Leiomyosarcoma of the Pericardium, with Epicardial Metastases and Peripheral Eosinophilia in a Dog

Causes of eosinophilic ascites – A systematic review

Background . In the last years an uprising interest for a relatively unknown entity, eosinophilic ascites (EA), has been recorded.

Our aim is to investigate the potential causes of EA development, as well as clinical, laboratory, endoscopic and radiologic features, management and outcome in these patients.

Methods . The following research was performed on PubMed (MEDLINE) database using the medical subject headings [Mesh] terms “Ascites” AND “Eosinophils”.

Results . A total of 284 results, dating from 1962 onwards, were found and abstracts were examined. 131 papers were excluded and the remaining 153 publications, consisting in case reports and series of cases, were analyzed.

From 171 patients with EA, 127 subjects (74%) had EGE, 17 (10%) parasitic and fungal infections, 11(7%) Hypereosinophilic syndrome and 16 patients (9%) less common diseases (eosinophilic pancreatitis, chronic eosinophilic leukemia, myelofibrosis, T-cell lymphoma, Churg Strauss Syndrome, Systemic lupus erythematosus, Familial paroxysmal polyserositis and Ménétrier’s disease). High eosinophil blood count and IgE levels as well as gastrointestinal symptoms are frequent. The diagnosis is based on ascitic fluid analysis, imaging and endoscopic biopsies. Therapy with corticosteroids results in resolution of eosinophilic ascites in almost all patients.

Conclusion . In most cases, in the absence of allergy, parasitic infections, malignancy, hematological disorders, peritoneal tuberculosis, inflammatory bowel disease or autoimmune disease, EA develops as a manifestation of eosinophilic gastroenteritis.

Pericardial Hemangiosarcoma in a 10-Year-Old Papillon

A 10 yr old papillon was evaluated for lethargy, inappetence, tachypnea, and labored breathing. Physical examination findings included dehydration, tachypnea, tachycardia, and muffled heart sounds. Thoracic radiographs revealed an enlarged cardiac silhouette. Echocardiography revealed a mild volume of pericardial effusion and no evidence of right atrial tamponade or a cardiac-associated mass. Cytological analysis of the pericardial effusion was consistent with blood. There was no evidence of neoplasia. Coagulation parameters were within normal limits. Initial treatment consisted of pericardiocentesis. A subtotal pericardiectomy was later performed. No surgical complications were noted, and the dog was discharged 2 days following surgery. Results of the histological examination of the pericardium revealed hemangiosarcoma. Treatment with doxorubicin was initiated 12 days after surgery, at which time, pulmonary metastasis was suspected. The dog survived for 18 days after subtotal pericardiectomy, when it was euthanized because of complications presumably related to pulmonary metastatic disease. This is the first published report of primary pericardial hemangiosarcoma. The dog had a short survival time; thus, the response to subtotal pericardiectomy combined with adjuvant doxorubicin treatment could not be determined. Pulmonary metastatic disease was suspected 12 days following surgery. Based on this case report, pericardial hemangiosarcoma carries a guarded prognosis.

Primary cardiac tumor presenting as left ventricular outflow tract obstruction and complex arrhythmia

An adult female mixed breed dog presented for recurrent collapsing episodes over several weeks. Holter evaluation revealed periods of sinus arrest and echocardiography identified a soft tissue mass with subsequent severe dynamic obstruction of the left ventricular outflow tract. The patient was euthanized five days after presentation for severe dyspnea. Necropsy revealed an irregular mass circumferentially lining the left ventricular outflow tract as well as multiple myocardial metastases. The final diagnosis was an undifferentiated pleomorphic endocardial sarcoma.

Pretreatment leukocyte ratios and concentrations as predictors of outcome in dogs with cutaneous mast cell tumours

Leukocyte ratios correlate with outcome in several human cancers. Little is known about their prognostic significance in mast cell tumour (MCT). The aim of the study was to evaluate the prognostic significance of pretreatment leukocyte concentrations and their ratios in dogs with MCT for survival. Medical records of 92 dogs with MCT were retrospectively reviewed. Tumour diagnosis was made by tumour biopsy or fine-needle aspirate. Only dogs without prior treatment were included. Eosinophil, lymphocyte, monocyte and neutrophil concentration were obtained by ADVIA 2120™ (Siemens Healthcare, Vienna, Austria). Neutrophil-to-eosinophil ratio (NER), lymphocyte-to-monocyte ratio (LMR) and neutrophil-to-lymphocyte ratio (NLR) were calculated from collected leukocyte concentrations. Relative eosinophil concentration (REC), NER (P < 0.001), NLR (P = 0.001) and LMR (P < 0.001) were significant prognostic factors for outcome in univariate analysis. REC (P = 0.008) and NER (P = 0.001) remained independent predictors of survival in multiple analyses. Leukocyte concentrations and ratios, especially REC and NER may serve as prognostic indicators in MCT.

