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Case report
Summary
Ajadi, T. A., O. L. Ajayi, A. A. Adeniyi & R. A. Ajadi, 2016. Vaginal wall hyperplasia with
fold prolapse in an eight-month-old Cane Corso dog. Bulg. J. Vet. Med., 19, No 3, 252–258.
An eight-month-old, female Cane Corso bitch was presented for treatment following complaint of
protrusion of oedematous tissue through the vulva lips one week after the commencement of the oes-
trous cycle. Clinical examination revealed a pear-shaped fibrous vaginal mass measuring about 5 cm
in diameter. Ultrasonography identified a single follicular cyst in the left ovary and vaginal smear
cytology revealed 100% keratinised cells. The treatment involved repositioning of the vaginal
prolapse with lacing of the vulva lips, hormonal therapy and surgical amputation of the protruding
tissue. The dog had completely recovered after the treatment with no recurrence of prolapse. It had a
physiological oestrus during the next cycle, was mated naturally and conceived a normal viable litter.
Key words: bitch, vaginal hyperplasia, vaginal prolapse
Vaginal prolapse, a clinical condition that the oestrous cycle. This results in the de-
is commonly seen in bitches is the protru- tection of vaginal hyperplasia during pro-
sion of oedematous vaginal tissue into the oestrus or oestrus of young bitches and is
vaginal lumen and often through the vulva regressed during dioestrus (Schaeferes-
lips of intact bitches during the proestrus Okkens, 2005).
or oestrus phase of the ovarian cycle An exaggeration of this oestrogenic
(Deniz nak & Gulnar, 2008). This disor- response can result in excessive mucosal
der is caused by accentuation of the nor- folding of the vaginal floor just cranial to
mal increase in vaginal hyperaemia and the urethral papilla, such that redundant
oedema secondary to the oestrogen stimu- mucosa begins to protrude through the
lus occurring during proestrus and oestrus vulvar labia. The exposed tissue rapidly
(Schaefers-Okkens, 2001). The vaginal becomes oedematous and inflamed and is
and vulvar mucosa normally become very easily traumatised (Suresh Kumar et al.,
oedematous during the follicular phase of 2011).
T. A. Ajadi, O. L. Ajayi, A. A. Adeniyi & R. A. Ajadi
A vaginal fold prolapse may occur in 2007). Follicular cysts are known to be
the young bitch during the first or second endocrinely active e.g. produce oestradiol-
follicular phase under oestrogen influence 17ß and progesterone (Olson et al., 1989),
and may reoccur at each subsequent oes- similarly to progesterone-producing lutein
trus, if not properly treated (Schaefers- cysts and cystic corpora lutea (McEntee,
Okkens, 2001). However, treatment de- 1990; Johnston et al., 2001).
pends on the extent of the fold prolapse, The present report describes the
whether one is dealing with a breeding or evaluation and management of a bitch
non-breeding bitch and whether or not the diagnosed with vaginal fold prolapse and
prolapse is present during oestrus or at the follicular cyst with no recurrence and sub-
end of pregnancy which is seen in excep- sequent normal heat, conception and par-
tional cases (Schaefers-Okkens, 2001). turition.
Based upon the degree of vaginal fold An eight-month-old female intact Cane
prolapse, Schutte (1967) has described a corso bitch weighing 32 kg was presented
three stage classification scheme in dogs. to the Veterinary Teaching Hospital of the
Bitches with type I prolapse have slight- Federal University of Agriculture, Abeo-
to-moderate eversion of vaginal mucosa kuta, Nigeria with vaginal bloody dis-
originating from the vaginal floor cranial charge and a protruded mass around the
to the urethral opening; type II prolapse vulva which was observed by the owner a
indicates protrusion of the vaginal mucosa week following the onset of her first oes-
through the vulvar labia, with the base trous cycle. The bitch was presented >day
also originating from the vaginal floor; 28 of first proestrual bleeding and was
bitches with type III prolapse have com- reported to be attracted to males but not
plete protrusion of the entire circumfe- standing for mating. On physical examina-
rence of the vaginal mucosa, often ac- tion the rectal temperature, pulse and res-
companied by exteriorisation of the ure- piratory rates of the patient were within
thral orifice. reference ranges. Vaginal bleeding, vulva
An ovarian cyst is a fluid-filled struc- oedema and a pear-shaped fibrous vagi-
ture (Olson et al., 1989) of any size pre- nal mass measuring about 5 cm in diame-
sent outside physiological prooestrus and ter was seen protruding out of the vulva
oestrus within the ovary (Johnston et al., on inspection of the genital tract (Fig. 1).
