Ovarian teratoma in a bearded dragon

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ABSTRACT

This case examine studies an ovarian teratoma in a feminine inland bearded dragon (Pogona vitticeps). The article comprises an in depth report of the diagnostic method to the case, together with a distinction radiograph that was carried out. An in depth checklist of all medicine, together with references, is contained.

The article describes the surgical method to the exploratory laparotomy in a bearded dragon and tumour removing with a profitable consequence. The dialogue focuses on the prevalence and studies of teratomas within the pet inhabitants. A number of studies can be found of various kinds of teratomas throughout totally different reptile species within the literature.

An adopted, three-year-old – presumed to be male – bearded dragon (Pogona vitticeps) was offered with a seven-day historical past of lethargy and lack of defecation.

The dragon appeared shiny on presentation and was sexed as feminine through the scientific examination. It weighed 540g, with a physique situation rating of three out of 5. Historical past revealed good husbandry, with acceptable environmental temperatures and an ultraviolet supply.

Throughout scientific examination, a giant, irregular and painful stomach mass was discovered, and impaction thought-about the most certainly differential.

Case development

Figure 1. A conscious, dorsoventral radiograph of the bearded dragon following administration of a contrast.
Determine 1. A acutely aware, dorsoventral radiograph of the bearded dragon following administration of a distinction.

The proprietor was eager on investigations into the stomach mass and the dragon was admitted. Ache aid within the type of meloxicam at zero.3mg/kg (Rowland, 2009) and tramadol at 10mg/kg (Souza and Cox, 2011), and IM injections, had been supplied, and the animal appeared extra comfy.

Acutely aware, dorsoventral radiographs of the dragon had been obtained, which revealed a well-calcified skeleton, in addition to a smooth tissue mass within the stomach. This didn’t assist with additional narrowing of the mass origin.

An additional ultrasonographic examination of the stomach was carried out, which revealed a part of the mass to be fluid-filled, with doable follicles current inside the stomach. Conservative remedy, and monitoring of urge for food and behavior, was elected at this stage.

Probiotic and electrolyte heat baths had been began, and a faecal pattern was obtained. This revealed a heavy infestation of nematodes and a product containing pyrantel was administered orally at 5mg/kg (Rowland, 2009).

Following defecation, the animal appeared brighter and the mass smaller. With permission of the proprietor, a barium sulfate answer was administered to additional support in figuring out the origin of the mass. An antibiotic injection, within the type of ceftiofur at 15mg/kg (Churgin et al, 2014), was additionally administered.

The next day, the dragon appeared to not have eaten in a single day, however was nonetheless comfy on stomach palpation. Repeat radiographs had been carried out, revealing the barium answer was transferring by the gastrointestinal tract correctly and the mass was not related to the tract, however was displacing it cranially (Determine 1). At this level, an exploratory laparotomy was mentioned with the proprietor, and a blood pattern was collected from the ventral tail vein for a normal well being profile and to verify the overall calcium ranges (Desk 1). This was run in-house. Though the calcium ranges weren’t raised above regular, a reproductive downside was the best differential. An exploratory laparotomy was scheduled for the next day. The identical painkillers had been administered the next morning as a part of a premedication protocol.

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The reptile was anaesthetised utilizing alfaxalone IV answer by way of the ventral tail vein at 5mg/kg (Rowland, 2009). The animal was intubated and positioned in dorsal recumbency, and a ventilator was used to help with intermittent positive-pressure air flow. Inhalant anaesthesia, within the type of sevoflurane, was used together with oxygen. The surgical space was ready with an iodine answer and a Doppler was used for coronary heart price monitoring. An off-midline, left stomach incision was made and the mass gently exteriorised (Determine 2).

A view of the ovarian teratoma. Figure 2. Before ligation of the ovarian stump.
A view of the ovarian teratoma. Determine 2. Earlier than ligation of the ovarian stump.

No apparent adhesions between the mass and different organs had been famous, however regular follicles had been current (Determine three). The ovarian pedicle was clamped and ligated with a single PDS-encircling ligature. Quite a few follicles had been famous in the fitting stomach cavity and, as mentioned with the proprietor previous to the surgical procedure, the dragon underwent a bilateral ovariectomy. The stomach cavity was flushed with sterile saline and inspected for any remaining follicles.

