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Endometrial hyperplasia
Introduction
- Cause: aging changes. It is believed to result from prolonged estrogenic and progesteronic stimulation, however the role of estrogen in the development of uterine adenocarcinoma from endometrial hyperplasia was not proven.
- Signs: hematuria, bloody vulval discharge, palpably enlarged uterus. Cystic mammary glands can also be seen.
- Diagnosis: radiography, ultrasonography, exploratory surgery and histopathology.
- Treatment: ovariohysterectomy.
- Prognosis: good prognosis after ovariohysterectomy if endometrial hyperplasia is present without further pathologies.
Presenting signs
- Bloody vulval discharge.
- Hematuria Urine: hematuria.
- Sometimes cystic mammary glands.
Acute presentation
- Hematuria or bloody vulval discharge.
Age predisposition
- Seen mostly in older rabbits, usually from 4 years old and above.
- Sometimes seen in rabbits <1 year of age.
Pathogenesis
Etiology
- Aging changes, with some sources describing a continuum from endometrial hyperplasia (polyps) to development of adenocarcinoma Uterine adenocarcinoma. Other sources state that there is no clear relationship with uterine adenocarcinoma, and adenocarcinomatous endometrial changes are simply a consequence of age-related atrophy of the endometrium with no association with cystic endometrial hyperplasia. The role of estrogen in the development of uterine adenocarcinoma from endometrial hyperplasia is controversial.
- In one publication, endometrial hyperplasia has been reported to be the second most common uterine pathology seen on post-mortem examination. Glandular-cystic changes were seen in most cases. Endometrial hyperplasia was found more often in slightly younger animals with the incidence increasing with age.
- In brown hares in Australia, endometrial hyperplasia and other uterine changes were observed in older hares exposed to estrogens in certain food crops.
Predisposing factors
General
- Entire female rabbits.
- Most frequently seen in rabbits 4 years or older.
Pathophysiology
- Characterized by thickening of the endometrium, cystic development of mucus-filled glands and accumulation of mucus in the lumen of the uterus (rare).
Diagnosis
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Treatment
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Prevention
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Outcomes
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Further Reading
Publications
Refereed papers
- Recent references from PubMed and VetMedResource.
- Bertram C A, Müller K & Klopfleisch R (2018) Genital Tract Pathology in Female Pet Rabbits (Oryctolagus cuniculus): a Retrospective Study of 854 Necropsy Examinations and 152 Biopsy Samples. J Comp Pathol 164, 17-26 PubMed.
- Harcourt-Brown F M (2017) Disorders of the reproductive tract of rabbits. Vet Clin North Am Exot Anim Pract 20 (2), 555-587 PubMed.
- Vinci A, Bacci B, Benazzi C et al (2010) Progesterone receptor expression and proliferative activity in uterine tumours of pet rabbits. J Comp Pathol 142 (4), 323-327 PubMed.
- Walter B, Poth T, Böhmer E et al (2010) Uterine disorders in 59 rabbits. Vet Rec 166 (8), 230-233 PubMed.
- Asakawa M G, Goldschmidt M H, Une Y et al (2008) The immunohistochemical evaluation of estrogen receptor-α and progesterone receptors of normal, hyperplastic, and neoplastic endometrium in 88 pet rabbits. Vet Pathol 45 (2), 217-225 PubMed.
- Scott P & Wight N (2004) Female reproductive tract abnormalities in European hares (Lepus europeaus) in Australia. J Wildl Dis 40 (4), 696-703 PubMed.
- Saito K, Nakanishi M & Hasegawa A (2002) Uterine disorders diagnosed by ventrotomy in 47 rabbits. J Vet Med Sci 64 (6), 495-497 PubMed.
- Paul-Murphy J & Ramer J C (1998) Urgent care of the pet rabbit. Vet Clin North Am Exotic Anim Pract 1 (1), 127-152 PubMed.
- Garibaldi B A, Fox J G, Otto G et al (1987) Hematuria in rabbits. Lab Anim Sci 37 (6), 769-772 PubMed.
- Elsinghorst T A, Timmermans H J & Hendrix H G (1984) Comparative pathology of endometrial carcinoma. Vet Q 6 (4), 200-208 PubMed.
- Baba M & von Haam E (1972) Animal models: spontaneous adenocarcinoma in aged rabbits. Am J Pathol 68 (3), 653-656 PubMed.
Other sources of information
- Bourne D (online) Endometrial Hyperplasia / Uterine Polyps in Lagomorphs. Website: http://wildpro.twycrosszoo.org. Last accessed 20th March 2019.
- Mancinelli E & Lord B (2014) Urogenital System and Reproductive Disease. In: BSAVA Manual of Rabbit Medicine. Eds: Meredith A & Lord B. BSAVA, UK. pp 191-204.
- Varga M (2013) Uterine Disorders. In: Clinical Veterinary Advisor: Birds and Exotic Pets. Eds: Mayer J & Donnelly T M. Elsevier, USA. pp 424-426.
- Ewringmann A (2005) Ed. Vaginalausfluss. In: Leitsymptome beim Kaninchen. Enke Verlag, Germany. pp 125-136.
- Kraus A L, Weisbroth S H, Flatt R E et al (1984) Biology and Diseases of Rabbits. In: Laboratory Animal Medicine. Eds: Fox J G et al. Academic Press, USA. pp 207-240.