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Can Vet J. Nov 2004; 45(11): 938–940.
PMCID: PMC545984

Language: English | French

Renal teratoma in a llama

Abstract

Teratomas are neoplasms of embryonal origin in domestic animals and are generally associated with reproductive organs. We report a case of teratoma involving the right kidney in a young llama that presented clinically with signs of mild colic and constipation.

Résumé

Résumé — Tératome rénal chez un lama. Chez les animaux domestiques, les tératomes et les néoplasmes d’origine embryonnaire sont généralement associés aux organes reproducteurs. Nous rapportons un cas de tératome impliquant le rein droit chez un jeune lama présenté en clinique avec des signes bénins de coliques et de constipation.

(Traduit par Docteur André Blouin)

A 5-month old female llama was presented with a history of anorexia, lethargy, and depression over the previous 36 h. During the previous 24 h, she had passed scant amount of feces and had urinated sparingly. The owner had drenched her with 100 mL of mineral oil 24 hours before presentation.

Upon examination, the llama appeared depressed and was in sternal recumbency. Her rectal temperature was 38.4°C (normal 37.5°C to 38.9°C), heart rate was 72 beats/min (normal 60 to 80 beats/min), and respiratory rate was 24 breaths/min (normal 10 to 30 breaths/ min) (1). No abnormal sounds were heard on auscultation of the thorax. First compartment (C1) sounds were absent on auscultation of the left paralumbar fossa over a period of 3 min (normal 3 to 4 contractions/min) (1). No high resonant sounds were heard on percussion and auscultation of the abdomen. Palpation of the abdominal organs per rectum was not possible due to the small size of the llama’s rectum; however, a few dry fecal pellets coated with mucus were obtained during digital examination of the distal part of the rectum. The abdomen appeared slightly distended when the patient was forced to stand and, within a short time, she resumed sternal recumbency, suggesting abdominal discomfort (2). Blood was collected by jugular venipuncture for a complete blood (cell) count (CBC) and serum biochemical panel. Abdominocentesis with an 18 G, 3.5-cm needle was performed with the llama in a standing position. Approximately 40 to 50 mL of serosanguinous fluid flowed freely from the needle and was collected. The abdominal fluid had an elevated specific gravity (1.026; normal 1.007 to 1.018), elevated total protein (0.38 g/L; normal < 0.20 g/L), numerous erythrocytes, and an elevated leukocyte count (5.75 < 109/L; normal < 5 × 109/L) (3). The differential count of the leukocytes in the abdominal fluid was 58% mononuclear cells, 41% neutrophils, and 1% bands (normal: non-degenerate neutrophils and mononuclear cells in approximately 1:1 ratio) (3). Based on these findings, the abdominal fluid was classified as modified transudate.

The CBC revealed a leukocytosis (25.4 × 109 cells/L; reference range 7.2 to 21.4 × 109 cells/L) and a neutrophilia (19.6 × 109 cells/L; reference range 4.6 to 16.3 × 109 cell/L), with an elevated band count (0.76 × 109 cells/L; reference range 0 to 0.36 × 109 cells/L) (3). Results from the serum biochemical panel showed the presence of low albumin (27 g/L; reference range 34 to 44 g/L), hyperglycemia (14.33 mmol/L; reference range 5.04 to 8.73 mmol/L), elevated gammaglutamyltransferase (GGT) (46 U/L; reference range 7 to 32 U/L), and hypokalemia (2.35 mmol/L; reference range 4.1 to 6.6 mmol/L) (3).

Based on the clinical signs and the results of the abdominal fluid and serum chemical analysis, a working diagnosis of transit abnormality of the gastrointestinal tract was established (2,4,5), and an exploratory laparotomy was recommended. The owner was given the option of taking the llama to a surgical referral facility; however, due to the driving distance of 5 h, the owner opted to allow the clinic to do an exploratory laparatomy on site.

The right paralumbar fossa was prepared for aseptic surgery and anesthetized by infiltration with 2% lidocaine in an inverted L block. With the llama in a sternal to lateral position, a 15-cm incision was made in the right paralumbar fossa. Upon entry into the abdominal cavity, a copious amount of serosanguinous fluid escaped and a large firm mass was encountered. This mass was attached dorsally to the lumbar area and medially to the root of the mesentery. Although the caudal portion of the left kidney was palpable, it was difficult to ascertain whether the mass involved only the right kidney or both kidneys. Due to the presence of the mass, it was not possible to exteriorize the small intestine and colon; however, palpation of caudoventral abdomen determined the presence of firm distended loops of intestines. A needle biopsy of the mass confirmed that it was composed of dense, firm tissue, with only small amount of blood tinged cloudy fluid being aspirated. No other adjacent masses were found and the liver felt normal on palpation. The owners were advised of the findings and they decided to have the llama euthanized because the mass could not be resected due to its close proximity to the aorta.

A postmortem examination was done by extending the abdominal incision to better visualize the abdominal organs. Although edema was present and there was distention and impaction of the spiral colon, there was no evidence of physical obstruction of the colon due to a foreign body or neoplasm. The mass was dissected free of its attachment to the aorta and the root of the mesentery and bisected, when it was discovered that it was an enlarged and encapsulated right kidney that had been infiltrated with tissue ranging from hard cartilage to material with a density similar to that of bone (Figure 1). Although the left kidney was normal in shape and texture, it had pale areas on the surface of the cortical region (Figure 1). No other abnormalities were observed on gross examination of the abdominal viscera. Sections of both kidneys were submitted for histopathologic examination.

