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Burti S, Zotti A, Rubini G, Orlandi R, Bargellini P, Bonsembiante F, Contiero B, Bendazzoli M, Banzato T. Contrast-enhanced ultrasound features of adrenal lesions in dogs. Vet Rec 2023; 193:e2949. [PMID: 37138528 DOI: 10.1002/vetr.2949] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 03/02/2023] [Accepted: 03/22/2023] [Indexed: 05/05/2023]
Abstract
BACKGROUND The contrast-enhanced ultrasound (CEUS) features of adrenal lesions are poorly reported in veterinary literature. METHODS Qualitative and quantitative B-mode ultrasound and CEUS features of 186 benign (adenoma) and malignant (adenocarcinoma and pheochromocytoma) adrenal lesions were evaluated. RESULTS Adenocarcinomas (n = 72) and pheochromocytomas (n = 32) had mixed echogenicity with B-mode, and a non-homogeneous aspect with a diffused or peripheral enhancement pattern, hypoperfused areas, intralesional microcirculation and non-homogeneous wash-out with CEUS. Adenomas (n = 82) had mixed echogenicity, isoechogenicity or hypoechogenicity with B-mode, and a homogeneous or non-homogeneous aspect with a diffused enhancement pattern, hypoperfused areas, intralesional microcirculation and homogeneous wash-out with CEUS. With CEUS, a non-homogeneous aspect and the presence of hypoperfused areas and intralesional microcirculation can be used to distinguish between malignant (adenocarcinoma and pheochromocytoma) and benign (adenoma) adrenal lesions. LIMITATIONS Lesions were characterised only by means of cytology. CONCLUSIONS CEUS examination is a valuable tool for distinction between benign and malignant adrenal lesions and can potentially differentiate pheochromocytomas from adenocarcinomas and adenomas. However, cytology and histology are necessary to obtain the final diagnosis.
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Affiliation(s)
- Silvia Burti
- Department of Animal Medicine, Production and Health, University of Padua, Legnaro, Italy
| | - Alessandro Zotti
- Department of Animal Medicine, Production and Health, University of Padua, Legnaro, Italy
| | | | | | | | - Federico Bonsembiante
- Department of Animal Medicine, Production and Health, University of Padua, Legnaro, Italy
| | - Barbara Contiero
- Department of Animal Medicine, Production and Health, University of Padua, Legnaro, Italy
| | - Margherita Bendazzoli
- Department of Animal Medicine, Production and Health, University of Padua, Legnaro, Italy
| | - Tommaso Banzato
- Department of Animal Medicine, Production and Health, University of Padua, Legnaro, Italy
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2
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Niessen SJM. Hypersomatotropism and Other Causes of Insulin Resistance in Cats. Vet Clin North Am Small Anim Pract 2023; 53:691-710. [PMID: 36906467 DOI: 10.1016/j.cvsm.2023.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/11/2023]
Abstract
True insulin resistance should be differentiated from management-related difficulties (eg, short insulin duration, inappropriate insulin injection, inappropriate storage). Hypersomatotropism (HST) is the number one cause of insulin resistance in cats, with hypercortisolism (HC) occupying a more distant second place. Serum insulinlike growth factor-1 is adequate for screening for HST, and screening at the time of diagnosis, regardless of presence of insulin resistance, is advocated. Treatment of either disease centers on removal of the overactive endocrine gland (hypophysectomy, adrenalectomy) or inhibition of the pituitary or adrenal glands by using drugs such as trilostane (HC), pasireotide (HST, HC) or cabergoline (HST, HC).
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Affiliation(s)
- Stijn J M Niessen
- Royal Veterinary College London, UK; Veterinary Specialist Consultations and VIN Europe, Loosdrechtseweg 56, Hilversum 1215 JX, the Netherlands.
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3
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Pey P, Specchi S, Rossi F, Diana A, Drudi I, Zwingenberger AL, Mayhew PD, Pisoni L, Mari D, Massari F, Dalpozzo B, Fracassi F, Nicoli S. Prediction of vascular invasion using a 7-point scale computed tomography grading system in adrenal tumors in dogs. J Vet Intern Med 2022; 36:713-725. [PMID: 35233853 PMCID: PMC8965227 DOI: 10.1111/jvim.16371] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 01/14/2022] [Accepted: 01/14/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Previous studies evaluating the accuracy of computed tomography (CT) in detecting caudal vena cava (CVC) invasion by adrenal tumors (AT) used a binary system and did not evaluate for other vessels. OBJECTIVE Test a 7-point scale CT grading system for accuracy in predicting vascular invasion and for repeatability among radiologists. Build a decision tree based on CT criteria to predict tumor type. METHODS Retrospective observational cross-sectional case study. Abdominal CT studies were analyzed by 3 radiologists using a 7-point CT grading scale for vascular invasion and by 1 radiologist for CT features of AT. ANIMALS Dogs with AT that underwent adrenalectomy and had pre- and postcontrast CT. RESULTS Ninety-one dogs; 45 adrenocortical carcinomas (50%), 36 pheochromocytomas (40%), 9 adrenocortical adenomas (10%) and 1 unknown tumor. Carcinoma and pheochromocytoma differed in pre- and postcontrast attenuation, contralateral adrenal size, tumor thrombus short- and long-axis, and tumor and thrombus mineralization. A decision tree was built based on these differences. Adenoma and malignant tumors differed in contour irregularity. Probability of vascular invasion was dependent on CT grading scale, and a large equivocal zone existed between 3 and 6 scores, lowering CT accuracy to detect vascular invasion. Radiologists' agreement for detecting abnormalities (evaluated by chance-corrected weighted kappa statistics) was excellent for CVC and good to moderate for other vessels. The quality of postcontrast CT study had a negative impact on radiologists' performance and agreement. CONCLUSIONS AND CLINICAL IMPORTANCE Features of CT may help radiologists predict AT type and provide probabilistic information on vascular invasion.
