History

A 4-year-old 54-kg mixed-breed nulliparous caprine doe presented to the Auburn University Large Animal Teaching Hospital with a 4-day history of hemorrhagic vaginal discharge and abdominal distention. The doe was housed on pasture with 1 doe sibling and no access to a buck. One day prior to presentation, the doe became lethargic and anorexic with copious hemorrhagic vaginal discharge present when posturing to urinate. A urinalysis was submitted by the referring DVM with no reported abnormalities. The doe received 500 mg of oxytetracycline, SC, and 750 mg of Vitamin B complex, SC, prior to referral. Initial physical examination indicated mild tachypnea (32 breaths/min; reference range, 12 to 24 breaths/min) and tachycardia (120 beats/min; reference range, 70 to 80 beats/min) and copious malodorous hemorrhagic vaginal discharge. Findings from the remainder of the physical examination were within normal limits, and no overt abdominal distention was appreciated. During the examination, normal urination was visualized. Body condition score was 5/5, and Faffa Malan Chart or “FAMACHA” score was 1/5. Transabdominal ultrasound (3-6MHertz macroconvex probe [Aplio i600; Canon Medical Systems Corp]) detected a 9.19 X 8.21-cm mixed-echogenic mass originating from the uterus and small amount of free abdominal fluid. Vaginal cytology revealed RBCs too numerous to count and occasional epithelial cells. A normal external cervical os was visualized with a duckbill vaginal speculum. Thoracic radiographs (2-view standing laterals) detected no evidence of metastatic disease. A CBC was within normal limits, with an elevated fibrinogen of 800 mg/dL (reference range, 0 to 200 mg/dL). Serum chemistry indicated hypoalbuminemia (2.13 g/dL; reference range, 2.9 to 4.0 g/dL), mild hypophosphatemia (3.5 mg/dL; reference range, 4.5 to 7.8 mg/dL), and hypokalemia (3.3 mmol/L; reference range, 4.2 to 6 mmol/L). Other values were within normal limits.

Diagnosis

Based on history, clinical findings, and the identification of a mass appearing to originate in the uterus, a presumptive diagnosis of neoplasia was made. Had ultrasound imaging not been available, differential diagnoses would have included endometritis, metritis, and urogenital masses.

Treatment and Outcome

Surgical exploration and ovariohysterectomy via midline laparotomy were recommended to evaluate and excise the mass. The doe was positioned in dorsal recumbency under general anesthesia. When the abdomen was entered, dark brown hemorrhagic fluid flowed freely from the incision. Numerous omental adhesions and severe fat necrosis of the omentum were obvious. Both ovaries and uterine horns were located; a large mass was identified in the uterine body and extended into the cervix. No normal cervical tissue was identifiable. Excisional biopsies of both ovaries, the uterus, and the cervix were collected (Figures 1 and 2) at the time of surgery. Due to the presence of concurrent peritonitis, the preexisting inappetence and lethargy, and poor prognosis for complete excision of the mass, the doe was humanely euthanized with 20 mL of Euthasol (390 mg of pentobarbital sodium/mL and 50 mg of phenytoin sodium/mL), IV, while under anesthesia. Necropsy confirmed no metastasis and mild chronic peritonitis.

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Postmortem dorsal (A) and ventral (B) views of the uterus from a 4-year-old 54-kg nulliparous goat that had undergone exploratory surgery due to a 4-day history of abdominal distention and hemorrhagic vaginal discharge and was euthanized intraoperatively due to a grave prognosis. The uterine horns (arrowheads) appear clinically normal; however, the uterine body (yellow bracket) is distended and firm and the external cervical os (asterick) and rest of the cervix (white brackets) have abnormal tissue evident.

Citation: Journal of the American Veterinary Medical Association 2025; 10.2460/javma.24.11.0711

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Gross (A and B) and histologic (C and D) images of the uterus in Figure 1. A—The uterine wall (white arrowheads) is markedly and circumferentially distorted by coalescing sessile to polypoid masses (green arrows). B—On cut surface, the growths (green arrows) are solid, pale tan, and closely apposed to the uterine cervix (black asterisk). C—The neoplasm (N) elevates the endometrium (E) and is partially contiguous with the adjacent myometrium (M). H&E stain; bar = 200 µm. D—The neoplastic cells (black arrows) are plump spindles with indistinct borders and organized in vague short bundles. H&E stain; bar = 50 µm.

