Standing Hand-Assisted Laparoscopic Diagnosis and Treatment of a Rare Case of Uterine Adenocarcinoma in an 18-Year-Old Mare.
Authors: Quéré Emilie, Bourzac Céline, Farfan Maëlle, Losada Andres, Volmer Christelle, Mespoulhès-Rivière Céline
Journal: Journal of equine veterinary science
Summary
# Editorial Summary Uterine adenocarcinoma represents a rare neoplastic condition in mares, yet early detection and appropriate surgical intervention may offer improved outcomes compared to systemic disease. This case describes an 18-year-old French Trotter presenting with three months of vaginal haemorrhage, in which transrectal ultrasound and hysteroscopy identified a 7 × 12 cm intramural mass within the right uterine horn; the clinicians elected to perform standing hand-assisted flank laparoscopy to achieve partial ovariohysterectomy, thereby obtaining definitive histopathological diagnosis whilst avoiding general anaesthesia-related complications. Histology confirmed a well-differentiated, infiltrating uterine adenocarcinoma with lymph node metastasis, though post-operative deterioration necessitated euthanasia two days after surgery due to small intestinal volvulus and significant lymph node involvement. Standing hand-assisted laparoscopic techniques offer clear advantages for equine reproductive neoplasia management—enabling tissue diagnosis, reducing anaesthetic risk in geriatric patients, and allowing visual assessment of adjacent structures—yet the authors emphasise that comprehensive pre-operative staging to identify metastatic disease remains essential, as occult systemic involvement may dramatically alter prognosis and treatment feasibility despite successful surgical removal of the primary lesion.
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Practical Takeaways
- •Vaginal bleeding in aged mares warrants transrectal ultrasound and hysteroscopy to rule out uterine neoplasia, which is uncommon but serious when present.
- •Standing hand-assisted laparoscopy is a viable surgical option for uterine mass removal in mares, avoiding general anesthesia risks in older patients, but thorough pre-operative metastatic staging is critical to prognosis.
- •Post-operative colic in the immediate post-surgical period can occur and may reflect pre-existing metastatic or complicating conditions; close monitoring and appropriate diagnostic imaging are essential.
Key Findings
- •An 18-year-old mare presented with a 3-month history of vaginal bleeding caused by a 7×12 cm infiltrating uterine adenocarcinoma in the right uterine horn.
- •Standing hand-assisted flank laparoscopy successfully enabled both partial ovariohysterectomy and histologic diagnosis of malignancy without general anesthesia.
- •Postmortem examination revealed lymph node metastasis and a fatal 720° small intestine volvulus occurring 2 days post-operatively.
- •While uterine adenocarcinoma is rare in mares, standing laparoscopic technique avoids anesthetic risks but requires comprehensive pre-operative staging to identify metastasis and guide treatment decisions.