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Gibson EA, Brust K, Steffey MA. Evaluation of mediastinoscopy for cranial mediastinal and tracheobronchial lymphadenectomy in canine cadavers. Vet Surg 2024; 53:834-843. [PMID: 38686899 DOI: 10.1111/vsu.14095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 02/17/2024] [Accepted: 03/23/2024] [Indexed: 05/02/2024]
Abstract
OBJECTIVE To report technical feasibility and describe procedural details of a novel single incision minimally invasive approach to the mediastinum in cadaver dogs. STUDY DESIGN Cadaveric study. ANIMALS Large breed (25-40 kg) cadaver dogs (n = 10). METHODS Three of 10 cadavers were used for preliminary technique development without data recording. Cadaver specimens underwent pre- and postoperative thoracic computed tomographic scans. Seven dogs were placed in dorsal recumbency and mediastinoscopy was performed via a SILS port placed cranial to the thoracic inlet with CO2 insufflation of the mediastinum at 2-4 mmHg. Retrieval of all CT and visually identified mediastinal lymph nodes (LN) was attempted; endoscopic compartmental and individual LN dissection times and subjective operative challenges were recorded. Procedural success scores for visualization and dissection as well as NASA-task force index scores were recorded per lymph node, per cadaver. RESULTS Median time required for initial approach including SILS placement was 5 min (range 5-10 min). Individual LN retrieval times ranged from 2 to 32 min. Mediastinoscopic retrieval of LNs was most commonly successful for the left tracheobronchial LN (7/7), followed by the right tracheobronchial LN (4/7), the left and right sternal LNs (3/7 each), and the cranial mediastinal LNs (1/7). Post-procedure pleural gas was identified on CT in 4/7 cadavers. CONCLUSIONS Mediastinoscopy as reported was feasible in large breed canine cadavers and retrieval or cup biopsy of a variety of lymph nodes is possible from the described approach. Application in living animals and its associated challenges should be further investigated. CLINICAL SIGNIFICANCE Mediastinoscopy may provide a novel minimally invasive approach to the evaluation and oncologic staging of the cranial mediastinum in dogs.
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Affiliation(s)
- Erin A Gibson
- William R. Prichard Veterinary Medical Teaching Hospital, School of Veterinary Medicine, University of California-Davis, Davis, California, USA
| | - Kelsey Brust
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California-Davis, Davis, California, USA
| | - Michele A Steffey
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California-Davis, Davis, California, USA
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McKenna C, Poirier VJ, Oblak ML, Nykamp S, Mutsaers AJ. Reason for euthanasia in dogs with urothelial carcinoma treated with chemotherapy or radiation therapy or both: A retrospective observational study. J Vet Intern Med 2024; 38:1127-1134. [PMID: 38317542 PMCID: PMC10937484 DOI: 10.1111/jvim.16994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 01/11/2024] [Indexed: 02/07/2024] Open
Abstract
BACKGROUND Clients want to know the ultimate cause of death in their pet after cancer treatment. The cause of euthanasia and investigation of urinary obstruction in treated dogs with urothelial carcinoma (UC) has not been specifically reported in veterinary literature. HYPOTHESIS/OBJECTIVES Our hypothesis was that the majority of treated dogs with UC are euthanized secondary to primary tumor factors, such as urinary obstruction. ANIMALS Fifty-nine client-owned dogs diagnosed with UC. METHODS Retrospective observational study on clinical signs and disease at euthanasia of dogs with UC treated by radiation therapy or chemotherapy or both. RESULTS The median overall survival time (OST) of all dogs was 339 days (range, 17-1996; 95% confidence interval [CI], 185-392; interquartile range [IQR], 112-505). Of dogs deemed to have been euthanized because of UC (50/59, 85%), the primary cause was considered to be local progression in 31/50 (62%), most often because of perceived complete or partial urinary obstruction (24/31, 77%). No variables were found to be predictive of urinary obstruction. The overall documented metastatic rate was 56%. In dogs euthanized because of UC, metastasis was deemed to be the cause in 19/50 (38%) dogs. CONCLUSIONS AND CLINICAL IMPORTANCE Regardless of the type of treatment, UC in dogs has a poor prognosis and there is a continuing need to improve treatments that focus on local control of the primary tumor, given its high contribution to the decision for euthanasia. Proactive management to avoid the high frequency of urinary obstruction may be worthy of future investigation.
