Male Pseudohermaphroditism with Clitoromegaly in a Dog: Diagnostic Evaluation and Surgical Correction

Resumo

Background: Hermaphroditism, or intersexuality, is a pathological condition in which an individual possesses both male and female reproductive organs. Hermaphroditism is classified as true or pseudo-hermaphroditism. True hermaphroditism is referred to an intersex condition in which an ovotestis is present. Pseudohermaphroditism is pathological condition in which an individual has gonads of one sex but the external genitalia of the opposite sex. This case report describes diagnostic procedures, surgical intervention and pathohistological findings in dog with male pseudohermaphroditism and clitoromegaly with penisoid appearance.

Case: A 6-month-old mixed-breed dog was brought to the University Veterinary Clinic (Department of Veterinary Medicine, Faculty of Agriculture, University of Novi Sad) due to frequent urination and licking the vulva. Clinical examination of the reproductive tract revealed an enlarged clitoris. Complete blood count and biochemical analysis of serum did not show any abnormalities in collected blood samples, while the concentrations of estradiol and testosterone were as follows: estradiol 28.5 pg/mL, testosterone 1.8 ng/mL. Castration and clitorectomy were scheduled for the following day. After the midline laparotomy, gonads corresponding macroscopically to testes were observed at the anatomical position of the ovaries. The os clitoris was carefully dissected from the clitoral tissue and completely removed. Pathohistological examination of the left and the right gonads revealed tissue composed of tubules lined solely by Sertoli cells, with no evidence of spermatogenesis. Morphologically, the gonadal tissue (testis) is consistent with the “Sertoli-cell-only” syndrome. No ovarian tissue was identified histologically.

Discussion: Pseudohermaphroditism is generally a rare condition associated with reproductive dysfunction in dogs. Diagnosis of intersex conditions requires a combination of clinical examination, ultrasonography, radiology, endocrinology, and pathohistology, as it has been illustrated in this case. Pathohistological analysis of both gonads confirmed the diagnosis of male pseudohermaphroditism. Microscopically, the presence of Sertoli cells without spermatogenesis and an epididymis without spermatocytes is described as “Sertoli-cell-only” syndrome, indicating that the testes in this case were not functionally developed. Oviductal tissue was also observed histologically. In the serum samples of dog in our case report, the testosterone level was 1.8ng/mL, which probably originates from the secretory role of Leydig cells. On the other hand, since the pathohistological analysis of both gonads did not find ovarian tissue (ovotestis), the question remains is - how the estradiol level was 28.5 pg/mL. Pathophysiologically, level of estradiol can be partially explained by pathology of Leydig cells or other physiological sources of the organism. This case confirms that early recognition of intersex conditions prevents complications and improves patient quality of life. Reproductive capability is not expected in such dogs, and surgical intervention ensures a favorable prognosis and preserves quality of life. Male pseudohermaphroditism with pronounced clitoromegaly is unfrequently described in the literature, while recent reports have described this condition in pure-breed dogs but also in one mix-breed, as it is described in this case. In this case report, the symptoms were completely resolved and the animal remained in good general condition after the surgery.

Keywords: reproduction, surgery, sexual disorders, DSD, pseudohermaphroditism.