Feline Endometrial Adenocarcinoma in Females <1 Year Old: A Description of Four Cases

Metastatic Uterine Adenocarcinoma in a Sable Antelope (Hippotragus niger)

Simple Summary

A female sable antelope with a history of gradual loss of body condition was found dead by the owner. Macroscopic examination revealed an enlarged spleen and liver that were covered in white-to-cream-coloured nodules. The uterus also showed a few small, white-to-cream-coloured nodules, with similar nodules present in other parts of the body. Microscopic analysis of sections of the uterus revealed tumour cells with an appearance that was similar those seen in sections of the other tissues. Critically, tumour cells were seen in the lymphatics within the lungs. The tumour cells in the uterus showed positive staining for cytokeratin as did the tumour cells in the sections of other tissues, confirming they were of epithelial origin. In addition, electron microscopy of the uterus and liver showed tumour cells arranged in groups with junctions present between the cells. This confirmed that the tumour cells seen in the liver were the same as those seen in the uterus and were of epithelial origin. Thus, a diagnosis was made of uterine adenocarcinoma with widespread metastasis. This is the first report of uterine adenocarcinoma in a sable antelope.

Abstract

A nine-year-old intact female sable antelope (Hippotragus niger) with a six-week history of gradual loss of body condition was found dead by the owner and presented for autopsy. Macroscopic examination revealed an enlarged spleen and liver with the hepatic and splenic parenchyma showing extensive infiltration with firm, white to cream-coloured nodules. The uterus showed a few small, firm, well-demarcated, white-to-cream-coloured nodules in the uterine body. Similar nodules were present in the mediastinum, parietal pleura, heart, and marrow cavity of the femur. Histological analysis of the uterus revealed densely cellular neoplastic proliferations, forming nests, tubules, and acini within an abundant fibrovascular stroma. The samples from the other tissues revealed neoplastic cells with a similar appearance to those seen in the uterus, also forming nests and acini in a fibrovascular stroma. Importantly, multiple neoplastic cells were also seen in the peribronchiolar lymphatic vessels. The neoplastic cells in the uterine sections showed positive immunohistochemical labelling for cytokeratin, as did the neoplastic cells in the sections of liver and parietal pleura, confirming they were of epithelial origin. In addition, transmission electron microscopy of the uterus and liver showed neoplastic cells arranged in groups surrounded by basement membranes and interspersed with collagen fibres. Junctions were present between the cells, and junctional complexes could be seen at some cell surfaces. This confirmed that the neoplastic cells seen in the liver sample were the same as those seen in the uterine sample and were of epithelial origin. Thus, a diagnosis was made of uterine adenocarcinoma with widespread metastasis. This is the first report of uterine adenocarcinoma in a sable antelope.

Endometrial Disease in Six Cats with Clinical and Histopathological Features Resembling Atypical Endometrial Hyperplasia in Humans

In humans, atypical endometrial hyperplasia (AEH) is considered as a precancerous lesion of endometrial adenocarcinoma (EA), from which it must be distinguished. Precancerous lesions have not been reported in cats with EA. We now document the histopathological features of endometrial lesions in six cats, which histopathologically resembled human AEH and had a good prognosis following ovariohysterectomy. Grossly, one cat presented with papillomatous nodules and three cats had pyometra. Histopathologically, proliferation of endometrial epithelial cells without atypia was observed in all cases. In some regions of the endometrium, cells had increased atypia and were arranged in stratified layers, which formed irregular ducts and papillary structures. No invasive behaviour or vascular invasion was observed. On the basis of these findings, the cats were diagnosed with non-invasive or early-stage adenocarcinoma. Immunohistochemistry for oestrogen receptor and progesterone receptor revealed an inverse correlation with the severity of the endometrial lesions and degree of malignancy of tumour cells. Ki67 labelling revealed that mitotic activity increased as the lesion developed. All cats survived, with a median survival time of 385 days (range: 229-744 days). The distribution of the histopathological endometrial changes and the non-invasive behaviour in these feline cases resemble cases of AEH in humans.

Acute phase proteins and antioxidant responses in queens with pyometra

Acute phase proteins (APP) and biomarkers of oxidative status have proved to be clinically useful biomarkers of pyometra in different species. Despite pyometra is considered one of the most important feline reproductive diseases, information about the APP response and the oxidative status in queens with pyometra is lacking. This study aimed to evaluate the APP and the antioxidant responses at diagnosis and in the post-operative period in feline pyometra. Serum concentrations of serum amyloid A (SAA), haptoglobin (Hp), albumin, total serum thiols (Thiol) and total antioxidant capacity determined by different assays, including trolox equivalent antioxidant capacity (TEAC) assessed by two different methodologies (TEAC1 and TEAC2), ferric reducing ability of plasma (FRAP), and cupric reducing antioxidant capacity (CUPRAC), were determined in 23 queens with pyometra at diagnosis and in 13 healthy control queens submitted to elective ovariohysterectomy. The APP and antioxidants were also evaluated in 11 queens of the pyometra group at days two and 10 after surgery. At diagnosis, queens with pyometra had serum concentrations of SAA, Hp, and FRAP significantly higher (P < 0.001, P < 0.001 and P < 0.05, respectively), and of albumin, Thiol, CUPRAC and TEAC2 significantly lower (P < 0.001, P < 0.001, P < 0.001 and P < 0.01, respectively) than controls. Moreover, concentrations of APP and antioxidants were significantly different (with a tendency to return to physiologic levels) at day 10 after surgery than before surgery. Significant associations were found between APP and antioxidants. According to these results, an APP response and the development of oxidative stress were detected in queens with pyometra. In addition, APP and antioxidants tended to return to physiologic values after surgery in the queens that recovered from the disease. Therefore, our results suggest that APP and selected antioxidants, such as Thiol and CUPRAC, could be potentially useful biomarkers in diagnosis and assessment of the post-operative period in feline pyometra.