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Affiliation(s)
- Pascaline Pey
- Department of Veterinary Medical ScienceAlma Mater Studiorum, University of BolognaOzzano Emilia (BO)Italy,Antech Imaging Services, IrvineCAUSA
| | - Swan Specchi
- Ospedale Veterinario i Portoni RossiBologna (BO)Italy
| | - Federica Rossi
- Clinica Veterinaria dell'OrologioSasso Marconi (BO)Italy
| | - Alessia Diana
- Department of Veterinary Medical ScienceAlma Mater Studiorum, University of BolognaOzzano Emilia (BO)Italy
| | - Ignazio Drudi
- Department of Statistical SciencesAlma Mater Studiorum, University of BolognaBologna (BO)Italy
| | - Allison L. Zwingenberger
- Department of Surgical & Radiological SciencesSchool of Veterinary Medicine, University of CaliforniaDavisCaliforniaUSA
| | - Philipp D. Mayhew
- Department of Surgical & Radiological SciencesSchool of Veterinary Medicine, University of CaliforniaDavisCaliforniaUSA
| | - Luciano Pisoni
- Department of Veterinary Medical ScienceAlma Mater Studiorum, University of BolognaOzzano Emilia (BO)Italy
| | | | | | - Boris Dalpozzo
- Clinica Veterinaria dell'OrologioSasso Marconi (BO)Italy
| | - Federico Fracassi
- Department of Veterinary Medical ScienceAlma Mater Studiorum, University of BolognaOzzano Emilia (BO)Italy
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4
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Hayes G. Update on Adrenalectomy. Vet Clin North Am Small Anim Pract 2022; 52:473-487. [DOI: 10.1016/j.cvsm.2021.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Lee D, Yun T, Koo Y, Chae Y, Chang D, Yang MP, Kang BT, Kim H. 18F-FDG PET/CT image findings of a dog with adrenocortical carcinoma. BMC Vet Res 2022; 18:15. [PMID: 34980137 PMCID: PMC8722145 DOI: 10.1186/s12917-021-03102-6] [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: 04/07/2021] [Accepted: 12/07/2021] [Indexed: 12/02/2022] Open
Abstract
Background In human medicine, 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET) has been used to differentiate between benign and malignant adrenal tumors and to identify metastases. However, canine adrenocortical carcinomas identified by 18F-FDG PET/computed tomography (CT) have not been reported. Case presentation A 13-year-old, castrated male, Cocker Spaniel dog with severe systolic hypertension exhibited an adrenal mass approximately 3.6 cm in diameter on ultrasonography. There was no evidence of pulmonary metastasis or vascular invasion on thoracic radiography and abdominal ultrasonography, respectively. 18F-FDG PET/CT was performed to identify the characteristics of the adrenal mass and the state of metastasis. One hour after injection of 5.46 MBq/kg 18F-FDG intravenously, the peripheral region of the adrenal mass visually revealed an increased 18F-FDG uptake, which was higher than that of the liver, and the central region of the mass exhibited necrosis. The maximal standardized uptake value (SUV) of the adrenal mass was 3.24; and relative SUV, calculated by dividing the maximal SUV of the adrenal tumor by the mean SUV of the normal liver, was 5.23. Adrenocortical carcinoma was tentatively diagnosed and surgical adrenalectomy was performed. Histopathologic examination of the resected adrenal mass revealed the characteristics of an adrenocortical carcinoma. After adrenalectomy, systolic blood pressure reduced to below 150 mmHg without any medication. Conclusion This is the first case report of 18F-FDG PET/CT findings in a dog with suspected adrenocortical carcinoma and may provide valuable diagnostic information for adrenocortical carcinoma in dogs.
