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Huerta Y, Lenz J, Flesner B, Abrams B, Amerman H, Griffin M. Resolution of paraneoplastic hypoglycemia following nephroureterectomy for treatment of canine renal cell carcinoma: Case report. Front Vet Sci 2023; 10:1134098. [PMID: 37065226 PMCID: PMC10102469 DOI: 10.3389/fvets.2023.1134098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 03/14/2023] [Indexed: 04/03/2023] Open
Abstract
ObjectivesTo describe the clinicopathologic findings, imaging results, surgical treatment, and outcome of a dog with renal cell carcinoma (RCC) and paraneoplastic hypoglycemia.AnimalsA 13-year-old female spayed mixed breed dog that was presented for facial twitching and neurologic decline and diagnosed with a renal mass and paraneoplastic hypoglycemia.Study designCase report.MethodsSerum chemistry revealed severe hypoglycemia and normal renal values. Abdominal ultrasonography showed a large, heterogeneous, cavitated mass associated with the left kidney and no evidence of abdominal metastatic disease. Thoracic radiographs revealed no evidence of pulmonary metastatic disease. Fasted serum insulin was low concurrently with severe hypoglycemia. No other causes of hypoglycemia were detected, and paraneoplastic hypoglycemia was suspected.ResultsAfter initial medical management of the dog's hypoglycemia, left nephroureterectomy was performed. Histopathology was consistent with RCC. Postoperatively, the dog's hypoglycemia resolved, and supplementation was discontinued. The dog remained stable and was discharged from the hospital 3 days after surgery. At 2-week, 3-month, and 5-month follow up evaluations, the dog remained euglycemic, and no definitive evidence of disease progression was detected. Eight months postoperatively, the dog was euthanized due to decline in mobility. Necropsy and histopathology revealed cerebral and spinal cord multifocal myelin sheath dilation and two primary pulmonary carcinomas with no evidence of recurrence or metastasis of the RCC.ConclusionSurgical treatment of RCC with subsequent resolution of paraneoplastic hypoglycemia has not previously been reported in veterinary medicine. In this dog, nephroureterectomy for RCC resulted in immediate and sustained resolution of paraneoplastic hypoglycemia.
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Affiliation(s)
- Yael Huerta
- Department of Clinical Sciences and Advanced Medicine, University of Pennsylvania School of Veterinary Medicine, Philadelphia, PA, United States
| | - Jennifer Lenz
- Department of Clinical Sciences and Advanced Medicine, University of Pennsylvania School of Veterinary Medicine, Philadelphia, PA, United States
| | - Brian Flesner
- Department of Clinical Sciences and Advanced Medicine, University of Pennsylvania School of Veterinary Medicine, Philadelphia, PA, United States
| | - Brittany Abrams
- Department of Clinical Sciences and Advanced Medicine, University of Pennsylvania School of Veterinary Medicine, Philadelphia, PA, United States
| | - Hayley Amerman
- Department of Pathobiology, University of Pennsylvania School of Veterinary Medicine, Philadelphia, PA, United States
| | - Maureen Griffin
- Department of Clinical Sciences and Advanced Medicine, University of Pennsylvania School of Veterinary Medicine, Philadelphia, PA, United States
- *Correspondence: Maureen Griffin
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Simons P, Lyons B, Bentley A, Mazzaferro E, Thalheim L, Finotello R, Ressel L. Case report: Severe, refractory hypoglycemia in a 9-year-old Brittany Spaniel with renal nephroblastoma. Front Vet Sci 2023; 10:1116846. [PMID: 37143502 PMCID: PMC10151700 DOI: 10.3389/fvets.2023.1116846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 03/24/2023] [Indexed: 05/06/2023] Open
Abstract
A 9-year-old female spayed Brittany Spaniel presented for weakness and stumbling, and was diagnosed with severe hypoglycemia. An insulin to glucose ratio was not consistent with insulinoma as a cause for hypoglycemia. Diagnostic imaging (abdominal ultrasound and computed tomography) revealed a large left renal mass and a possible metastatic lesion in the right kidney. Glucagon therapy was initiated, but hypoglycemia was refractory to therapy. A left nephrectomy was performed and hypoglycemia subsequently resolved. Histopathology of the mass was consistent with nephroblastoma and immunohistochemistry for anti-insulin-like Growth Factor-2 (IGF-2) antibody revealed immunoreactivity in over 50% of the neoplastic cells. Chemotherapeutic treatment was initiated with a combined protocol of vincristine and doxorubicin. To the authors' knowledge, this is the first case report documenting the treatment of severe, refractory non-islet cell tumor-induced hypoglycemia in a dog, suspected to be secondary to an IGF-2 secreting nephroblastoma.
