Hepatobiliary neuroendocrine carcinoma in cats: a clinicopathologic, immunohistochemical, and ultrastructural study of 17 cases

Gallbladder Neuroendocrine Neoplasms in Dogs and Humans

Gallbladder neuroendocrine neoplasms (GB NENs) are among the rarest cancers reported in humans and dogs. This review provides a detailed review of the canine GB NEN literature and an interspecies comparison of demographics, clinical pathophysiology, pathobiology, and therapeutic response of GB NENs. The aim of this work is to explore the relevance of dogs as a spontaneous model for human GB NENs.

Ultrasound appearance of the duodenal papilla in clinically healthy cats

OBJECTIVES

The duodenal papilla (DP) is an anatomical structure located in the duodenal wall, a few centimetres from the pylorus. In cats, the pancreatic and bile ducts merge as they enter the DP, and this explains why cats are more likely than dogs to have concomitant digestive, pancreatic and hepatic infections. Ultrasonography of the DP has been previously established in dogs but not in cats. The purpose of our prospective study was to describe the ultrasound features of the DP in 30 adult clinically healthy cats.

METHODS

A full abdominal ultrasound was performed. Five measurements were recorded: the width and the height in a transverse section; the length and the height in a longitudinal section; and the thickness of the duodenal wall adoral to the DP in a longitudinal section. The subjective appearance (echogenicity and shape) of the DP was described.

RESULTS

The dimensions of the DP were a mean ± SD width of 3.13 ± 0.68 mm and height of 2.47 ± 0.63 mm in the transverse section, and length of 3.98 ± 1.27 mm and height of 2.44 ± 0.57 mm in the longitudinal section. The DP was homogeneous, subjectively isoechoic to fat and had a round and oval shape in the transverse and longitudinal sections, respectively. There was no correlation between the DP measurements and the weight, age or sex of the cats. The animals that were fed a mixed diet had a longer DP than those fed dry food.

CONCLUSIONS AND RELEVANCE

This study provides reference values for the dimensions of the DP, as well as information on its ultrasonographic appearance in clinically healthy adult cats. We did not find any correlation between the age of the cats and the size of the papilla, but the age range was small and another study in older cats should be undertaken to address this more thoroughly.

Clinical, histopathologic, and immunohistochemical features of 13 cases of canine gallbladder neuroendocrine carcinoma

In this retrospective descriptive study, we characterized the clinical, histologic, and immunohistochemical features of 13 cases of canine gallbladder neuroendocrine carcinoma (GB-NEC). Immunohistochemical stains for neuroendocrine (neuron-specific enolase [NSE], chromogranin A, synaptophysin) and gastrin markers were evaluated, and clinicopathologic and follow-up data were obtained for all cases. The average age at diagnosis was 8.9 y, and breeds included 6 Boston Terriers, 2 Bichon Frise, 1 Poodle, 1 English Bulldog, 1 French Bulldog, and 2 mixed-breed dogs. Boston Terriers were overrepresented in this cohort, and therefore a breed predilection is possible. Most dogs were presented with emesis and elevated liver enzyme activities: 13 of 13 had elevated alanine aminotransferase and alkaline phosphatase activities; 8 of 13 had elevated aspartate aminotransferase activity; 7 of 13 had elevated gamma-glutamyl transferase activity. Abdominal ultrasound and/or exploratory surgery revealed a gallbladder mass. All neoplasms had similar histologic features and positive immunoreactivity for NSE, chromogranin A, synaptophysin, and gastrin. Vascular invasion was noted in 8 of 13 neoplasms, and metastasis was present in 6 of 13 cases (4 hepatic and 2 pulmonary metastases). The median survival time was 3.7 y in patients who died; 5 of 8 deaths were directly attributed to the GB-NEC, 3 of which had metastatic spread. GB-NECs have the potential to metastasize; however, surgical excision may be curative in a subset of dogs.

