pISSN 1598-298X / eISSN 2384-0749

J Vet Clin 35(5) : 222-225 (2018)

http://dx.doi.org/10.17555/jvc.2018.10.35.5.222

Endometrial Polyps with Open-Cervix Pyometra in a Cat

Sang-Ho Lee†, Chul-Ho Park†* and Chang-Ho Son1
College of Veterinary Medicine, Chonnam National University, Gwangju 61186, Republic of Korea
*Chonnam National University Veterinary Teaching Hospital, Gwangju 61186, Republic of Korea

(Received: August 20, 2018 / Accepted: September 14, 2018)

Abstract : The current study describes a case of endometrial polyps accompanied by an open-cervix pyometra in a
15-year-old female Chinchilla Persian cat. The cat was presented with a history of a large mass in the endometrium
and purulent discharge from the vulva. Ovariohysterectomy was performed and pedunculated polypoid mass on the
endometrium was seen protruded into the uterine cavity. Histologically, the mass was composed of multiple cystically
dilated glands surrounded by fibrous stroma. Based on gross and histologic findings, the diagnosis for this case was
concluded.
Key words : Endometrial polyp, Pyometra, Feline.

Introduction for several days.

Occurrence of endometrial polyps are rarely observed in
cats (18). Currently, only five reported cases of endometrial
polyps in cats are found in the literature (1,7,15,16,18).
Endometrial polyps are generally one of the several benign
growths consisting of a focal proliferation of both glandular
and stromal elements in the endometrium (18). Occasionally,
these larger polyps become well-developed that it occupies
the entire uterine lumen and be easily confused with tumors
of the uterus (18).
Pyometra is a uterine infection that is commonly observed
in bitches and queens (6). It is characterized by cystic
endometrial hyperplasia, caused by the effect of sex hor-
mones on the endometrium (6). Un-spayed female dogs are
more commonly susceptible to have cystic endometrial hyper-
plasia-pyometra than cats, since ovulation in cat is induced
by coitus and the uterus is less exposed with sex hormones,
thus have lower risk for the disease (12,14).
This paper reports a case of endometrial polyps with open-
cervix pyometra in a cat.
Haematological examination revealed moderate leukocyto-
sis [white blood cell (WBC) 22.19 K/µL, normal range 2.87-
17.02 K/µL], moderate neutrophilia [neutrophil (NEU) 15.48
K/µL, normal range 1.48-10.29 K/µL]. Serum biochemistry
examination showed a slight elevation in the levels of blood
urea nitrogen (BUN 55 mg/dL, normal range 16-36 mg/dL),
and creatinine (CREA 2.8 mg/dL, normal range 0.8-2.4 mg/
dL). Abdominal ultrasonography examination revealed a
mild-to-moderate cystic endometrial hyperplasia with anechoic
or hypoechoic fluid, and a multicystic pedunculated poly-
poid mass, measuring about 3 cm × 2 cm in diameter in the
left uterine horn cavity (Fig 1).

Case
A 15-year-old, 3.1 kg, Chinchilla Persian cat was referred
to the Veterinary Teaching Hospital of Chonnam National
University, due to presence of mass in endometrium with
hypoechoic fluid accumulation in lumen observed through
ultrasonography. The cat showed clinical signs seen in an
open-cervix pyometra consisting of grayish purulent vaginal
discharge, anorexia, depression, polydipsia/polyuria, vomit-
ing and arrhythmia. Antibiotic treatment was administered

Fig 1. Ultrasonographic images of a mild-to-moderate cystic

†
These authors contribute equally to this work endometrial hyperplasia with anechoic or hypoechoic fluid, and
1 a multicystic pedunculated polypoid endometrial mass, measur-
Corresponding author.
E-mail : chson@jnu.ac.kr ing approximately 3 cm × 2 cm in diameter.

222
 Endometrial Polyps with Open-Cervix Pyometra in a Cat 223

Fig 2. (a) Gross appearance of the excised polyp from the left
uterine horn. A pedunculated polypoid mass protruded into the
uterine cavity. The mass was round, edematous, and had mul-
tiple cyst formations on the cut surface. The scale on the mea-
sure is 1 mm. (b) Polypoid mass was projected into uterine
lumen and had several, large cystic formations (*) derived from
endometrial gland. H&E. Bar size = 4 mm.
An ovariohysterectomy (OHE) was performed with the
owner’s consent. A median ventral laparotomy revealed the
presence of distended uterus. Grossly, the uterine wall
appeared thinned and the uterine lumen showed a remark-
able amount of grayish purulent exudate. The mass was
round, edematous, and had several, large cystic formation
derived from endometrial gland (Fig 2a) The resected polyp
from the left uterine horn showed a pedunculated polypoid
mass measuring about 3 cm × 2 cm in diameter that pro-
truded into the uterine cavity. The ovaries, uterus, and
endometrial mass were excised in a routine manner and were
submitted for histopathological examination. Microscopi-
cally, polypoid mass was projected into uterine lumen and
had several, large cystic formations derived from endome-
trial gland (Fig 2b). After surgery, the queen was treated with
antibiotic and antiphlogistic for 7days after surgery. Sutures
were removed after 10 days and was in process of good
recovery.
Microscopically, the mass was composed mainly of hyper-
plastic endometrial glands embedded into stroma composed
of spindle shaped cells with variable amounts of collagen
fiber (Fig 3a). The lining of the glands was composed of sim-
ple cuboidal to columnar epithelium, but some of these were
Fig 4. In the stroma, there was a moderate to severe prolifera-
tion of connective tissue with admixed small blood vessels and
occasional compactly arranged spindle shaped cells surrounding
the thick-walled blood vessels (perivasucular whorled arrange-
ment). H&E.
flattened by pressure from the fluid within the cysts (Fig 3b).
In the stroma, there was a moderate to severe proliferation of
connective tissue with admixed small blood vessels and
occasional compactly arranged spindle shaped cells surround-
ing the thick-walled blood vessels (perivasucular whorled
arrangement) (Fig 4). Based on the gross and histopathologi-
cal findings, a final diagnosis of multiple endometrial polyps
was made. Follow up treatment was carried out four weeks
after the surgery and no clinical complication was present.
Discussion
There are few reported cases of endometrial polyps in dogs
and cats (16). Also, the exact prevalence and prognosis of
endometrial polyps are unknown (7,16). In the veterinary lit-
erature, pedunclated proliferative mass protruding into the
uterine lumen in cats and dogs have been described as
endometrial polyps, hyperplastic endometrial polyps or
endometrial stromal polyps (16). The histopathology charac-
teristics between endometrial polyps and polypoid form of
cystic endometrial hyperplasia are different in domestic ani-