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Affiliation(s)
- Charly McKenna
- Biomedical Sciences, Ontario Veterinary CollegeUniversity of GuelphGuelphOntarioCanada
- Clinical Studies, Ontario Veterinary CollegeUniversity of GuelphGuelphOntarioCanada
| | - Valerie J. Poirier
- Clinical Studies, Ontario Veterinary CollegeUniversity of GuelphGuelphOntarioCanada
| | - Michelle L. Oblak
- Clinical Studies, Ontario Veterinary CollegeUniversity of GuelphGuelphOntarioCanada
| | - Stephanie Nykamp
- Clinical Studies, Ontario Veterinary CollegeUniversity of GuelphGuelphOntarioCanada
| | - Anthony J. Mutsaers
- Biomedical Sciences, Ontario Veterinary CollegeUniversity of GuelphGuelphOntarioCanada
- Clinical Studies, Ontario Veterinary CollegeUniversity of GuelphGuelphOntarioCanada
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3
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Marks TA, Rossanese M, Yale AD, Stewart S, Smallwood K, Rigas K, Guillén A. Prognostic factors and outcome in cats with thymic epithelial tumours: 64 cases (1999-2021). J Small Anim Pract 2024; 65:47-55. [PMID: 37800196 DOI: 10.1111/jsap.13675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 07/18/2023] [Accepted: 09/06/2023] [Indexed: 10/07/2023]
Abstract
OBJECTIVES To describe the clinical presentation, treatment and outcomes of cats diagnosed with thymic epithelial tumours and to determine prognostic factors for survival and recurrence. MATERIALS AND METHODS Clinical records of cats diagnosed with a thymic epithelial tumour between 1999 and 2021 at three referral institutions were retrospectively reviewed. RESULTS Sixty-four cats were included. Paraneoplastic syndromes were present in nine cats and metastatic disease was seen in two cats, one at diagnosis and one at the time of recurrence. Median tumour diameter was 6 cm (range, 2 to 15) and a cystic appearance was described on imaging in 25 cats. Surgical excision was attempted in 54 cats with a perioperative mortality rate of 11%. Median survival time for cats surviving to hospital discharge was 897 days (range, 21 to 3322). The 1-, 2- and 5-year survival rates for surgically treated thymic epithelial tumour were 86%, 70% and 66%, respectively. Survival was longer for cats with Masaoka-Koga stage I and II tumours compared to stages III and IV (1366 days versus 454 days; P=0.002). Masaoka-Koga stage was the only significant prognostic factor detected on multi-variable analysis, with stage III and IV tumours associated with increased risk of death (hazard ratio: 5.67, 95% confidence interval: 1.29 to 24.91, P=.021). Tumour recurrence occurred in 11 cats at a median of 564 days (range, 93 to 1095); no significant prognostic factors for recurrence were identified. CLINICAL SIGNIFICANCE Cats with thymic epithelial tumours had a good long-term prognosis following surgery. Tumour recurrence can occur late in the disease course and ongoing monitoring should therefore be considered. Masaoka-Koga stage may influence survival time and could be used to predict outcome.