A case of feline primary duodenal carcinoid with intestinal hemorrhage

A 15-year-old neutered male Persian cat was presented with recurrent hematemesis and melena. Abdominal ultrasonography and computed tomography revealed a mass in the proximal descending duodenal wall. Endoscopic examination revealed hemorrhage on the luminal side of the mass. Fine-needle aspiration of the mass was performed. Microscopic analysis revealed a cluster of cells with oval nuclei and indistinct cell borders, suggesting a neoplastic disease of neuroendocrine origin. The mass located near the major duodenal papilla was partially resected, and the bleeding was stopped by cauterization. However, the surgical procedures could not control the hemorrhage from the tumor mass, and the cat died of severe anemia. Immunohistopathological analysis revealed that the tumor was a duodenal carcinoid.

A retrospective pathology study of two Neotropical deer species (1995-2015), Brazil: Marsh deer (Blastocerus dichotomus) and brown brocket deer (Mazama gouazoubira)

This retrospective study describes the biological and epidemiological aspects, gross and microscopical findings, and most likely causes of death (CD) in two species of Neotropical deer in Brazil. The animals were collected between 1995 and 2015 and represented 75 marsh deer (MD) and 136 brown brocket deer (BBD). Summarized, pneumonia was diagnosed microscopically in 48 MD and 52 BBD; 76 deer suffered trauma, involving dog attack (14 BBD) and vehicle-collision (14 BBD). Pulmonary edema (50 MD; 55 BBD) and congestion (57 MD; 78 BBD) were the most common findings for both species. Additionally, we diagnosed ruminal and myocardial mycosis in MD and BBD, respectively; ovarian dysgerminoma and pancreatic trematodiasis in BBD; and lesions suggestive of malignant catarrhal fever and orbiviral hemorrhagic disease in both species. The main CD in MD was: respiratory (41/75), alimentary, nutritional, trauma and euthanasia (3/75 each). Correspondingly, in BBD were: trauma (34/131), respiratory (30/131) and euthanasia (9/131). Respiratory disease was often defined by pulmonary edema and pneumonia. We provide evidence that respiratory disease, mainly pneumonia, is a critical pathological process in these Neotropical deer species. Although no etiological agents were identified, there is evidence of bacterial and viral involvement. Our results show trauma, mainly anthropogenic, as a common ailment in BBD. We propose to prioritize respiratory disease in future research focused on South American deer health aspects. We believe anthropogenic trauma may be a primary threat for populations of BBD.

Pancreatic neuroendocrine carcinoma with exocrine differentiation in a young cat

A 35-mo-old spayed female mixed-breed cat with continuous vomiting, emaciation, and abdominal distention for 2 wk was presented to a private veterinary clinic for evaluation. At 71 d after the initial visit, the cat died with anemia, jaundice, and hypoalbuminemia, and was subjected to autopsy. Grossly, numerous firm masses, 0.5-2.5 cm diameter, were randomly located in the left lobe of the pancreas. Histologic examination revealed that the pancreatic mass consisted of 2 tumor cell types: mostly small round cells with a minority of epithelial cells. The small cells were arranged in nests of various sizes, which were separated by thin fibrous stroma, and had small, round, hyperchromatic nuclei, scant cytoplasm containing argyrophilic granules, and often formed rosettes. The epithelial cells formed luminal structures. Metastases were observed in the liver, greater omentum, and pancreatic, gastric, pulmonary, and mediastinal lymph nodes. Immunohistochemical examination revealed that the small cells were positive for vimentin, neuron-specific enolase, chromogranin A, cytokeratin (CK) AE1/AE3, and trypsin, whereas the epithelial cells were positive for AE1/AE3, trypsin, CK19, and nestin. Ultrastructurally, the small cells contained abundant electron-dense granules, ~200 nm diameter, whereas the epithelial cells had apical microvilli and numerous zymogen granules, ~300 nm diameter. These findings indicated that the tumor was a pancreatic neuroendocrine carcinoma with exocrine differentiation and systemic metastases.