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Affiliation(s)
- Dohee Lee
- Laboratory of Veterinary Internal Medicine, College of Veterinary Medicine, Chungbuk National University, Cheongju, Chungbuk, 28644, South Korea
| | - Taesik Yun
- Laboratory of Veterinary Internal Medicine, College of Veterinary Medicine, Chungbuk National University, Cheongju, Chungbuk, 28644, South Korea
| | - Yoonhoi Koo
- Laboratory of Veterinary Internal Medicine, College of Veterinary Medicine, Chungbuk National University, Cheongju, Chungbuk, 28644, South Korea
| | - Yeon Chae
- Laboratory of Veterinary Internal Medicine, College of Veterinary Medicine, Chungbuk National University, Cheongju, Chungbuk, 28644, South Korea
| | - Dongwoo Chang
- Department of Veterinary Imaging, Veterinary Teaching Hospital, College of Veterinary Medicine, Cheongju, Chungbuk, 28644, South Korea
| | - Mhan-Pyo Yang
- Laboratory of Veterinary Internal Medicine, College of Veterinary Medicine, Chungbuk National University, Cheongju, Chungbuk, 28644, South Korea
| | - Byeong-Teck Kang
- Laboratory of Veterinary Internal Medicine, College of Veterinary Medicine, Chungbuk National University, Cheongju, Chungbuk, 28644, South Korea
| | - Hakhyun Kim
- Laboratory of Veterinary Internal Medicine, College of Veterinary Medicine, Chungbuk National University, Cheongju, Chungbuk, 28644, South Korea.
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Cervone M, Blondel M, Moissonnier P, Chabanne L. Multiple endocrine neoplasia type 2‐like syndrome in a crossbred dog. VETERINARY RECORD CASE REPORTS 2021. [DOI: 10.1002/vrc2.61] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Mario Cervone
- Département clinique des animaux de compagnie de loisir et de sport Campus vétérinaire de Lyon Université de Lyon, VetAgro Sup Marcy l'Etoile France
| | - Margaux Blondel
- Surgery Unit, Lyon Veterinary Teaching Hospital Université de Lyon VetAgro Sup Marcy l'Etoile France
| | - Pierre Moissonnier
- Surgery Unit, Lyon Veterinary Teaching Hospital Université de Lyon VetAgro Sup Marcy l'Etoile France
| | - Luc Chabanne
- Département clinique des animaux de compagnie de loisir et de sport Campus vétérinaire de Lyon Université de Lyon, VetAgro Sup Marcy l'Etoile France
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Abstract
PRACTICAL RELEVANCE Abdominal ultrasound plays a vital role in the diagnostic work-up of many cats presenting to general and specialist practitioners. Ultrasound examination of the adrenal glands can provide important information pertaining to several conditions including hyperaldosteronism and hyperadrenocorticism. CLINICAL CHALLENGES Despite ultrasonography being a commonly used modality, many practitioners are not comfortable performing an ultrasound examination or interpreting the resulting images. Even for the experienced ultrasonographer, differentiating between incidental findings, such as adrenal mineralisation, and clinically significant pathological changes can be challenging. AIM This review, part of an occasional series on feline abdominal ultrasonography, discusses the ultrasonographic examination of the normal and diseased adrenal glands. Aimed at general practitioners who wish to improve their knowledge of and confidence in feline abdominal ultrasound, this review is accompanied by high-resolution images and videos available online as supplementary material. EQUIPMENT Ultrasound facilities are readily available to most practitioners, although the use of ultrasonography as a diagnostic tool is highly dependent on operator experience. EVIDENCE BASE Information provided in this article is drawn from the published literature and the author's own clinical experience.
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Affiliation(s)
- Sally Griffin
- BVSc, Ce666rtAVP, DipECVDI, Radiology Department, Willows Veterinary Centre and Referral Service, Highlands Road, Shirley, Solihull B90 4NH, UK
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Nagumo T, Ishigaki K, Yoshida O, Iizuka K, Tamura K, Sakurai N, Terai K, Seki M, Edamura K, Asano K. Utility of contrast-enhanced ultrasound in differential diagnosis of adrenal tumors in dogs. J Vet Med Sci 2020; 82:1594-1601. [PMID: 32968037 PMCID: PMC7719881 DOI: 10.1292/jvms.20-0427] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
This prospective case study aimed to clarify the clinical significance of contrast-enhanced ultrasound (CEUS) for the differential diagnosis of canine adrenal tumors. Forty-three client-owned dogs with adrenal tumors were included. All dogs underwent CEUS, which was evaluated qualitatively and quantitatively. The peak signal intensity (PI), time to peak signal intensity (TPI), mean transit time (MTT), upslope, and downslope were calculated for each time-intensity curve. The histopathological diagnosis of each resected mass was compared with the CEUS findings and parameters. Enhancement distribution, vascularity, tortuous nourishing vessels, enhancement pattern, and late-phase enhancement did not differ significantly between adrenal cortical adenoma (CA), adenocarcinoma (CAC), and pheochromocytoma (PHEO) in qualitative assessment. In PHEO, the TPI was significantly more rapid compared with that in CA (P=0.0287) and CAC (P=0.0404). The MTT in PHEO was significantly shorter than that in CA (P=0.0016) and CAC (P=0.0003). Upslope in PHEO was larger than that in CAC (P=0.0406). Downslope in PHEO was significantly larger than that in CA (P=0.0048) and CAC (P=0.0018). A receiver operating characteristic curve analysis demonstrated that the area under the MTT curve yielded 0.91 for distinguishing PHEO from adrenocortical tumors in dogs; an MTT cut-off value less than 6,225 msec yielded a sensitivity of 69%, specificity of 94%, and likelihood ratio of 12.46. CEUS appears to be clinically applicable for the differential diagnosis between cortical and medullary origins of primary adrenal tumors in dogs.