Citation: Journal of the American Veterinary Medical Association 2025; 10.2460/javma.24.11.0711

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The reproductive tract and biopsies were evaluated by the Auburn University College of Veterinary Medicine’s Department of Pathobiology and Defense Health Agency’s Joint Pathology Center. Macroscopically, the formalin-fixed uterus near the cervix was markedly enlarged (15 cm diameter) and distorted by multiple coalescing, up to 3 X 2 X 2-cm, broad-based, irregular to polypoid smooth masses expanding the uterine wall. On the cut surface, masses were light tan and predominantly solid, with a few cysts up to 0.5 cm in diameter filled with pale yellow gelatinous material, and projected into and partially obliterated the uterine lumen. Gross lesions were confined to the endometrium and muscular layers. The mesometrial serosal surface was spared.

Histologically, the sessile to polypoid growths comprised short streams and bundles of neoplastic spindle cells in a fibromyxomatous matrix within the uterine submucosa, elevating the endometrium and compressing the tunica muscularis. Anisokaryosis was overall mild with a few areas of marked nuclear atypia and low mitotic count (1 mitotic figure in 2.37 mm²). Intermixed with the neoplastic cells were numerous hyperplastic dilated and torturous endometrial glands, occasionally forming thin papillary projections into the lumen of the uterus.

Neoplastic cells had diffuse strong immunolabeling for muscle-specific actin, smooth muscle actin, and caldesmon and were positively immunolabeled with the CD10 antibody. Collectively, the results were conclusive for a diagnosis of uterine leiomyosarcoma with atypical endometrial gland hyperplasia.

Four months following the presentation of the doe in this report, the sibling and pasture mate of the affected animal presented with vaginal discharge. The sibling doe was ultimately diagnosed via transabdominal ultrasound and exploratory laparotomy with a nonresectable uterine mass. The sibling doe was discharged to the owners’ care with palliative treatment, and no biopsy of the mass was performed. Two years later, the sibling doe was examined by the Auburn University Large Animal Teaching Hospital Ambulatory service following a 1-week duration hemorrhagic vaginal discharge and increasing lethargy. The owners declined further diagnostics, and the doe was humanely euthanized with 20 mL of Euthasol (390 mg of pentobarbital sodium/mL and 50 mg of phenytoin sodium/mL), IV, due to poor prognosis. Necropsy was declined. The occurrence of uterine masses in 2 sibling does housed together raises speculation of genetic predisposition or an environmental influence contributing to the development of uterine neoplasia in these related animals.

Discussion

Vaginal discharge is a common presenting complaint in small ruminants. Small ruminants with abnormal vaginal discharge may present systemically well or unwell with clinical signs including, but not limited to, weight loss, inappropriate mammary development, stranguria, or abdominal distention. The type of vaginal discharge present may indicate the underlying pathologic processes. In this case, neoplasia and metritis were the primary differential diagnoses for the malodorous hemorrhagic vaginal discharge. In addition to thorough physical examination, evaluation and diagnostics indicated for cases with vaginal discharge may include transabdominal ultrasound, vaginal cytology, abdominal radiographs, and CT. Transabdominal ultrasound of this doe quickly ruled out primary metritis, pseudopregnancy, and pregnancy by identifying the large mass originating from the uterus.

Uterine tumors in domestic species are described routinely. Most are isolated occurrences or identified at the abattoirs, unassociated with herd disease status. Uterine tumors in the bitch and queen account for 0.3% to 0.4% and 0.29% of all tumors.¹ In the doe, genital system tumors have accounted for 13.71% of all tumors.² Hananeh et al³ report the most common uterine tumor in small ruminants is leiomyoma, followed by adenocarcinoma and leiomyosarcoma, with only rare reports of other reproductive neoplasia. Animals diagnosed with leiomyomas have a better prognosis than those diagnosed with malignancies such as leiomyosarcomas and uterine adenocarcinoma, as the latter are malignant entities that can be invasive and metastasize over time, while the former typically remains locally confined.³

In this case, exploratory laparotomy was elected over a fine-needle aspirate due to the extent of the mass and recognition that surgical excision of benign uterine masses can be curative.³ The authors believe that veterinarians may increasingly identify uterine neoplasia as the population of pet goats increases, with a parallel increase in owner expectations. The presence of the uterine mass in this case highlights the importance of thorough evaluation of the reproductive tract in intact female animals. The early diagnosis and evaluation of this uterine mass might have impacted the case outcome, and complete removal may have been curative. Extralabel drug use was performed with owner consent and complied with provisions of AMDUCA and the Code of Federal Regulations.⁴

Disclosures

The authors have nothing to disclose. No AI-assisted technologies were used in the generation of this manuscript.

Funding

The authors have nothing to disclose.