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updated 7:16 PM UTC, Aug 29, 2018

Hamartom la o leoaica - studiu de caz

Formatiune pseudotumorala constituita din aceleasi componente tisulare, ca si organul la nivelul caruia se dezvolta, dar se deosebeste prin structura, aranjamentul si gradul de diferentiere anormal al tesuturilor. Se distinge hamartom histioid, in care predomina un tesut similar cu organul unde se formeaza si hamartom organoid, care contine elemente ale diferitelor tesuturi.

Exemple de hamartom: hemangiomul cavernos hepatic sau cutanat, nevii pigmentari etc. Din hamartom se poate dezvolta tumoarea maligna - hamartoblastomul (rabdomioblastomul, nefroblastomul, hepatoblastomul). Formatiunea a fost observata in urma cu doi ani, dar in ultimele luni a crescut foarte rapid in dimensiuni, generand un disconfort vizibil pentru animal, care se deplasa mai greu, se ranea frecvent in zona abdominala. De asemenea, exista riscul abcedarii formatiunii respective si suprainfectarea plagii create, cu bacterii patogene.

In luna ianuarie 2013 s-a luat in discutie posibilitatea interventiei chirurgicale, analizandu-se in mod obiectiv atat motivele favorabile intereventiei, cat si factorii de risc care nu ar fi recomandat o astfel de interventie.

Motivele favorabile interventiei au fost:

1. in situatia in care se afla animalul respectiv, nu mai putea fi expus publicului, deoarece ar fi avut un impact emotional negativ atat pentru publicul adult, dar si pentru copii.

2. Riscul suprainfectarii cauzat de ranirile frecvente, formatiunea fiind foarte voluminoasa.

3. Riscul metastazarii cauzat de traumatismele frecvente la acest nivel.

4. Disconfortul vizibil pentru animal.

5. O sansa, chiar daca mica din punct de vedere statistic pentru astfel de formatiuni la feline, ca tumora sa fie bengina, si lasata neoperata sa malignizeze in cele din urma.

Factorii de risc care nu recomandau o interventie chirurgicala:

1. Varsta inaintata, femela avand 12 ani.

2. Posibilitatea ca formatiunea sa fie maligna, iar interventia ar fi grabit procesul metastazarii.

3. Riscul anestezic legat de varsta animalului si eventualele patologii de organ care nu erau diagnosticate clinic.

4. Dificultatile legate de ingrijirile postoperatorii, avand in vedere ca este vorba de un animal salbatic, orice complicatie aparuta postoperator necesitand anestezie generala.

Pregatiri pentru interventie: aducerea instrumentarului in sala de operatie (Figurile 2, 3),

fig2

fig3

deplasarea spre locul de cazare al leoaicei in vederea tranchilizarii acesteia, tranchilizarea animalului (Figura 7),

fig7

transportul animalului de la locul de cazare spre sala de operatie, pregatirea locului de electie pentru fixarea branulei, fixarea branulei, conectarea la perfuzii pentru mentinerea anesteziei, conectarea la monitor , fixarea pe masa de interventie, pregatirea campului operator prin tunderea parului, dezinfectia cu alcool, tinctura de iod si betatina (Figura 16).

fig16

S-au recoltat probe de sange pentru efectuarea examenului biochimic anteoperator, iar rezultatele au fost corespunzatoare, permitand interventie cu riscuri minime. Analizele au fost efectuate la locul interventiei de catre doamna dr. Viorica Caliga si doamna dr. Corina Ignat.

Tehnica operatorie Incizia pielii in felie de pepene in jurul formatiunii (Figura 18, 19),

fig18

fig19

dilacerararea formatiunii cu atentie pentru a evita sectionarea vaselor mari, vasele mari sunt izolate si se ligatureaza (Figura 20),

fig20

dupa realizarea stazei s-a continuat dilacerarea din aproape in aproape , pana la izolarea formatiunii tumorale de tesutul sanatos (Figurile 21, 23, 24)

fig21

fig23

fig24

Pe parcursul interventiei au fost monitorizate permanent functiile vitale, de catre doamna doctor Manuela Pascal ajutata de studentele de la Facultatea de Medicina Veterinara Bucuresti .

Sutura pielii in puncte separate (Figurile 27, 29),

fig27

fig29

deconectarea animalului de la perfuzii si monitor, si pregatirea pentru transportul la locul de cazare, recoltarea de probe pentru examenul histologic, transportul la locul de cazare . Postoperator au fost administrate antiotice in apa de baut timp de 7 zile. La o luna de la interventie animalul prezenta o stare clinica foarte buna (Figura 33).

fig 33

Histologic Sectiune partial acoperita de epiderm alcatuita din tesut mezenchimal reprezentat de straturi dense de fibre de colagen, multifocal discret desprinse de un spatiu optic gol (edem). Alaturi de fibrele dense de colagen sunt prezente vase limfatice si fibroblaste tipice. Nu sunt prezente atipii celulare, nici metastaze in vasele limfatice si sangvine adiacente. Discret, la marginea sectiunii, sunt prezente numeroase capilare ectaziate si o usoara hemoragie care infiltreaza tesutul colagenic (hemoragie acuta corelata cu interventia chirurgicala). Aspectul histologic este caracteristic pentru hamartom fibroadenomatos. Acest proces tumoral se incadreaza in categoria tumorilorbenigne, avand prognostic favorabil, fara recidiva locala.

 Autori

Prof Alexandru Diaconescu

Medic veterinar Dan Gisca

Medic veterinar Manuela Pascal

Medic veterinar Teodoru Soare

Ultima modificareSâmbătă, 04 August 2018 20:04
Prof Dr Alexandru Diaconescu

Conf. Dr. Alexandru Diaconescu - Profesor Universitar FMV Bucuresti

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