Equine granulosa cell tumours among other ovarian conditions: Diagnostic challenges.

BACKGROUND: Granulosa cell tumours (GCT) are the most common ovarian tumours in mares. While the classical presentation may not represent diagnostic challenges, diagnosis is not easy in the early stages. OBJECTIVES: Illustrate the variability in the presentation and serum biomarkers associated with ovarian abnormalities in the mare. STUDY DESIGN: Retrospective case series. METHODS: Nonclassical cases of GCTs and other ovarian conditions were identified and behaviour, GCT endocrine results, palpation and ultrasonographic findings are described and the diagnostic value of each is discussed. RESULTS: Mares in this case series with GCTs had been presenting clinical signs ranging from no behavioural changes to behaviours including aggression, stallion-like and inability to work under saddle. Hormonal profiles of endocrinologically functional GCTs can be erratic and unpredictable. The clinical form and ultrasonographic appearance may also vary with time from an initially enlarged/anovulatory follicular structure that later develops a multicystic 'honeycomb' appearance. Mares with GCTs can also present with persistent anovulatory follicles or apparent luteal tissue that are unresponsive to treatment. If both ovaries are of relatively normal size and symmetry, but hormonal biomarkers are markedly increased (AMH >10 ng/mL, inhibin B and/or testosterone >100 pg/mL; 0.37 nmol/L), it is likely that a functional GCT is present. Still, it can be a challenge to decide which ovary to remove. Post-surgical endocrine testing can be helpful, especially if histopathology is not performed or a GCT is not found. MAIN LIMITATIONS: Cases limited to 14. CONCLUSIONS: Granulosa cell tumours present with a wide variety of clinical signs that do not fit what is commonly described as 'classic'. Only if AMH, testosterone and inhibin B concentrations are markedly increased, and there is an abnormally enlarged ovary, the diagnosis of a GCT is more confident. In the presence of normal size ovaries, normal hormonal biomarkers and abnormal behaviour, it is more likely that the ovaries are not involved.

Evaluation of chlorhexidine hydrochloride treatment on endometrial health of normal mares.

Chlorhexidine gluconate solution is a potent antimicrobial and therefore could be used effectively for treatment of endometritis, but historically this substance has been implicated as irritating to mucous membranes, including the endometrium of the mare. The use of chlorhexidine hydrochloride suspension (Nolvasan Suspension, Zoetis, Florham Park, NJ, USA) was evaluated in the uterus of normal mares to determine if adverse effects on endometrial health were noted. Twelve healthy, adult light breed mares were included in this study. Procedures were approved by the Auburn University Institutional Animal Care and Use Committee. All mares were determined to be reproductively normal by evaluation of endometrial histopathology, cytology, and bacterial culture. Mares were randomly assigned to treatment or control groups (n = 6 per group). Each mare was treated during estrus with an intrauterine infusion of 1 g (28 mLs per tube; 35.7 mg/mL) of chlorhexidine hydrochloride suspension (treatment group) or an equal volume of lactated ringer's solution (control group) once daily for 3 consecutive days. Biopsy and cytology samples were taken 3, 7, and 14 days after completion of treatment. Cytology and biopsy samples were read by a board-certified pathologist (L.N.) blinded to treatments, and biopsy samples were graded using a standardized Kenney-Doig score. There was no difference with respect to biopsy grade, degree of endometrial fibrosis, or presence of cytologic inflammation comparing control and treatment groups (P = 0.55, 0.7, and 0.06, respectively), neither when accounting for sampling day. The suspension was visible within the uterine lumen when mares were examined with transrectal ultrasonography for up to 4 days after treatment. Treatment with chlorhexidine hydrochloride in this formulation and at this concentration does not appear to have a deleterious effect on short term endometrial health in mares.

Infection of an equine placenta with a novel mycobacterial species leading to abortion.

A 25-year-old pregnant American Quarter Horse mare presented with a 1-week history of progressively worsening vaginal discharge. Transrectal ultrasound revealed increased thickness of the combined uterus and placenta with evidence of chorioallantoic edema but no placental separation. A thickened amnion was visible on transabdominal ultrasound. Abortion occurred 2 days after presentation despite medical treatment. At necropsy, the chorioallantois had variable but diffuse thickening with focally extensive browning of the chorionic surface in the right horn and adjacent body. There were fluid-filled sacculations on the allantoic surface of the umbilical cord, allantoamnion, and chorioallantois associated with diffuse perivascular fluid microscopically. A nonbranching acid-fast bacterium identified as belonging to the genus Mycobacterium Runyon group IV was isolated from the chorioallantois and uterine fluid. Ziehl-Neelsen stain confirmed the presence of intracellular acid-fast bacilli in trophoblasts of the gravid horn and the cervical star area. The current case is unique in that the mycobacteria did not initiate a significant granulomatous inflammatory response in the chorion unless villar necrosis occurred. Sequence analysis of the 16S ribosomal RNA gene and the rpoß gene, encoding the ß subunit of RNA polymerase, indicated that the strain of mycobacteria isolated in this case belonged to a novel species of rapidly growing mycobacteria and not to an established species. Mycobacteria are an uncommon and sporadic cause of placentitis and abortion, but should be suspected in cases of chronic placentitis that are not restricted to the cervical star area.