Caesarean, mammary and other reproductive surgery

• Tumours of the ovary - overview

  Rare in both and dogs and cats.

  Infrequency might be because many individuals undergo neutering at a young age.

  Affected individuals are most frequently older, nulliparous individuals, although teratoma will often occur in younger individuals
• Benign tumours of the ovary and their site

  Surface epithelial tumours (40-50% of cases):

  • Cystadenoma
  • Papillary adenoma

  Gonadostromal tissue tumours (35-50% of cases):

  • Thecoma
  • Luteoma

  Germ cell tumours (6-20% of cases):

  • Teratoma
• Malignant tumours of the ovary and their site

  Surface epithelial tumours (40-50% of cases):

  • Cystadenocarcinoma
  • Papillary adenocarcinoma
  • Undifferentiated carcinoma.

  Gonadostromal tissue tumours (35-50% of cases):

  • Granulosa cell tumour

  Germ cell tumours (6-20% of cases)

  • Dysgerminoma
  • Teratoma
  • Carcinoma
• What are the clinical signs of the tumours of the ovary?

  Pyometra

  Abnormal oestrus

  Vaginal discharge

  Secondary sex organ change

  Lumbar pain

  Presence of an abdominal mass.

  Enlarged abdomen (presence of effusion and/or mass)

  Lethargy

  Weight gain or weight loss
• What is the clinical approach to the tumours of the ovary?

  Physical examination

  Blood samples

  Imaging techniques:

  • Radiography
  • Ultrasonography
  • Computed tomography.

  Cytology

  Biopsy

  Often and incidental finding at the time of OE or OHE.
• Tumours of the uterus and cervix - overview

  Rare, in both dogs and cats.

  Infrequency might be because many individuals undergo neutering at a young age.

  In the bitch, benign tumours occur with greatest frequency.

  In the queen, although very uncommon, malignant tumours more frequent.
• Benign and malignant tumours of the uterus and the cervix

  Benign:

  • Fibroma
  • Fibroleiomyoma
  • Leiomyoma
  • Adenoma

  Malignant:

  • Fibrosarcoma
  • Leiomyosarcoma
  • Adenocarcinoma
  • Lymphoma
• Approach and treatment of tumours of the uterus and cervix

  Similar clinical approach to ovarian tumours.

  Treatment - surgical OHE or hysterectomy in neutered individuals.
• Tumours of the vagina and vulva - overview

  Excluding mammary tumours, vaginal, vestibular and vulval tumours are the most common tumours of the reproductive tract in the bitch.

  Tumours of these sites are in queens.

  Benign mesenchymal tumours, such as leiomyoma, affect entire, aged bitches.

  Majority of tumours are seen in nulliparous individuals.
• Benign Tumours of the vagina and vulva

  Leiomyoma

  Fibroma

  Fibroleimyoma

  Lipoma
• Malignant Tumours of the vagina and vulva

  Leiomyosarcoma

  Adenocarcinoma

  Transmissible venereal tumour

  Squamous cell carcinoma

  Haemangiosarcoma

  Osteosarcoma

  MasT cell tumour.
• Smooth muscle tumours of the vagina and vulva

  Benign smooth muscle tumours account for approximately 80-90% of vaginal and vulval tumours reported in bitches.

  The growth of many of these bending smooth muscle tumours is associated with the ovarian secretion of oestrogen.

  The most common malignant tumour of the vagina and vulva is the leiomyosarcoma.

  Transmissible venereal tumour (TVT) is seen more commonly in females than in males.
• Tumours of the vulval labia

  Tumours of the vulval labia can be associated with any form of cutaneous tumour, particularly squamous cell carcinoma (SCC) and mast cell tumours (MCT).
• Tumours of the testicle - overview

  Common in the male dog.

  Usually seen in dogs older than 10-years old.

  Earlier in cryptorchid animals (20 fold increased risk).

  Three common types seen are; interstitial cell tumour, Seminoma and Sertoli cell tumour.

  Rarely seen in the tom cat (related to elective castration).
• Benign tumours of the testicle and their site

  Gonodostromal tissue tumours

  • Interstitial cell (Leydig) tumour

  Germ cell tumours

  • Teratoma
• Malignant tumours of the testicle and their site

  Gonadostromal tissue tumour:

  • Sertoli cell tumour

  Germ cell tumours:

  • Seminoma
• Tumours of the testicle - Sertoli cell tumour

  Sertoli cell tumour (and sometimes seminoma) will often prodice excess oestrogen, causing the development of feminisation syndrome.