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Affiliation(s)
- T A Marks
- Royal Veterinary College, Hatfield, AL9 7TA, UK
| | - M Rossanese
- Royal Veterinary College, Hatfield, AL9 7TA, UK
| | - A D Yale
- Royal Veterinary College, Hatfield, AL9 7TA, UK
| | - S Stewart
- Royal Veterinary College, Hatfield, AL9 7TA, UK
| | - K Smallwood
- North Downs Specialist Referrals, Bletchingley, RH1 4QP, UK
| | - K Rigas
- Southfields Veterinary Specialists, Basildon, Essex, SS14 3AP, UK
| | - A Guillén
- Royal Veterinary College, Hatfield, AL9 7TA, UK
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4
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Kline S, Manley SR, Timothy C, Jennings SH, Nolen-Walston R, Conrado FO. Spindle-cell thymoma colliding with a bronchogenic cyst in a Yorkshire terrier. Vet Clin Pathol 2023; 52:709-715. [PMID: 37914539 DOI: 10.1111/vcp.13301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 05/31/2023] [Accepted: 07/28/2023] [Indexed: 11/03/2023]
Abstract
An 8-year-old male Yorkshire terrier was presented to the Tufts Veterinary Hospital for evaluation of increased respiratory effort. A mediastinal mass composed of a spindle-cell thymoma within a bronchogenic cyst was diagnosed with computed tomography thoracic imaging, ultrasound-guided fine-needle aspirate biopsy, and histopathologic evaluation after surgical removal. Histologic evaluation showed a multilocular cyst structure as well as a mass characterized by spindle to polygonal thymic epithelial cells. The cyst was characterized by a lining of ciliated pseudostratified respiratory epithelium. To the authors' knowledge, this is the first report of a spindle-cell thymoma being associated with a mediastinal bronchogenic cyst in a dog.
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Affiliation(s)
- Stephanie Kline
- Department of Clinical Sciences, Cummings School of Veterinary Medicine at Tufts University, North Grafton, Massachusetts, USA
| | - Sabrina R Manley
- Department of Clinical Sciences, Cummings School of Veterinary Medicine at Tufts University, North Grafton, Massachusetts, USA
| | - Clare Timothy
- Department of Clinical Sciences, Cummings School of Veterinary Medicine at Tufts University, North Grafton, Massachusetts, USA
| | | | - Rose Nolen-Walston
- Department of Comparative Pathobiology, Cummings School of Veterinary Medicine at Tufts University, North Grafton, Massachusetts, USA
| | - Francisco O Conrado
- Department of Comparative Pathobiology, Cummings School of Veterinary Medicine at Tufts University, North Grafton, Massachusetts, USA
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Molazem M, Soroori S, Bahonar A, Karimi S. Computed Tomographic Features of Thymus in Dogs: Correlation with Age, Gender, Breed and Body Fat Content. Vet Sci 2023; 10:418. [PMID: 37505824 PMCID: PMC10384453 DOI: 10.3390/vetsci10070418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 06/12/2023] [Accepted: 06/23/2023] [Indexed: 07/29/2023] Open
Abstract
BACKGROUND The thymus is the first lymphoid organ formed to regulate a newborn's immunity. It reaches its maximum size during puberty, after which it undergoes an atrophic procedure called involution, but its ability to grow again in response to some stresses, such as infections, neoplasia, surgeries, chemotherapy, and radiotherapy is maintained. There is no comprehensive study on computed tomographic features of thymus in dogs. So, the goal of the present study is to gain better insight into the thymus using computed tomography as a non-invasive method. METHODS One hundred and fifty dogs classified in five age groups and five breed groups were recruited to this study and the thymus was evaluated using a 2-slice computed tomography machine. The inclusion criteria for the present study were having a normal complete blood count, plain and post-contrast CT scan examination of the thoracic region and no history of neoplasia, chemotherapy or radiotherapy. The visibility, density, enhancement, grade, size, volume, shape, borders and lateralization of the thymus were evaluated and statistical analysis was performed. The effect of obesity on thymic grade and volume was also investigated. RESULTS The visibility, density, dorsal length, volume and grade decreased with increasing age. The thymic shape and lateralization were mostly wedge shaped and left sided, respectively. The borders became concave with aging and increasing body fat content caused an increase in the fatty degeneration of the thymus. CONCLUSIONS Declining thymic density, grade, size and volume with aging are related to thymic involution and fatty degeneration was accelerated by increasing body fat content. Females and males were different only in thymic shape and small and large breeds were different only in thymic volume. The thymus was visible in some geriatric dogs with no underlying disease. We expect that the present work can be used by radiologists in reading thoracic computed tomography but investigation of thymic characteristics in dogs with neoplasia and history of chemotherapy, radiotherapy and thoracic surgeries can complete this study.
