Standing Hand-Assisted Laparoscopic Diagnosis and Treatment of a Rare Case of Uterine Adenocarcinoma in an 18-Year-Old Mare.

The research paper is a case study about the diagnosis and treatment of an uncommon case of uterine adenocarcinoma in an 18-year-old horse. The study promotes the use of a standing hand-assisted laparoscopic technique to remove the cancerous tumor, which avoids the risks associated with general anesthesia.

Case Presentation

• An 18-year-old French Trotter horse was brought to the Clinique Equine, Ecole Nationale Vétérinaire d’Alfort for examination following a 3-month-duration of vaginal bleeding.
• Upon transrectal ultrasound examination, the vets discovered a mass within the right uterine horn wall of the horse. The mass was suspected during the transrectal palpation, and confirmed later as a firm heterogeneous intramural mass (7 x 12 cm) located in the right uterine horn.

Diagnosis

• Hysteroscopy, which is a form of endoscopy that allows medical professionals to look inside the uterus, confirmed the irregular and ulcerated shape of the mass.
• A standing hand-assisted flank laparoscopy was conducted to perform a partial ovariohysterectomy – a surgical removal of the ovaries and uterus.
• Two days post surgery, the horse had severe symptoms of colic and sadly had to be euthanized. The postmortem examination revealed a 720° small intestine volvulus at the mesenteric root, a left dorsal displacement of the large colon, and iliac and tracheobronchial lymph node hypertrophy.
• The histopathological examination of the removed uterine mass confirmed it was well-differentiated and infiltrating uterine adenocarcinoma, a form of invasive cancer, with lymph node metastasis – indicating that cancer had spread to the lymph nodes.

Findings and Conclusions

• The study concluded that this form of uterine neoplasia, or tumor, particularly adenocarcinoma, is uncommon in horses, and it can be successfully removed using the standing hand-assisted laparoscopic technique. This technique eliminates the risks associated with general anesthesia.
• Despite the initial success of the surgical intervention, the study also points out that the initial identification of metastasis and staging of the disease remain significant challenges that can influence the treatment strategy.