Medical and Surgical Management of Phaeohyphomycosis in a Kea (Nestor notabilis).

A 2.5-year-old female kea (Nestor notabilis) weighing 711 g was presented for acute lethargy, pelvic limb paraparesis, and decreased appetite. Results from a complete blood count revealed a leukocytosis (67540 cells/µL [reference interval 4200 - 37880 cells/µL]). Radiographic images revealed a mass effect within the mid coelom. The patient was provided supportive care that included antifungal medication (voriconazole 15 mg/kg PO q12h x 6 months and 10 days) and antibiotic therapy (enrofloxacin 20 mg/kg PO q12h x 27 days). A discrete 2.3 × 2.7 × 2.6 cm soft tissue mass adjacent to multiple organs was identified on contrast computed tomographic images (IsoVue 370 at 4 mL/kg IV over 2 minutes). The mass was medial and dorsal to the proventriculus, cranial to the ventriculus, caudal to the liver, and ventral to the cranial renal divisions. The mass had an irregular vascularized wall with a poorly vascularized center. Ten days after initial presentation, exploratory coeliotomy and mass removal via left lateral coeliotomy were performed. Bacterial (aerobic and anaerobic) and fungal cultures were negative. Fourteen days postsurgery, the leukocytosis was resolved. Microscopic review of the submitted tissue mass found multinucleated giant cells, macrophages, and brown fungal hyphae with irregular internal septations and some branching, leading to a diagnosis of phaeohyphomycosis. Panfungal polymerase chain reaction testing and sequencing were unsuccessful at speciation. Treatment with voriconazole was continued until behavioral, hematologic, and computed tomographic assessments indicated resolution of the problem 6 months postsurgery. No recurrence of disease has been reported 20 months following mass removal.

Diagnosis of Seminoma With Metastasis to the Brain and Kidneys in a Moluccan Eclectus (Eclectus roratus) Using Advanced Contrast Based Imaging.

A 20-year-old male Moluccan eclectus (Eclectus roratus) was presented with a history of falling off the perch, ataxia, unilateral blindness, hyporexia, and progressive lethargy. The eclectus was found to have a leukocytosis (52 × 103 cells/µL), characterized by an absolute and relative heterophilia (42.6 × 103 cells/µL and 82%, respectively), relative lymphopenia (18%), elevated bile acids (88 µmol/L), and elevated triglycerides (236 mg/dL). Radiographic images revealed a mass effect within the caudal coelom. After 13 days of outpatient supportive care, the patient was rechecked and had normalized bile acids (<35 µmol/L), static triglycerides (232 mg/ dL), and hyperuricemia (18.6 mg/dL). Computed tomography was performed antemortem with and without iodinated contrast agent, 4 mL/kg IV over 2 minutes, and a mass was found associated with the left kidney. Due to worsening neurologic signs and involvement with surrounding structures, the owner elected euthanasia. Before the postmortem examination, a postmortem intravascular contrast agent was used to provide a more thorough visualization of internal anatomical structures, including left renal vasculature disruption, mass vasculature, caudal coelomic organ displacement, and increased irregular optic chiasm radiodensity. Postmortem, a 4 × 4.1 × 5.1-cm white to tan mass was identified. Histopathology confirmed a seminoma with metastasis to the kidneys and optic chiasm. Seminomas have been described in avian species; however, seminoma metastasis in an eclectus parrot confirmed by histopathology has not been reported, and optic chiasm metastasis of a seminoma has not been described in any avian species. This report describes postmortem computed tomographic angiography of metastatic seminoma in a Moluccan eclectus with metastasis to the optic chiasm.

Differences in uterine innervation at hysterectomy.

OBJECTIVE: Our purpose was to identify patterns of uterine innervation in normal uteri and selected clinical conditions including adenomyosis and chronic pelvic pain. STUDY DESIGN: A retrospective survey was performed of stored uteri removed at hysterectomy for a variety of clinical conditions, including 8 uteri from nulliparous subjects (group 1, mean age 40.0 years, range 30-52 years), 21 uteri with no reported histologic abnormality from multiparous subjects (group 2, mean age 43.4 years, range 32-53 years; mean parity 2.0, range 1-4), 31 uteri reported with adenomyosis (group 3, mean age 42.4 years, range 29-54 years; parity 2.0, range 0-4), and 17 uteri from subjects with pelvic pain (group 4, mean age 39.1 years, range 30-52 years; parity 2.5, range 1-7). Sections were cut from paraffin blocks of the isthmus of stored uteri (in the majority of cases) and stained with protein gene product 9.5 to identify nerves. Sections of pancreas provided positive controls. Each section was reviewed by two unblinded observers. RESULTS: Group 1 (n = 8, nulliparous uteri) showed significant nerve bundles at the endometrial-myometrial interface and in the subserosal layers, with nerve fibers noted in intervening neurovascular bundles supplying the myometrial stroma. Group 2 (n = 21, histologically normal uteri from parous subjects) showed patterns of innervation similar to those of group 1 with the exception that 6 uteri demonstrated areas of nerve fiber proliferation (see below, group 4). In group 3 (n = 31, uteri with adenomyosis), 30 uteri (30/31) showed large areas of myometrium without nerves and absence of nerves in the neurovascular bundles supplying these areas. Five uteri showed areas of nerve fiber proliferation at the margins of the adenomyosis. Subserosal nerves were present in the majority of these uteri. In group 4 (n = 17), uteri were removed for chronic pelvic pain. Eleven uteri demonstrated proliferation of small-diameter nerve fibers throughout the myometrium; in 6 uteri there was asymmetry of nerve fiber proliferation. CONCLUSIONS: Variations in uterine innervation were noted in the isthmic region of uteri stored after hysterectomy. Uteri with adenomyosis frequently demonstrated large areas with absence of nerve fibers; uteri from subjects with chronic pelvic pain showed proliferation of small-diameter nerve fibers throughout the myometrial stroma. Nerve fiber proliferation was asymmetric in some of these specimens.