Background: Pheochromocytomas have been previously reported in horses, but successful antemortem diagnosis and surgical removal without recurrence of clinical signs have not been described.
Objective: To report the clinical presentation, diagnostic evaluation, surgical technique, anaesthetic management and post-operative care of a mare diagnosed with pheochromocytoma.
Study design: Clinical case report.
Methods: An 18-year-old Quarter Horse mare presented for recurrent episodes of colic, profuse sweating, muscle fasciculations and agitation over a 2-month period. Clinical, clinicopathologic and ultrasonographic (transcutaneous, transrectal) abnormalities were consistent with a unilateral left-sided adrenal mass. Surgical removal of the mass was performed via a trans-costal approach with removal of the 18th rib and retraction of the left kidney to improve exposure. Associated vasculature was ligated, and the adrenal mass was removed and submitted for histopathology and immunohistochemistry.
Results: A trans-costal surgical approach provided excellent visualisation of the adrenal mass and allowed for identification and ligation of associated vessels. Total surgical and anaesthesia time were 86 and 114 min, respectively. Several intraoperative (hypertension, tachycardia) and post-operative (colic with tachycardia, tachypnea, large colon pelvic flexure impaction and nasogastric reflux) complications were encountered and managed successfully. Immunohistochemistry demonstrated positive labelling for synaptophysin and chromogranin A, confirming diagnosis of pheochromocytoma. The mare had recovered well at 6-week recheck post-operatively and returned to training at 6 months post-operatively. No further clinical signs consistent with pheochromocytoma have been observed following removal.
Conclusions: The trans-costal approach allowed for surgical removal of a pheochromocytoma in a mare. Surgical removal of adrenal masses in horses may be associated with complications yet was successfully performed without subsequent recurrence of clinical signs associated with tumour presence and return to athletic use in this mare.
背景: 马匹有过嗜铬细胞瘤的报道，但尚未有完整描述生前诊断和成功手术切除，而不复发症状的病例。 目的: 报道临床诊断为嗜铬细胞瘤的母马的临床表现、诊断评估、手术技术、麻醉管理和术后护理。 研究设计: 临床病例报告 方法: 一匹18岁的夸特马在2个月内反复出现腹痛、大量出汗、肌肉紧张和痉挛等症状。临床检查、临床病理学和超声(经皮肤、经直肠)检查，发现左侧单侧肾上腺肿块，异常。通过跨肋入路，手术切除肿块，切除第18根肋骨并缩回左肾，改善暴露。结扎相关血管，切除肾上腺肿块，进行组织病理学和免疫组织化学检查。 结果: 经肋手术方法为肾上腺肿块提供了出色的视野，方便识别和结扎相关血管。手术和麻醉总时间分别为86分钟和114分钟。并成功处理了几起术中(高血压、心动过速)和术后(腹痛伴心动过速、呼吸急促、骨盆曲结肠梗阻和鼻胃反流)并发症。免疫组织化学显示突触素和嗜铬粒蛋白A的阳性标记，证实了嗜铬细胞瘤的诊断。这匹母马在术后六周的复查中恢复良好，并在术后六个月恢复训练。术后没有观察到与嗜铬细胞瘤相关的进一步临床症状。 结论: 经肋入路可以手术切除母马的嗜铬细胞瘤。马肾上腺肿块的手术切除可能引起并发症，但手术成功进行，没有复发以及与肿瘤相关的临床症状，术后母马恢复良好重新运动竞技。.
Keywords: adrenal; horse; multiple endocrine neoplasia; pheochromocytoma.
© 2023 The Authors. Equine Veterinary Journal published by John Wiley & Sons Ltd on behalf of EVJ Ltd.