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Affiliation(s)
- Paula Simons
- Department of Emergency and Critical Care, Cornell University Veterinary Specialists, Stamford, CT, United States
- *Correspondence: Paula Simons
| | - Bridget Lyons
- Department of Emergency and Critical Care, Cornell University Veterinary Specialists, Stamford, CT, United States
| | - Adrienne Bentley
- Department of Surgery, Cornell University Veterinary Specialists, Stamford, CT, United States
| | - Elisa Mazzaferro
- Department of Emergency and Critical Care, Cornell University Veterinary Specialists, Stamford, CT, United States
| | - Lindsay Thalheim
- Department of Oncology, Cornell University Veterinary Specialists, Stamford, CT, United States
| | - Riccardo Finotello
- Department of Small Animal Clinical Science, Institute of Infection Veterinary and Ecological Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Lorenzo Ressel
- Department of Veterinary Anatomy Physiology and Pathology, Institute of Infection Veterinary and Ecological Sciences, University of Liverpool, Liverpool, United Kingdom
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3
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Tamura K, Ishigaki K, Yoshida O, Terai K, Iizuka K, Sakurai N, Heishima T, Asano K. Glucoregulatory factors in canine hepatocellular carcinoma and leiomyosarcoma with non-islet cell tumour hypoglycaemia. Res Vet Sci 2022; 152:640-646. [DOI: 10.1016/j.rvsc.2022.09.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 09/13/2022] [Accepted: 09/29/2022] [Indexed: 11/06/2022]
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Song DW, Ro WB, Sur JH, Seung BJ, Kang HM, Kim JW, Park SH, Park HM. Evaluation of circulating IGF-I and IGFBP-3 as biomarkers for tumors in dogs. J Vet Sci 2021; 22:e77. [PMID: 34697923 PMCID: PMC8636663 DOI: 10.4142/jvs.2021.22.e77] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 08/05/2021] [Accepted: 08/31/2021] [Indexed: 11/23/2022] Open
Abstract
Background Serum-based parameters are considered non-invasive biomarkers for cancer detection. In human studies, insulin-like growth factor-I and II (IGF-I and IGF-II) and insulin-like growth factor binding protein-3 (IGFBP-3) are useful as diagnostic or prognostic markers and potential therapeutic targets. Objectives This study examined the diagnostic utility of circulating IGF-I, IGF-II, and IGFBP-3 levels in healthy dogs and dogs with tumors. Methods The serum concentrations of these biomarkers in 86 dogs with tumors were compared with those in 30 healthy dogs using an enzyme-linked immunosorbent assay (ELISA). Results The ELISA results showed no difference between healthy dogs and dogs with tumors in the serum IGF-II concentrations. On the other hand, there was a significant difference in the circulating IGF-I and IGFBP-3 levels between healthy dogs and dogs with tumors. The concentrations of serum IGF-I (median [interquartile range], 103.4 [59.5–175] ng/mL) in dogs with epithelial tumors were higher than those (58.4 ng/mL [43.5–79.9]) in healthy dogs. Thus, the concentrations of serum IGFBP-3 (43.4 ng/mL [33.2–57.2]) in dogs with malignant mesenchymal tumors were lower than those (60.8 ng/mL [47.6–70.5]) in healthy dogs. Conclusions The serum IGF-I and IGFBP-3 levels can be used as diagnostic biomarkers in dogs with tumors.
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Affiliation(s)
- Doo-Won Song
- Laboratory of Veterinary Internal Medicine, College of Veterinary Medicine, Konkuk University, Seoul 05029, Korea
| | - Woong-Bin Ro
- Laboratory of Veterinary Internal Medicine, College of Veterinary Medicine, Konkuk University, Seoul 05029, Korea
| | - Jung-Hyang Sur
- Department of Veterinary Pathology, Small Animal Tumor Diagnostic Center, College of Veterinary Medicine, Konkuk University, Seoul 05029, Korea
| | - Byung-Joon Seung
- Department of Veterinary Pathology, Small Animal Tumor Diagnostic Center, College of Veterinary Medicine, Konkuk University, Seoul 05029, Korea
| | - Hyun-Min Kang
- Laboratory of Veterinary Internal Medicine, College of Veterinary Medicine, Konkuk University, Seoul 05029, Korea
| | - Jong-Won Kim
- Laboratory of Veterinary Internal Medicine, College of Veterinary Medicine, Konkuk University, Seoul 05029, Korea
| | - See-Hyoung Park
- Department of Biological and Chemical Engineering, Hongik University, Sejong 30016, Korea
| | - Hee-Myung Park
- Laboratory of Veterinary Internal Medicine, College of Veterinary Medicine, Konkuk University, Seoul 05029, Korea.
