Haemoperitoneum associated with bilateral granulosa cell tumours in a pregnant mare treated by standing ovariectomy

Abstract

This report describes the likely development and growth of bilateral granulosa cell tumours (GCTs) in a Warmblood pony mare, during the first trimester of pregnancy after artificial insemination. The GCTs were initially suspected to be ovarian haematomas and were managed conservatively. However, they ultimately led to life-threatening haemoperitoneum (HP) and were later diagnosed as GCTs with histopathology. The case was successfully managed with emergency standing laparoscopic-assisted bilateral ovariectomy after haemodynamic supportive therapy. The mare made a full recovery and delivered a live filly foal at term. GCTs can be a rare cause of life-threatening HP and can be successfully managed with haemodynamic support and standing laparoscopic-assisted removal. Bilateral ovariectomy in a pregnant mare after 70 days of gestation can result in successful delivery of a live foal.

Successful intra-abdominal resection of a 24 kg ovarian granulosa cell tumour in a Warmblood mare

“…The treatment of choice for GCT is surgical removal ( Alexander et al , 2004 ; Crabtree, 2011 ; Sherlock et al , 2016 ) and several surgical approaches for ovariectomy have been described. These include midline, flank, and paramedian laparotomy, colpotomy, and bilateral or unilateral laparoscopic approaches in the standing sedated horse ( Smith and Mair, 2008 ; Gee et al , 2012 ; Ragle, 2012 ; Daniel et al , 2015 ; Colbath et al , 2017 ; Sinovich et al , 2022 ). Conservative treatment in some cases was followed by surgical removal at a later stage ( Alexander et al , 2004 ) once medical stabilization was achieved.…”

“…Surgical removal of the affected ovary is the treatment of choice, ( Meagher et al , 1977 ; Perino and Didier, 1985 ; McCue, 1998 ) as these tumors rarely metastasize ( Bosu et al , 1982 ; Perino and Didier, 1985 ; Meagher et al , 1977 ). The surgical approach of choice for the removal of a GCT is a laparoscopic ovariectomy in the standing mare ( Smith and Mair, 2008 ; Sinovich et al , 2022 ). Ovariectomy under general anesthesia is preferred in horses with large GCTs that cannot be removed via flank laparotomy.…”

Ancillary treatment to support pregnancy in cases of medical disease

“…Systemic disease occurring in the pregnant mare presents many unique challenges and complications to routine case management, including the limitations on surgical interventions and pharmaceutical choices, as well as the inherent need to support fetoplacental health to prevent pregnancy loss. The Case Report by Sinovich and colleagues in this issue exemplifies some of these challenges (Sinovich et al, 2022). Cases of maternal medical disease affecting almost all body systems can have profound effects on fetoplacental health, fetal viability and pregnancy maintenance due to the presence of severe stress, endotoxaemia or endogenous prostaglandin production (Giles et al, 1993;Perkins, 1999;Bucca, 2006).…”