RETROSPECTIVE STUDIES

Radiographic and Ultrasonographic Findings

of Uterine Neoplasms in Nine Dogs
Michail Patsikas, PhD, DVM, MD, DECVDI, Lysimachos G. Papazoglou, PhD, DVM, MRCVS,
Samuel Jakovljevic, DVM, DVR, DECVDI, MRCVS, Nikolaos G. Papaioannou, PhD, DVM, Paraskevi L. Papadopoulou,
PhD, DVM, Christina B. Soultani, DVM, Ioannis A. Chryssogonidis, PhD, MD, Konstantinos A. Kouskouras, PhD, MD,
Nikolaos E. Tziris, PhD, MD, Afroditi A. Charitanti, PhD, MD

ABSTRACT
The records of nine female intact dogs with histologically confirmed uterine tumors were reviewed retrospectively, and the
related radiographic and ultrasonographic signs of the lesions detected were recorded. Radiography revealed a soft-tissue
opacity between the urinary bladder and colon in six of seven dogs with uterine body and/or cervical tumors, and a soft-
tissue opacity in the midventral abdomen in two dogs with uterine horn tumors. Ultrasonography revealed masses in all dogs
with uterine body/cervical tumors and could delineate the origin of the mass in one of two dogs with uterine horn tumors. The
mass was characterized ultrasonographically as solid in three dogs (all leiomyomas), solid with cystic component in four dogs
(two adenocarcinomas, one leiomyoma, and one fibroleiomyoma), and cystic in two (both leiomyomas). Hyperechoic foci in the
mass were observed in three dogs. Ultrasonography was a useful method for demonstrating uterine body and/or cervical
tumors. However, it was not possible to ascertain sonographically that a mass originated in a uterine horn unless there
was associated evidence of uterine horn to which the mass could be traced. The ultrasonographic appearance of uterine
tumors was variable, and the type of neoplasm could only be determined by taking biopsies of the mass. (J Am Anim Hosp
Assoc 2014; 50:330–337. DOI 10.5326/JAAHA-MS-6130)

Introduction excised specimens.3 To the authors’ knowledge, no studies have been

Tumors of the uterus, including horn, body and cervix, are relatively
rare in dogs and comprise 0.3 to 0.4% of all canine tumors.
Mesenchymal, tumors constitute the vast majority of cases of uterine
tumors, leiomyomas representing 85 to 90% and leiomyosarcomas
representing 10% of all tumors.3 Uterine adenomas, adenocarcino-
mas, fibromas, and lipomas have been reported occasionally.
published describing the ultrasonographic characteristics of uterine
1,2
tumors in dogs. The purposes of the current study were to describe
the radiographic and ultrasonographic signs observed with uterine
tumors in nine dogs and to evaluate the usefulness of ultrasonog-
raphy in determining the origin of the masses.
1,4

Uterine tumors are rarely associated with clinical signs and consis-
tent laboratory abnormalities have not been reported. Abdominal
radiographs may confirm the presence of a soft-tissue mass in the
caudal aspect of the abdomen and ultrasonography may help deter-
mine the origin of the mass. A definitive diagnosis of uterine tumor
is usually obtained by histopathological examination of surgically
From the School of Veterinary Medicine (M.P., L.P., N.P., P.P., C.S.) and
School of Medicine (I.C., K.K., N.T., A.C.), Aristotle University of
Thessaloniki, Thessaloniki, Greece; and Dick White Referrals Ltd.,
New Market, UK (S.J.).
Correspondence: patsikm@vet.auth.gr (M.P.)
Materials and Methods
Nine female intact dogs with histologically confirmed uterine
tumors that presented to the School of Veterinary Medicine,
Aristotle University of Thessaloniki, Greece, between October 1996
and August 2011 were identified from the medical records and
included in the current study. Patient signalment (age and breed),
clinical history, physical examination, radiographic and ultraso-
nographic findings, and histopathological results were reviewed for
each dog.
Abdominal radiographs in right lateral recumbency and
thoracic radiographs in right lateral and sternal recumbency were
obtained in all dogs. Radiographic reports were reviewed for the