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Affiliation(s)
- Takahiro Nagumo
- Laboratory of Veterinary Surgery, Department of Veterinary Medicine, College of Bioresource Sciences, Nihon University, 1886 Kameino, Fujisawa, Kanagawa 252-0880, Japan
| | - Kumiko Ishigaki
- Laboratory of Veterinary Surgery, Department of Veterinary Medicine, College of Bioresource Sciences, Nihon University, 1886 Kameino, Fujisawa, Kanagawa 252-0880, Japan
| | - Orie Yoshida
- Laboratory of Veterinary Surgery, Department of Veterinary Medicine, College of Bioresource Sciences, Nihon University, 1886 Kameino, Fujisawa, Kanagawa 252-0880, Japan
| | - Keigo Iizuka
- Laboratory of Veterinary Surgery, Department of Veterinary Medicine, College of Bioresource Sciences, Nihon University, 1886 Kameino, Fujisawa, Kanagawa 252-0880, Japan
| | - Kei Tamura
- Laboratory of Veterinary Surgery, Department of Veterinary Medicine, College of Bioresource Sciences, Nihon University, 1886 Kameino, Fujisawa, Kanagawa 252-0880, Japan
| | - Naoki Sakurai
- Laboratory of Veterinary Surgery, Department of Veterinary Medicine, College of Bioresource Sciences, Nihon University, 1886 Kameino, Fujisawa, Kanagawa 252-0880, Japan
| | - Kazuyuki Terai
- Laboratory of Veterinary Surgery, Department of Veterinary Medicine, College of Bioresource Sciences, Nihon University, 1886 Kameino, Fujisawa, Kanagawa 252-0880, Japan
| | - Mamiko Seki
- Laboratory of Veterinary Surgery, Department of Veterinary Medicine, College of Bioresource Sciences, Nihon University, 1886 Kameino, Fujisawa, Kanagawa 252-0880, Japan
| | - Kazuya Edamura
- Laboratory of Veterinary Surgery, Department of Veterinary Medicine, College of Bioresource Sciences, Nihon University, 1886 Kameino, Fujisawa, Kanagawa 252-0880, Japan
| | - Kazushi Asano
- Laboratory of Veterinary Surgery, Department of Veterinary Medicine, College of Bioresource Sciences, Nihon University, 1886 Kameino, Fujisawa, Kanagawa 252-0880, Japan
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Pey P, Diana A, Rossi F, Mortier J, Kafka U, Veraa S, Groth A, MacLellan M, Marin C, Fracassi F. Safety of percutaneous ultrasound-guided fine-needle aspiration of adrenal lesions in dogs: Perception of the procedure by radiologists and presentation of 50 cases. J Vet Intern Med 2020; 34:626-635. [PMID: 32159260 PMCID: PMC7096638 DOI: 10.1111/jvim.15743] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Accepted: 02/14/2020] [Indexed: 01/30/2023] Open
Abstract
Background Percutaneous ultrasound (US)‐guided fine‐needle aspiration (FNA) of adrenal gland lesions is controversial in veterinary medicine. Objective To evaluate the frequency and radiologists' perception of the risk of the procedure as well as determining the incidence of complications. Methods Retrospective study. A first survey was submitted by e‐mail to all board‐certified radiologists of the American College of Veterinary Radiology (ACVR) and European College of Veterinary Diagnostic Imaging (ECVDI). A second survey was sent to radiologists who declared having performed the procedure at least once in their career (observational cross‐sectional case study). Results The first survey was sent to 977 diplomates and answered by 138. Of 138 diplomates, 40 currently performed the procedure and 98 did not; 44 of the 98 gave the hypertensive crisis risk in pheochromocytoma as a reason. To the second survey, 12 of 65 responded positively; 50 dogs with 58 lesions were recruited, including 23 pheochromocytomas. Complications were reported in 4 of 50 dogs; 3 hemorrhages (1 mild and 1 moderate) and 1 death from acute respiratory distress syndrome (possibly related to laryngeal paralysis). No hypertensive crisis was reported. There was no relationship between the method of FNA/type of needle used and occurrence of complications. Based on the recollection of these 65 radiologists, who performed approximately 200 FNA of adrenal lesions, a death rate of approximately 1% was estimated. Conclusions and Clinical Importance Percutaneous US‐guided FNA of adrenal lesions can be considered a minimally risky procedure, despite the negative perception by radiologists.
