Ultrasonographic findings in the bladder of cattle at different stages of evolution of bovine enzootic hematuria in Brazil

Despite the diagnostic capacity of ultrasonography (US) in cases of bovine enzootic hematuria (BEH), it has been underused in the medical clinic for ruminants. Studies comparing ultrasound findings in healthy animals (HA) with subclinical (SCH) and clinical (CH) BEH are scarce in the literature. As a result, the present work aims to describe the US findings of cattle at different stages of BEH evolution, evaluating the diagnostic capacity and precocity of the technique. The study was carried out on five rural properties in the municipalities of Rio Preto and Bom Jardim de Minas - MG, Brazil, using 46 dairy cattle, females over 18 months of age, evaluated and classified as G1/CH, G2/SCH and G3/HA, according to history, clinical examination and urinalysis, with subsequent ultrasound analysis of the bladder. The mean bladder wall thickness was 36.50 mm in G1/CH, 33.53 mm in G2/SCH and 37.93 mm in G3/HA. Irregular walls were observed in 53.33 % (8/15) of G1/CH, 27 0.78 % (5/18) of G2/SCH and 38.46 % (5/13) of G3/HA. Loss of the architecture of the urothelium layers was observed in 53.33 % (8/15) of G1/CH, 33.33 % (6/18) of G2/SCH and 38.46 % (5/13) of G3/HA. Multifocal and Grade I lesion were the most common. Ultrasonography allowed the identification of lesions in 38.46 % of animals that did not present hematuria and in 33.33 % of animals that presented occult blood and proved to be an efficient technique for detecting pre-clinical cases of BEH, allowing easy identification. and early onset of BEH cases.

Usefulness of squash preparation cytology in the diagnosis of canine urinary bladder carcinomas

BACKGROUND

Epithelial cells show varying degrees of cytologic atypia in dogs with nonmalignant lesions (NML) and carcinomas (ubC) of the bladder, making histopathologic examination necessary for a definitive diagnosis.

OBJECTIVES

This study aimed to investigate the diagnostic performance of squash preparation cytology and identify several cytomorphologic features of ubC to assist in diagnoses.

METHODS

Squash preparations were made and reviewed in dogs that underwent transurethral cystoscopy. The results were compared with histopathologic diagnoses. Two cytopathologists performed blinded assessments using a scoring system established for 11 cytologic features, including the presence of macronuclei, abnormal nucleoli, atypical mitoses, signet ring cells, multinucleated cells, nuclear molding, anisokaryosis, cytoplasmatic microvacuolization, cell arrangements, and neutrophil and lymphocyte infiltrations. Based on cytologic and histopathologic diagnoses, dogs were divided into ubC and NML groups. Associations between cytologic and histopathologic diagnoses were investigated, and agreement between the cytopathologists was calculated. Cytologic features were analyzed with multivariate logistic regression models. The performance of predictors in the final model was evaluated in terms of Sensitivity (Se), Specificity (Sp), accuracy, positive predictive value (PPV), negative predictive value (NPV), likelihood ratio positive (LR+), and negative (LR-) values, and the diagnostic odds ratio (DOR).

RESULTS

Forty-four dogs diagnosed with ubC, and 17 with NML were included in the study. Cytologic and histopathologic diagnoses were significantly associated with each cytopathologist. There was an almost perfect agreement between cytopathologists (κ = 0.88). The absence of neutrophilic infiltration, the presence of multinucleated cells, and nuclear molding were associated with ubC; using a combination of these features in parallel testing resulted in Se = 0.98, Sp = 0.65, accuracy = 0.89, PPV = 0.88, NPV = 0.92, LR + =2.77, LR- = 0.04, and DOR = 7.7.

CONCLUSIONS

Squash preparation cytology could be a reliable technique to diagnose ubC in dogs. The best diagnostic combination was the absence of neutrophilic infiltration, multinucleated cells, and nuclear molding.

