Monday, March 21, 2011

A Soapbox in Answer to a Question

So I'm using the excuse of answering the question posed about my strange case to jump on a soapbox of mine:)

Yes, it was definitely cancer although I couldn't actually send out anything for histopath (no money from the client and I am currently a poor part-time vet who has a lot of debt so I can't afford to send out for my own curiosity.) Most probably, it started with the retained testicle then spread to the urinary system via the lymph nodes and possibly to other organs that appeared grossly normal but may have had microscopic changes.


Retained testicles are dramatically more likely to develop cancer than normal testicles that are in the scrotum. We don't completely understand why but part of the theory revolves around temperature since testicles should be at a lower temperature than the core body temperature, hence being outside the abdomen in the scrotal sac. Neutering completely eliminates the possibility of testicular cancer in normal pets and especially in cryptorchid pets.

There are several types of tumors that affect testicles. In this dog's case, I didn't take time to mention the other clinical signs with the point of my story being that the big picture can be misleading. He also had bilateral hair loss, evidence of feminization (i.e. large nipples, small prepuce), and the retained testicle. The tumors that cause feminization release estrogen creating these effects and also affecting the bone marrow resulting in severe anemia and panleukopenia (both also exhibited by this patient.) The bone marrow effects are yet another potential avenue for spread. The other possibility is that he had two separate tumors - one of the testicle affecting the bone marrow and the other affecting the urinary system. This would not be abnormal, especially with my history as I have actually in the past had a dog with 3 separate tumors detected on necropsy.

The saddest part of this tale is that had he been neutered as I am sure was recommended, it would have been avoided. The other sad part is that most testicular tumors have good outcomes if treated early, prior to spread but, like all too many of my patients, he did not present until he was literally on death's doorstep.

Now that I've screamed from my soapbox, I'll address the other part of the question. You are correct, if an animal becomes obstructed, it leads to death. Typically this is because of the severe electrolyte imbalances caused by obstruction in combination with kidney failure. Potassium cannot be excreted and as it rises causes the heart rate to slow then arrest (most common cause of death). In this case, I presume that it had not happened yet because he was only partially obstructed. When I expressed his bladder, I could create a thin stream of urine but not a normal stream. The urinary catheter would not pass from outside but after opening the bladder, I could pass it from inside and pushed out blood clots. Eventually, it would likely have resulted in bladder rupture or complete obstruction if his other disease(s) failed to kill him first. And lastly, often they really surprise us at how much they can go through and still be alive. Anyone who thinks medicine is an exact science is insane!


Anonymous said...

Of course any dog with an undescended testicle should be neutered, no question.
But if you look up the most current research, contrary to what was previously believed, on balance neutering does not provide a health benefit, actually more the opposite.
Not the same for spaying, particularly because of the pyo risk, there are more health benefits.
Check out the Swedish data - neutering and spaying is illegal there, so they have plenty of data. Someone also did a bit of a meta analysis of the studies.

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