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Affiliation(s)
- Mohammad Molazem
- Faculty of Veterinary Medicine, Department of Veterinary Surgery and Diagnostic Imaging, University of Tehran, Azadi Street, Tehran 1419963111, Iran
| | - Sarang Soroori
- Faculty of Veterinary Medicine, Department of Veterinary Surgery and Diagnostic Imaging, University of Tehran, Azadi Street, Tehran 1419963111, Iran
| | - Alireza Bahonar
- Faculty of Veterinary Medicine, Department of Food Hygiene and Quality, University of Tehran, Azadi Street, Tehran 1419963111, Iran
| | - Saghar Karimi
- Faculty of Veterinary Medicine, Department of Veterinary Surgery and Diagnostic Imaging, University of Tehran, Azadi Street, Tehran 1419963111, Iran
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Mignan T, White R, Stee K, Bonanno G, Targett M, Lowrie M. Case report: Immune remission from generalized myasthenia gravis in a dog with a thymoma and cholangiocellular carcinoma. Front Vet Sci 2023; 10:1124702. [PMID: 37008354 PMCID: PMC10063851 DOI: 10.3389/fvets.2023.1124702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 02/24/2023] [Indexed: 03/19/2023] Open
Abstract
A 9-year-old male neutered Cockapoo was presented with an acute and progressive history of exercise induced weakness involving all limbs, and bilateral decreased ability to blink. Investigations revealed generalized myasthenia gravis alongside the presence of a thymoma and a cholangiocellular carcinoma. Symptomatic treatment through pyridostigmine bromide was used to control clinical signs, and complete surgical removal of the thymoma and cholangiocellular carcinoma was performed. Serum acetylcholine receptor antibody concentration was measured serially. Clinical remission defined as resolution of clinical signs alongside discontinuation of treatment was achieved by day 251 (8.2 months). Immune remission defined as normalization of serum acetylcholine receptor antibody concentration alongside resolution of clinical signs and discontinuation of treatment was achieved by day 566 (18.5 months). Neurological examination was normal, and the owners did not report any clinical deterioration during the final follow-up appointment on day 752 (24 months), hence outcome was considered excellent. This is the first report describing the temporal evolution of serum acetylcholine receptor antibody concentration in a dog with thymoma-associated myasthenia gravis which achieved immune remission following thymectomy. Treatment was successfully discontinued without any evidence of clinical deterioration thereafter despite serum acetylcholine receptor antibody concentration not normalizing for another 315 days (10 months).
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Affiliation(s)
- Thomas Mignan
- Dovecote Veterinary Hospital, CVS Group PLC, Castle Donington, United Kingdom
- School of Veterinary Medicine and Science, The University of Nottingham, Sutton Bonington, United Kingdom
- *Correspondence: Thomas Mignan
| | - Robert White
- School of Veterinary Medicine and Science, The University of Nottingham, Sutton Bonington, United Kingdom
| | - Kimberley Stee
- Dovecote Veterinary Hospital, CVS Group PLC, Castle Donington, United Kingdom
| | - Giuseppe Bonanno
- Dovecote Veterinary Hospital, CVS Group PLC, Castle Donington, United Kingdom
| | - Mike Targett
- School of Veterinary Medicine and Science, The University of Nottingham, Sutton Bonington, United Kingdom
| | - Mark Lowrie
- Dovecote Veterinary Hospital, CVS Group PLC, Castle Donington, United Kingdom
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Allen C, Lowrie M, Garosi LS, Van Lelyveld S, Ortiz AL, Gomes SA. Megaoesophagus and dysphagia presumed secondary to medulla oblongata compression by multilobular tumour of bone in a dog. VETERINARY RECORD CASE REPORTS 2022. [DOI: 10.1002/vrc2.467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
| | | | | | | | - Ana L. Ortiz
- School of Veterinary Medicine and Sciences University of Nottingham Sutton Bonington Campus Sutton Bonington UK
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Lukács RM, Johnston C, Erles K, Berman K. What is your diagnosis? Mediastinal mass in a dog. Vet Clin Pathol 2022; 51:289-291. [PMID: 35233809 DOI: 10.1111/vcp.13049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 04/07/2021] [Accepted: 06/04/2021] [Indexed: 11/30/2022]
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Trageser E, Martin T, Hoaglund E, Leary D, LaRue S, Boss MK. Outcomes of dogs with thymoma treated with intensity modulated stereotactic body radiation therapy or non-modulated hypofractionated radiation therapy. Vet Comp Oncol 2021; 20:491-501. [PMID: 34936172 DOI: 10.1111/vco.12797] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 12/15/2021] [Accepted: 12/16/2021] [Indexed: 11/27/2022]
Abstract
