Screen+Shot+2020-01-10+at+10.35.34+AM(2).png — Uterine Adenomyosis and Cystic Endometrial Hyperplasia in a 2 Year Old Feline

Dr. Lauren Pike

Patient Information:

Age: 2 years

Gender: Female

Species: Feline

Breed: Scottish Fold

History:

Pet presented for failure to conceive when bred. Owner also reported recent hemorrhagic vaginal discharge.

Image Interpretation:

Uterus: The uterus is markedly enlarged (Lt/Rt - 0.9/0.8 cm diameter), having thickened, mildly hyperechoic walls. It exhibits a moderately tortuous course.

Ovaries: The left ovary is normal size (0.8x0.6 cm), shape, and echogenicity. The right ovary has an anechoic cyst measuring 0.9x0.8 cm; the ovary is overall mildly enlarged (1.2x1.0 cm), with otherwise normal shape and echogenicity

Additional Testing and Diagnosis:

Fine-needle biopsies of the uterus was declined. Ovariohysterectomy was performed, with histopathology of the reproductive organs. This diagnosed cystic endometrial hyperplasia and severe andenomyosis with pyogranulomatous endometritis and metritis

Discussion:

Adenomyosis is defined as a benign condition where endometrial glands and stroma occur in a disorganized fashion deep within the myometrium. Uterine adenomyosis is a rare disorder of domestic animals, though it does occur with variable frequency in humans. The pathogenesis is not well understood, though increased estrogen, abnormal musculature, and increased luminal pressure have been implicated. Endometriosis shares several characteristics with adenomyosis, but in endometriosis, aberrant endometrium is found only outside the uterus and endometriosis occurs only in menstruating species (primates). In women, the most common clinical signs of uterine adenomyosis are dysmenorrhea and menorrhagia, followed by abdominal and pelvic pain and reproductive difficulties (2). Approximately 35% of women are asymptomatic, and most (rare) cases of veterinary cases are without symptoms. Medical treatment of adenomyosis in women has met with variable success. In veterinary medicine, where reproductive conservation is often less critical, ovariohysterectomy is the most commonly recommended treatment. However, this disease process has been described in rare zoo felids, where reproductive ability would ideally be preserved. Therefore, long-term progestin treatments, which are suspected to contribute to development but have been used to suppress signs of estrus, should be avoided in these species.

Cystic endometrial hyperplasia is most often due to increased sensitivity to endogenous progesterone, though it also can be seen as a result of administration of exogenous estrogen. It is a common cause of infertility in queens and often is associated with endometritis, as seen here. Pyometra can also result.