A descriptive review of cardiac tumours in dogs and cats

Cardiac tumours are uncommon in the canine and feline population and often an incidental finding. Common types include haemangiosarcoma (HSA), aortic body tumours (chemodectoma and paraganglioma) and lymphoma. These neoplasms can cause mild to severe, life-threatening clinical signs that are independent of the histological type and may be related to altered cardiovascular function or local haemorrhage/effusion into the pericardial space. Cardiac tumours may require symptomatic treatment aimed at controlling tumour bleeding and potential arrhythmias, and other signs caused by the mass effect. Additional treatment options include surgery, chemotherapy and radiotherapy. For all medical therapies, complete remission is unlikely and medical management, beyond adjunctive chemotherapy in HSA, requires further investigation but combination chemotherapy is recommended for lymphoma. The aim of this report is to summarize and critically appraise the current literature in a descriptive review. However, interpretation is limited by the lack of definitive diagnosis and retrospective nature of most studies.

Prevalência e aspectos anatomopatológicos das neoplasias primárias do coração, de tecidos da base do coração e metastáticas, em cães do Sul de Minas Gerais (1994-2009)

Este estudo teve como objetivo determinar a prevalência e achados anatomopatológicos de tumores primários e metastáticos do coração ou de tecidos da base do coração, diagnosticados em caninos do Sul de Minas Gerais. O diagnóstico foi realizado mediante análise histopatológica e imuno-histoquímica das neoplasias. Durante os anos de 1994-2009, foram realizadas 2397 necropsias em caninos. Neoplasias no coração foram detectadas em 31 cães (1,29%), onde, sete (22,58%) eram primárias e 24 (77,42%) metastáticas. As neoplasias diagnosticadas como primárias do coração foram o hemangiossarcoma (1/7) e o mixoma (1/7); e como primárias da base do coração o quimiodectoma (3/7) e o carcinoma de tireoide ectópica (2/7). A frequência foi maior em cães machos (5/7), da raça Boxer (3/7) e com idade média de 9,7±1,88 anos. Nas neoplasias metastáticas, a frequência foi maior em fêmeas (15/24), em cães da raça Rottweiler (7/24) e a idade média foi de 7,5±3,23 anos, sendo o linfoma de células T a neoplasia metastática de maior ocorrência (7/27).

Cardiac magnetic resonance in the differentiation of neoplastic and nonneoplastic pericardial effusion

BACKGROUND

Cardiac magnetic resonance (CMR) is the imaging modality of choice for cardiac tumors in people. Although neoplastic pericardial effusion (PE) carries a poor prognosis, benign idiopathic pericardial effusion does not. Definitive diagnosis is critical for surgical intervention, but currently available diagnostic techniques such as echocardiography and pericardial fluid cytology often are inconclusive.

HYPOTHESIS/OBJECTIVE

Describe CMR findings associated with PE and determine whether CMR aids in differentiation of benign and neoplastic causes of PE.

ANIMALS

Eight client-owned dogs with PE diagnosed by transthoracic echocardiography (TTE).

METHODS

CMR was performed with a 1.5 T, including dark blood, steady-state free procession cine, pre- and postcontrast T1-weighted imaging, and delayed inversion recovery prepped imaging.

RESULTS

CMR confirmed a cardiac mass and supported suspected tumor type in 4 dogs with suspected hemangiosarcoma. In 1 equivocal TTE case, CMR did not demonstrate a mass, but neoplasia was later diagnosed. In another equivocal case, CMR did not demonstrate a mass but showed findings consistent with a pericardiocentesis complication. In 1 dog without evidence of cardiac neoplasia, abdominal magnetic resonance imaging identified presumptive hepatic and splenic metastases. On reevaluation of the original CMR study, the 2 equivocal cases that were interpreted as tumor negative were reassessed as tumor positive.

CONCLUSIONS AND CLINICAL IMPORTANCE

CMR did not substantially improve diagnosis of cardiac tumors compared with TTE in these 8 cases, but it yielded useful descriptive information regarding extent, anatomic location, and potential tumor type and confirmed that CMR requires extensive additional training for tumor identification.