2001). It can occur solitaire or multiple in The surface of the mass was smooth with
one or on both ovaries (Dow, 1960) and is some degree of contamination with sand
endocrinely active or inactive (Olson et but there was no evidence of necrosis of
al. 1989). Hormonally active ovarian cysts the mass.
are of high clinical relevance because they Large number of non-cornified cells
are a significant source of hyperoestroge- consisting predominantly of parabasal
nism in bitches (Johnston et al., 2001), cells, small and large intermediate cells
which may result in prolonged oestrus and few superficial cells were observed in
(Arlt et al., 2011; Knauf et al., 2013). the vaginal cytology (Fig. 2) stained with
There are different types of ovarian cysts: Giemsa stain confirming that the bitch was
follicular cysts, cysts of subsurface epithe- still in mid-proestrus stage with a 60%
lial structures (SES), cystic rete ovarii, vaginal cornification indicative of vaginal
lutein cysts and cystic corpora lutea hyperplasia. A diagnosis of type II vaginal
(Johnston et al., 2001; Schlafer & Miller, prolapse was made based on the vaginal
SI
LI
Fig. 2. Vaginal cytology smear showing predominantly small (SI) and large intermediate (LI) cells
indicative of follicular phase of oestrous cycle.
K
C
O
Fig. 3. Transcutaneous abdominal B-mode ultrasound of the 8-month-old Cane Corso with vaginal
hyperplasia showing cyst (C) in the ovary (O) and a proximally located kidney (K).
ameter protruding through the vulva in a with a size 21 gauge scalp vein needle and
pendulous manner in less than 24 hours the cardiovascular system supported with
after suture removal. Thus it was decided lactated Ringer’s solution at a rate of
to carry out surgical resection of the mass. 0.2 mL/kg/min.
The dog was first pre-medicated with Following anaesthesia, the prolapsed
intramuscular injection of 3 mg/kg of 5% vagina was rinsed with normal saline solu-
tramadol hydrochloride (Amadol®, Union tion. Thereafter, a purse string suture was
Korea Pharma, Korea) followed 30 min placed round the neck of the vagina to
later with intramuscular injections of 0.03 ensure that a large proportion of the pro-
mg/kg of 0.1% atropine sulphate (Amo- lapsed hyperplastic vagina was included
pin®, Yanzhou Pharmaceuticals, China) in the resection. Ligatures were placed on
and 1 mg/kg of 2% xylazine hydrochlo- visible blood vessels using size 0 chromic
ride (XYL-M2®, V.M.D, Germany). In catgut. The pear-shaped prolapsed portion
addition, 3 mL of lignocaine was infil- of vagina was then carefully resected with
trated into the lumbosacral epidural place a scalpel. Care was taken not to occlude
to ensure proper analgesia of the perineal the vestibule. Mattress suture pattern with
area and reduce the dosage of the anaes- size 0 chromic catgut was used to appose
thetic induction agent. Thereafter, anaes- the end of the resected vagina mucosa and
thesia was induced and maintained with also to control bleeding. The remnant of
intravenous injections of 0.2 mg/kg of the vagina tissue was allowed to retract
0.5% diazepam (Calmpose® Ranbaxy, inward. The resected tissue was fixed in
India) and 10 mg/kg of 5% ketamine hyd- 10% buffered formaldehyde and sectioned
rochloride (Ketamin hydrochloride USP®, for histopathology. Following recovery,
Rotex Medica, Germany). Following pre- the dog was treated with 100 mg of
medication, venous access was secured tramadol orally twice daily for five days
and penicillin-streptomycin injection (Pen- or follicles of any size present any time
Strep®, Kepro, Holland) was administered during late oestrus (post ovulation), dioes-
intramuscularly for seven days. Histopa- trus or anoestrus are defined as follicular
thology of the mass revealed loosely ar- cysts (Johnston et al., 2001). In this pre-
ranged un-encapsulated proliferation of sent case, the bitch had prolonged proes-
stellate to spindle shaped cells. There are trus which is correlative to the findings of
few giant cells and moderate to numerous Johnston et al., (2001) who reported cycle
lymphocytes suggestive of vaginal hyper- irregularity exhibited as irregular interoes-
plasia with chronic inflammation (Fig. 4). trus interval and prolonged proestrus or
Vaginal prolapse is usually seen in oestrus as the most common presenting
younger bitches (<2 to 3 years of age) clinical signs of cystic ovarian follicular
during their first three oestrous cycles. No diseases.