Canine thymomas are routinely treated with radiotherapy (RT). In this study, we investigate the response and toxicity of canine thymoma treated with intensity-modulated stereotactic body radiation therapy (SBRT) relative to dogs treated with hypofractionated non-modulated radiation therapy (NMRT). A retrospective study was performed of dogs with thymoma treated with RT (total: n=15; SBRT: n=8, NMRT: n=7). Tumor response was evaluated in six dogs (40%); following SBRT, three dogs (100%) experienced stable disease (SD); following NMRT, one dog (33%) had a PR, and two dogs (67%) had SD. Median PFS was 116 days (range 66-727 days) for the SBRT group and 134 days (range 10-405 days) for the NMRT group. The MST for the SBRT group was 250 days (range 1-727 days) and 155 days (range 10-405 days) for NMRT. Median disease-specific survival (DSS) was 250 days (range 1-727 days) for the SBRT group and 169 days (range 20-405 days) for the NMRT group. No significant differences in survival data were found between the treatment groups, however the results from the small number of dogs analyzed are likely underpowered for statistical comparisons. Reported acute and late side effects were limited to the lungs and heart and were statistically significantly more common in the NMRT (71%) compared to the SBRT group (25%) (p=0.04). We suggest similar treatment efficacy may be provided for canine thymoma treated with either approach, but SBRT could provide the clinical benefit of reduced incidence of radiation-induced toxicity and completion of RT in a shorter time frame. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Erin Trageser
- Department of Environmental and Radiological Health Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, Colorado
| | - Tiffany Martin
- Department of Environmental and Radiological Health Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, Colorado
| | - Elizabeth Hoaglund
- Department of Environmental and Radiological Health Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, Colorado
| | - Del Leary
- Department of Environmental and Radiological Health Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, Colorado
| | - Susan LaRue
- Department of Environmental and Radiological Health Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, Colorado
| | - Mary-Keara Boss
- Department of Environmental and Radiological Health Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, Colorado
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Canine Epithelial Thymic Tumors: Outcome in 28 Dogs Treated by Surgery. Animals (Basel) 2021; 11:ani11123444. [PMID: 34944221 PMCID: PMC8698125 DOI: 10.3390/ani11123444] [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: 09/28/2021] [Revised: 11/18/2021] [Accepted: 12/01/2021] [Indexed: 11/20/2022] Open
Abstract
Simple Summary Thymoma is a tumor of the cranial mediastinum rarely reported in dogs and should be differentiated from mediastinal lymphoma. CT and fine-needle aspirates or core biopsies are helpful in differential diagnosis, but flow cytometry may improve the pre-operative diagnostic ability. In thymomas, paraneoplastic syndromes such as myasthenia gravis and hypercalcemia may develop concurrently with the tumor. Their role as prognostic factors is not well determined. Surgical excision is the treatment of choice, but adjuvant radiotherapy and/or chemotherapy may prolong survival in cases of incomplete excision or if a thymic carcinoma is diagnosed. Local recurrence and metastasis are infrequently reported; therefore, a long survival is expected if the tumor is completely excised or if adjuvant therapy is undertaken. This article reports the authors’ experience with 28 dogs affected by 18 thymomas and 10 thymic carcinomas surgically treated from January 2000 to August 2021. The median overall survival time of the entire population was 1137 days; the median disease-free time was 903 days. Dogs with thymic carcinomas had significantly shorter disease-free intervals and shorter, although not statistically significant, survival times. Dogs with Masaoka Stage III tumors had worse outcomes. Abstract Thymoma is a tumor rarely reported in dogs and should be differentiated from mediastinal lymphoma. Clinical signs may have a late onset, and thymoma is often diagnosed when symptoms related to the space-occupying effect or paraneoplastic syndromes occur. CT and fine-needle aspirates or core biopsies are helpful in differential diagnosis, but flow cytometry may improve the pre-operative diagnostic ability. Concurrent paraneoplastic syndromes such as myasthenia gravis and hypercalcemia have been reported; however, their role as prognostic factors is not well determined. Surgical excision is the treatment of choice; adjuvant radiotherapy and/or chemotherapy may prolong survival in cases of incomplete excision or when a thymic carcinoma is diagnosed. Local recurrence and metastasis are infrequently reported; therefore, a long survival time is expected if the tumor is completely excised or if adjuvant therapy is undertaken. This article reports the authors’ experience with 28 dogs affected by 18 thymomas and 10 thymic carcinomas. The median overall survival in this series was 1173 days, and the median disease-free interval was 903 days. Dogs with thymic carcinoma had significantly shorter disease-free intervals and shorter, although not statistically significant, survival times. Dogs with Masaoka Stage III tumors had worse outcomes.
