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Lisa Benson Cornell University College of Veterinary Medicine Class of 2014 4/16/14 SURGICAL TREATMENT OF VAGINAL LEIOMYOSARCOMA IN A MIXED BREED DOG.

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Presentation on theme: "Lisa Benson Cornell University College of Veterinary Medicine Class of 2014 4/16/14 SURGICAL TREATMENT OF VAGINAL LEIOMYOSARCOMA IN A MIXED BREED DOG."— Presentation transcript:

1 Lisa Benson Cornell University College of Veterinary Medicine Class of /16/14 SURGICAL TREATMENT OF VAGINAL LEIOMYOSARCOMA IN A MIXED BREED DOG

2 HISTORY 11 year old FS Mixed Breed Dog Presenting Complaint: Mass of the Colon Tenesmus x 2 weeks: 3 Days Lactulose Rapid Growth Cough x 2 weeks Progressive Right Hind Limb Lameness Bilateral Hind Limb Lameness - Chronic

3 HISTORY 11 year old FS Mixed Breed Dog Presenting Complaint: Mass of the Colon Tenesmus x 2 weeks: 3 Days Lactulose Rapid Growth Cough x 2 weeks Progressive Right Hind Limb Lameness Bilateral Hind Limb Lameness - Chronic

4 PHYSICAL EXAM: ABNORMALITIES Very Nervous Sensitive Hind Limbs/Caudal Trunk Right Hind Limb Lameness: Lateral Extension Left Hind Limb: Firm, Movable Subcutaneous Mass Digital Rectal Palpation Hard, Bony Mass: Left Ventral Pelvic Canal Firm, Rounded Mass: Right Ventrolateral Pelvic Canal Complete Obstruction

5 PROBLEM LIST Chronic, Mild Bilateral Hind Limb Lameness: Lifetime Mass – Pelvic Canal Progressive Right Hind Limb Lameness Tenesmus Cough Left Hind Limb Subcutaneous Mass

6 PROBLEM LIST Mass – Pelvic Canal Tenesmus Progressive Right Hind Limb Lameness Cough (?) Left Hind Limb Subcutaneous Mass (?)

7 DIFFERENTIAL DIAGNOSES Broad Pelvic Mass Differential Diagnosis Tumor or Abscess Arising from the Following: 1. Rectum 2. Vagina 3. Urethra 4. Bony Pelvis

8 DIAGNOSTICS Bloodwork: Complete Blood Count/Blood Chemistry: Unremarkable Imaging: Full Body CT Scan Thorax Abdomen Pelvic Canal Proximal Hind limbs

9 CT SCAN: SAGITTAL IMAGE Bladder Heart Cranial Caudal Mass

10 CT SCAN: SAGITTAL IMAGE Colon Urethra

11 CT SCAN: SAGITTAL IMAGE

12

13 CT SCAN: FRONTAL IMAGE

14 CT SCAN: TRANSVERSE IMAGE

15 CT SCAN: FINDINGS Thorax and Abdomen: Negative for Metastasis Pelvis: Large Mass – Sciatic n. Compression Vaginal Origin – Not Colon Incidental: Left Hind limb Mass: Lipoma Hip and Shoulder Osteoarthritis - Mild

16 DIFFERENTIAL DIAGNOSES Vaginal Mass: Neoplasia vs. Inflammation Neoplasia Benign: Leiomyoma Malignant: Leiomyosarcoma Inflammation: Stump Pyometra Less Likely: 10.5 years post Spay No Signs of Ovarian Remnant

17 LEIOMYOMA VS LEIOMYOSARCOMA Smooth Muscle Tumors: GI more common location Lack of Vaginal Cases and Information 2.4% - 3% of ALL Canine Tumors are from Reproductive System 83% Benign (Leiomyoma Most Common) Intact Females

18 LEIOMYOMA VS LEIOMYOSARCOMA Leiomyosarcomas – Hormonally Independent Complete Excision (Vaginal): Curative Moderate Risk Metastasis/Recurrence Impact of Adjuvant Radiation/Chemotherapy: Outcome on Survival Unknown