  • Bilaterally symmetrical alopecia
  • Attractiveness to male dogs.
  • Pendulous prepuce
  • Gynaecomastia (mammary enlargement, nipple enlargement)
  • Atrophy of affected testicle.
  • Myelosuppression (anaemia, neutropenia and thrombocytopenia)
• Treatment for tumours of the testicle

  Treatment consists primarily of orchiectomy (castration).

  • Closed rather than open
  • Cryptorchid cases might prove more difficult dependant on where the testicle is situated.

  Often will prove curative

  Feminisation signs might take 6-weeks or more to resolve.
• Tumours of the penis - overview

  Tumours of the penis are, in general, rare in both the dog and cat.

  However, TVT is recognised as a relatively common condition in certain parts of the world.

  Apart from TVT, the majority of penile tumours occur in the older dog.

  Where TVT is not endemic, squamous cell carcinoma (SCC) is the most common tumour of the penis in the dog.
• What are the benign and malignant tumours of the penis?

  Benign:

  • Papilloma

  Malignant

  • Squamous cell carcinoma
  • Transmissible venereal tumour
  • Haemangiosarcoma.
• Tumours of the penis - prepuce

  The prepuce may be affected by any type of skin tumour.

  Tumours commonly associated with this structure include MCTs, melanomas
• What are the clinical signs of the tumours of the penis?

  Clinical signs associated with penile tumours are related to local tissue irritation, infection and bleeding.

  • Licking of prepuce and penis.
  • Haemorrhagic and/or prurulent discharge from the prepuce
  • Haematuria (may be frank blood at the beginning or end of micturition).
  • Dysuria
  • Increased frequency of urination
  • Phimosis
  • Parahimosis
• Tumours of the penis - clinical signs

  The presence of the tumour will often become apparent only when the penis is extruded from the prepuce.

  
• Tumours of the penis - TVT

  TVT (histiocytic tumour) can be treated using either chemotherapy or radiotherapy.

  Metastasis, although reported, is considered unusual.

  Prognosis is excellent in the majority of individuals.
• Mammary tumours - overview

  Common in female dogs, but rare in male dogs and cats.

  Surgical excision recommended for most cases (chemo may be required following surgery in some cases).

  Prognosis often very good following surgery in bitches, but prognosis worse for certain types of tumour in dogs and all mammary tumour in cats.

  Of dogs, poodles, dachshunds, and spaniels are most affected.

  In cats, Siamese or other oriental breeds and domestic short hairs are most often affected.
• What are the clinical signs of mammary tumours?

  A palpable mass underneath the skin of the abdomen or near a nipple is the most common findings in dogs and cats with mammary tumours.

  However, other signs and symptoms include discharge from a mammary gland, ulceration of the skin over a gland, painful, swollen breasts, loss of appetite, weight loss and generalised weakness.
• Diagnosis of mammary tumours

  A good general physical exam is needed to find the location, size and character of all the mammary masses and assess local lymph node enlargement.

  Other procedures are performed to stage the cancer (determine what type it is and where it is located in the body).

  • Full haematology and biochemsitry, urinalysis, +/- clotting profile.
  • Abdominal ultrasound, chest radiographs/ CT scans (mets)
  • FNA and cytology - lymph nodes
  • Biopsy may be indicated to rule out an inflammatory mammary carcinoma
• Inflammatory mammary carcinoma

  Surgery is not recommended for dogs with inflammatory mammary carcinoma because it does not improve the survival rate.

  Unfortunately, an effective treatment has not been discovered.

  Radiation therapy in combination with a non-steroidal anti-inflammatory drug has been shown to provide the most effective pain relief in dogs, but the prognosis remains poor.
• Mammary tumours - surgery

  The type of surgery depends on the size, location, and number of mammary tumours and species.

  In general, surgery is more conservative for dogs with mammary tumours and involves removal of either the mass alone or the affected mammary gland.

  However, in cats, more aggressive surgery is recommended with removal of one or preferably both sets of mammary glands.
• Closure of the hysterotomy

  3/0 or 4/0 monofilament absorbable.

  Taperpoint or tapercut needle.

  Single-layer continuous pattern or double layer continuous patterns (simple continuous appositional inner layer and continuous inverting outer layer)

  Suture should engage submucous but not penetrate the lumen.