Prolonged Survival Following Treatment of Histiocytic Sarcoma of the Canine Urinary Bladder

A 9 yr old castrated male miniature schnauzer was diagnosed histopathologically with a mucosal histiocytic sarcoma of the urinary bladder apex, biopsied at the time of surgical cystotomy. Sequential adjuvant chemotherapy, including both lomustine (discontinued because of adverse effects) and then doxorubicin, were employed. A response to both agents was documented. Ultimately, a complete response was achieved following completion of the doxorubicin protocol. A complete response persisted 768 days following diagnosis at last follow-up. Histiocytic sarcoma of the urinary bladder remains a rare diagnosis in veterinary medicine. Only one previous case report is currently published. This case contrasts with the previous case report, which reported a survival of only 2 mo.

Prognostic role of ΔNp63 expression in canine transitional cell carcinoma of the urinary bladder

Background

Decreased p63 protein expression in canine transitional cell carcinoma (TCC) of the urinary bladder is associated with vascular invasion of the tumor, metastasis, and shortened survival. ΔNp63, an isoform of p63, is downregulated in high-grade invasive urothelial carcinoma in humans. However, the clinical significance of ΔNp63 expression in canine urinary bladder tumors is unknown. Therefore, it is essential to investigate ΔNp63 expression patterns in TCC, the most common urinary bladder tumor in dogs.

Aim

This study aimed to evaluate the expression and role of ΔNp63 in canine TCC of the urinary bladder.

Methods

ΔNp63 expression was compared between the normal canine urinary bladder, polypoid cystitis, and TCC. The correlation of ΔNp63 expression with histopathological and clinical findings were further evaluated, and its usefulness as a prognostic factor was examined.

Results

We observed that ΔNp63 was highly expressed in dogs' normal urinary bladder and polypoid cystitis, and its expression levels were low in TCC. Furthermore, low levels of ΔNp63 expression were associated with vascular invasion, metastasis, and shortened survival in dogs with TCC.

Conclusion

These results indicate that ΔNp63 expression could serve as a valuable biomarker for invasion, metastasis, and prognosis of canine TCC of the urinary bladder.

Fall time may be a reliable discriminator between neoplastic and non-neoplastic urinary bladder lesions in dogs undergoing contrast-enhanced ultrasound: a pilot study

Contrast-enhanced ultrasound (CEUS) can provide quantitative information on enhancement patterns and perfusion of lesions, based on time-intensity curves (TICs). No published studies have compared CEUS parameters in neoplastic and non-neoplastic urinary bladder lesions in dogs. The aim of the current prospective, pilot study was to quantitatively characterize the CEUS pattern of neoplastic and non-neoplastic urinary bladder lesions in dogs, assessing the influence of contrast arrival time (CAT) on the final appearance of the curves. Fourteen dogs with cyto-histopathological diagnoses were included (seven malignant and seven inflammatory lesions). B-mode ultrasound was performed followed by CEUS examination after an intravenous bolus injection of 0.04 mL/kg of contrast medium, and TICs were elaborated by dedicated software. Receiver operating characteristic curves (ROC) for each TIC parameter were obtained. Neoplastic lesions had subjectively shorter rise time (RT), time to peak (TTP) and fall time (FT) than inflammatory lesions. Based on ROC curve analyses, fall time ≥ 10.49 s was the most reliable parameter for diagnosing non-neoplastic disease in this small sample of dogs (area under the curve [AUC] 0.75, sensitivity 83.33%, specificity 66.67%). No difference was found between ROCs calculated for each parameter of TICs by adding or removing CAT. Results of the current study provide background for future, larger scale studies evaluating use of a CEUS FT threshold of 10.49 s as a possible discriminator for urinary bladder neoplastic lesions in dogs.

Leiomyosarcoma of urinary bladder in a Shih Tzu dog

A 10-year-old intact male Shih Tzu dog presented with hematuria. Double-contrast cystography revealed a polypoid filling defect at the apex of the urinary bladder. Ultrasonography revealed a heterogeneously hypoechoic intramural mass with minimal vascular flow beneath the submucosal layer. After partial cystectomy, a well-demarcated bladder leiomyosarcoma was diagnosed on histopathology. The patient was alive and well without any clinical signs, recurrence, or metastasis at the 29-month follow-up after the surgical removal of the bladder mass. Leiomyosarcoma should be considered as a differential diagnosis if mass-like lesions are observed in the urinary bladder, although this type of malignancy is rare in canines. Histopathological confirmation is important for predicting prognosis and determining further medical plans.