330 JAAHA | 50:5 Sep/Oct 2014 ª 2014 by American Animal Hospital Association

location, size, opacity, and margination of the lesions detected.
Ultrasonographic examination of the entire abdomen was recorded
on videotape and performed using either a 7.5 MHz mechanical
sector transducera or an 8 MHz electronic microconvex trans-
b
ducer . Ultrasonographic reports were reviewed for the location,
size margination, and echogenicity of the lesions seen and for
evidence of uterine and other abdominal visceral abnormalities.
The masses observed were classified, according to their ultraso-
nographic pattern, either as a solid lesion, a solid lesion with cystic
component, or a cystic lesion, based on the percentage of well-
defined anechoic cavities in relation to the amount of solid pa-
renchyma. The cystic nature of the anechoic cavities was ascertained
by lack of signal with spectral and color Doppler ultrasonography.
Solid lesions had ,10% anechoic cavities, solid lesions with cystic
component had from 10 to 50% of anechoic cavities, and cystic
lesions had .50% anechoic cavities.5 Histopathological diagnosis
was obtained following surgical ovariohysterectomy in eight dogs
and necropsy in one dog. Tissues were fixed in formalin and rou-
tinely sectioned and stained with hematoxylin and eosin.
Results
The signalment, clinical, radiographic, ultrasonographic, surgical,
gross pathologic, and histopathological findings are reported in
Table 1. Four were mixed-breed dogs, whereas only a single dog
for each of the remaining breeds was seen. The mean age of the
dogs was 10.1 yr (range, 8–14 yr).
The clinical signs at the time of presentation included palpable
abdominal mass in nine dogs, vulvovaginal discharge in three dogs,
constipation in four dogs, anorexia in two dogs, stranguria in four
dogs, respiratory distress in one dog, and mammary gland tumor
in one dog. Laboratory results revealed no abnormalities, except for
leucocytosis and neutrophilia in two dogs.
Abdominal radiographic findings included a soft-tissue opacity
between the urinary bladder and colon in six dogs (cases 2, 4, 5, 6, 8,
and 9). In those six dogs, the outer margin of the lesion was well
defined in three (cases 2, 4, and 5) and ill defined in the other three
(cases 6, 8, and 9). The size of the lesion in the six dogs varied from 4
to 12 cm in diameter (Figure 1). In two of the remaining three dogs,
an ill-defined, soft-tissue tubular structure associated with reduced
serosal detail was found in one dog (cases 3) and an ill-defined,
mineralized soft-tissue opacity in another dog (case 7), both in the
midventral part of the abdomen (Figure 2). In the last of the
remaining three dogs (case 1), no abnormality was detected, except
for mild dorsal displacement of the descending colon. Cranial dis-
placement of the urinary bladder in four dogs (cases 2, 4, 5, and 9),
dorsal displacement of the descending colon in seven (cases 1, 2, 4,
5, 6, 8, and 9) and mild uterine enlargement in one (case 7) were
Imaging Findings of Uterine Neoplasms in Dogs
also noted. The thorax was radiographically normal in eight dogs,
and there was evidence of miliary pulmonary pattern, compatible
with pulmonary metastatic disease in one dog (case 7).
Ultrasonographically, a mass at either the dorsal aspect of the
abdominal urethra (cases 2, 4, 5, and 9) or urinary bladder (cases 1,
6, and 8) was observed in seven dogs in which a tentative diagnosis
of uterine body/cervical mass was made (Figures 3, 4). In all seven
dogs, a uterine body/cervical mass was confirmed at surgery. In
the remaining two dogs (cases 3 and 7) an ill-defined mass in the
midabdomen was detected. The origin of the mass was deter-
mined to be the uterine horn in one dog (case 3), whereas a mass
in the uterine horn was included in the differential diagnosis of
the other (case 7) as shown in Figure 5. In the latter two dogs, the
uterine horn masses were confirmed either at surgery or post-
mortem examination. Ultrasonographically, the size of the masses
varied from 3 to 12 cm in diameter. The masses were character-
ized as solid in three dogs (cases 5, 7, and 9) as shown in Figure 3,
solid with cystic component in four dogs (cases 1, 4, 6, and 8),
and cystic in two (cases 2 and 3) as shown in Figures 4 and 5.
Diffuse hyperechoic foci within the masses were observed in three
dogs (cases 2, 4, and 7), casting a clean shadow in one (case 7) as
shown in Figure 4. There was ultrasonographic evidence of fluid
accumulation in the uterus of two dogs (cases 3 and 8), thickened
uterine wall (20 mm uterine diameter) with anechoic lesions
embedded in the wall that was compatible with cystic hyperplasia
in one (case 7), and small cysts in both ovaries in one (case 3). No
evidence of abdominal metastatic disease or other abnormality of
the abdominal viscera was noted.
A uterine body/cervical mass and a uterine horn mass were
confirmed after either exploratory surgery or necropsy in seven
dogs and two dogs (cases 3 and 7), respectively. In three cases (cases
5, 7, and 9), in which the histopathological diagnosis was uterine
leiomyoma (including case 7 that had also dystrophic minerali-
zation and osseous metaplasia), gross pathologic examination of
the tumor revealed a homogeneous firm cut surface). In case 7,
necropsy was performed after the owner declined further treat-
ment due to radiographic evidence of pulmonary metastatic dis-
ease from a mammary adenocarcinoma. In the remaining six dogs,
the tumor had a heterogeneous cut surface with either hemor-
rhagic foci or mucin and blood filled cavities. In those six cases,
histopathological diagnosis was uterine leiomyoma in three dogs
(cases 2, 3, and 6), uterine adenocarcinoma in two (cases 1 and 8),
and uterine fibroleiomyoma in one (case 4).
Discussion
A small number of dogs with uterine tumors were observed over
a period of 15 yr. The incidence, breed, and age of the dogs in this
JAAHA.ORG 331
332
TABLE 1

