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Home / Equine Research Bank / Equine Vet J / Successful surgical removal of a pheochromocytoma in a mare ...
Equine veterinary journal2023; 55(6); 1012-1020; doi: 10.1111/evj.13931

Successful surgical removal of a pheochromocytoma in a mare via trans-costal approach.

Abstract: Pheochromocytomas have been previously reported in horses, but successful antemortem diagnosis and surgical removal without recurrence of clinical signs have not been described. Objective: To report the clinical presentation, diagnostic evaluation, surgical technique, anaesthetic management and post-operative care of a mare diagnosed with pheochromocytoma. Methods: Clinical case report. Methods: An 18-year-old Quarter Horse mare presented for recurrent episodes of colic, profuse sweating, muscle fasciculations and agitation over a 2-month period. Clinical, clinicopathologic and ultrasonographic (transcutaneous, transrectal) abnormalities were consistent with a unilateral left-sided adrenal mass. Surgical removal of the mass was performed via a trans-costal approach with removal of the 18th rib and retraction of the left kidney to improve exposure. Associated vasculature was ligated, and the adrenal mass was removed and submitted for histopathology and immunohistochemistry. Results: A trans-costal surgical approach provided excellent visualisation of the adrenal mass and allowed for identification and ligation of associated vessels. Total surgical and anaesthesia time were 86 and 114 min, respectively. Several intraoperative (hypertension, tachycardia) and post-operative (colic with tachycardia, tachypnea, large colon pelvic flexure impaction and nasogastric reflux) complications were encountered and managed successfully. Immunohistochemistry demonstrated positive labelling for synaptophysin and chromogranin A, confirming diagnosis of pheochromocytoma. The mare had recovered well at 6-week recheck post-operatively and returned to training at 6 months post-operatively. No further clinical signs consistent with pheochromocytoma have been observed following removal. Conclusions: The trans-costal approach allowed for surgical removal of a pheochromocytoma in a mare. Surgical removal of adrenal masses in horses may be associated with complications yet was successfully performed without subsequent recurrence of clinical signs associated with tumour presence and return to athletic use in this mare. 背景: 马匹有过嗜铬细胞瘤的报道，但尚未有完整描述生前诊断和成功手术切除，而不复发症状的病例。 目的: 报道临床诊断为嗜铬细胞瘤的母马的临床表现、诊断评估、手术技术、麻醉管理和术后护理。 研究设计: 临床病例报告 方法: 一匹18岁的夸特马在2个月内反复出现腹痛、大量出汗、肌肉紧张和痉挛等症状。临床检查、临床病理学和超声(经皮肤、经直肠)检查，发现左侧单侧肾上腺肿块，异常。通过跨肋入路，手术切除肿块，切除第18根肋骨并缩回左肾，改善暴露。结扎相关血管，切除肾上腺肿块，进行组织病理学和免疫组织化学检查。 结果: 经肋手术方法为肾上腺肿块提供了出色的视野，方便识别和结扎相关血管。手术和麻醉总时间分别为86分钟和114分钟。并成功处理了几起术中(高血压、心动过速)和术后(腹痛伴心动过速、呼吸急促、骨盆曲结肠梗阻和鼻胃反流)并发症。免疫组织化学显示突触素和嗜铬粒蛋白A的阳性标记，证实了嗜铬细胞瘤的诊断。这匹母马在术后六周的复查中恢复良好，并在术后六个月恢复训练。术后没有观察到与嗜铬细胞瘤相关的进一步临床症状。 结论: 经肋入路可以手术切除母马的嗜铬细胞瘤。马肾上腺肿块的手术切除可能引起并发症，但手术成功进行，没有复发以及与肿瘤相关的临床症状，术后母马恢复良好重新运动竞技。.
© 2023 The Authors. Equine Veterinary Journal published by John Wiley & Sons Ltd on behalf of EVJ Ltd.
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Publication Date: 2023-02-22 PubMed ID: 36754850DOI: 10.1111/evj.13931Google Scholar: Lookup
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Summary

This research summary has been generated with artificial intelligence and may contain errors and omissions. Refer to the original study to confirm details provided. Submit correction.

The researchers detailed the successful surgical removal of a pheochromocytoma (a rare tumor) from a mare (female horse) through a trans-costal approach, which has not been documented in prior cases. Despite experiencing numerous complications, the horse fully recovered post-operation and showed no signs of recurrence.

Clinical Presentation and Evaluation

  • The research centers on an 18-year-old Quarter Horse mare that had shown symptoms of colic, excessive sweating, muscle spasms, and restlessness for two months.
  • Clinical, clinicopathologic, and ultrasonographic tests pointed to a unilateral left-sided adrenal mass, leading to suspicions of a pheochromocytoma.

Surgical Procedure

  • The team employed a trans-costal approach, which involves performing the surgery across the ribs.
  • The 18th rib was removed and the left kidney retracted to improve visibility and accessibility to the adrenal mass.
  • The tissue surrounding the adrenal mass, which was vascular in nature, was ligated off (tied) to minimize bleeding during the procedure.
  • The adrenal mass was successfully removed and sent for further analysis.

Results and Post-operative Care

  • The trans-costal approach provided excellent visibility of the adrenal mass and made it easier to identify and ligate the associated vessels.
  • The surgical and anaesthesia times were relatively short, clocking in at 86 minutes and 114 minutes, respectively.
  • Several complications arose during and following the operation, such as high blood pressure, rapid heart rate, colic with tachycardia, rapid breathing, and nasogastric reflux. However, all were successfully managed.
  • Tests confirmed the presence of pheochromocytoma through positive labelling for synaptophysin and chromogranin A, two proteins usually found in such tumors.
  • The mare made a good recovery at the six-week post-operative check, was back in training by six months, and showed no signs of a recurrence of the pheochromocytoma.

Conclusions

  • The researchers conclude that the trans-costal approach was successful in removing the pheochromocytoma and could be a viable option for treating adrenal masses in horses.
  • While there can be complications associated with the surgical removal of adrenal masses in horses, successful procedures may result in no recurrence of the clinical signs related to the tumor’s presence.

Cite This Article

APA
O'Brien TJ, Pezzanite LM, Acutt EV, Vilander AC, Hassel DM, Hector RC, Hendrickson DA. (2023). Successful surgical removal of a pheochromocytoma in a mare via trans-costal approach. Equine Vet J, 55(6), 1012-1020. https://doi.org/10.1111/evj.13931

Publication

Equine veterinary journal
ISSN: 2042-3306
NlmUniqueID: 0173320
Country: United States
Language: English
Volume: 55
Issue: 6
Pages: 1012-1020

Researcher Affiliations

O'Brien, Thomas J
  • Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, Colorado, USA.
Pezzanite, Lynn M
  • Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, Colorado, USA.
Acutt, Elizabeth V
  • Department of Environmental and Radiological Health Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, Colorado, USA.
Vilander, Allison C
  • Department of Microbiology, Immunology and Pathology, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, Colorado, USA.
Hassel, Diana M
  • Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, Colorado, USA.
Hector, Rachel C
  • Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, Colorado, USA.
Hendrickson, Dean A
  • Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, Colorado, USA.

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