Figure 1
Left kidney and right kidney with the teratoma within the capsule of the right kidney.

Microscopic examination of the right kidney revealed that the mass contained large numbers of proliferating cells of epithelial origin, with islands of cartilage surrounded by both loose and well-organized fibrous connective tissue. Clusters of lymphocytes around blood vessels were present in some areas throughout the mass. Based on these findings, the tumor was classified as a teratoma. The left kidney had interstitial fibrosis at the corticomedullary junction, with radially oriented areas of fibrosis extending outwards from there to the capsule. Although occasional lymphocytes were present in the areas of fibrosis, active inflammation was not a major feature of the lesions. The pathologist surmised that there might have been an earlier insult to the left kidney that led to the fibrosis. Impaction of the spiral colon may have been due to ileus, secondary to abdominal discomfort.

Of all colic cases seen at a teaching hospital, 11% were due to true obstruction of the bowel and another 2% were due to colonic impaction (6). Because the abdominal fluid was a modified transudate, septic peritonitis associated with an infection or devitalized bowel were not high on the list of possible causes of the problem. Hypoalbuminemia may have resulted from loss of protein from the damaged and altered kidneys; however, because urine was not analyzed, proteinuria could not be confirmed or excluded. Hypokalemia has been reported in cases of anorexia and gastrointestinal obstruction in camelids (4). It can also occur if there is decreased intake of potassium rich forage with ongoing renal excretion (4). Elevation of serum GGT occurs in cases of hepatobiliary disorders (3). In this case, there were no obvious lesions of the liver on gross examination, and liver specific enzymes indicative of acute hepatic damage, such as sorbitol dehydrogenase and aspartate aminotransferase, were not elevated (3). Renal disease was not considered high on the list of possible causes of the problem, because blood urea nitrogen and serum creatinine were not elevated. The history and clinical examination suggested a high probability of gastrointestinal abnormality, and colic has been a well documented concern in camelids (2,4,5).

A variety of tumors can involve the kidney, either as a site of metastasis or as a primary tumor. Although lymphoma is the most common neoplasm involving the kidneys of domestic animals, the most common primary tumors of the kidney are renal carcinoma and embryonal nephroma, also known as nephroblastoma (7).

Teratomas reported in domestic animals have been more associated with the ovary and testis; however, they have also been reported in kidneys (7,8). Clinical cases of teratomas in llama have not been reported; however, in examination of 1140 genital tracts of female one-humped dromedary camels (Camelus dromedaries), a 0.4% frequency of ovarian teratoma was reported (9). Teratomas arise from totipotential primordial germ cells of the gonads and are generally benign. They contain tissues derived from at least 2 of the 3 embryonic germ cell layers and mature into well differentiated organoid structures (8). Because the tumor in this case contained tissues from all embryonic germ cell layers, it was classified as a teratoma (7,10). The presence of gut, lymphoid tissue, sweat glands, and hair favors a diagnosis of teratoma over nephroblastoma (7).

In retrospect, transabdominal ultrasonography would have been useful in evaluating the liver, kidneys, and spleen, and an ultrasound-guided biopsy would have helped to establish a diagnosis prior to surgical intervention. CVJ

Footnotes

Dr. Patel’s current address is Department of Large Animal Clinical Sciences, Western College of Veterinary Medicine, University of Saskatchewan, 52 Campus Drive, Saskatoon, Saskatchewan S7N 5B4.

References

1. Fowler ME. Physical examination, restraint and handling. Vet Clin North Am Food Anim Pract. 1989;5:27–35. [PubMed]
2. Smith JA. Non-infectious diseases, metabolic diseases, toxicities and neoplastic diseases of South American camelids. Vet Clin North Am Food Anim Pract. 1989;5:101–143. [PubMed]
3. Franklyn G. Clinical Pathology of Llamas. Vet Clin North Am Food Anim Pract. 1989;5:55–70. [PubMed]
4. Garry F. Assessment of colic in llamas. Proc Am Coll Vet Int Med, 11th Annu Forum. Washington D.C. 1993:817–820.
5. Fowler ME. Medicine and Surgery of South American Camelids. Ames, Iowa: Iowa State Univ Pr, 1998:305–359.
6. Pearson E, Gerros T. Internal Medicine. In: Smith B. Camelid Medicine and Surgery, Contin Educ Prog Oregon State Univ 1995: 66–92.
7. Meuten DJ. Tumors in Domestic Animals, 4th ed. Ames, Iowa: Iowa State Univ Pr, 2002:509–522.
8. McGavin MD, Carlton WW, Zachary JF. Thompson’s Special Veterinary Pathology, 3rd ed. St. Louis: Mosby 2001:235–277.
9. El-Wishy AB. Genital abnormalities in camels. Etudes-et- Syntheses-ed-IIEMVT 1993;41:163–174.
10. McGavin MD, Carlton WW, Zachary JF. Thompson’s Special Veterinary Pathology, 3rd ed. St. Louis: Mosby 2001:635–652.

Articles from The Canadian Veterinary Journal are provided here courtesy of Canadian Veterinary Medical Association

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