JAAHA |
Summary of Signalment, Clinical Signs, Radiographic, Ultrasonographic, Surgical, Gross Pathological, and Histopathological Findings in Nine Dogs with Uterine Neoplasms

Ultrasonographic Findings

Survey Surgical and Gross

Clinical Radiographic Other Abdominal Pathologic Findings Histopathological
Case Signalment Signs Findings Uterus Viscera and Therapy Findings
1 11 yr old Vulvovaginal discharge, Mild dorsal displacement 4 cm 3 5 cm well-demarcated, Normal Uterine body/cervical mass; Adenocarcinoma
mixed-breed dog palpable abdominal of descending colon solid mass with cystic firm, heterogeneous cut

50:5 Sep/Oct 2014

mass
2 8 yr old German Stranguria, constipation, 8 cm 3 9 cm well-defined,
shepherd dog palpable abdominal soft-tissue opacity between
mass the urinary bladder and
colon; cranial displacement
of the bladder; dorsal
displacement of the
descending colon
3 10 yr old Vulvovaginal discharge, Reduced serosal detail;
mixed-breed dog palpable abdominal ill-defined, tubular, soft-tissue
mass structures at the midventral
abdomen
4 12 yr old Anorexia, stranguria, 12 cm 3 8 cm, well-defined,
mixed-breed constipation, palpable soft-tissue opacity between
abdominal mass urinary bladder and colon;
cranial displacement of the
bladder; dorsal displacement
of the descending colon
5 10 yr old Greek Anorexia, stranguria, 9 cm 3 8 cm, well-defined,
hunter constipation, palpable soft-tissue opacity between
abdominal mass urinary bladder and colon;
cranial displacement of the
bladder; dorsal displacement
of descending colon
6 10 yr old husky Vulvovaginal discharge, 4 cm 3 5 cm, ill-defined,
palpable abdominal soft-tissue opacity between
mass the urinary bladder and colon;
dorsal displacement of
descending colon
component located at the
dorsal aspect of the bladder
neck
7 3 9 cm well-demarcated cystic
mass at the dorsal aspect of
abdominal urethra; small
hyperechoic foci in the mass
5 cm 3 12 cm, ill-demarcated,
cystic mass in the midabdomen
originating from the uterine horn;
mild fluid accumulation in the
uterus
11 cm 3 7 cm, well-demarcated,
solid mass with cystic
component at the dorsal aspect
of the abdominal urethra; small,
hyperechoic foci in the mass
8 cm 3 9 cm, well-demarcated,
solid mass at the dorsal aspect
of the abdominal urethra
4 cm 3 7 cm, well-demarcated,
solid mass with cystic
component mass at the dorsal
aspect of the bladder body
and neck
surface with mucin and
blood filled cavities;
ovariohysterectomy
Normal Uterine body/cervical mass, Leiomyoma
heterogeneous cut surface
with blood filled cavities,
ovariohysterectomy
Cysts in the left Left uterine horn mass, Leiomyoma,
and right ovary heterogeneous cut surface pyometra
with blood filled cavities,
fluid in the uterus,
ovariohysterectomy
Normal Uterine body/cervix mass Firm, Fibroleiomyoma
nodular cut surface with
blood filled cavities;
ovariohysterectomy
Normal Uterine body/cervical mass; Leiomyoma
firm, homogeneous cut
surface; ovariohysterectomy
Normal Uterine body/cervical mass; Leiomyoma
Firm, heterogeneous cut
surface with blood filled
cavities; ovariohysterectomy
(Table continues)
 TABLE 1 (Continued )
Ultrasonographic Findings