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5
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Costa LRR, Donelly CG, Crowe CM, Vaughan B, Alex CE, Aleman M. Electroencephalographic alterations in a mare with presumed intermittent neuroglycopenia caused by severe hypoglycaemia‐associated with nonislet cell tumour. EQUINE VET EDUC 2020. [DOI: 10.1111/eve.12947] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- L. R. R. Costa
- School of Veterinary Medicine, Veterinary Medicine and Epidemiology University of California‐Davis USA
| | - C. G. Donelly
- Veterinary Medical Teaching Hospital – Large Animal Clinic University of California‐Davis USA
| | - C. M. Crowe
- Neurology and Neurosurgery Service – Electrophysiology Laboratory University of California‐DavisUSA
| | - B. Vaughan
- Surgical and Radiological Sciences University of California‐DavisUSA
| | - C. E. Alex
- Veterinary Medical Teaching Hospital – Anatomic Pathology Service University of California‐Davis USA
| | - M. Aleman
- School of Veterinary Medicine, Veterinary Medicine and Epidemiology University of California‐Davis USA
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Noguchi S, Kubo Y, Araki M, Koh M, Hamamoto Y, Tamura K, Otsuka H, Yasuda A, Azakami D, Michishita M, Soeta S. Big Insulin-like Growth Factor 2-Producing Tumor in a Hypoglycemic Dog. Vet Pathol 2020; 57:432-436. [PMID: 32148182 DOI: 10.1177/0300985820906897] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
A 10-year-old female Papillon dog that had previously developed a mammary tumor was admitted for treatment of a hypoglycemic attack. Blood examination showed severe hypoglycemia and decreased blood insulin concentration. Computed tomography indicated multiple tumors in the cranial and caudal lobes of the right lung. These tumors were resected surgically and diagnosed as pulmonary adenocarcinomas by histopathologic examination. Hypoglycemia was temporarily improved after the resection, but a hypoglycemic event occurred 2 months after the surgery. Immunohistochemistry of the tumor demonstrated the expression of insulin-like growth factor 2 in tumor cells. Western blot analysis revealed the expression of high-molecular-weight (big)-insulin-like growth factor 2 in the tumor region. Insulin-like growth factor 2 mRNA expression was also confirmed in the tumor using reverse transcription-polymerase chain reaction. These findings indicate the diagnosis of non-islet cell tumor-induced hypoglycemia caused by big-insulin-like growth factor 2 produced by the tumor in the dog. This report provides information on differentiating tumors that cause paraneoplastic hypoglycemia.
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Affiliation(s)
- Syunya Noguchi
- Department of Veterinary Anatomy, Nippon Veterinary and Life Science University, Tokyo, Japan
| | - Yoshiaki Kubo
- Veterinary Medical Teaching Hospital, Nippon Veterinary and Life Science University, Tokyo, Japan
| | - Mami Araki
- Department of Veterinary Anatomy, Nippon Veterinary and Life Science University, Tokyo, Japan
| | - Miki Koh
- Department of Veterinary Anatomy, Nippon Veterinary and Life Science University, Tokyo, Japan
| | - Yuji Hamamoto
- Veterinary Medical Teaching Hospital, Nippon Veterinary and Life Science University, Tokyo, Japan
| | - Kyoichi Tamura
- Department of Veterinary Clinical Pathology, Nippon Veterinary and Life Science University, Tokyo, Japan
| | - Hirotada Otsuka
- Department of Veterinary Anatomy, Nippon Veterinary and Life Science University, Tokyo, Japan
| | - Akiko Yasuda
- Veterinary Medical Teaching Hospital, Nippon Veterinary and Life Science University, Tokyo, Japan
| | - Daigo Azakami
- Department of Veterinary Nursing, Nippon Veterinary and Life Science University, Tokyo, Japan
| | - Masaki Michishita
- Department of Veterinary Pathology, Nippon Veterinary and Life Science University, Tokyo, Japan
| | - Satoshi Soeta
- Department of Veterinary Anatomy, Nippon Veterinary and Life Science University, Tokyo, Japan
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Lodzinska J, Ballber C, Smith SH, Bavcar S. Hypoglycaemia associated with gastrointestinal and extragastrointestinal stromal tumour in two dogs. VETERINARY RECORD CASE REPORTS 2019. [DOI: 10.1136/vetreccr-2018-000784] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Joanna Lodzinska
- Hospital for Small AnimalsUniversity of Edinburgh Royal Dick School of Veterinary StudiesEaster BushUK
