Exérese Radical Seguida de Vulvoplastia no Tratamento de Carcinomas de Células Escamosas em Vaca Girolando

Resumo

Background: Squamous cell carcinomas (SCC) are malignant tumors of the spinous layer of the cellular epithelium. The main risk factor associated with its formation is solar radiation, therefore, despite appearing anywhere on the body, it is more common in depigmented regions, mainly in mucocutaneous junctions. In small lesions, it is possible to use hyperthermia, cryotherapy, surgical excision, associated with the use of cauterization and application of topical (mitomycin C and 5-fluouracil) or intralesional (interleukin-2, BCG and cisplatin) drugs. In large and invasive lesions, associating surgical excision with other treatments is recommended. The objectives of the present study were to report the radical surgical excision followed by vulvoplasty in the treatment of extensive vulvar SCC in a Girolando cow, in addition to the successful use of the impermeable plastic field, aiming to reduce contamination in the postoperative period.

Case: A ¨6-year-old and 400-kg Girolando cow was referred for hospital care after a clinical evolution of 5 months. At physical examination, vital parameters were within the physiological parameters for cattle. Dermatological evaluation revealed an ulcerated tumor-like lesion with irregular shape and firm consistency affecting both vulvar lips, reaching approximate dimensions of 10 x 15 cm. Two 8mm punch biopsies were performed at the borderline junction between affected tissue and healthy vulvar skin. Histological examination confirmed the diagnosis of keratinizing SCC. Therefore, the cow was submitted to radical surgical excision followed by vulvoplasty. After removal of the bilaterally affected tissue, the dead space was obliterated by simple separated stitches with 2-0 polyglactin. Dermorrhaphy was accomplished by Wolf pattern captonated with 0-nylon thread. In order to reduce post-surgical contamination, we opted for fixing an impermeable plastic drape above the dorsal commissure of the vulva with 0-nylon continuous suture. Despite the involvement of the surgical margins, no recurrences were reported within 6 months after the surgical procedure.

Discussion: Hereford and Holstein breeds, as well as their crosses, due to their hypopigmented skin, are more prone to develop SCC. In the present report, it is believed that the main risk factor was high sun exposure, since the herd was raised extensively, and the Girolando cow had areas of depigmentation on the vulva. Despite the epidemiology and clinical findings being suggestive of SCC, histological confirmation is essential, as this neoplasm is invasive and its histological characteristics allow the differentiation from other types of vulvar neoplasms, helping to treatment choice and determining prognosis. In cases of very extensive, infiltrative and poorly differentiated neoplasms, radical surgical treatment is recommended, but there is great concern about recurrences. Therefore, the earlier the surgical intervention, the better the prognosis, since the SCC tends to have invasive growth, which increases the risk of compromising the surgical margins by tumor cells. Additionally, the use of an impermeable surgical drape fixed in the perineal region provided less contamination of the surgical region. In this case, healing occurred without major complications, and hospital discharge on the 18th postoperative day. Thus, in the present report, radical excision followed by vulvoplasty in the treatment of SCC in the Girolando cow was successful. We reiterate the use of waterproof plastic surgical drapes in the postoperative period of genital surgeries in cows, given its low cost and adjuvant action in reducing post-surgical complications, mainly infections and dehiscence.