Diagnosis of canine renal lymphoma by cytology and flow cytometry of the urine

Lymphoma is a common hematopoietic neoplasm of dogs. A definitive diagnosis typically requires the collection of samples via fine-needle aspirate or biopsy. A unique case of canine renal T-cell lymphoma diagnosed using urine sediment microscopy with flow cytometry and PCR for Antigen Receptor Rearrangement (PARR) is presented. A fresh urine sample was collected via a urinary catheter and immediately prepared for cytologic examination, flow cytometry, and PARR. The flow cytometric study revealed that 83% of the cells were large CD3⁺ CD8⁺ T cells, while PARR identified a clonally rearranged T-cell receptor gene, supporting the flow cytometry findings. Despite supportive care, the patient progressed to anuric renal failure and was humanely euthanized. A necropsy was performed, and tissues from the upper and lower urinary tracts were collected. Histologically, the right and left kidneys were infiltrated by a neoplastic round cell population effacing the cortex and medulla. Immunohistochemistry for the T- and B-cell antigens CD3 and CD20, respectively, revealed that the neoplastic population within the kidney demonstrated diffuse, strong, membranous to intracytoplasmic CD3 expression while lacking CD20 expression. These results confirmed the diagnosis of renal T-cell lymphoma. This is the first known report of canine lymphoma diagnosed using either urine flow cytometry or clonality testing. Therefore, in select cases, urine flow cytometry and/or PARR are feasible to perform on urine-derived cells as a quick and cost-effective means to aid in the diagnosis of urinary tract lymphoma.

Ultrasound characteristics of feline urinary bladder transitional cell carcinoma are similar to canine urinary bladder transitional cell carcinoma

Feline transitional cell carcinoma (TCC) is a rare neoplasia of cats with an estimated prevalence of 0.18%. Cats with TCC share clinical signs with common pathologies like feline idiopathic cystitis or urinary tract infections. Nonspecific clinical signs include hematuria, pollakiuria, or stranguria. The literature lacks a feline-specific ultrasound description of TCC. The aim of this multicenter retrospective descriptive study was to report ultrasound findings of a collection of feline TCC and then assess if feline TCC and canine TCC have similar ultrasound appearances. It was hypothesized that the ultrasound characteristics would be similar between feline and canine TCC. Ultrasound studies were assessed for tumor shape, number of isolated mural masses, location within the bladder, presence of Doppler signal, echogenicity of urine, mineralization within the mass, extension of the mass into the proximal urethra or ureters, urethral/ureteral obstruction, pyelectasia, and sublumbar lymphadenopathy. Feline studies were compared to 20 cases of confirmed canine TCC. A total of 20 cats with histologically or cytologically confirmed diagnosis of TCC were included. Feline and canine TCC had similarities when viewed using ultrasound. Statistically significant differences were identified for location of the bladder mass (cats were more likely to be mid-body vs trigonal in dogs, P = .011) and urethral extension of the tumor was less likely in cats than dogs (P = .0436). Based on this sample of 20 cats, feline TCC was most commonly a singular, broad-based mass within the mid-body or apex of the urinary bladder.

Lower Urinary Tract Neoplasia

Lower urinary tract neoplasia in companion animals is a debilitating and often life-threatening disease. Tumors of the bladder, urethra, and prostate often occur independently, although extension of these tumors into adjacent regions of the lower urinary tract is documented frequently. The most common lower urinary tract tumor in dogs and cats is transitional cell carcinoma (TCC). In both dogs and cats, TCC affecting the urinary bladder is generally considered to be highly aggressive with both local and metastatic disease potential, and this disease poses unique treatment challenges. Whereas much literature exists regarding the TCC disease process, treatment options, and prognosis in dogs, relatively few studies on feline TCC have been published due to the lower incidence of TCC in this species. Prostate tumors, most commonly adenocarcinomas, occur less commonly in dogs and cats but serve an important role as a comparative model for prostate neoplasia in humans. This article serves as a review of the current information regarding canine and feline lower urinary tract neoplasia as well as the relevance of these diseases with respect to their human counterparts.