19 PLAN Surgery: Mass Excision Episiotomy +/- Abdominal Exploratory Pubic Osteotomy Partial Vaginectomy Histopathology for Definitive Diagnosis

20 SURGERY: NEUROANATOMY Pelvic Plexus Hypogastric n. (Evans, de LaHunta) Perineal n. Pudendal n. Pelvic n.

21 SURGERY: EPISIOTOMY

22 SURGERY White Catheter: Urethral Papilla Orange Catheter: Vaginal Canal Mass

23 SURGERY: ABDOMINAL Uterine Remnant Urinary Bladder Random Loop of Intestine Colon

24 SURGERY: MASS LOCATED Pubic Symphysis Mass

25 SURGERY: PUBIC OSTEOTOMY

26 SURGERY: MASS EXCISION

27 Pelvic Plexus

28 SURGERY: VAGINAL WALL REFLECTED

29 SURGERY: MASS EXCISION

30 SURGERY: DISSECT CAREFULLY

31 SURGERY: REPAIR OSTEOTOMY

32 SURGERY: MASS REMOVED

33 HISTOPATHOLOGY

34

35 HISTOPATHOLOGY: LEIOMYOSARCOMA

36 POST SURGICAL CARE Antibiotic: Clindamycin IV 11mg/kg BID Pain Management: Fentanyl CRI 2 mcg/kg/hr  Patch Dexmedetomidine IV 15 mcg PRN Q4h Carprofen 2 mg/kg BID Gabapentin 3 mg/kg BID Tramadol 3 mg/kg PRN Supportive Care: IV Fluids, Ice and Check Tegaderm Q6h

37 POST SURGICAL CARE Main Concern: Urinary Incontinence Monitor for Urination, Check for Leakage 1 Day Post Surgery: Steady Controlled Stream Discharged That Evening

38 UPDATE 2 week Recheck – Tenesmus Gave Pumpkin and Lactulose Lactulose Overdose  Diarrhea Once Owners “Very Pleased” No Signs Now Bladder Control 7 hours (Reduced) Lactulose PO 5 ml BID

39 COSTS Combined Total CostsDollar Amount Administrative Management Anesthesia Clinical Pathology67.88 Imaging Professional Services Hospitalization/Inpatient Care All Supplies and Materials Pharmacy Grand Total$ 3,926.86

40 REFERENCES Buergelt, Claus D. Color Atlas of Reproductive Pathology of Domestic Animals. St. Louis: Mosby Print. Evans, H., de Lahunta, A. Miller's Anatomy of the Dog. 4th Ed. St. Louis: Elsevier Saunders Print. Maxie, M G, K V. F. Jubb, P C. Kennedy, and Nigel Palmer. Jubb, Kennedy, and Palmer's Pathology of Domestic Animals. Edinburgh: Elsevier Saunders Print. McEntee, Kenneth. Reproductive Pathology of Domestic Mammals. San Diego: Academic Press Print. Nelissen, P, and RA White. "Subtotal Vaginectomy for Management of Extensive Vaginal Disease in 11 Dogs." Veterinary Surgery : Vs (2012): Print North, Susan M, and Tania A. Banks. Small Animal Oncology: An Introduction. Edinburgh: Elsevier Saunders Print. Thacher, C, and RL Bradley. "Vulvar and Vaginal Tumors in the Dog: a Retrospective Study." Journal of the American Veterinary Medical Association (1983): Print. Tobias, Karen M, and Spencer A. Johnston. Veterinary Surgery: Small Animal. St. Louis, Mo: Elsevier Print. Weissman A, D Jimenez, B Torres, K Cornell, and SP Holmes "Canine Vaginal Leiomyoma Diagnosed by CT Vaginourethrography". Journal of the American Animal Hospital Association. 49, no. 6. Withrow, Stephen J, and David M. Vail. Withrow & Macewen's Small Animal Clinical Oncology. St. Louis: Saunders Elsevier Print.

41 THANK YOU! Dr. Flanders Dr. Hume Dr. Ruby Dr. Asakawa The Class of 2014 My Family

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