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Affiliation(s)
- Pascaline Pey
- Department of Veterinary Medical Science, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Alessia Diana
- Department of Veterinary Medical Science, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | | | - Jeremy Mortier
- Service of Diagnostic Imaging, Small Animal Teaching Hospital, Institute of Veterinary Science, University of Liverpool, Neston, United Kingdom
| | - Ulrike Kafka
- James Cook University, Townsville, Queensland, Australia
| | - Stefanie Veraa
- Division of Diagnostic Imaging, Faculty of Veterinary Medicine, Utrecht, The Netherlands
| | - Anna Groth
- North Downs Specialist Referrals, Bletchingley, United Kingdom
| | | | - Chiara Marin
- Department of Veterinary Medical Science, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Federico Fracassi
- Department of Veterinary Medical Science, Alma Mater Studiorum, University of Bologna, Bologna, Italy
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10
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Favorable outcome of pheochromocytoma in a dog with atypical Cushing's syndrome and diabetes mellitus following medical treatment: a case report. BMC Vet Res 2020; 16:3. [PMID: 31900158 PMCID: PMC6942262 DOI: 10.1186/s12917-019-2225-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 12/25/2019] [Indexed: 12/21/2022] Open
Abstract
Background Pheochromocytoma (PCC) has poor prognosis and adrenalectomy is hard to be performed, in case of caudal vena cava invasion. The long-term administration of phenoxybenzamine in PCC has not been reported in dogs. Case presentation A 14-year-old castrated male Poodle dog presented with an abdominal mass. On physical examination, hypertension, increased lens opacity, calcinosis cutis, generalized alopecia, and systolic murmur were observed. Serum chemistry and urinalysis profiles revealed hyperglycemia, hypercholesterolemia, elevated liver enzymes, and glucosuria. Abdominal ultrasonography showed a right adrenal mass with invasion of the caudal vena cava, which was cytologically diagnosed as suspected PCC. An adrenal mass (width × height × length, 28 × 26 × 48 mm3) was found on computed tomography and diagnosed as PCC with increased plasma metanephrines and normetanephrines. An adrenocorticotropin hormone stimulation test showed elevated adrenal hormones (androstenedione, estradiol, progesterone, and 17-OH progesterone) with normal cortisol, compatible with atypical Cushing’s syndrome. The dog was managed with trilostane, phenoxybenzamine, and insulin therapy. Glycosylated hemoglobin and fructosamine levels gradually decreased, and hypertension resolved. In the 10-month follow-up period, the liver enzymes levels gradually decreased, and the clinical signs of the dog were well-controlled without deterioration. Conclusions This case report describes long-term medical management without adrenalectomy of PCC complicated with atypical Cushing’s syndrome and DM.
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Heinrich DA, Avery AC, Henson MS, Overmann JA, Rendahl AK, Walz JZ, Seelig DM. Cytology and the cell block method in diagnostic characterization of canine lymphadenopathy and in the immunophenotyping of nodal lymphoma. Vet Comp Oncol 2019; 17:365-375. [PMID: 31012996 DOI: 10.1111/vco.12484] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 04/10/2019] [Accepted: 04/12/2019] [Indexed: 12/24/2022]
Abstract
Minimally invasive techniques used to evaluate canine peripheral lymphadenopathy (PLN), including fine needle aspiration biopsy with cytological evaluation (FNAB-C) and flow cytometry (FC), have benefits and limitations. The cell block (CB) method is an alternate processing technique in which fine needle aspirate biopsy samples are concentrated, fixed, and embedded in paraffin for routine histological processing/staining. Utilizing three observers, we determined the diagnostic value of the CB in evaluating canine PLN across six categories (non-diagnostic, reactive, inflammatory/infectious, probable lymphoma and lymphoma, metastatic neoplasia) and correlated findings to immunophenotypic and clonal antigen receptor rearrangement results in canine nodal lymphoma. Eighty-five paired FNAB-C and CB samples were evaluated from canine patients presenting to the University of Minnesota Veterinary Oncology or Internal Medicine services. Diagnostic quality samples were obtained in 55/85 (65%) CB and 81/85 (95%) FNAB-C samples, respectively, and nodal pathology impacted CB diagnostic yield. Overall percent agreement between diagnostic-quality FNAB-C and CB samples was 86%, but increased to 95% if the categories of lymphoma and probable lymphoma were combined. There was 100% agreement for both the diagnoses of metastatic neoplasia and reactive lymph nodes and 92% agreement for the diagnosis of lymphoma/probable lymphoma. Using immunohistochemistry (IHC), CB samples correctly immunophenotyped 22/23 (96%) cases of B-cell lymphoma, but only 1/6 (17%) cases of T-cell lymphoma. IHC was not completed on nine cases of lymphoproliferative disease because of insufficient cellularity. When the CB method (CBM) yielded diagnostic quality samples there was good to excellent agreement with FNAB-C samples and CB samples were suitable for some IHC tests.
