The male dog pt 2

Question 1

Primary Testicular Neoplasia; what type of animals do we find it in

Answer 1

Common in dogs
◦ Usually older
◦ Cryptorchids

Question 2

Primary Testicular Neoplasia; types, distribution

Answer 2

Types:
◦ Sertoli cell tumor
◦ Seminoma
◦ Interstitial cell tumor (Leydig cell tumor)
Incidence roughly 1/3rd for each

Bilateral involvement is common

Multiple types can occur concurrently
◦ Mixed neoplasia

Question 3

Sertoli Cell Tumor more common when?

Answer 3

More common in retained testes

Question 4

Sertoli Cell Tumor symptoms

Answer 4

Paraneoplastic syndrome

◦ Hyperestrogenism
◦ FEMINIZATION
◦ Behavioral change, alopecia (bilateral symmetrical), gynecomastia, hyperpigmentation, pendulous prepuce, squamous metaplasia of the prostate, attraction to males, decreased libido
◦ Pancytopenia – life threatening
◦ 1st transient increased granulopoiesis with peripheral neutrophilia
◦ Then, neutropenia, thrombocytopenia & non-regenerative anemia
◦ Bone marrow replaced by fibrous tissue + fat

Metastasis
◦ Not common

Question 5

Sertoli Cell Tumor physical characteristics

Answer 5

• White to grey
• Firm
• Greasy on cut section

Question 6

Interstitial Cell Tumors (Leydig Cell Tumor) more common when?

Answer 6

More common in descended testes
◦ Rare reports of interstitial cell tumors in cryptorchid testes

Question 7

Interstitial Cell Tumors (Leydig Cell Tumor) secrete what? signs and results?

Answer 7

Can secrete estrogen or testosterone
◦ Similar clinical signs to SCT if estrogen producing
◦ If hypertestosteronism:
> Perinal adenomas, perineal hernia, prostatic disease

Usually diagnosed incidentally unless steroid producing

Very rare to metastasize

Question 8

Interstitial Cell Tumor appearance

Answer 8

• Soft
• Yellow-orange
• Cystic with serous/ serosanguineous fluid

Question 9

Seminoma often occurs when?

Answer 9

Often occur in retained testes

Question 10

seminoma can produce what? results?

Answer 10

Can produce steroids occasionally (estrogens)
Rarely metastasize
Carcinoma in situ (CIS)

Question 11

seminoma appearance

Answer 11

-soft
-homogenous
-ivory colour
-+/- lobulation
-smaller but can get large

Question 12

seminoma diagnosis

Answer 12

History
◦ Cryptorchid
◦ Hx of late testicular descent

Physical exam
◦ Signs of hyperestrogenism?
◦ Scrotal enlargement
◦ Enlarged, asymmetrical testis
◦ Testicular palpation
◦ Enlarged nipples

Preputial swab
Ultrasound

Question 13

testicular tumor treatment, prognosis, and prevention

Answer 13

Castration

Submit tissue for histopathology

Supportive care if paraneoplastic syndrome present
◦ Blood transfusion
◦ Broad spectrum antibiotics (secondary
infections)
◦ Fluid therapy

Prognosis
◦ Unfavorable if severe pancytopenia
Prevention is key – castrate cryptorchids!!!

Question 14

Important to rule out what if suspect orchitis/epididymitis

Answer 14

Brucella canis

Question 15

Conditions of the Prostate

Answer 15

◦ Benign Prostatic Hypertrophy (BPH)
◦ Prostatitis
◦ Prostatic cysts
◦ Prostatic Adenocarcinoma

Question 16

Benign Prostatic Hyperplasia/Hypertrophy (BPH); how does it occur?