Pulmonary neuroendocrine tumor in a female wolf (Canis lupus lupus)

A 17-year-old female wolf (Canis lupus lupus) had a right lung mass that was adhered to the thoracic cavity. Histopathological examination revealed that the mass consisted of sheets, cord or ribbon-like structures of monotonous, small, cuboidal cells with round, oval or short-spindle nuclei and scant clear cytoplasm, demarcated by a fine fibrovascular stroma. Focal necrosis, congestion and thrombi were observed. Immunohistochemically, the tumor cells diffusely expressed cytokeratin AE1/AE3, and some expressed chromogranin A, neural cell adhesion molecule (CD56) and thyroid transcription factor-1. The number of proliferating cell nuclear antigen-positive tumor cells was low. A diagnosis of pulmonary neuroendocrine tumor was based on the resemblance to carcinoids.

Hepatobiliary Neoplasia

Older companion animals may be uncommonly affected with hepatobiliary neoplasia. If clinical signs are shown they are often nonspecific. Animals may have increased liver enzyme activities detected on serum biochemistry. Ultrasound imaging can help to characterize liver lesions and guide sampling with fine needle aspiration. Treatment for massive liver tumor morphology involves liver lobectomy. Prognosis depends on the tumor morphology, type, and stage, but can be good for cats and dogs with massive hepatocellular tumors, with animals experiencing prolonged survival and low recurrence rates.

Classification of primary hepatic tumours in the cat

Hepatic tumours in dogs have recently been re-classified to follow a revised human classification system that takes account of identified hepatic progenitor cells. This study investigated the presence and relative frequency of morphological types of feline primary hepatic neoplasms and aimed to determine whether a similar new classification scheme could be applied in cats. Feline primary liver tumours (n = 61) were examined histologically and with a series of immunohistochemical markers. Six cases of nodular hyperplasia and 21 tumours of hepatocellular origin were diagnosed. The latter were subdivided into hepatocellular tumours that were well differentiated and had no evidence of metastases (n = 18) and tumours that showed poorly differentiated areas with marked cellular and nuclear pleomorphism and had intrahepatic and, or, distant metastases (n = 3). These malignant feline hepatocellular tumours maintained their hepatocellular characteristics (HepPar-1, MRP2, pCEA positive) and were negative, or only <5% positive, for K19. Twenty-five cholangiocellular tumours were diagnosed and all had intrahepatic and, or, distant metastases. Eight NSE positive small cell carcinomas (carcinoids) were diagnosed and subdivided into small cell carcinomas with HPC characteristics (K19 positive) and neuroendocrine carcinomas (K19 negative). In addition, one squamous cell carcinoma originating from the distal part of the choledochal duct was recognised. Feline primary hepatic neoplasms can be sub-divided into benign and malignant hepatocellular tumours, cholangiocellular carcinomas, small cell carcinomas with HPC characteristics, neuroendocrine carcinomas and squamous cell carcinomas. The marked species difference justifies a specific classification for feline primary hepatic neoplasms.

Benign gastric neuroendocrine tumors in three snow leopards (Panthera uncia)

Neuroendocrine tumors are relatively rare neoplasms arising from neuroendocrine cells that are distributed throughout the body and are predominant in the gastrointestinal tract. This report describes benign, well-differentiated gastric neuroendocrine tumors in three captive snow leopards (Panthera uncia). All tumors were well circumscribed, were within the gastric mucosa or submucosa, and had histologic and immunohistochemical features of neuroendocrine tumors. Histologic features included packeted cuboidal to columnar epithelial cells that were arranged in palisades or pseudorosettes and contained finely granular cellular cytoplasm with centrally placed, round nuclei. Cytoplasmic granules of neoplastic cells strongly expressed chromogranin A, variably expressed neuron-specific enolase, and did not express synaptophysin or gastrin. Each leopard died or was euthanatized for reasons unrelated to its tumor.

Mechanisms, causes, investigation and management of vomiting disorders in cats: a literature review

Vomiting is a common presenting complaint in feline practice. This article differs from previous reviews in that it is an evidence-based review of the mechanisms, causes, investigation and management of vomiting in the domestic cat. Published evidence was reviewed, and then used to make recommendations for clinical assessment, diagnosis, antiemetic drug treatment, dietary management and monitoring of cats presenting with vomiting. The strength of the evidence on which recommendations are made (and areas where evidence is lacking for cats) has been highlighted throughout.