| | | | | | - Spela Bavcar
- Hospital for Small AnimalsUniversity of Edinburgh Royal Dick School of Veterinary StudiesEaster BushUK
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Azuma K, Asakawa M, Konno T, Fukuda S, Goto Asakawa M. Hypoglycemia associated with disseminated metastatic tonsillar squamous cell carcinoma producing insulin-like growth factor-I in a Pomeranian dog. Vet Clin Pathol 2019; 48:429-434. [PMID: 31280499 DOI: 10.1111/vcp.12753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2018] [Revised: 01/03/2019] [Accepted: 01/09/2019] [Indexed: 11/28/2022]
Abstract
A 13-year-old spayed female Pomeranian dog was presented for persistent, severe hypoglycemia (37 mg/dL; reference interval [RI] 75-128 mg/dL). Progressive nonregenerative anemia (hematocrit 23.3%-15.9%; RI 37.0%-55.0%) and severe thrombocytopenia (36 000/µL; RI 200-500 000/µL) were also noted. The serum insulin concentration was low (0.24 ng/mL; RI 0.302-1.277 ng/mL). Computed tomography revealed multiple splenic nodules (1-6 mm in diameter) and several hepatic nodules (7.6, 12 mm in diameter). Ultrasound-guided fine-needle aspiration of the splenic and hepatic nodules revealed low numbers of epithelial cells with mild cellular atypia, suggestive of a metastatic epithelial tumor, but the primary site was unknown at that time. On careful oral examination under general anesthesia, an enlarged right tonsil was noted grossly, and histopathologic examination of the tonsil diagnosed squamous cell carcinoma. Bone marrow aspirates and biopsies of the splenic and hepatic nodules were performed; all samples were diagnosed as metastatic carcinoma on histopathologic examination. No nodules were present in the pancreas, despite careful palpation during exploratory laparotomy. On immunohistochemistry, the neoplastic cells were positive for cytokeratin AE1/3 and insulin-like growth factor (IGF)-I but were negative for chromogranin A, PGP9.5, insulin, and inconclusive for IGF-II. This is the first report of a primary IGF-I-producing squamous cell carcinoma in the tonsil of a dog with metastases to bone marrow, liver, and spleen, resulting in hypoglycemia.
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Affiliation(s)
- Kazushi Azuma
- Synergy Animal General Hospital, Kawaguchi-shi, Saitama, Japan
| | - Makoto Asakawa
- Synergy Animal General Hospital, Kawaguchi-shi, Saitama, Japan
| | - Toshiaki Konno
- Synergy Animal General Hospital, Kawaguchi-shi, Saitama, Japan
| | - Shoko Fukuda
- Synergy Animal General Hospital, Kawaguchi-shi, Saitama, Japan
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Guillen A, Ressel L, Finotello R, German AJ, Freeman A, Blackwood L. Non-islet-cell tumour hypoglycaemia in a cat with hepatocellular carcinoma. JFMS Open Rep 2019; 5:2055116919856129. [PMID: 31263567 PMCID: PMC6595665 DOI: 10.1177/2055116919856129] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Case summary An 11-year-old male neutered domestic shorthair cat presented with behavioural changes. Physical examination revealed bradycardia and a cranial abdominal mass. The cat was persistently hypoglycaemic (1.2 mmol/l; reference interval [RI] 3.5–5.5 mmol/l) with decreased fructosamine concentration suggesting chronic hypoglycaemia, and decreased insulin concentration excluding insulinoma. Alanine aminotransferase activity was markedly increased (1219.31 U/l; RI 15–60 U/l). On staging CT a large, multilobulated hepatic mass was identified, with no evidence of metastatic disease. After surgical removal serum glucose concentration and heart rate quickly returned to within the RIs. Histopathology was consistent with a solid-to-trabecular, well-differentiated, hepatocellular carcinoma. There was no recurrence of signs or mass during 8 months of follow-up, and the cat was still alive 20 months after surgery. Relevance and novel information Non-islet-cell tumour hypoglycaemia (NICTH) is a rare but life-threatening paraneoplastic syndrome. In humans, hepatocellular carcinoma is the most common epithelial tumour causing NICTH, but these are uncommon in cats, and associated paraneoplastic hypoglycaemia has not been reported. Possible mechanisms include aberrant secretion of big insulin growth factor 2; however, this could not be confirmed. NICTH should be considered in the differential diagnosis of cats with persistent hypoglycaemia.