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Perillo R, Menchetti M, Giannuzzi PA, Marchiori A, Rondena M, Gasparini S. Acquired myasthenia gravis with concurrent polymyositis and myocarditis secondary to a thymoma in a dog. Open Vet J 2021; 11:436-440. [PMID: 34722208 PMCID: PMC8541714 DOI: 10.5455/ovj.2021.v11.i3.16] [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: 04/15/2021] [Accepted: 08/02/2021] [Indexed: 11/25/2022] Open
Abstract
Background: Canine thymomas are associated with multiple paraneoplastic syndromes, among which myasthenia gravis (MG) is the most common. Acquired MG is an autoimmune disease characterized by the presence of antibodies against acetylcholine receptors (ACHRs). ACHRs antibodies are the most commonly formed, but the production of antistriational antibodies binding to skeletal and cardiac muscle proteins has also been recorded both in humans and dogs. An association between the occurrence of antistriational antibodies and a severe form of myocarditis, giant cell myocarditis, has been described in humans. Case Description: A 4-year-old mixed-breed dog was referred because of 1 month history of exercise-induced weakness, hypersalivation, and regurgitation. The neurologic examination was indicative of a neuromuscular junction disease, and MG was suspected. A computed tomographic scan examination showed the presence of a megaoesophagus and a thymic mass. Serum antibodies against ACHRs confirmed the diagnosis of MG. Treatment with pyridostigmine was started, and the thymic mass was surgically excised, and a diagnosis of thymoma was confirmed by histology. 24 hours after surgery, the dog developed a third-degree atrioventricular block. Severe arrhythmia and increased troponin serum levels suggested myocarditis which rapidly led to cardiopulmonary arrest. Histopathologic examination of the heart, esophagus and diaphragm revealed a lymphocytic and macrophagic infiltration, consistent with myocarditis and polymyositis. Scattered rare giant multinucleated cells were also detected in the myocardium. Conclusion: To the author’s knowledge, this is the first report of thymoma-associated MG with concurrent polymyositis and giant cell-like myocarditis in a dog.