A case of hepatic carcinoid in a red deer hind (Cervus elaphus)

A carcinoid tumour in the liver of a red deer hind (Cervus elaphus) is described. Macroscopically, the liver was considerably enlarged with multifocal, firm, yellow and red nodular neoplastic masses, which were histopathologically diagnosed as hepatic carcinoids. The diagnosis was confirmed by modified Grimelius staining, which demonstrated numerous small argyrophilic granules in the cytoplasm of neoplastic cells, and by immunohistochemistry. The neoplastic cells gave a strong positive reaction for neuron-specific enolase (NSE) and synaptophysin and a weak positive reaction for chromogranin A. To our knowledge, this is the first report of a hepatic carcinoid in red deer.

Nasal tumor with widespread cutaneous metastases in a Golden Retriever

An intact, 8-year-old, male Golden Retriever dog was presented for evaluation of a nasal mass and approximately 30 firm, raised, variably ulcerated dermal and subcutaneous masses. Histopathology of both nasal and multiple skin masses revealed multiple nonencapsulated, infiltrative masses comprising clusters, anastomosing trabeculae, and packets of neoplastic, round to ovoid, hyperchromatic cells with marked nuclear molding. Surrounding the neoplastic cells was a marked stromal response in which many of the spindle-shaped cells expressed muscle-specific actin and had ultrastructural features consistent with myofibroblasts. A literature search indicates that this is the first report in a peer-reviewed journal of cutaneous metastasis of a nasal neuroendocrine tumor in any domestic animal species.

Use of color flow Doppler ultrasonography to diagnose a bleeding neuroendocrine tumor in the gallbladder of a dog

CASE DESCRIPTION

A 13-year-old neutered female Keeshond-cross was evaluated because of a history of melena, anemia, hematemesis, vomiting, and high serum liver enzyme activities over a 1.5-year period.

CLINICAL FINDINGS

Abdominal ultrasonography revealed a hyperechoic mass in the gallbladder. In the gallbladder mass itself, a distinct linear blood flow pattern was detected by use of color flow Doppler ultrasonography.

TREATMENT AND OUTCOME

A cholecystectomy was performed, and clinical signs resolved. Samples of the mass were examined histologically and immunohistochemically, and findings supported a diagnosis of neuroendocrine tumor of the gallbladder.

CLINICAL RELEVANCE

Tumors of the biliary tree are a potential source of blood loss into the gastrointestinal tract. Color flow Doppler ultrasonography in conjunction with conventional grayscale ultrasonography may be useful in evaluation of the gallbladder in dogs. When echogenic material is detected in the gallbladder, it is important to evaluate the region for blood flow.

Nasal neuroendocrine carcinoma in a free-living Japanese raccoon dog (Nyctereutes procyonoides viverrinus)

Neuroendocrine carcinoma was diagnosed in the left nasal cavity of a free-living Japanese raccoon dog (Nyctereutes procyonoides viverrinus). Microscopically, the tumour consisted of sheets of anaplastic cells separated by narrow zones of fibrovascular stroma. The neoplastic cells had varying numbers of cytoplasmic granules stained by the Grimelius method. Immunohistochemically, the neoplastic cells were variably labelled for cytokeratin AE1/AE3, vimentin, chromogranin A and S-100. Ultrastructurally, some of the neoplastic cells had cytoplasmic membrane-bound dense-core granules of approximate diameter 140-240nm. The tumour had infiltrated the cerebrum and metastasized to the pituitary gland, mandibular and pulmonary lymph nodes, lungs, thyroid gland and adrenal glands.

Primary hepatic neuroendocrine carcinoma in a baboon (Papio sp.)

BACKGROUND

Primary neuroendocrine carcinomas of the liver have rarely been reported in humans and domestic animals, but not in non-human primates.

METHODS

We describe the morphologic and immunohistochemical features of a primary hepatic neuroendocrine carcinoma found in a 29-year-old female baboon.