Survey Surgical and Gross

Clinical Radiographic
Case Signalment Signs Findings
7 14 yr old Respiratory distress, Ill-defined, calcified, soft-tissue
mixed-breed mammary gland opacity at the mid-ventral
tumor, palpable abdomen; mild uterine body
abdominal mass enlargement; pulmonary
miliary pattern
8 8 yr old poodle Constipation, palpable 5 cm 3 4 cm, ill-defined,
abdominal mass soft-tissue opacity between
urinary bladder and colon;
dorsal displacement of
descending colon
9 10 yr old cocker Stranguria, palpable, 7 cm 3 8 cm, ill-defined,
spaniel abdominal mass soft-tissue opacity between
the urinary bladder and colon;
cranial displacement of the
bladder; dorsal displacement
of the descending colon
Other Abdominal Pathologic Findings Histopathological
Uterus Viscera and Therapy Findings
10 cm 3 8 cm ill-demarcated, Normal Euthanasia. Right uterine Leiomyoma with
solid mass at the midventral horn mass and mild dystrophic
aspect of the abdominal cavity; uterus enlargement at calcification and
prominent, diffuse hyperechoic necropsy; firm, osseous
foci in the mass casting homogeneous cut surface metaplasia; cystic
acoustic shadow; thickened with areas of calcification endometrial
uterine wall (20 mm uterine hyperplasia;
diameter) with anechoic metastatic
lesions embedded in the wall, mammary
compatible with cystic adenocarcinoma
hyperplasia in the lungs
4 cm 3 3 cm, well-demarcated, Normal Uterine body/cervical mass, Adenocarcinoma,
solid mass with cystic firm enlargement of the pyometra
component at the dorsal aspect uterus composed of mucin
of the bladder body and neck; and blood-filled cavities,
mild fluid accumulation in the fluid in the uterus,
uterine horns ovariohysterectomy
7 cm 3 7 cm, well -demarcated, Normal Uterine body/cervical mass, Leiomyoma
solid mass at the dorsal aspect firm nodular proliferation
of abdominal urethra within the myometrium
with homogeneous cut
surface, ovariohysterectomy

