Rare case of Sertoli cell Tumor in German Shephered dog and its surgical management: A case report

Introduction

Sertoli cell tumor (SCT) is a neoplasm originating from Sertoli cell or nurse cell of the testis. Occurrence of this tumor is more in intact cryptorchid aged dogs (Ciaputa et al., 2012) [2] . Johnston et al. (2001) [6] reported that mean age at the time of diagnosis of Sertoli cell tumors is 7 years. Boxers and Weimeraners are more prone for Sertoli cell tumors (Johnston et al., 2001) [6] . Dogs with cryptorchid testes, causes 26-fold increase risk for SCT and 15-fold increase risk for seminomas (Hong et al., 2011) [5] . Malignancy of the SCTs is low (2-6%) but increases greatly in case of retained abdominal testis (Hohsteter et al., 2014) [4] . About 70% of SCT's of abdominal testes origin are functional and exhibit Feminizing Paraneoplastic Syndrome (FPS) (Quartuccio et al., 2011) [8] such as non-pruritic bilateral symmetrical alopecia, hyperpigmentation, gynaecomastia, pendulous penile sheath, attraction to other males, attaining squat posture while urinating. Bilateral orchiectomy is the treatment of choice for Sertoli cell tumors (Kisani et al., 2017) [7] . In malignancy cases chemotherapy is advised as an adjuvant therapy with tumor excision. Through this communication, we put forth a case of successful surgical management of Sertoli cell tumor in Germen Shepherd Dog.

Case History and Observations

A seven-year-old male germen shepherd dog presented to the clinics of department of gynaecology with a complaint of bilateral alopecia, skin lesions for 6 months, loss of appetite, and swelling at left inguinal region. Clinico-andrological examination revealed symmetrical bilateral alopecia on the croup regions, hyperpigmentation on the peri-anal and inguinal regions, gynaecomastia, oedematous and pendulous prepuce (Fig. 1). The animal was dull, weak and dehydrated. Only one testis was descended into scrotum with swelling on left inguinal region. On abdominal palpation, intra-abdominal hard mass could be palpated.

Diagnosis and Treatment

Ultrasonography of the left inguinal region and abdomen revealed Presence of large hypoechoic mass of cryptorchid testis (Fig. 2). Ultrasonography of the prostate did not show any significant change in the size of prostate except slight change in the echogenicity. Hematobiochemical studies revealed anaemia, thrombocytopenia, marginal leukopenia with normal level of creatinine and BUN. Serum estrogen estimation by ELISA method was found to be 110 pg/mL. Stained smear from preputial washings showed large number of cornified cells (Fig. 3). Based on above findings, case was tentatively diagnosed as Sertoli cell tumor and decided to go for surgical excision. The animal was stabilized preoperatively for three days with supportive therapy. The dog was Premedicated with Diazepam and butorphanol @ 0.5 mg/kg BW and 0.2 mg/kg i/v respectively, followed by induction of anaesthesia with 1% Propofol. The descended testis was surgically removed by pre scrotal approach and then laparotomy was performed by mid ventral approach to remove retained abdominal testis after ligating the spermatic cord. Cephalexin oral medication was administered for 7 days with alternate day wound dressing. Surgical wound healed completely and skin sutures removed on 12 th day. The gradual reversal of the recorded signs such as improvement in appetite, regrowth of hairs on the alopetic area, decrease in pigmentation over peri-anal region was noticed. The animal recovered uneventfully within two months post-surgery (Fig . 7). Weight of the excised testicular mass was about two kgs with engorged veins on mass. Grossly the mass was hard, multinodular with diffuse grey appearance (Fig. 4). Based On histopathological findings, the mass was confirmed to be Sertoli cell tumor.

Discussion and Conclusion

Among the testicular tumors, the Sertoli cell tumor has the potential to produce clinical effects due to hormonal changes (Suresh Kumar, 2012) [9] . Based on clinical signs and Ultrasonography, initial diagnosis of the tumor condition can be done. Squamous metaplasia of the prostate and abscessation in SCT has been reported by Borbil1 and Cătoi (2007) [1] . This could be due to excessive androgen secretions, whereas in the reported case no much significant changes in the size of prostate was noticed. Normal level of serum estrogen in intact male dogs is 35-50 pg/ml by Frank et al., 2003) [3] . But Serum estrogen level of 2-to-3-fold increase is evident in dogs with SCT which was recorded in this case. Preputial cytology is one of the diagnostic aids where we can expect large number of cornified cells in the dogs exposed to hyperestrogenemia (Jhonston et al., 2001) [6] which was evidenced in this case. Estrogen myelotoxicity causing bone marrow hypoplasia is common in SCT (Jhonston et al., 2001) [6] which can be evidenced in this case through its blood report. Spermiogram, usually reveals oligospermia and teratozoospermia in case of unilateral cryptorchid and azoospermia in bilateral cryptorchid cases. Borbill and Catoi (2007) [1] have reported that Grossly Sertoli cell tumours are Multinodular, firm white or grey appearance having tan or yellow areas of hemorrhage or fluid-filled cysts. These lesions are correlated with the appearance of mass excised in this case. Histopathology is the best method to confirm the type of tumor. The HP of the excised mass in this case revealed compactly arranged neoplastic cells with mitotic figure and vacuolations suggestive of Sertoli cells (Fig 5, 6). Sertoli cell tumors are to be differentiated from Seminoma and Leydig cell tumors through HP and from Hypothyroidism and Hyperadrenocorticism through hormonal assay. Bilateral orchiectomy is the treatment of choice for Sertoli cell tumors (Kisani et al., 2017) [7] . In malignancy cases, Chemotherapy is suggested using Cisplatin at dose rate of 60mg/m 2 , 2-5 doses in every 3 weeks once (Jhonston et al., 2001) [6] . Combination of drugs like Vinblastine cyclophosphamide, and methotrexate have also been described (Jhonston et al., 2001) [6] . Blood transfusion and supportive treatment can be done in severe estrogen induced anemia cases.

References

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