Contrast-Enhanced Ultrasound in Cystic Endometrial Hyperplasia-Pyometra Complex in the Bitch: A Preliminary Study.

Marco Quartuccio,Santo Cristarella,Tiziana D’Arrigo,Giovanni Lanteri,Antonio Ieni,Luigi Liotta,Massimo De Majo

doi:10.3390/ani10081368

Abstract

Simple SummaryIn canine cystic endometrial hyperplasia–pyometra (CEH) syndrome, toxic factors and endometrial inflammatory reactions are responsible of increased blood flow and lower vascular resistance in uterine arteries. Color Doppler ultrasound is regarded as an adjunctive tool for quantitative assessment of endometrial vascularization during uterine disorders. The aim of this study was to assess, through contrast-enhanced ultrasound (CEUS) exam, the vascularization in endometrial microvessels in CEH-pyometra in order to evaluate the possibility of application in this syndrome. In twelve female dogs with clinical symptoms related to pyometra, echographic, Color Doppler and CEUS exams were performed. Histopathological examination revealed severe CEH and pyometra, immunohistochemical stain with CD 34 confirmed the presence of angiogenesis. CEUS exam revealed a widespread, intense and rapidly developing homogeneous enhancement of the hyperplastic endometrium with absence of signal only in cystic areas. All parameters of the quantitative analysis were not significantly influenced by region of interest dimension and position. CEUS may improve not invasive evaluations in the CEH-pyometra syndrome and virtually in CEH-mucometra.In cystic endometrial hyperplasia (CEH)–pyometra syndrome, toxic factors and endometrial remodeling culminate in changes characterized by exudative and degenerative inflammatory reaction. Recent studies on hemodynamic found an increased blood flow and lower vascular resistance in uterine arteries, suggesting color Doppler ultrasound as an adjunctive tool for quantitative assessment of endometrial vascularization during pyometra. The aim of this study was to assess, through contrast-enhanced ultrasound (CEUS) exam, the vascularization in endometrial microvessels in CEH-pyometra in order to evaluate the possibility of application in this syndrome. In twelve female dogs with clinical symptoms related to pyometra, B-mode, color Doppler and CEUS exams were performed. In CEH-pyometra uteri, histopathological examination revealed severe CEH and pyometra, immunohistochemical stain with CD 34 confirmed the presence of angiogenesis. CEUS exams revealed a widespread, intense and rapidly developing homogeneous enhancement of the hyperplastic endometrium, with absence of signal only in cystic areas. All parameters of the quantitative analysis were not significantly influenced by region of interest dimension and position. CEUS has the potential to improve clinical not invasive evaluations in the CEH-pyometra syndrome and virtually in CEH-mucometra.

Highlights

Cystic endometrial hyperplasia (CEH)–pyometra syndrome is a severe and frequent diestral disorder of intact bitches [1,2], its pathogenesis and differential diagnosis are a challenge to studies aimed at reproductive disorders
Some authors hypothesize that differential diagnosis element between pyometra and diestrus or CEH-mucometra in bitches is marked by the simultaneous expression of inflammatory mediators and endometrium proliferative pattern [4,5,6,7]
Angiogenesis is activated by VEGF, an angiogenic mediator in many cell types mainly related to cytokines such as interleukin-1-alpha and interleukin-6 [8,9]

Summary

Introduction

Cystic endometrial hyperplasia (CEH)–pyometra syndrome is a severe and frequent diestral disorder of intact bitches [1,2], its pathogenesis and differential diagnosis are a challenge to studies aimed at reproductive disorders. Some authors hypothesize that differential diagnosis element between pyometra and diestrus or CEH-mucometra in bitches is marked by the simultaneous expression of inflammatory mediators and endometrium proliferative pattern [4,5,6,7]. Angiogenesis is activated by VEGF (vascular endothelial growth factor), an angiogenic mediator in many cell types mainly related to cytokines such as interleukin-1-alpha and interleukin-6 [8,9]. The activation of FLT-1 and KDR receptors by VEGF culminates in cell migration to the target tissue [11] VEGF acts through its FLT-1 and KDR receptors, which directly participate in the regulation of angiogenesis and induce cell differentiation and transport in the uterine lumen and glandular epithelium [10].

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