RESULTS AND CONCLUSIONS

The neoplasm was characterized by multiple solid nodules that were multifocally distributed in the liver. Metastases were not observed. Histologically, the neoplasm was composed of cords and nests of epithelial cells arranged in a neuroendocrine pattern, occasionally forming glandular and rosette-like structures. On immunohistochemical evaluation, the neoplastic cells were immunopositive for pancytokeratin, chromogranin A, neuron-specific endolase, and synaptophysin and were negative for vimentin, S100 protein, glucagon, and insulin.

Nasal and paranasal adenocarcinomas with neuroendocrine differentiation in dogs

Tumors of the nasal cavity or paranasal sinuses of 18 dogs were examined histopathologically, immunohistochemically, and histochemically. The tumors were classified histologically as 13 adenocarcinomas, 3 transitional carcinomas, 1 squamous cell carcinoma, and 1 adenosquamous carcinoma. Tumor cells were strongly immunoreactive for broad-spectrum cytokeratins in all cases, for cytokeratin 8/18 in 16 cases, and for cytokeratin 19 in 17 cases. None of the 18 carcinomas had cytologic or histologic features indicative of neuroendocrine differentiation, yet tumor cells in 5 of the 13 adenocarcinomas were argyrophilic and immunohistochemically positive for synaptophysin and chromogranin A. Results of this study indicate that neuroendocrine markers may be detected immunohistochemically and histochemically in canine nasal or paranasal adenocarcinomas despite the lack of typical histologic features of neuroendocrine differentiation.

Neuroendocrine carcinoma of the liver and gallbladder in a cow

A 15-year-old Limousin-cross cow was presented for examination with neurological signs and serum biochemical changes consistent with liver disease. Necropsy revealed enlargement of the liver with multifocal firm, depressed, pale, circumscribed lesions throughout the parenchyma. Within the gallbladder there were exophytic and villiform mucosal masses. Microscopically, hepatic structure was displaced by neoplastic cells forming trabeculae, nests and rosettes. There was transmural infiltration of the gallbladder by similar cells. The histological pattern of growth of the neoplastic cells, the presence of silver-stained cytoplasmic granules within these cells and the immunohistochemical demonstration of chromogranin A supported the diagnosis of neuroendocrine carcinoma. Bovine liver and gallbladder neuroendocrine carcinomas are rare and this is the first detailed documentation of the disease in the United Kingdom.

Immunohistochemical Characterization of a Hepatic Neuroendocrine Carcinoma in a Cat

A hepatic mass was identified in a 5-year-old, female mixed-breed cat that died spontaneously after a clinical history of progressive emaciation, ptyalism, and persistent coryza. At necropsy, a 7-cm-diameter, yellow-brown, firm, multilobulated tumor was identified in the liver. Microscopically, the mass consisted of neoplastic cells arranged in small, closely packed nests within a thin fibrovascular stroma. These cells were of medium sized and polygonal, with fine argyrophilic cytoplasmic granules. Nuclei were predominantly round with finely stippled chromatin and indistinct nucleoli. Mitotic figures were numerous. Immunohistochemically, most of the neoplastic cells were immunoreactive for chromogranin A, neuron-specific enolase (NSE), and cytokeratin AE1/AE3 and weakly labeled for synaptophysin. The tumor was negative for glial fibrillary acidic protein (GFAP), vimentin, and cytokeratins 5, 6, 8, and 17. Vascular emboli and intrahepatic micrometastasis were also identified with chromogranin A. All these features were consistent with a hepatic neuroendocrine carcinoma and emphasized the importance of using a panel of antibodies to diagnose such rare tumors.

Mucinous Cholangiocarcinoma in a Cat

Mucinous cholangiocarcinoma was diagnosed in a 14-year-old, castrated male, domestic shorthaired cat with marked peritoneal effusion. Cytological confirmation of malignancy by fluid analysis and fine-needle, ultrasound-guided aspiration of the liver was followed by histological examination of tissue samples obtained at surgery and necropsy. No observed response followed chemotherapy with doxorubicin and carboplatin. Electron microscopy and immunohistochemistry helped to further characterize this unusual tumor.