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Affiliation(s)
- Daniel A Heinrich
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, University of Minnesota, St. Paul, Minnesota
| | - Anne C Avery
- Department of Microbiology, Immunology, and Pathology and the Flint Animal Cancer Center, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, Colorado
| | - Michael S Henson
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, University of Minnesota, St. Paul, Minnesota
| | - Jed A Overmann
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, University of Minnesota, St. Paul, Minnesota
| | - Aaron K Rendahl
- Department of Veterinary Biomedical Sciences, University of Minnesota, St. Paul, Minnesota
| | - Jillian Z Walz
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, University of Minnesota, St. Paul, Minnesota
| | - Davis M Seelig
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, University of Minnesota, St. Paul, Minnesota
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12
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Béguin JS, Chevallier L, Rannou B, Fontaine JJ, Benchekroun G. Primary hypoaldosteronism in a dog with pituitary and adrenal T-cell lymphoma. J Small Anim Pract 2018; 61:588-592. [PMID: 30390298 DOI: 10.1111/jsap.12955] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2018] [Revised: 07/19/2018] [Accepted: 09/28/2018] [Indexed: 11/24/2022]
Abstract
A 7-year-old mixed breed dog was presented with a 2-week history of vomiting, diarrhoea, weakness and loss of appetite. Initial laboratory tests revealed hyponatraemia and hyperkalaemia consistent with hypoadrenocorticism. Basal plasma cortisol and adrenocorticotropic hormone concentrations were not suggestive of primary hypoadrenocorticism but the aldosterone concentration was undetectable. Abdominal ultrasound scan showed a mass within the left kidney and a nodular enlargement of the left adrenal gland. Cytological analysis revealed a large granular lymphoma. The dog died 17 days later. Post mortem histological and immunohistochemical examinations revealed a diffuse large granular T-cell lymphoma involving the mediastinal lymph node, kidneys, pancreas, adrenal and pituitary glands.
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Affiliation(s)
- J S Béguin
- Department of Internal Medicine, Ecole nationale vétérinaire d'Alfort, Paris, F-94700, France
| | - L Chevallier
- Department of Pathology, Ecole nationale vétérinaire d'Alfort, Paris, F-94700, France
| | - B Rannou
- Department of Biochemistry, VetAgro Sup Campus Vétérinaire de Lyon, Université de Lyon, 69280, Lyon, France
| | - J J Fontaine
- Department of Pathology, Ecole nationale vétérinaire d'Alfort, Paris, F-94700, France
| | - G Benchekroun
- Department of Internal Medicine, Ecole nationale vétérinaire d'Alfort, Paris, F-94700, France
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Attipa C, Beck S, Lipscomb V, English K, Carvalho S, Kiupel M, Szladovits B, Peters LM. Aldosterone-producing adrenocortical carcinoma with myxoid differentiation in a cat. Vet Clin Pathol 2018; 47:660-664. [PMID: 30240029 DOI: 10.1111/vcp.12658] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2018] [Accepted: 04/30/2018] [Indexed: 01/20/2023]
Abstract
A 10-year-old male neutered Persian cat was presented with an abdominal mass and history of weakness. Blood smear examination found marked elliptocytosis, and serum biochemical analysis revealed hypokalemia, hypochloremia, increased creatine kinase activity, and a high aldosterone concentration. Cytologic examination of the mass revealed neoplastic endocrine cells with moderate criteria of malignancy, favoring adrenocortical neoplasia. The adrenal mass was surgically excised and histologically characterized by lobules of mildly pleomorphic, polygonal neoplastic cells with moderate to abundant, occasionally granular, eosinophilic cytoplasm. Lobules were separated by fine fibrovascular trabeculae, and numerous cystic cavities containing amorphous eosinophilic material that stained positive with Alcian blue and periodic acid-Schiff were seen. Neoplastic cells were multifocally positive for cytochrome P450 aldosterone synthase. Based on clinicopathologic and immunohistochemical findings the present case was diagnosed as an aldosterone-producing adrenocortical carcinoma with myxoid differentiation. While this entity has not been reported in cats, myxoid differentiation of adrenocortical carcinomas has been found in other species and can pose a major diagnostic challenge on microscopic examination.