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Affiliation(s)
- Raffaella Perillo
- San Marco Veterinary Clinic and Laboratory, Neurology and Neurosurgery Division, Veggiano (PD), Italy
| | - Marika Menchetti
- San Marco Veterinary Clinic and Laboratory, Neurology and Neurosurgery Division, Veggiano (PD), Italy
| | - Pasquale A Giannuzzi
- San Marco Veterinary Clinic and Laboratory, Neurology and Neurosurgery Division, Veggiano (PD), Italy
| | - Angela Marchiori
- San Marco Veterinary Clinic and Laboratory, Oncology Division, Veggiano (PD), Italy
| | - Marco Rondena
- San Marco Veterinary Clinic and Laboratory, Pathology Division Veggiano (PD), Italy
| | - Stefania Gasparini
- San Marco Veterinary Clinic and Laboratory, Pathology Division Veggiano (PD), Italy
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12
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Forgash JT, Chang YM, Mittelman NS, Petesch S, Benedicenti L, Galban E, Hammond JJ, Glass EN, Barker JR, Shelton GD, Luo J, Garden OA. Clinical features and outcome of acquired myasthenia gravis in 94 dogs. J Vet Intern Med 2021; 35:2315-2326. [PMID: 34331481 PMCID: PMC8478050 DOI: 10.1111/jvim.16223] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 06/25/2021] [Accepted: 07/12/2021] [Indexed: 12/22/2022] Open
Abstract
Background Factors known to be associated with outcome of acquired myasthenia gravis (MG) in dogs are limited. Hypothesis/Objectives Of dogs with MG, advancing age and comorbid neoplasia are associated with poor long‐term prognosis and low rates of remission. Animals Ninety‐four client‐owned dogs with MG diagnosed by acetylcholine receptor antibody (AChR Ab) assay between 2001 and 2019 from a university clinic and 3 private clinics in the United States. Methods Cases were retrospectively evaluated and data were collected to determine clinical signs, treatment, and response to therapy defined by means of a clinical scoring rubric. Immunological remission was defined as a return of the AChR Ab concentration to <0.6 nmol/L. Multivariable binary logistic regression analysis was used to identify clinical criteria predicting remission. Results An anticholinesterase drug was used to treat 90/94 (96%) dogs, which in 63/94 (67%) was the sole treatment; other drugs included immune modulators. Clinical remission (lack of clinical signs ≥4 weeks after treatment cessation) was observed in 29 (31% [95% confidence interval (CI): 22.4‐40.8%]) dogs, clinical response (lack of clinical signs on treatment) in 14 (15% [95% CI: 9.0‐23.6%]) dogs, clinical improvement (on treatment) in 24 (26% [95% CI: 17.8‐35.2%]) dogs, and no clinical improvement in 27 (29% [95% CI: 20.5‐38.6%]) dogs. Immunological remission was observed in 27/46 (59%) dogs, with clinical remission in all 27. Younger age (P = .04) and comorbid endocrine disease (P = .04) were associated with clinical remission. Initial AChR Ab concentration (P = .02) and regurgitation (P = .04) were negatively associated with clinical remission. Conclusions and Clinical Importance Clinical remission in MG is less likely in older dogs and dogs presenting with regurgitation or high initial AChR Ab concentration, but more likely in younger dogs and dogs with comorbid endocrine disease.
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Affiliation(s)
- Jennifer T Forgash
- Department of Clinical Sciences & Advanced Medicine, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Yu-Mei Chang
- Research Support Office, Royal Veterinary College, University of London, London, United Kingdom
| | - Neil S Mittelman
- Department of Clinical Sciences & Advanced Medicine, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Scott Petesch
- Department of Clinical Sciences & Advanced Medicine, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Leontine Benedicenti
- Department of Clinical Sciences & Advanced Medicine, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Evelyn Galban
- Department of Clinical Sciences & Advanced Medicine, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - James J Hammond
- Department of Neurology and Neurosurgery, Pieper Memorial Veterinary Center, Middletown, Connecticut, USA
| | - Eric N Glass
- Section of Neurology and Neurosurgery, Red Bank Veterinary Hospital, Tinton Falls, New Jersey, USA
| | - Jessica R Barker
- Department of Neurology and Neurosurgery, Bush Veterinary Neurology Service, Springfield, Virginia, USA
| | - G Diane Shelton
- Department of Pathology, School of Medicine, University of California San Diego, La Jolla, California, USA
| | - Jie Luo
- Department of Clinical Sciences & Advanced Medicine, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Oliver A Garden
- Department of Clinical Sciences & Advanced Medicine, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Baptista LFMM, Haugland S, Juvet F, Coldrick O, Lukács RM. What is your diagnosis? Mediastinal mass in a dog. Vet Clin Pathol 2021; 50:455-458. [PMID: 34331312 DOI: 10.1111/vcp.12941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 09/05/2020] [Accepted: 09/29/2020] [Indexed: 11/28/2022]
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14
