Intrapelvic Intestinal Leiomyoma in a Dog - Diagnostic and Therapeutic Challenges

Endreo Alan Pail dos Santos, Maria Lígia de Arruda Mestieri, Mauren Picada Emanuelli, Laís Fernanda Wojahn, Fabiana Wurster Strey, Bruno Leite dos Anjos

Abstract


Background: Rectal tumors are uncommon in dogs and cats. The clinical signs result from intra- and extraluminal compression. Diagnosis and treatment of rectal tumors are challenging due to their intraplevic location.  Owing to considerable bone superposition, computed tomography is the best exam to evaluate the tumor and plan surgery; however, poor availability and high costs may hinder its use. The objective of this case report is to describe the successful use of a combination of diagnostic techniques, namely transrectal ultrasound, transrectal fine-needle aspiration, and colonoscopy, for diagnosis and surgery planning in a case of intrapelvic intestinal leiomyoma in a dog.

Case: A 13-year-old female mongrel dog with tenesmus, low stool production, and hematochezia for two months was presented for examination. During this two-month period, a symptomatic treatment was administered, but there was no clinical improvement. In the clinical evaluation revealed a painless mass on the left dorsolateral region, at a depth of around 4 cm, with considerable luminal reduction. Abdominal ultrasound revealed a mass close to the descending colon; however, bone superposition precluded identification of its origin or delimitation of its boundaries. The patient was subjected to transrectal ultrasound imaging, colonoscopy, and cytological examination of fine-needle aspiration biopsy material collected under general anesthesia. The mass was located at the final portion of the descending colon; it was extraluminal, and measured around 7 x 7 cm. The integrity of the intestinal wall was preserved.  Next, radiographic examination of the thorax using three projections (ventrodorsal, left lateral, and right lateral) was performed to check for metastases, and no alteration was detected. Cytology suggested presence of leiomyoma. The patient underwent exploratory laparotomy with pubic osteotomy for intrapelvic access. The extraluminal mass was found adhered to the dorsal colorectal surface, whose serosa was compromised. The mass, which occupied around 80 to 90% of the pelvic canal, was completely removed and submitted to histopathological examination, which confirmed presence of proliferative neoplastic mesenchymal cells (intestinal leiomyoma). The patient's clinical picture evolved without intercurrences, and the patient was discharged 40 days after the pubic bone consolidation procedure.

Discussion: The occurrence of leiomyomas in the colorectal segment of the intestine is rare in dogs. Neoplasms that develop in such a region of the intestine are usually more frequently found in elderly animals, such as the patient of this report. Leiomyomas are benign (non-invasive) neoplasms with slow growth. Consequently, clinical signs emerge when the mass exhibits a large size, which causes intra- or extraluminal compression, tenesmus, diminished production or absence of defecation, and hematochezia, as observed in the present case. Even though the clinical signs are similar in these cases, they are unspecific; consequently, for reaching a diagnosis, biopsy and histological investigation are required. In spite of the usefulness of these procedures for diagnosis, computed tomography is the exam of choice to investigate neoplasms in intrapelvic intestinal segments because it allows three-dimensional reconstruction of the affected structures and facilitates surgical planning. Unfortunately, computed tomography was not available for this case. Consequently, colonoscopy, transrectal ultrasound, and transrectal fine-needle aspiration biopsy were performed. When combined, these procedures allowed determination of the location, size and type of neoplasm, which were crucial pieces of information for the correct diagnosis and surgical planning, thus contributing for the successful management of the patient.


Full Text:

PDF

References


Adamovich-Rippe K.N., Mayhew P.D., Marks S.L., Selmic L.E., Culp W.T., Youello A.M., Runge J.J., Holt D.E., Kass P.H. & Peauroi J.R. 2017. Colonoscopic and histologic features of rectal masses in dogs: 82 cases (1995–2012). Journal of the American Veterinary Medical Association. 250(4): 424-430.

Alagarda C.C., Díaz-Bertrana S.C., Durall R.I., de la Fuente H.C., Silvestrini P. & Piviani M. 2010. Resonancia magnética nuclear de un leiomioma rectal en un perro. In: Comunicaciones y Casos clínicos. 44 Congreso Nacional de AVEPA. v.30. (Barcelona, España). p.54.

Baines S.J. & Aronson L.R. 2018. Rectum, anus, and perineum. In: Johnston S.A. & Tobias K.M. (Eds). Veterinary Surgery Small Animal. 2nd edn. St. Louis: Saunders-Elsevier, pp.1783-1827.

Bonfanti U. 2020. Intestines and Rectum. In: Sharkey L.C., Radin M.J. & Seelig D. (Eds). Veterinary Cytology. Hoboken: Jonh Wiley & Sons Inc, pp.394-406.

Brown L.K., Clark N.R., Conway J. & Mishra G. 2019. Rectal ultrasound with fine needle aspiration: an underutilized modality for delineating and diagnosing perirectal, presacral, and pelvic lesions. Endoscopy international open. 7(2): 171-177.

