SURGICAL TREATMENT OF VAGINAL
LEIOMYOSARCOMA IN A MIXED BREED DOG
Lisa Benson
Cornell University
College of Veterinary Medicine
Class of 2014
4/16/14
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
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
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
PROBLEM LIST
• Chronic, Mild Bilateral Hind Limb Lameness: Lifetime
• Mass – Pelvic Canal
• Progressive Right Hind Limb Lameness
• Tenesmus
• Cough
• Left Hind Limb Subcutaneous Mass
PROBLEM LIST
• Mass – Pelvic Canal
• Tenesmus
• Progressive Right Hind Limb Lameness
• Cough (?)
• Left Hind Limb Subcutaneous Mass (?)
DIFFERENTIAL DIAGNOSES
• Broad
• Pelvic Mass Differential Diagnosis
• Tumor or Abscess Arising from the Following:
1. Rectum
2. Vagina
3. Urethra
4. Bony Pelvis
DIAGNOSTICS
• Bloodwork: Complete Blood Count/Blood Chemistry:
• Unremarkable
• Imaging: Full Body CT Scan
• Thorax
• Abdomen
• Pelvic Canal
• Proximal Hind limbs
CT SCAN: SAGITTAL IMAGE
Mass
Cranial
Caudal
Heart
Bladder
CT SCAN: SAGITTAL IMAGE
Colon
Urethra
CT SCAN: SAGITTAL IMAGE
CT SCAN: SAGITTAL IMAGE
CT SCAN: FRONTAL IMAGE
CT SCAN: TRANSVERSE IMAGE
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
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
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
LEIOMYOMA VS LEIOMYOSARCOMA
• Leiomyosarcomas – Hormonally Independent
• Complete Excision (Vaginal): Curative
• Moderate Risk Metastasis/Recurrence
• Impact of Adjuvant Radiation/Chemotherapy:
• Outcome on Survival Unknown
PLAN
• Surgery: Mass Excision
• Episiotomy
• +/- Abdominal Exploratory
• Pubic Osteotomy
• Partial Vaginectomy
• Histopathology for Definitive Diagnosis
SURGERY: NEUROANATOMY
Hypogastric n.
Pelvic n.
Pudendal n.
Perineal n.
Pelvic Plexus
(Evans, de LaHunta)
SURGERY: EPISIOTOMY
SURGERY
Mass
White Catheter:
Urethral Papilla
Orange
Catheter:
Vaginal Canal
SURGERY: ABDOMINAL
Colon
Uterine Remnant
Urinary Bladder
Random Loop of Intestine
SURGERY: MASS LOCATED
Mass
Pubic Symphysis
SURGERY: PUBIC OSTEOTOMY
SURGERY: MASS EXCISION
SURGERY: MASS EXCISION
Pelvic Plexus
SURGERY: VAGINAL WALL REFLECTED
SURGERY: MASS EXCISION
SURGERY: DISSECT CAREFULLY
SURGERY: REPAIR OSTEOTOMY
SURGERY: MASS REMOVED
HISTOPATHOLOGY
HISTOPATHOLOGY
HISTOPATHOLOGY: LEIOMYOSARCOMA
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
POST SURGICAL CARE
• Main Concern: Urinary Incontinence
• Monitor for Urination, Check for Leakage
• 1 Day Post Surgery: Steady Controlled Stream
• Discharged That Evening
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
COSTS
Combined Total Costs
Dollar Amount
Administrative Management
697.00
Anesthesia
818.50
Clinical Pathology
67.88
Imaging
832.20
Professional Services
100.00
Hospitalization/Inpatient Care
595.00
All Supplies and Materials
616.55
Pharmacy
199.73
Grand Total
$ 3,926.86
REFERENCES
•
Buergelt, Claus D. Color Atlas of Reproductive Pathology of Domestic Animals. St. Louis: Mosby. 1997. Print.
•
Evans, H., de Lahunta, A. Miller's Anatomy of the Dog. 4th Ed. St. Louis: Elsevier Saunders. 2013. 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. 2007. Print.
•
McEntee, Kenneth. Reproductive Pathology of Domestic Mammals. San Diego: Academic Press. 1990. Print.
•
Nelissen, P, and RA White. "Subtotal Vaginectomy for Management of Extensive Vaginal Disease in 11 Dogs." Veterinary
Surgery : Vs. 41.4 (2012): 495-500. Print
•
North, Susan M, and Tania A. Banks. Small Animal Oncology: An Introduction. Edinburgh: Elsevier Saunders. 2009.Print.
•
Thacher, C, and RL Bradley. "Vulvar and Vaginal Tumors in the Dog: a Retrospective Study." Journal of the American
Veterinary Medical Association. 183.6 (1983): 690-2. Print.
•
Tobias, Karen M, and Spencer A. Johnston. Veterinary Surgery: Small Animal. St. Louis, Mo: Elsevier. 2012. Print.
•
Weissman A, D Jiménez, B Torres, K Cornell, and SP Holmes. 2013. "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.
2007. Print.
THANK YOU!
• Dr. Flanders
• Dr. Hume
• Dr. Ruby
• Dr. Asakawa
• The Class of 2014
• My Family