Fig 3. (a) The lesion composed of various number of endometrial glands embedded into a stroma of spindle shaped cells with variable
amounts of collagen fiber. Endometrial glands were of various sizes and shapes, some of which were hyperplastic. H&E. Bar
size = 200 µm. (b) The lining of the glands was composed of a simple cuboidal to columnar epithelium. H&E. Bar size = 50 µm.
224 Sang-Ho Lee, Chul-Ho Park and Chang-Ho Son
mals, but somewhat overlapping (16). The exact differences
between true endometrial polyps and polypoid endometrial
hyperplasia relies on the presence of pedunculated mass and
a vascular connective tissue stalk or contain a substantial
connective stroma in addition to glands in case of the former
(13). Therefore, the present case was diagnosed as endome-
trial polyps due to this detailed definition.
Based on histopathology and morphological evidence, it
was suggested that endometrial polyps arise from focal areas
of endometrial hyperplasia (18). Authors reported that most
of the animals with endometrial polyps had endometrial
hyperplasia in adjacent areas of the uterus (7,20). Some of
studies showed that endometrial hyperplasia are predisposed
to endometrial polyp formation in different species of ani-
mals and confirms the association of endometrial polyps with
advanced age (7,18,20). In women, it has been suggested that
the estrogen-α receptors play a critical role in the pathophys-
iology of endometrial polyps and that endometrial polyps
arise from localized overexpression of estrogen-α receptor
(19,24). Some authors reported that more and more estrogen-
α receptors activation lead to the development of endome-
trial hyperplasia in cats (17). Connection between the
endometrial polyps and endometrial hyperplasia has been
reported previously (3,20).
Cystic endometrial hyperplasia is an important general
lesion that can lead to pyometra (5,21). It has generally been
presumed that the pathogenesis of the cystic endometrial
hyperplasia/pyometra syndrome requires the progression of
events starting with development of endometrial hyperplasia,
with or without cyst formation, which stimulates a local
inflammatory reaction (23). Consequently, the hyperplastic
endometrium causes secretions to accumulate, followed by
the establishment of a bacterial infection (23). Therefore,
infection within the endometrial and uterine lumen would
result in accumulation of exudate in the uterine lumen (pyo-
metra) (23). The incidence of pyometra in cats is observed
less commonly than in dogs (9). Almost 20% of female
intact dogs experienced pyometra by 10 years of age (11).
Whereas, 2.2% of cats in overall breed experienced the dis-
ease by 13 years of age, although this proportion varies from
0.9% in mixed breed cats to the Norwegian forest cat with
14.1%. In Persian breeds like the case presented, 3.4% of
cats was diagnosed the pyometra before 13 years of age (9).
The fatality rate in all cats for pyometra was 5.7%, which is
slightly higher than equivalent reports in dogs of 3% to 4%
(9). The reason for the higher fatality rate in cats is unclear,
but some of hypothesis has been considered that this species
is less sensitive to endotoxin, or not as prone to show clini-
cal signs unless they develop sepsis (4,25).
In clinical pathology, specific renal abnormalities have
been described in pyometra, including the decreased ability
of the renal tubules to concentrate urine as a result of the
effects of endotoxin, which accounts for both the decreased
specific gravity and the clinical signs of polyuria and poly-
dipsia. Moreover, abnormalities in serum chemistry include
azotemia (2,10). Authors reported that neutrophils are capa-
ble of releasing their DNA in response to infectious agents to
form neutrophil extracellular traps (NETs) to destroy patho-
gens (22). Also, NETs elements have been related to the
development of a number of diseases. Anti-neutrophil cyto-
plasmic antibodies associated with NETs promote a general-
ized vessel inflammation that may lead to glomerulonephritis
(8). So, NETs persistence might contribute to renal dysfunc-
tion (22). As mentioned previously, the cat in this case study
showed mild azotemia and may be due to the impaired func-
tion of the kidney.
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