JAAHA.ORG
Imaging Findings of Uterine Neoplasms in Dogs

333

FIGURE 1 Lateral abdominal radiograph of a 10 yr old cocker
spaniel (case 9) with uterine body/cervix leiomyoma showing an ill-
defined, soft-tissue opacity (m) between urinary bladder ( bl), and
colon (c) that is displacing the bladder cranially and colon dorsally.
study were similar to those reported in the literature. Uterine
neoplasms were rare, affected middle-aged to older animals, and
no breed predilection occurred. 3
The clinical signs of uterine tumors depend on the tumor size,
the presence of metastases, and other concurrent disease, such
either a mucometra or pyometra. 6,7 Anorexia, constipation,
stranguria, and vulvovaginal discharge, as observed in some dogs
in this study, have also been reported in dogs with uterine
FIGURE 2 Lateral abdominal radiograph of a 14 yr old mixed-
breed dog with uterine horn leiomyoma with dystrophic minerali-
zation and osseous metaplasia (case 7) showing an ill-defined,
mineralized, soft-tissue opacity at the midventral abdomen. The
uterus body (u) is mildly enlarged. bl, urinary bladder.
334 JAAHA | 50:5 Sep/Oct 2014
FIGURE 3 Ultrasonographic section of the uterine body/cervical
leiomyoma that is demonstrated in Figure 1 (case 9) showing a well-
defined, echogenic, solid mass at the caudal aspect of the urinary
bladder. Arrows demonstrate mass periphery. bl, bladder.
tumors.8 A palpable abdominal mass that was found in all cases of
this study may be considered the most consistent clinical finding
of uterine neoplasms in dogs, but an accurate diagnosis could not
be based on that finding alone.
The normal uterus is tubular, approximately 1 cm in diameter,
located between the colon and the urinary bladder and usually not
visible on survey radiographs.9 Uterine body neoplasms tend to
achieve a large size between the descending colon and urinary
bladder and may be seen radiographically as localized uterine
FIGURE 4 Transverse ultrasonographic section of the uterine
body/cervical leiomyoma in a 8 yr old German shepherd dog (case 2).
Multiple anechoic cavities and hyperechoic foci in the mass. Calipers
measure the size of the mass.

