What is your diagnosis?

Feminisatie en ernstige pancytopenie veroorzaakt door testiculaire neoplasie in een cryptorche hond

“…The present case showed pancytopenia, namely a combination of non-regenerative anemia, leukopenia and thrombocytopenia, on complete blood count. General causes of pancytopenia can be divided into two groups: diseases that cause a decrease or an increase in hematopoietic bone marrow cell production (Kearns and Ewing, 2006;Sontas et al, 2009). The etiology of both groups is further illustrated in Figure 5.…”

“…This is followed by a decrease in erythrocyte production. Anemia is often delayed in onset, because of the longer life span of erythrocytes (120 days, compared to 4 to 8 hours for leukocytes and 5 to 7 days for platelets) (Kearns and Ewing, 2006;Sontas et al, 2009;De Bosschere and Deprest, 2010). Recovery, in cases of acute injury and especially in chronic cases, may take weeks to months after the removal of the causative agent.…”

“…In cases of chronic exposure to estrogens, damage is often irreversible and leads to a replacement of the red bone marrow by fat or fibrous tissue (75-100%). This results into irreversible neutropenia, thrombocytopenia and moderate to severe anemia (Kearns and Ewing, 2006;Sontas et al, 2009;De Bosschere and Deprest, 2010). Estrogen-induced myelotoxicity may be caused by exogenous estrogens or endogenous estrogens produced by ovarian or testicular neoplasms (Sontas et al, 2009) and should be a major differential for pancytopenia in cryptorchid dogs or dogs suspected of testicular tumors.…”

“…Therefore, a complete blood examination is usually performed in canine cases suspected of testicular neoplasia. Especially hematology is important because of the possible myelotoxic effects when the tumor is secreting estrogens (Kearns and Ewing, 2006;Sontas et al, 2009;De Bosschere and Deprest, 2010). In cases with leukopenia, pancytopenia and/or fever, urinalysis is also indicated.…”

“…In cases of estrogen toxicity, necrotic and inflammatory lesions can be seen in the bone marrow, which may develop into a condition of hypocellularity in chronic cases. In particular, hypocellularity in combination with replacement of the red bone marrow by fat or fibrous tissue indicates a poor prognosis (Sontas et al, 2009). Bone marrow aspiration and biopsy were discussed with the owners of this dog, but they preferred to evaluate the effect of the surgery without examining the bone marrow.…”