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Pyometra or Abdominal Mass

Patient Information

Age
13 Years
Gender
Female, Intact
Species
Canine

Images

The left ovary presented a cystic portion that measured 2.0 cm with an attached mass that measured 5.57 x 4.92 cm. This is consistent with a left ovarian tumor. Carcinoma or granulosa cell tumor is suspected. US-guided FNA of the parenchymal portion of the mass was performed without complication. The region of the right ovary was unremarkable. The uterine body was unremarkable.
The left adrenal gland was uniform and measured 0.58 cm (not shown). The right adrenal gland was mildly enlarged and slightly irregular which may be normal for this patient given the age. The right adrenalmeasured 2.14 x 1.29 cm. After further imaging of the CVC and right phrenic vein, the irregular right adrenal gland appeared to slightly invade the vena cava with attached caval thrombus or caval extension of the tumor.
reveal 40x cytology of the left ovarian granulosa cell tumor obtained by 25 gauge US-guided FNA.
reveal 100x cytology of the left ovarian granulosa cell tumor obtained by 25 gauge US-guided FNA.

History

Why do we always perform a full abdominal sonogram from diaphragm to pelvic urethra? Simple ovarian tumor and eventual OVH? Even though it may seem so, the prudent clinical sonographer will image the right adrenal gland in full (even if not overtly indicated form the history) and not be satisfied with the simple 2-D right adrenal view.

Dr. Doug Casey of English Bay Ultrasound Service, Vancouver, B.C, Canada gives the practitioner and client something more to think about in this month’s SonoPath November 2012 case of the month.

A 13-year-old, intact female Fox terrier was presented for evaluation of possible pyometra or abdominal mass. A mid abdominal thickening was palpable.

Clinical Differential Diagnosis

(Lobetti): Mass - neoplasia/granuloma/abscess/cyst of spleen, kidney, liver, ovary, intestine, mesentery, lymph node Hydronephrosis Splenic torsion Pyometra

Sonographic Differential Diagnosis

(Lindquist DMV, DABVP): Left ovarian tumor, appears resectable. Right adrenal gland mass. Slight invasion or attached thrombus. This is potentially resectable. Right adrenal differentials include adenocarcinoma or pheochromocytoma given the invasive activity, possible adenoma with attached thrombosis. Recommend ovariohysterectomy and right adrenalectomy in this patient. CT evaluation of the right adrenal could also be considered. Blood pressure measurements and full adrenal gland panel is recommended.

Sampling

FNA revealed granuloma cell tumor of the ovary.

Outcome

The owners are considering their options.

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