The pores and skin was closed utilizing a horizontal mattress suture, making certain an everting sample. Restoration from anaesthesia was uneventful.

Consequence

The next day, the reptile appeared shiny and freed from ache – and confirmed curiosity in meals, consuming quite a few bugs. It was discharged with an oral NSAIDs suspension and a postoperative check-up appointment was booked for seven days after, with a closing suture removing in six weeks.

Mass monitoring

Following the mass removing, the nurse continued to watch it for 30 minutes.

Table 1. Patient’s biochemistry results.
Desk 1. Affected person’s biochemistry outcomes.

A smooth tissue, fluid-filled part was wrapped round half of the mass (later confirmed as a part of a gastrointestinal tract) and appeared to point out peristalsis-like actions. One other, smaller, blood-filled part current on the other aspect of the tumour appeared to have quite a few blood vessels leaving it and continued to contract for 30 minutes post-removal. The primary, arduous part of the mass was incised into, revealing cartilage, bones and reptile pores and skin inside. With the proprietor’s consent, the mass was despatched for histopathological examination, which confirmed an ovarian teratoma, as suspected.

Case dialogue

A teratoma is outlined as a tumour composed of a mix of tissues totally different to that it originates from (Willis, 1951). Teratomas have been described in lots of veterinary species, with most studies amongst mammals.

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Ovarian neoplasias in cats and canine are reported as uncommon. They will usually be asymptomatic, and an incidental discovering throughout routine surgical procedures with a medium age of onset (Cote, 2014). In people, the scale of ovarian teratomas seems to be age associated, with greater and extra symptomatic tumours present in youthful sufferers (Kim et al, 2011).

The potential for malignancy of an ovarian neoplasia depends upon its degree of differentiation, with much less developed tumours, corresponding to embryonal carcinomas, exhibiting extra malignancy than teratomas (Patnaik and Greenlee, 1987).

Teratomas are usually not unique to a single intercourse or the reproductive tract, and studies of their incidence in different tissues, such because the skull, exist (Reindel et al, 1996).

A view of the ovarian teratoma. Figure 3. The ovarian stump, the tumour and normal-looking follicles attached to the tumour.
A view of the ovarian teratoma. Determine three. The ovarian stump, the tumour and normal-looking follicles hooked up to the tumour.

The gross look of this affected person’s tumour, with no apparent stomach adhesions, lack of radiographic proof of metastasis and histopathological report, would warrant a low potential of metastasis.

It’s shocking how such a giant mass, with a really well-developed blood provide, originated from such a small ovarian pedicle. It’s unknown whether or not the animal was uncovered to males of its species or used for breeding prior to vary of possession. Previous to the sudden onset of lethargy and inappetence, the animal exhibited no signal of being unwell, and it’s, due to this fact, troublesome to estimate the timeline of the tumour growth.

A number of studies of ovarian teratomas in reptiles exist, starting from benign tumours in a red-eared slider (Hidalgo-Vila et al, 2006) to malignant in the identical species (Newman et al, 2003).

Hidalgo-Vila et al (2006) discovered elevated calcium ranges of their affected person, which are sometimes current in gravid, feminine reptiles, however had been missing on this affected person. That is an attention-grabbing variation on this case, because the reptile was discovered to be gravid and, subsequently, spayed through the exploratory laparotomy. A traditional, whole blood calcium degree ought to, due to this fact, not exclude a reproductive downside.

Ovarian teratomas have been nicely described within the inexperienced iguana (Wenger et al, 2010), with a great surgical consequence. Most reported scientific signs are these anticipated to be brought on by an stomach space-occupying lesion, corresponding to respiratory or digestive disturbance (Reavill and Schmidt, 2007).

Conclusion

Ovarian neoplasias are uncommon in veterinary species and suspected to be usually underdiagnosed in much less acquainted species, corresponding to reptiles.

Our lack of expertise of ache expression in reptiles makes it troublesome to identify illness early for a lot of house owners and lots of reptiles are sometimes offered to the clinician in late levels of illness.

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