FIGURE 5 B-mode (A) and color Doppler (B) ultrasonographic
section of the uterine horn leiomyoma of a 10 yr old mixed-breed dog
(case 3). The mass (m) containing multiple anechoic cavities is
confluent with the uterine horn ( h). Color Doppler did not reveal
any flow in the anechoic cavities. Lines represent the color sector
window.
enlargement that may displace the descending colon dorsally.10
That finding was observed in six of seven dogs with uterine body/
cervical tumors in this series and was considered consistent with
uterine body/cervical neoplasms in intact bitches. However, seg-
mental pyometra, early pregnancy, stump pyometra, or granuloma
in a neutered animal may appear similar on survey radiographs and
should be included in the differential diagnosis.11–13
The size and the location (cranial or caudal) of the uterine
masses may determine the clinical and radiographic findings, and
a mass at the level of the body of the urinary bladder may produce
urinary incontinence. A mass at the level of the urinary bladder
neck may cause hydroureter, and a mass adjacent to the urethra
may produce urinary outflow obstruction of the urinary bladder
and dorsal displacement of the cranial part of the rectum.14 As
Imaging Findings of Uterine Neoplasms in Dogs
expected, the study authors found that the larger the uterine
body/cervical mass, the bigger the displacement of adjacent vis-
cera. Also, a mass smaller than the diameter of the adjacent viscera
will not have a mass effect and may not be visible on plain radio-
graphs, as was the case in one dog in the current study (case 1).
The radiographic examination of the abdomen in the cases of
this study included a single lateral view. If uterine horn enlarge-
ment does not exceed the diameter of an intestinal loop, it is
unlikely that a ventrodorsal view of the abdomen would show
changes related to the uterus. In cases when uterine enlargement
does exceed the diameter of an intestinal loop, both the lateral and
ventrodorsal views are likely to show abnormalities. Although the
authors agree that a ventrodorsal abdominal view may be par-
ticularly useful to characterize focal uterine horn enlargement and
masses, in the context of the authors’ daily clinical procedures
where most dogs suspected of uterine disease would be further
assessed ultrasonographically, it was considered justified to per-
form a single lateral radiograph of the abdomen. Uterine horn
masses usually appear on radiographs as either well or ill-
demarcated, round lesions in the midabdomen that may dis-
place intestinal loops.15,16 Similar findings were also observed in
dogs included in this study with uterine horn tumors (cases 3 and
7). However, those radiographic findings were not characteristic
of uterine horn tumors because they have also been observed in
a number of uterine horn diseases (i.e., cystic endometrial hy-
perplasia, localized pyometra, uterine adenomyosis) as well as in
cases of mesenteric masses.13,15,17
Ultrasonography was helpful in demonstrating the uterine
body/cervical origin of a mass in all dogs, and the anatomic lo-
cation of the mass between either the abdominal urethra or bladder
neck and the descending colon enabled to confirm the tissue of
origin.18 Although it is possible to differentiate the uterine body
and cervix in the normal, nongravid uterus with ultrasound, it
may be difficult to ascertain whether a uterine mass had either
a body or cervical origin.
Ultrasonography was helpful in showing uterine horn tumors
in two dogs included in this study (cases 3 and 7), but was able to
detect the horn origin of the mass in only one dog (case 3). In the
other dog, the horn origin of the mass was included in the list of
differential diagnoses. Ultrasound was a reliable technique to
determine the origin of an abdominal mass when there was rec-
ognizable parenchyma to which the mass could be traced.5 Normal
uterine horns are difficult to identify by ultrasound because they
become lost in small bowel echoes and mesenteric fat; however,
fluid accumulation in the lumen of uterine horns makes them
easily visible.19 It is possible that enlargement and fluid accu-
mulation in the horns was helpful in tracing the origin of the mass
JAAHA.ORG 335
in case 3, but in the dog in which the origin of the mass was not
delineated precisely (case 7), there was no fluid accumulation in
the uterine horns. In women, recognition of the origin of gyne-
cologic tumors by ultrasound is difficult and gastrointestinal
20
stromal tumors were misdiagnosed as uterine leiomyomas.
Similarly, uterine horn adenomyosis in a dog was misinterpreted
as gastrointestinal tract tumor.15 The authors support the hy-
pothesis that it may not be possible to determine that a mass
originates in a uterine horn unless there is associated fluid dis-
tension of the uterus. Searching for a “sliding organ sign” may be
useful for distinguishing a possible mass confluent with the uterus
from one separate from it.20,21
There is a paucity of reports on the ultrasonographic char-