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Affiliation(s)
- Charalampos Attipa
- Pathobiology and Population Sciences, Royal Veterinary College, University of London, Hatfield, Hertfordshire, UK
| | - Samuel Beck
- Pathobiology and Population Sciences, Royal Veterinary College, University of London, Hatfield, Hertfordshire, UK
| | - Victoria Lipscomb
- Clinical Science and Services, Royal Veterinary College, University of London, Hatfield, Hertfordshire, UK
| | - Kate English
- Pathobiology and Population Sciences, Royal Veterinary College, University of London, Hatfield, Hertfordshire, UK
| | - Sofia Carvalho
- Clinical Science and Services, Royal Veterinary College, University of London, Hatfield, Hertfordshire, UK
| | - Matti Kiupel
- Diagnostic Center for Population and Animal Health, Michigan State University, Lansing, Michigan
| | - Balázs Szladovits
- Pathobiology and Population Sciences, Royal Veterinary College, University of London, Hatfield, Hertfordshire, UK
| | - Laureen M Peters
- Pathobiology and Population Sciences, Royal Veterinary College, University of London, Hatfield, Hertfordshire, UK
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14
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Sumner JA, Lacorcia L, Rose AM, Woodward AP, Carter JE. Clinical safety of percutaneous ultrasound-guided fine-needle aspiration of adrenal gland lesions in 19 dogs. J Small Anim Pract 2018; 59:357-363. [DOI: 10.1111/jsap.12829] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Revised: 12/15/2017] [Accepted: 01/22/2018] [Indexed: 11/30/2022]
Affiliation(s)
- J. A. Sumner
- Melbourne Veterinary School, Faculty of Veterinary and Agricultural Sciences; The University of Melbourne; Melbourne Victoria 3030 Australia
| | - L. Lacorcia
- Melbourne Veterinary School, Faculty of Veterinary and Agricultural Sciences; The University of Melbourne; Melbourne Victoria 3030 Australia
| | - A. M. Rose
- Melbourne Veterinary School, Faculty of Veterinary and Agricultural Sciences; The University of Melbourne; Melbourne Victoria 3030 Australia
- School of Veterinary Science, Faculty of Science; The University of Queensland; Gatton Queensland 4343 Australia
| | - A. P. Woodward
- Melbourne Veterinary School, Faculty of Veterinary and Agricultural Sciences; The University of Melbourne; Melbourne Victoria 3030 Australia
| | - J. E. Carter
- Melbourne Veterinary School, Faculty of Veterinary and Agricultural Sciences; The University of Melbourne; Melbourne Victoria 3030 Australia
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15
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Boland LA, Barrs VR. Peculiarities of feline hyperadrenocorticism: Update on diagnosis and treatment. J Feline Med Surg 2017; 19:933-947. [PMID: 28838299 PMCID: PMC11128894 DOI: 10.1177/1098612x17723245] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Practical relevance: Hyperadrenocorticism (HAC) is a relatively uncommon endocrinopathy of older cats, with a mean age at diagnosis of 10 years. In addition to pituitary-dependent and adrenal-dependent hypercortisolism, clinical signs of HAC can result from adrenal sex steroid-producing tumours. Clinical challenges: While HAC in cats has many similarities to canine HAC, there are key differences in presentation, diagnosis and response to therapy. Most, but not all, cats with HAC have concurrent diabetes mellitus, which is often insulin resistant. Up to a third of cats with HAC have extreme skin fragility and are at high risk of debilitating iatrogenic skin tears during diagnostic or therapeutic interventions. Infections of the skin and nail beds, and urinary, respiratory and gastrointestinal tract, secondary to cortisol-induced immune suppression, are also common. Cats respond differently to dogs to adrenal function tests including adrenocorticotropic hormone (ACTH) stimulation and dexamethasone suppression tests; a 10-fold higher dose of dexamethasone is recommended in cats to screen for HAC. Curative treatment options include adrenalectomy or transsphenoidal hypophysectomy. Radiation or medical treatment may improve clinical signs. The response to mitotane therapy is poor. While trilostane is the medical treatment of choice based on retrospective studies, investigations into the pharmacokinetics of this drug in cats are lacking. Global importance: Feline HAC occurs worldwide and is not associated with any purebreed predisposition. Although uncommon, adrenal sex steroid-producing tumours have a higher prevalence in cats than in dogs. Evidence base: The information in this review is drawn from over 180 reported cases of feline HAC. Reports investigating clinical presentation, clinicopathological findings and treatment outcomes are observational, retrospective multiple case series (EBM grade III) or single case reports (EBM grade IV). While most endocrine testing studies for diagnosis are cohort controlled analytical studies (EBM grade III), prospective, randomised, placebo-controlled studies have been performed (EBM grade I).
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Affiliation(s)
- Lara A Boland
- Valentine Charlton Cat Centre, Sydney School of Veterinary Science, Faculty of Science, University of Sydney, NSW, Australia
| | - Vanessa R Barrs
- Valentine Charlton Cat Centre, Sydney School of Veterinary Science, Faculty of Science, and Marie Bashir Institute for Infectious Diseases and Biosecurity, University of Sydney, NSW, 2006, Australia
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16
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Abstract
CASE SUMMARY Herein a drug-resistant IgG-lambda-type multiple myeloma associated with probable phaeochromocytoma in a cat is described. A 12-year-old cat presented with weakness, weight loss, progressive blindness and open-mouth breathing, in addition to polyuria and polydipsia of 2 months' duration. Abdominal ultrasonography revealed a left adrenal mass. Phaeochromocytoma was suspected on the basis of cytology and was associated with systemic hypertension. Biochemistry showed hyperproteinaemia. Serum protein electrophoresis revealed a narrow spike in the gamma region, identified as IgG lambda type at immunoelectrophoresis. Bone marrow cytology revealed an infiltrate with numerous mature plasma cells. The cat was resistant to two different drugs for multiple myeloma and was euthanased 6 months later because of anorexia and persistent poor general condition. RELEVANCE AND NOVEL INFORMATION This is the first clinical description of multiple myeloma associated with a suspected phaeochromocytoma in a cat.