Changes in c-erbB-2 Immunoexpression in Feline Endometrial Adenocarcinomas

Human epidermal growth factor receptor type 2 (c-erbB-2), an oncoprotein with potential prognostic marker and therapeutic use, is overexpressed in several human and animal tumours. But information regarding this molecule in feline tumours is scarce. This study aimed to assess the changes in the immunohistochemical expression of c-erbB-2 in feline endometrial adenocarcinomas (FEA) compared to normal endometrium. An immunohistochemistry assay using a specific antibody against c-erbB-2 was performed in FEA samples (n = 34) and in normal endometrium in the follicular (FS; n = 12) and luteal (LS; n = 11) stages. In FEA, the c-erbB-2 immunoexpression was assessed in neoplastic epithelial cells whilst in normal endometria it was individually evaluated in the surface and the superficial and deep glandular epithelia (SE, SGE and DGE, respectively). In FS and in LS, all the epithelia were positive for c-erbB-2; positivity was higher in the SE and the SGE than in DGE. Twenty of the 34 FEA samples (58.8%) were positive for c-erbB-2 immunolabelling. Nevertheless, its expression was higher in all the epithelia in the FS compared to FEA (p ≤ 0.0001) or the LS (p = 0.016). The results presented herein suggest that c-erbB-2 molecule is differently expressed in the feline endometrium through the oestrous cycle and though it may also be involved in feline endometrial carcinogenesis, a question remains unanswered on the importance of additional pathways of epithelial proliferation in the neoplastic changes in feline endometrium.

An immunohistochemical study on the expression of sex steroid receptors, Ki-67 and cytokeratins 7 and 20 in feline endometrial adenocarcinomas

BACKGROUND

Endometrial adenocarcinomas are a rare type of tumour in cats. Though different morphologies have been reported, the most frequent histological type of feline endometrial adenocarcinoma (FEA) is the papillary serous. Characterization of molecular markers expression in FEA may contribute to clarify the pathogenesis of these tumours and to assess the differences between normal endometrium and FEA regarding the expression pattern of several proteins. Therefore, this study aimed to evaluate the immunohistochemical profile of a wide panel of antibodies (specific for ER-α, PR, Ki-67, CK7 and CK20) in twenty-four cases of FEA. Comparisons were made between FEA and feline normal cyclic endometrium in follicular (n = 13) and luteal (n = 10) stages. Except for Ki-67, all other molecular markers were assessed independently for the intensity of immunolabeling and for the percentage of cells expressing the protein.

RESULTS

This study showed that in FEA a loss of expression occurs for ER-α (P ≤ 0.0001) and less markedly also for PR. The lost in sex steroid receptors concerns a decrease in both the proportion of labelled cells and the intensity of immunolabelling (P = 0.002 and P = 0.024, respectively). Proliferative activity, estimated via Ki-67 immunoreaction, significantly increased in FEA as compared to normal endometrium (P ≤ 0.0001). Feline endometrial adenocarcinomas maintained the CK7+/CK20+ status of normal endometrium. However, FEA showed decreased CK7 intensity of labelling compared to normal endometria (P ≤ 0.0001) and loss of CK20 expression, both in intensity (P ≤ 0.0001) and in percentage of positive cells (P = 0.01), compared to normal tissues.

CONCLUSIONS

Data gathered in this study suggest that proliferation in FEA accompanies ER-α down-regulation, possibly following activation of pathways mediated by local growth factors. Moreover, FEA retains combined expression of CK7 and CK20, as evidenced in normal endometrial epithelia, although a decrease in CK7 expression was observed.

Incidence of pyometra in Swedish insured cats

Pyometra is a clinically relevant problem in intact female cats and dogs. The etiology is similar in both animal species, with the disease caused by bacterial infection of a progesterone-sensitized uterus. Here, we studied pyometra in cats with the aim to describe the incidence and probability of developing pyometra based on age and breed. The data used were reimbursed claims for veterinary care insurance or life insurance claims or both in cats insured in a Swedish insurance database from 1999 to 2006. The mean incidence rate (IR) for pyometra was about 17 cats per 10,000 cat years at risk (CYAR). Cats with pyometra were diagnosed at a median age of 4 years and a significant breed effect was observed. The breed with the highest IR (433 cats per 10,000 CYAR) was the Sphynx, and other breeds with IR over 60 cats per 10,000 CYAR were Siberian cat, Ocicat, Korat, Siamese, Ragdoll, Maine coon, and Bengal. Pyometra was more commonly diagnosed with increasing age, with a marked increase in cats older than 7 years. The mean case fatality rate in all cats was 5.7%, which is slightly higher than corresponding reports in dogs of 3% to 4%. Geographical location (urban or rural) did not affect the risk of developing the disease. The present study provides information of incidence and probability of developing pyometra based on age, breed, and urban or rural geographical location. These data may be useful for designing cat breeding programs in high-risk breeds and for future studies of the genetic background of the disease.