acteristics of uterine tumors in dogs. Leiomyomas and fibrol-
eiomyomas are composed of spindle-shaped smooth muscle
cells arranged in whorl-like patterns separated by variable amounts
of fibrous connective tissue and have a firm homogeneous cut
surface in gross pathologic examination. This histological pattern
corresponds to a typical ultrasonographic appearance of a solid
echogenic mass. The echogenicity of a mass depends on the relative
ratio of connective tissue to smooth muscle, the extent of de-
generation, and the presence of either necrosis or dystrophic
mineralization. The presence of necrosis, degeneration, and/or
mineralization within the tumor is likely to cause a mass to
have a heterogeneous echogenicity and echotexture. With an in-
creased fibrous component in a mass, there is increased echo-
genicity of the mass. In this study, a solid mass was found in three
leiomyomas for which the gross pathologic examination dem-
onstrated a firm, homogeneous cut surface. Similarly, in another
case report, a uterine leiomyoma was observed as isoechoic to the
22
surrounding uterine tissue, projecting in to the uterine lumen. As
a tumor enlarges, it may outgrow its blood supply, resulting in
ischemia, cystic degeneration and necrosis, producing blood-filled
spaces in the tumor that appear ultrasonographically hetero-
23
geneous, with anechoic cyst-like cavities into the solid mass. In
this study, three leiomyomas and one fibroleiomyoma demon-
strated ultrasonographically anechoic, cyst-like lesions, which, on
gross pathological and histopathological examination, were con-
firmed as blood-filled cavities due to necrosis. However, a similar
ultrasonographic pattern has been reported with a leiomyosarcoma,
and it would therefore appear that it is not possible to differentiate
leiomyomas, fibroleiomyomas, and leiomyosarcomas from their
ultrasonographic appearance alone.16 In women, leiomyomas are
commonly solid masses; hypoechoic or isoechoic to normal sur-
rounding uterine tissue; but different forms of internal degenera-
tion, hemorrhage, or proteolytic liquefaction cause anechoic areas
in the tumor.23 If anechoic areas are extensive enough, they may
336 JAAHA | 50:5 Sep/Oct 2014
have a cystic appearance and can mimic predominantly cystic or
multiseptated adnexal or ovarian masses.24 Furthermore, this var-
iable ultrasonographic pattern may also mimic numerous pelvic
conditions and add to diagnostic confusion.24
A solid mass with cystic component due to mucin and blood-
filled cavities in the tumor was also demonstrated ultrasono-
graphically in two adenocarcinomas in this study. The ultraso-
nographic pattern may resemble the pattern described for
leiomyomas with cystic component. In women, most endometrial
adenocarcinomas are either diffusely or partially echogenic with
either irregular or poor endometrial thickening that usually
measures .5 mm.25 Although rare, cystic changes in adeno-
carcinomas are probably due to associated endometrial hyper-
plasia and necrosis.26,27 Because cystic changes may be present in
either benign or malignant endometrial tumors, it is not possible
to use ultrasound, without biopsies, to exclude a malignancy.16,27
Many neoplastic diseases appeared to have hyperechoic foci due
to either fibrosis or dystrophic mineralization within the tumors,
with related acoustic shadowing if there was enough sound atten-
uation.19 The hyperechoic foci seen in a leiomyoma (case 2) and in
a fibroleiomyoma (case 4) in this study may reflect the abundant
fibrous connective tissue that those neoplasms were found to
contain.28 In women, many leiomyomas may demonstrate areas of
acoustic attenuation or shadowing due to dense fibrosis within the
substance of the tumor.23 Hyperechoic foci casting a clean shadow
indicative of mineralization and/or osseous metaplasia, as con-
firmed by histopathology in one leiomyoma in this study (case 7),
have also been reported in a uterine leiomyosarcoma in the dog and
in uterine leiomyomas in women.16,23,27 In older women, calcifi-
cation in a uterine tumor may appear as a curvilinear echogenic
rim, which may simulate the outline of a fetal head.23
Uterine tumors are easily differentiated from segmental
pyometra and pregnancy because the latter have a typical ultra-
sonographic appearance. The presence of a hyperechoic capsule
is compatible with a granuloma; however, uterine granulomas
may have a similar appearance to neoplastic tumors ultrasono-
graphically. The only way to differentiate granulomas from tumors
is either by fine-needle aspiration or biopsy, both of which can be
performed under ultrasound guidance.15,18,29
Conclusion
Ultrasonography was a useful method of detecting either uterine
body or cervical tumors in dogs. However, it was not possible to
ascertain that a mass originated in a uterine horn unless there was
also associated evidence of involvement of the uterine horn to which
the mass could be traced. The ultrasonographic appearance of
uterine tumors in dogs was variable and the only way to differentiate