breed preposition has been described, Vaginal prolapse is usually categorised
although it appears that the incidence of into type I, II, and III depending on the
the condition is higher in large-breed extent of protrusion of the mass, type III
bitches (Johnston et. al., 2001). The ani- or true vaginal prolapse has been earlier
mal in this case is an 8-month-old bitch reported to occur near parturition as a
and in her first heat. This may be because result of decreasing progesterone and an
first heat usually presents with an abnor- elevation in oestrogen concentration (Vee-
mal oestrous cycle and in this case there raieah & Srinivas, 2010). It sometimes
was an abnormal cycle due to the follicu- occurs concurrent with the exteriorisation
lar cyst present in the left ovary which was of other organs, such as the bladder, ute-
secreting oestrogen and in turn provoked rine body, or distal part of the colon (Gou-
the vaginal prolapse. Ovarian follicular letsou et al., 2009). This case was a type
structures greater than 8 mm present du- II vaginal prolapse because the prolapse
ring proestrus or oestrus prior to ovulation did not involve the entire vaginal wall.
Fig. 4. Photomicrograph of the vagina of an 8-month-old Cane Corso with vaginal hyperplasia
showing numerous spindle-shaped cells with moderate to numerous lymphocytes and few giant cells.
mestic Animals, eds. K. McEntee, Aca- Suresh Kumar, R. V., P. Veena, P. Sankar, N.
demic Press, San Diego, pp. 52–67. Dhana Lakshmi, Ch. Sreelatha & Kokila,
Mostachio, G. Q., W. R. R. Vicente, D. J. 2011. Vaginal hyperplasia in a dog – a
Cardilli, E. A. Pires & G. H. Toniollo, case report. Tamilnadu Journal of Veteri-
2007. Anovulvar cleft and vaginal pro- nary & Animal Sciences, 7, 174–175.
lapse hyperplasia in a bitch. Journal of Veeraiah, G. & M. Srinivas, 2010. Spontane-
Small Animal Practice, 48, 713–715. ous extrusion of the intestines and uterus
Olson, P. N., R. H. Wrigley, P. W. Husted, R. as a sequeal to vaginal prolapse in a buf-
A. Bowen & T. A. Nett, 1989. Persistent falo heifer: A case report. Buffalo Bulletin,
estrus in the bitch. In: Textbook of Veteri- 29, 60–64.
nary Internal Medicine, eds. S. J. Ettinger Wykes, P. M,. 1986. Diseases of the vagina
& E. C. Feldman, Philadelphia: Saunders, and vulva in the bitch. In: Current Ther-
pp. 1792–1796. apy in Theriogenology: Diagnosis, Treat-
Schaefers-Okkens, A. C., 2001. Vaginal oe- ment and Prevention of Reproductive Dis-
dema and vaginal fold prolapse in the eases in Small and Large Animals, ed. D.
bitch, including surgical management. In: A. Morrow, W. B. Saunders Co., London,
Recent Advances in Small Animal Repro- pp. 476–481.
duction, eds. P. W. Concannon G. England
& J. Verstegen, International Veterinary
Information Service (www.ivis. org),
Ithaca, New York. Document No.
A1210.0401
Schaeferes-Okkens, A. C., 2005. Estrous cycle
and breeding management of the healthy Paper received 24.03.2015; accepted for
bitch. In: Textbook of Veterinary Internal publication 15.06.2015
Medicine, eds. S. J. Ettinger & E. C.
Feldman, W. B. Saunders Co., London, p.
Correspondence:
1641.
Schlafer, D. H. & R. B. Miller, 2007. Female T. A. Ajadi
genital system. In: Jubb, Kennedy and Department of Veterinary Public
Palmer's Pathology of Domestic Animals. Health and Reproduction
4th edition, eds. M. G. Maxie, Philadel- Federal University of Agriculture, Abeokuta
phia: Elsevier Saunders pp. 429–564. PMB 2240, Alabata Road, Abeokuta,
Schutte, A. P. 1967. Vaginal prolapse in the Ogun State, Nigeria
bitch. Journal of South African Veterinary tel: 234-803-956-0868
Association, 38, 197–203. e-mail: ayisat_ajadi@yahoo.com