Answer 16

Prostatic growth & secretion
◦ Occurs in response to testosterone metabolite
> dihydrotestosterone (DHT)

BPH = Spontaneous, age-related condition of intact males

Common condition
◦ >80% of intact males >6 age old have BPH

Causes prostate gland enlargement
◦ Prostatic volume in affected dogs is 2-6.5x greater than normal dogs of equal size

Question 17

Benign Prostatic Hyperplasia/Hypertrophy (BPH) most common clinical signs

Answer 17

Most common clinical signs

Serosanguinous fluid dripping for the penis or blood in semen/urine

Should NOT see dysuria

Question 18

BPH diagnosis

Answer 18

◦ Often found incidentally
◦ Detection of blood in prostatic fluid of the ejaculate/on tip of penis
◦ Uniform prostatic enlargement by palpation, radiographs, ultrasound

Question 19

BPH treatment

Answer 19

◦ Goal = decrease prostatic size
◦ Castration – works fastest
◦ Medical
> Finasteride - works by acting on the enzyme that converts testosterone to DHT (5⍺-reductase) – breeding males
> Anti-androgens, progestagens

Important to treat as predisposes to other prostatic disease if left untreated

Question 20

Cystic prostatic disease; types

Answer 20

Retention cysts
Paraprostatic cysts

Question 21

Retention cysts: occurence, appearance, clinical signs, treatment, possible sequelae

Answer 21

◦ Occur as BPH progresses
◦ Can be multiple small cysts and/or 1-2 large cysts
◦ Contain serosanguineous fluid
◦ Clinical signs > similar to BPH
◦ Rarely need surgical treatment or drainage
◦ Can lead to prostatic abscess if left untreated

Question 22

Paraprostatic cysts: occurence, appearance, treatment

Answer 22

◦ Cysts adjacent to prostate
◦ Can get quite large
◦ Clinical signs: dysuria, tenesmus, perineal hernia > space occupying
◦ Treatment
◦ Surgical removal
◦ Drainage via ultrasound guidance

Question 23

prostatitis; acute: rarity, severity, symptoms

Answer 23

• Not common
• Severe, acute illness – systemic involvement
  > Neutrophilia

Painful:
* Abdominal pain
* Pain on palpation of prostate
* Prostate is enlarged
* Difficulty walking (hunched up)
* Fever

Question 24

prostatitis; chronic: rarity, severity, symptoms

Answer 24

• More common
• Subclinical/low grade disease
  > Recurring urinary tract disease or subfertility
• 2nd to BPH, urinary disease
• Urethral discharge
• Hemospermia
• Enlarged irregular prostate
• Commonly caused by commensals
  > E.coli

Question 25

Acute Prostatitis diagnosis, treatment

Answer 25

• Culture is important for diagnosis & treatment
  > From urine
• Prostatic barrier not intact
  > Base antibiotics on sensitivity
• Supportive care as needed

Question 26

Chronic Prostatitis; diagnosis, treatment

Answer 26

• Prostatic barrier is intact
  > Need to take this into account for antibiotic selection
• Typically do not need supportive care

Question 27

in all cases of prostatitis, what do we need to treat? how?

Answer 27

in both instances need to treat prostatic enlargement
-castration; fastest option’
-finasteride etc.

Question 28

prostatitis leads to what if left alone

Answer 28

can lead to prostatic abscess

Question 29

Antibiotic selection for prostatitis;

Answer 29

Do not use:
-Penicillins
-Cephalosporins
-Aminoglycosides

Better to use:
-Fluoroquinolones
-Trimethoprim/sulfa
-Chloramphenicol
-Doxycycline

Question 30

length of treatment for prostatitis

Answer 30

IMPORTANT: Length of treatment
Minimum 4-6 weeks
Recheck often

Question 31

Prostatic Neoplasia; where do we find it? what kind? prognosis?

Answer 31

Uncommon
More common in neutered males

Prostatic adenocarcinoma = most common
Transitional cell carcinoma (TCC) = also possible

HIGH rates of metastasis
Prognosis is GRAVE

Question 32

If you see dysuria… is it BPH? what should we think of?

Answer 32

• Means it is not BPH

Indicative of something more serious:
* Prostatitis
* Abscess
* Cyst
* Tumor

Question 33

what is concerning with testicular neoplasia? in one word

Answer 33

Hyperestrogenism