the type of neoplasm was by taking a biopsy of the mass. Ultra-
sonographic techniques, such as power Doppler imaging, contrast
ultrasound, and elastography, as well as contrast enhanced com-
puted tomography and magnetic resonance imaging could all be
used for further investigation of the different tumor types.
FOOTNOTES
a
Apogee 800 ATL; Advanced Technology Labs Inc., Bothell, WA
b
Prosound Alpha 6 Aloka; Aloka Co. Ltd., Tokyo, Japan
REFERENCES
1. Herron MA. Tumors of the canine genital system. J Am Anim Hosp
Assoc 1983;19:981–94.
2. Brodey RS, Roszel JF. Neoplasms of the canine uterus, vagina, and
vulva: a clinicopathologic survey of 90 cases. J Am Vet Med Assoc
1967;151(10):1294–307.
3. Klein MK. Tumors of the female reproductive system. In: Withrow
SJ, Vail DM, eds. Withrow and MacEwens small animal clinical on-
cology. 4th ed. Philadelphia (PA): WB Saunders; 2007:610–8.
4. Vos JH. Uterine and cervical carcinomas in five dogs. Zentralbl
Veterinarmed A 1988;35(5):385–90.
5. Diez-Bru N, Garcia-Real I, Martinez EM, et al. Ultrasonographic
appearance of ovarian tumors in 10 dogs. Vet Radiol Ultrasound
1998;39(3):226–33.
6. Pena FJ, Gines JA, Duque J, et al. Endometrial adenocarcinoma and
mucometra in a 6-year-old Alaska Malamute dog. Reprod Domest
Anim 2006;41(2):189–90.
7. Choi YK, Lee JY, Kim DY, et al. Uterine extramedullary plasmacy-
toma in a dog. Vet Rec 2004;154(22):699–700.
8. Cave TA, Hine R, Howie F, et al. Uterine carcinoma in a 10-month-
old golden retriever. J Small Anim Pract 2002;43(3):133–5.
9. Ackerman N. Radiographic evaluation of the uterus. Vet Radiol
1981;22:252–7.
10. Kealy JK, McAllister H, Graham JP. Diagnostic radiology and ultra-
sonography of the dog and cat. 5th ed. St. Louis (MO): Saunders
Elsevier; 2011:181–91.
11. Burk LR, Ackerman N. Small animal radiology and ultrasonography.
2nd ed. Philadelphia (PA): WB Saunders; 1996:389–401.
12. Dennis R, Kirberger RM, Wringley RH, et al. Handbook of small
animal radiological differential diagnosis. London: WB Saunders;
2001:185–208.
13. Feeney DA, Johnston GR. The uterus, ovaries and testes. In: Thrall
DE, ed. Textbook of veterinary diagnostic radiology. 5th ed. St Louis
(MO): Saunders Elsevier; 2007:738–49.
Imaging Findings of Uterine Neoplasms in Dogs
14. Bartels JE. Radiology of the genital tract. In: O’Brien TR, ed. Ra-
diographic diagnosis of abdominal disorders in the dog and cat.
Philadelphia (PA): WB Saunders; 1978:615–60.
15. Stöcklin-Gautschi NM, Guscetti F, Reichler IM, et al. Identification
of focal adenomyosis as a uterine lesion in two dogs. J Small Anim
Pract 2001;42(8):413–6.
16. Tsioli VG, Gouletsou PG, Loukopoulos P, et al. Uterine leiomyo-
sarcoma and pyometra in a dog. J Small Anim Pract 2011;52(2):
121–4.
17. Root CR. Abdominal masses. In: Thrall DE, ed. Textbook of veteri-
nary diagnostic radiology. 4th ed. Philadelphia (PA): WB Saunders;
2002:493–513.
18. Dickie A. Imaging of the reproductive tract. In: Mannion P, ed.
Diagnostic ultrasound in small animal practice. Oxford (UK):
Blackwell Science; 2006:145–69.
19. Mattoon JS, Nyland TG. Ultasonography of the genital system. In:
Nyland TG, Mattoon JS, eds. Veterinary diagnostic ultrasound.
Philadelphia (PA): WB Saunders; 1995:141–64.
20. Pinto V, Ingravallo G, Cicinelli E, et al. Gastrointestinal stromal
tumors mimicking gynecological masses on ultrasound: a report of
two cases. Ultrasound Obstet Gynecol 2007;30(3):359–61.
21. Barr F. Diagnostic ultrasound in the dog and cat. Oxford (UK):
Blackwell Science; 1990:78–95.
22. Poffenbarger EM, Feeney DA. Use of gray-scale ultrasonography in
the diagnosis of reproductive disease in the bitch: 18 cases (1981–
1984). J Am Vet Med Assoc 1986;189(1):90–5.
23. Salem S, Wilson SR. Gynecologic ultrasound. In: Rumack CM,
Wilson SR, Charboneau WJ, et al, eds. Diagnostic ultrasound. 3rd ed.
St Louis (MO): Elsevier Mosby; 2005:527–87.
24. Baltarowich OH, Kurtz AB, Pennell RG, et al. Pitfalls in the sono-
graphic diagnosis of uterine fibroids. AJR Am J Roentgenol 1988;
151(4):725–8.
25. Fleischer AC, Cullinan JA, Jones HW. Transvaginal sonography of
endometrial disorders. In: Fleischer AC, Manning FA, Jeanty P, et al,
eds. Sonography in obstetrics and gynecology. 5th ed. London (UK):
Pentice-Hall International Inc.; 1996:869–85.
26. Itoh K, Toki T, Shiohara S, et al. A comparative analysis of cross
sectional imaging techniques in minimal deviation adenocarcinoma
of the uterine cervix. BJOG 2000;107(9):1158–63.
27. Atri M, Nazarnia S, Aldis AE, et al. Transvaginal US appearance of
endometrial abnormalities. Radiographics 1994;14(3):483–92.
28. MacLachan NJ, Kennedy PC. Tumors of the genital systems. In:
Meuten DJ, ed. Tumors in domestic animals. 4th ed. Ames (IA): Iowa
State Press; 2002:547–57.
29. Boza S, Lucas X, Zarelli M, et al. Late abscess formation caused by
silk suture following hysterectomy in a female dog. Reprod Domest
Anim 2010;45(5):934–6.
JAAHA.ORG 337