Caslick/Endometrial biopsy (practical) Flashcards
What are the indications for a Caslick Vulvoplasty?
–Correction of mild conformational abnormalities which cause pneumovagina
–Sunken anus
–Sloping of the vulva
Explain briefly how you perform a Caslick Vulvoplasty
–Restrain mare
–Clean vulva
–Local infiltration
–Remove 4 mm wide strip of vulvar mucosa at m-c junction
•From the dorsal commissure to level of bony pelvis
–Do not remove skin as that will cause fibrosis
–Close with interrupted or continuous sutures
–Remove sutures (faeces stick to sutures)
What are the primary indications for collection of an endometrial biopsy in the mare?
The primary indications for collection of an endometrial biopsy include examination of barren mares, problem breeding mares, and mares with a history of pregnancy loss, and as part of a pre-purchase evaluation of a potential broodmare.
Wen should an endometrial biopsy be taken in the mare?
Samples may be collected prior to the onset of the breeding season, during the breeding season, or at the end of the breeding season. A biopsy may be collected during any stage of the estrous cycle, although individual veterinarians may prefer to collect samples when the mare is either in diestrus or in early estrus.
Before taking an endometrial biopsy in the mare, what should you check first?
It is critical that the pregnancy status of the mare be confirmed, as collection of a biopsy from a pregnant mare will almost certainly result in pregnancy loss.
Explain how to perform an endometrial biopsy in the mare
To collect a biopsy sample, the tail is wrapped and held out of the way. The perineal area is cleaned by repeated washings with a non-residual soap and dried. A sterile endometrial biopsy instrument is guided into the vagina, and then carefully passed through the cervix into the uterus. The person collecting the sample then removes the arm that guided the biopsy instrument into the vagina and inserts it into the rectum to manually aid in directing the instrument to the base of a uterine horn. A small sample (1 to 2 cm) of endometrial tissue is obtained and placed into a fixative solution (Bouin’s solution or 10% formalin) in a container labeled with the name of the mare, collection date, and other pertinent information.
What are endometrial biopsy samples often examined for?
Endometrial biopsy samples are examined for the presence of inflammatory and degenerative changes.
What is inflammation recognised by on endometrial biopsy?
Is this treatable?
Inflammation is recognized by the accumulation of inflammatory cells (white blood cells) in the endometrial tissue. Acute inflammation (i.e. a recent onset of inflammation) is recognized by the presence of a specific type of white blood cell called the polymorphonuclear leukocyte (PMN) or neutrophil. Chronic inflammation (i.e. long- 2 standing inflammation) is characterized by the presence of lymphocytes and other mononuclear cells in the endometrium. Inflammation may be infectious or noninfectious in origin, but is a potentially treatable pathologic condition
What the hallmark of degeneration of the endometrium?
Is this treatable?
The hallmark of degeneration of the endometrium is deposition of fibrosis or scar tissue around endometrial glands, often forming what are called glandular ‘nests’. Other degenerative changes detected in biopsy evaluation include cystic dilation of glands and glandular necrosis. In contrast to inflammation, fibrosis represents a permanent, untreatable pathologic condition.
The endometrium is classified on a garding scale based on biopsy characteristics from 1 - 3.
What are the grades?
The endometrium is classified on a grading scale based on biopsy characteristics that ranges from I to III. Grade I endometrium is essentially normal, with minimal inflammation or fibrosis. Grade III endometrium includes severe inflammatory and/or fibrotic changes. Grade II is a broad category, often divided into subcategories IIA and IIB, encompassing mild to moderate pathologic conditions between Grades I and III.
Additional information as to the potential cause of endometrial pathology is often available from diagnostic tests performed in conjunction with the biopsy, such as WHAT?
Additional information as to the potential cause of endometrial pathology is often available from diagnostic tests performed in conjunction with the biopsy, such as ultrasonography, speculum examination, uterine culture and uterine cytology. As noted previously, fibrosis or scar tissue is considered a permanent condition. However, if the source of inflammation is identified and successfully treated, one would expect to see an improvement in the endometrial grade on a subsequent evaluation
Explain what can be see on this equine endometrial biopsy
Equine endometrial biopsy exhibiting mild periglandular fibrosis and the artifact of missing luminal epithelium. H&E.
Explain what can be seen on this equine endometrial biopsy
Equine endometrial biopsy exhibiting moderate periglandular fibrosis and mixed inflammation, especially of the stratum compactum. Note crush artifact at bottom of section
Name some indications for endometrial biopsy in mares
- Barren mares
- Repeat breeder mares
- Observed or palpable genital tract abnormalities
- Breeding soundness examination
- Mares behaviorally anestrus during the breeding season
- Mares with pyometra or mucometra
- Mares with recent early embryonic or fetal death
- Mares requiring genital or non-emergency surgery
- Recipient mares in embryo transfer programs
- Mares in research programs where foals are important
What can be seen on this equine endometrial biopsy?
Equine endometrial biopsy exhibiting numerous neutrophils in the interstitial spaces and marginating within vessels of the stratum compactum. Some neutrophils are transmigrating the superficial epithelial surface. Marginated intravascular neutrophils and very tall columnar epithelium likely indicate a biopsy acquired during estrus, but interstitial infiltrates suggest an inflammatory response as well
What can be seen on this equine endometrial biopsy?
Equine endometrial biopsy exhibiting a diffuse, moderate to severe, infiltrate of lymphocytes within the stratum compactum.
What can be seen on this equine endometrial biopsy?
Equine endometrial biopsy exhibiting numerous hemosiderin-laden macrophages (siderocytes/siderophages) within the midregions of the stratum spongiosum. Mild inflammation is also present.