Canine urinary bladder transitional cell carcinoma tumor volume is dependent on imaging modality and measurement technique

Transitional cell carcinoma is the most common cancer of the canine urinary tract. The inconsistent appearance of transitional cell carcinoma in patients introduces error if applying mathematic models for extrapolating total tumor volume from linear measurements. Reliable techniques to assess tumor size are important for monitoring treatment response. A method comparison study was performed comparing four techniques for calculating tumor volume were compared: (1 and 2) contoured tracing of tumor margins using serial computed tomography (CT) images using pre-(1) and postintravenous (2) contrast medium studies, (3) longest three linear dimensions using CT, and (4) longest three linear dimensions on abdominal ultrasound. Volumes of the transitional cell carcinoma tumor calculated by CT tracing techniques were significantly smaller than volumes calculated with an ellipsoid mathematic model using the linear measurements (P < 0.01). Intravenous contrast medium did not significantly change the volumes calculated from tracing tumor margins on CT for observer B; however, volumes differed for observer A. The volumes extrapolated from linear measurements using CT and ultrasound did not differ significantly. The interobserver reliability was highest for the precontrast CT contoured technique and was lowest using the ultrasound linear technique. Tumor volumes differed significantly between techniques of contoured tracing of the tumor margins on serial CT images compared to calculation of tumor volume from linear dimensions. The calculated volume of a transitional cell carcinoma depends upon the technique used. Characterizing the response of urinary bladder transitional cell carcinoma tumor size to therapy differs based on the method and modality used.

Quantitative evaluation of canine urinary bladder transitional cell carcinoma using contrast-enhanced ultrasonography

Background

In veterinary medicine, contrast-enhanced ultrasonography allowed the accurate quantification of liver, splenic and kidney vascularization in healthy dogs and the differentiation between malignant and benign hepatic, renal, and splenic nodules in dogs and cats based on perfusion patterns. The utility of contrast-enhanced ultrasonography in other applications is still under study.

The aim of this study was to develop diagnostic criteria by contrast-enhanced ultrasonography in 8 client-owned adult dogs affected by urinary bladder transitional cell carcinoma with definitive diagnosis made by cytopathologic evaluation after suction biopsy. The contrast enhancement pattern and the quantification of blood flow parameters of this tumor were reported.

Results

Examinations with B-mode, Doppler ultrasonography and contrast-enhanced ultrasonography were performed in all not sedated dogs. Assessments of bladder masses and bladder wall infiltration were performed. Each dog received 2 bolus injections of sulfur hexafluoride during the contrast-enhanced ultrasonography. Quantitative analysis of the contrast-enhanced ultrasonography images were performed. For each dog, one region of interest was manually drawn around the entire tumor. Software analysis of contrast-enhanced time-intensity curves was used to identify peak enhancement, time to peak enhancement, regional blood volume, regional blood flow, and mean transit time.

Contrast-enhanced ultrasonography showed an avid enhancement of the tumour tissue, with a heterogeneous or homogeneous pattern. The exam also showed the loss of planes between the lesion and the muscular layer. The presence of vascularized tissue through the bladder wall confirms the infiltrative feature of the tumour. Post-processing quantitative analysis showed a time-intensity curve with a rapid wash-in, a low level of signal intensity and a slow wash-out.

Conclusions

Contrast-enhanced ultrasonography provided useful clinical information and defined a vascular enhancement patterns and calculated parameters associated with TCC. It may be a useful, noninvasive and reproducible tool for detecting these tumors in dogs.

Clinical experience of MRI in two dogs with muscle-invasive transitional cell carcinoma of the urinary bladder

This study described high-field magnetic resonance imaging (MRI) and computed tomography (CT) characteristics of muscle-invasive bladder transitional cell carcinoma (TCC) in two dogs. Ultrasonography revealed a urinary bladder mass with ambiguous result about invasion to the muscular layer. Contrast-enhanced CT showed that the bladder wall in which the mass was attached was more intensely enhanced than the normal bladder walls, supporting invasion to the muscular layer. The mass revealed an intermediate signal intensity with interruption of the hypointense muscular layer on T2-weighted MRI and showed greater enhancement compared with the normal bladder wall on postcontrast T1-weighted images. T2-weighted MRI, postcontrast T1-weighted MRI and contrast-enhanced dual-phasic CT were useful for evaluating muscle-invasive bladder TCC in dogs.