulins and opsonins) and physical mecha-
Inflammation of the endometrium (endometritis) nisms that the tract can employ to help defend,
is one of the most common causes of subfertility in restore normal function and heal in the face of
the mare. Endometritis is categorised into persistent these insults. If any of these mechanisms do not
mating-induced endometritis, infectious endometri- function properly, the uterus will not be able to
tis, chronic degenerative endometritis and sexually protect itself and infections will occur and persist.
transmitted diseases. With age and increasing number of pregnancies,
The tubular reproductive tract, especially the physical and immunological changes in the tract
uterus, is subjected to a variety of insults during the render the mare more susceptible to infection and
life of a broodmare including mating, pregnancy less able to resolve it. Failure of mechanical clear-
and parturition. These insults include trauma to ance of fluid, debris and inflammatory substances
tissues and contamination with bacteria, fungi, from the lumen of the uterus is thought to be one
semen, faeces, urine and other liquids/debris. of the major predisposing factors associated with
There are cellular (neutrophil phagocytosis), the development of endometritis.