Chang S.S., Anthony S., Koder P.C. & Brown S.G. 1997. Transrectal ultrasound guided manipulation of the canine prostate with minimum intervention. Laboratory Animals. 31(3): 219-224.

Culp W.T., Johnson E.G., Giuffrida M.A., Palm C.A., Mayhew P.D., Kent M.S., Rebhun R.B. & Burton J.H. 2019. Use of transrectal ultrasonography for assessment of the size and location of prostatic carcinoma in dogs. American journal of veterinary research. 80(11): 1012-1019.

Danova N.A., Robles-Emanuelli J.C. & Bjorling D.E. 2006. Surgical excision of primary canine rectal tumors by an anal approach in twenty-three dogs. Veterinary surgery. 35(4): 337-340.

Davies J.V. & Read H.M. 1990. Sagittal pubic osteotomy in the investigation and treatment of intrapelvic neoplasia in the dog. Journal of Small Animal Practice. 31(3): 123-130.

Frgelecová L., Škorič M., Fictum P. & Husník R. 2014. Canine gastrointestinal tract tumours: a restrospective study of 74 cases. Acta Veterinaria Brno. 82(4): 387-392.

Frost D., Lasota J. & Miettinen M. 2003. Gastrointestinal stromal tumors and leiomyomas in the dog: a histopathologic, immunohistochemical, and molecular genetic study of 50 cases. Veterinary Pathology. 40(1): 42-54.

Katamoto H., Kumagai D., Kouzai N., Takigami S., Kuwamura M., Yamate J. & Kotani T. 2003. Space-occupying leiomyoma in the pelvic canal of a dog. Journal of small animal practice. 44(6): 277-279.

Kim N.K., Kim M.J., Yun S.H., Sohn S.K. & Min J.S. 1999. Comparative study of transrectal ultrasonography, pelvic computerized tomography, and magnetic resonance imaging in preoperative staging of rectal cancer. Diseases of the Colon & Rectum. 42(6): 770-775.

Munday J.S., Löhr C.V. & Kiupel M. 2017. Tumors of the alimentary tract. In: Meuten D.J. (Ed). Tumor in Domestic Animals. 5th edn. Ames: Jonh Wiley & Sons Inc, pp.499-601.

Nucci D.J., Liptak J.M., Selmic L.E., Culp W.T., Durant A.M., Worley D., Maritato K.C., Thomson M., Annoni M., Singh A., Matz B. & Benson J. 2014. Complications and outcomes following rectal pull-through surgery in dogs with rectal masses: 74 cases (2000-2013). Journal of the American Veterinary Medical Association. 245(6): 684-695.

Park N.W., Chung W.H., Han J.W. & Eom K.D. 2015. Dynamic Computed Tomographic Characteristics of a Colorectal Leiomyoma in a Dog. Journal of Veterinary Clinics. 32(2): 200-204.

Randall V.D., Boston S.E., Gardner H.L., Griffin L., Oblak M.L. & Kubicek L. 2016. Pubectomy and stereotactic radiotherapy for the treatment of a non-resectable sacral osteosarcoma causing pelvic canal obstruction in a dog. The Canadian Veterinary Journal. 57(9): 945.

Senagore A., Milsom J.W., Senagore P., Mazier W.P., Scholten D.J. & Zydbel P. 1988. A comparison between intrarectal ultrasound and CT scanning in staging of experimental rectal tumors. Journal of Surgical Research. 44(5): 522-526.

Slaviero M., Argenta F.F., Ehlers L.P., Lorenzo C.D., Pavarini S.P., Driemeier D. & Sonne L. 2020. Primary nonlymphoid gastrointestinal neoplasms in dogs in Rio Grande do Sul. Pesquisa Veterinária Brasileira. 40(1): 61-71.

Smeak D.D. 2020. Approaches to the Rectum and Pelvic Canal. In: Monnet E. & Smeak D.D. (Eds). Gastrointestinal Surgical Techniques in Small Animals. Hoboken: Jonh Wiley & Sons Inc., pp.235-243.

Sobral R.A. & De Nardi A.B. 2016. Tumores do Trato Digestório. In: Daleck C.R. & De Nardi A.B. (Eds). Oncologia em Cães e Gatos. 2.ed. Rio de Janeiro: Roca, pp.395-405.

Spector D.I., Fischetti A.J. & Kovak-McClaran J.R. 2011. Computed tomographic characteristics of intrapelvic masses in dogs. Veterinary Radiology & Ultrasound. 52(1): 71-74.

Yoon H.Y. & Mann F.A. 2008. Bilateral pubic and ischial osteotomy for surgical management of caudal colonic and rectal masses in six dogs and a cat. Journal of the American Veterinary Medical Association. 232(7): 1016-1020.




DOI: https://doi.org/10.22456/1679-9216.105393

Copyright (c) 2021 Endreo Alan Pail dos Santos, Maria Ligia de Arruda Mistieri, Laís Fernanda Wojahn, Fabiana Wurster Strey, Mauren Picada Emanuelli, Bruno Leite dos Anjos

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.