| Two
Normal Mare Ovaries
On
the Left, one (small) normal for the non-breeding
season.
On
the Right, one (large) what we expect during the season.
"Tea"
mare presented for breeding and complications found!!!
Tea
was purchased late October of 2007, as a three year
old and new addition to Starlight Ranch after a five
year search for a mare like her. She was healthy,
with just a hock injury when she was younger that
left a scare on her left hind leg.
Tea
was put under lights and prepared for a early 2008
breeding. Tea was delivered to Kruger Ranch to prepare
Tea for breeding on January 19th. On January 25th
Tea was first seen by Dr. Peters for a repro check
to see where she was in her cycle.
Left Ovary showed a 33 x 45, 64x73, Right Ovary
22x25
Ton good, no edema, no fluid, cx1
Issue detected as the entire Left ovary is markedly
enlarged and very hard. It was not painful to palpation
and was suspected to be a CH. But felt we had to
rule out a Granulosa Cell Tumor by doing HCG stim/testosterone
assay.
Further
evaluations found the large structure was approximately
110mm x 90mm, and at times was mildly painful to
palpation. The blood work sent to Kentucky came
back inconclusive so felt it was a CH structure
that needed time to go away, but would need monitored.
On
January 30, Tea was put on a 10 day Regimate routine
to be followed by Prostaglandin to see if they could
stimulate her system to start cycling normally and
to help break down the large mass or at the time
CH.
On
February 19, Tea began building what looked like
a breed able follicle 33x39 and the mass was down
to around 80mm.
On
February 21, Tea was bred by AI with hopes that
the mass would continue to go down and that she
would settle in foal. The follicle was a 44x31 and
ovulation was detected on February 22, 2008.
Once
the weather cleared we brought Tea home so that she
could be checked by WSU on 14 day check.
This
was just the beginning of evaluation for the next
three months.
On
March 7, Tea was present to Dr. Tibary at the WSU
Vet School for a 14 days pregnancy diagnosis.
On
palpation, she presented a freely moveable, large
left ovary in more central position than normal. The
right ovary was small and the uterus presented some
tone, the cervix was normal.
The
ultrasound examination revealed large left ovary with
a cystic mass 83.8mm containing fluid with a medium
echogenicity and a smaller follicular structure with
anechoic structure measuring 35mm follicle. Several
smaller fluid-filled cystic dilations were noted around
the ovarian mass. The right ovary was small without
any follicular structure and the uterus was normal,
no fluid, cervix was closed. Blood was taken again
to run a GCT test, which screens differently than
the blood test run in January. Level did not show
the structure as being a tumor.
Ultrasounds
conducted during evaluation phase, these are zoomed
out to show all of the mass to be seen. On normal
settings to see a follicle this mass would fill up
the whole screen.
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We
continued to haul Tea into WSU every 10 days for evaluation,
this was done to monitor any change in the left ovary
and to determine if the right ovary was functional.
The left ovary remained unchanged over several evaluations
and the right ovary showed normal follicular activity
and ovulation although the interval between ovulation
was slightly increased.
The
uterus and cervix showed normal palpation and ultrasonographic
changes consistent with changes observed on the right
ovary. The luteal phase following ovulation of the
right ovary was normal as confirmed by a rise in progesterone
following ovulation. Uterine cytology and culture
were performed and the results were negative.
No
definitive diagnosis can be reached as to the cause
and nature of this ovarian enlargement. The most common
cause are Granulosa cell tumor, cysadenoma and hematoma.
About 10% of the GCT will not show on the endocrine
panel and about 5% of these tumors do not cause arrest
of activity on the contraletral ovary. Hematomas usually
regress after a few weeks. This was not observed in
the case of Tea.
The
enlarged left ovary could be a cystadenoma or an atypical
hematoma or a rare form of hematoma.
On April 22, 2008 it was noted that most ovarian tumors
have a tendency to grow very slowly. So the lack of
change in Tea is not surprising. It was recommended
that the best course of action is to perform a laparoscopy
and overiectomy. Doing this should increase the chances
for Tea to get pregnant early in 2009.
A
diagnosis like what we have dealt with on Tea is not
something the vets rush into quickly. They will need
to monitor over a few months period of time before
they will even consider or make the suggestion to
take the ovary. So patience is very important in this
case, which is not easy when your used to getting
in fixing the problem then working with recovery.
Surgery
Day is Scheduled!!
On
April 26th, Tea was delivered to WSU to begin preparing
her for the surgery. She would need to be off feed
for at least two days possibly three to clear out
her intestines so the surgery could be performed.
April
28, 2008, Tea was prepared for surgery which started
around 12:30 pm. It was to be around a two hour surgery,
three hours later they were able to complete the procedure.
The
mass was the size of a large cantaloupe with a few
smaller masses. It was so large that it also was irritating
the uterine horn as it is swollen and inflamed. Because
the mass was filled with fluid and not hard, they
were able to drain it and remove it out two small
incisions that they made into one larger incision.
Pathology test should be back by May 2nd.
Mass
& Left Ovary once removed!
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Two
hours out of surgery Tea was allowed some hay and
she attacked it. She did very well the first night
with little rise in temperature which was expected.
They will continue to monitor Tea until May 1st or
2nd when she will come home. But she will still need
to be confined and monitored closely for the following
two weeks. She will be on our barncam if anyone would
like to check in on her. Starlight
Ranch Cam
The
vets are extremely positive that Tea will be healthy
and ready for breeding in 2009. The right ovary will
be larger as it will be working every cycle and the
cycle timeline could vary a little. But over all she
should be 100%. As a good friend said when they removed
one of her ovaries she became a breeding machine,
we are hoping this happen with Tea.
We
are presenting this page as a learning experience
for others to share with us. There is always something
new to learn and things like this do not happen often.
So we hope you enjoy learning from our experience
with Tea.
Please
check back often to check on Tea's progress as we
prepare her for an early 2009 breeding. We will update
this page as Tea heals from surgery.
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