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17
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Sapierzyński R, Czopowicz M, Ostrzeszewicz M. Factors affecting the diagnostic utility of canine and feline cytological samples. J Small Anim Pract 2016; 58:73-78. [DOI: 10.1111/jsap.12598] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Revised: 07/28/2016] [Accepted: 09/04/2016] [Indexed: 01/04/2023]
Affiliation(s)
- R. Sapierzyński
- Department of Pathology and Veterinary Diagnostics; Faculty of Veterinary Medicine, Warsaw University of Life Sciences (SGGW); Warsaw 02-766 Poland
| | - M. Czopowicz
- Laboratory of Veterinary Epidemiology and Economics; Faculty of Veterinary Medicine, Warsaw University of Life Sciences (SGGW); Warsaw 02-766 Poland
| | - M. Ostrzeszewicz
- Department of Small Animal Diseases With Clinic, Faculty of Veterinary Medicine; Warsaw University of Life Sciences (SGGW); Warsaw 02-766 Poland
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18
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Robat C, Houseright R, Murphey J, Sample S, Pinkerton M. Paraganglioma, pituitary adenoma, and osteosarcoma in a dog. Vet Clin Pathol 2016; 45:484-9. [DOI: 10.1111/vcp.12376] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Cecilia Robat
- UW Madison School of Veterinary Medicine; Madison WI USA
| | | | | | - Saundra Sample
- UW Madison School of Veterinary Medicine; Madison WI USA
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19
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Wünsche S, Rosati M, Matiasek K. Diagnostic yield and accuracy of postmortem cytological sampling from the brain surface of animals with neurological abnormalities. Vet J 2016; 211:57-63. [PMID: 27009475 DOI: 10.1016/j.tvjl.2016.02.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Revised: 02/25/2016] [Accepted: 02/27/2016] [Indexed: 11/28/2022]
Abstract
Clarification of central nervous system (CNS) disorders frequently requires pathological investigation via brain biopsy or postmortem examination. The use of cytology is usually restricted to diagnosis of mass lesions and septic meningitis. The value of brain cytology at postmortem examination has not been explored sufficiently. This study aimed to clarify the diagnostic value of meningeal imprint cytology at postmortem brain examination. Samples were taken from cerebrum and cerebellum and stained with the modified Wright stain and with haematoxylin-eosin. The slides were evaluated and findings were compared to brain histopathology with respect to resemblance, discrepancy and diagnostic validity. The study included 169 cases involving multiple animal species. Histopathology identified inflammatory disorders in 60/135 (44.4%) cases, neoplasia in 19/135 (14.1%) and non-infiltrative diseases in 56/135 (41.5%). Cytology revealed pathological changes in 79/135 (58.5%) of these cases. The histopathological diagnosis was reproduced in 57/135 (42.2%) cases, 43/57 (75.4%) of which were inflammatory. Non-diagnostic cases included 16/135 (11.9%) with sub-diagnostic cytological features and 3/135 (2.2%) with unclear phenomena. In 55/135 (40.7%) of brains with histological lesions, cytology proved inferior, providing negative results, including 40/55 (72.7%) cases with non-infiltrative diseases, 12/55 (21.8%) with inflammation and 3/55 (5.5%) with neoplasia. Conversely, 3/34 (8.8%) of controls showed cytological abnormalities. Cytological sampling from CNS adds to the sensitivity of neuropathological investigations, even if restricted to non-invasive surface imprints. The diagnostic accuracy exceeds 40%, with infiltrative diseases being five times more likely to be detected than non-infiltrative diseases.
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Affiliation(s)
- S Wünsche
- Section of Clinical and Comparative Neuropathology, Institute of Veterinary Pathology, Centre for Clinical Veterinary Medicine, Ludwig Maximilians University of Munich, Veterinaerstr. 13, D-80539 Munich, Germany
| | - M Rosati
- Section of Clinical and Comparative Neuropathology, Institute of Veterinary Pathology, Centre for Clinical Veterinary Medicine, Ludwig Maximilians University of Munich, Veterinaerstr. 13, D-80539 Munich, Germany
| | - K Matiasek
- Section of Clinical and Comparative Neuropathology, Institute of Veterinary Pathology, Centre for Clinical Veterinary Medicine, Ludwig Maximilians University of Munich, Veterinaerstr. 13, D-80539 Munich, Germany.
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