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Affiliation(s)
- Alexandra Guillen
- Department of Small Animal Clinical Science, Institute of Veterinary Science, University of Liverpool, Neston, UK
| | - Lorenzo Ressel
- Department of Veterinary Pathology and Public Health, Institute of Veterinary Sciences, University of Liverpool, Neston, UK
| | - Riccardo Finotello
- Department of Small Animal Clinical Science, Institute of Veterinary Science, University of Liverpool, Neston, UK
| | - Alexander J German
- Department of Small Animal Clinical Science, Institute of Veterinary Science, University of Liverpool, Neston, UK
| | - Alistair Freeman
- Department of Small Animal Clinical Science, Institute of Veterinary Science, University of Liverpool, Neston, UK
| | - Laura Blackwood
- Department of Small Animal Clinical Science, Institute of Veterinary Science, University of Liverpool, Neston, UK
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Datte K, Guillaumin J, Barrett S, Monnig A, Cooper E. Retrospective evaluation of the use of glucagon infusion as adjunctive therapy for hypoglycemia in dogs: 9 cases (2005-2014). J Vet Emerg Crit Care (San Antonio) 2016; 26:775-781. [DOI: 10.1111/vec.12513] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2014] [Accepted: 02/26/2015] [Indexed: 11/29/2022]
Affiliation(s)
- Kristen Datte
- Department of Veterinary Clinical Sciences; The Ohio State University Veterinary Medical Center; Columbus OH
| | - Julien Guillaumin
- Department of Veterinary Clinical Sciences; The Ohio State University Veterinary Medical Center; Columbus OH
| | - Susan Barrett
- Department of Veterinary Clinical Sciences; The Ohio State University Veterinary Medical Center; Columbus OH
| | - Andrea Monnig
- Department of Veterinary Clinical Sciences; The Ohio State University Veterinary Medical Center; Columbus OH
| | - Edward Cooper
- Department of Veterinary Clinical Sciences; The Ohio State University Veterinary Medical Center; Columbus OH
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Finotello R, Ressel L, Arvigo M, Baroni G, Marchetti V, Romanelli G, Burrow R, Mignacca D, Blackwood L. Canine pancreatic islet cell tumours secreting insulin-like growth factor type 2: a rare entity. Vet Comp Oncol 2014; 14:170-80. [PMID: 24428588 DOI: 10.1111/vco.12085] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2013] [Revised: 12/10/2013] [Accepted: 12/18/2013] [Indexed: 12/19/2022]
Abstract
Insulin-like growth factor type II (IGF-II) is the main cause of non-islet cell tumour hypoglycaemia (NICTH) and insulin is thought to be the only factor causing hypoglycaemia in insulinomas. However, two case reports of pancreatic neuroendocrine tumours (PNETs) producing IGF-II have been previously published: a human and a canine patient. In this study, we investigated clinical, histopathological, immunohistochemical and ultrastructural features, and biological behaviour of canine pancreatic IGF-II-omas, a subgroup of PNETs that has not been previously characterized. Case records of 58 dogs with confirmed PNETs and hypoglycaemia were reviewed: six patients were affected by IGF-II-omas. Surgery was performed in all cases and two dogs had metastases. Four patients remained alive and in remission at 370, 440, 560 and 890 days post-diagnosis; two died of non-tumour-related causes. IGF-II-omas can be differentiated from insulinomas through hypoinsulinaemia, IGF-II positive and insulin negative immunostaining. The prevalence of this neoplasia is low, accounting for just 6% of PNETs.
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Affiliation(s)
- R Finotello
- Small Animal Teaching Hospital, School of Veterinary Sciences, University of Liverpool, Liverpool, UK
| | - L Ressel
- Section of Veterinary Pathology, School of Veterinary Sciences, University of Liverpool, Liverpool, UK
| | - M Arvigo
- Department of Internal Medicine and Medical Specialities, University of Genova, Genova, Italy
| | - G Baroni
- Division of Pathological Anatomy, Department of Surgery and Translational Medicine, University of Florence, Florence, Italy
| | - V Marchetti
- Department of Veterinary Sciences, Veterinary Teaching Hospital, University of Pisa, Pisa, Italy
| | | | - R Burrow
- Small Animal Teaching Hospital, School of Veterinary Sciences, University of Liverpool, Liverpool, UK
| | - D Mignacca
- Clinica Veterinaria Roma Sud, Rome, Italy
| | - L Blackwood
- Small Animal Teaching Hospital, School of Veterinary Sciences, University of Liverpool, Liverpool, UK
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