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Palmer A, Wu CC, Miwa Y, Turek M, Sladky KK. Outcomes and survival times of client-owned rabbits diagnosed with thymoma and treated with either prednisolone or radiotherapy, or left untreated. J Exot Pet Med 2021. [DOI: 10.1053/j.jepm.2021.04.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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15
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Yale AD, Priestnall SL, Pittaway R, Taylor AJ. Thymic epithelial tumours in 51 dogs: Histopathologic and clinicopathologic findings. Vet Comp Oncol 2021; 20:50-58. [PMID: 34036722 DOI: 10.1111/vco.12705] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Revised: 05/07/2021] [Accepted: 05/09/2021] [Indexed: 11/27/2022]
Abstract
Canine thymic epithelial tumours (TET) are uncommon and little is known about their behaviour. Previous attempts at histologic classification have varied, and as such reliable prognostic information is unavailable. The aim of this retrospective multi-institutional study was to evaluate cases of canine TETs, irrespective of subtype, in order to identify useful histopathologic and clinicopathologic prognostic factors. Cases were included if the tumour arose from the cranial mediastinum and a diagnosis of TET was made on the basis of histopathology. Fifty-one dogs were included. In addition to clinicopathologic data, histology samples were reviewed for the following features: mitotic count, percentage of necrosis, presence of Hassall's corpuscles, lymphocytic infiltrate, cellular pleomorphism and vascular or capsular invasion. The median survival time for all dogs was 449 days. The 1- and 2-year survival rate was 52.6% and 26.3% respectively. On multivariable analysis surgical excision of the thymic tumour was associated with significantly prolonged survival; the presence of metastasis, myasthenia gravis and moderate or marked cellular pleomorphism were associated with significantly reduced survival. Additional studies are needed to further evaluate prognostic factors to aid treatment recommendations.
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16
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Tham HL, Linder KE, Olivry T. Deep pemphigus (pemphigus vulgaris, pemphigus vegetans and paraneoplastic pemphigus) in dogs, cats and horses: a comprehensive review. BMC Vet Res 2020; 16:457. [PMID: 33228633 PMCID: PMC7686683 DOI: 10.1186/s12917-020-02677-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 11/13/2020] [Indexed: 12/28/2022] Open
Abstract
Pemphigus is the term used to describe a group of rare mucocutaneous autoimmune bullous diseases characterized by flaccid blisters and erosions of the mucous membranes and/or skin. When the autoantibodies target desmosomes in the deep layers of the epidermis, deep pemphigus variants such as pemphigus vulgaris, pemphigus vegetans and paraneoplastic pemphigus develop. In this article, we will review the signalment, clinical signs, histopathology and treatment outcome of pemphigus vulgaris, pemphigus vegetans and paraneoplastic pemphigus in dogs, cats and horses; where pertinent, we compare the animal diseases to their human homologue. Canine, feline and equine pemphigus vulgaris, pemphigus vegetans and paraneoplastic pemphigus have many features similar to the human counterpart. These chronic and often relapsing autoimmune dermatoses require aggressive immunosuppressive therapy. In animals, the partial-to-complete remission of pemphigus vulgaris and pemphigus vegetans has been achieved with high dose glucocorticoid therapy, with or without adjunct immunosuppressants; the prognosis is grave for paraneoplastic pemphigus.
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Affiliation(s)
- Heng L. Tham
- Department of Small Animal Clinical Sciences, Virginia-Maryland College of Veterinary Medicine, Virginia Tech, Blacksburg, VA USA
| | - Keith E. Linder
- Comparative Medicine Institute, College of Veterinary Medicine, North Carolina State University, Raleigh, NC USA
- Department of Population Health and Pathobiology, College of Veterinary Medicine, North Carolina State University, Raleigh, NC USA
| | - Thierry Olivry
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC USA
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Hansford J, Henao-Guerrero N. Orthostatic hypotension secondary to a suspected thymoma in a dog: a case report. BMC Vet Res 2020; 16:388. [PMID: 33050932 PMCID: PMC7552379 DOI: 10.1186/s12917-020-02604-z] [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: 03/10/2020] [Accepted: 10/01/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This is the first case report description, to our knowledge, of a cranial mediastinal mass (suspected thymoma) causing orthostatic hypotension in a dog. CASE PRESENTATION A Labrador Retriever presented for urethral stent placement during cystoscopy secondary to transitional cell carcinoma diagnosis. During anesthesia, the patient had unexpected severe and poorly-responsive hypotension following a shift in position. Several days later, an intrathoracic mass was discovered, raising concerns that the position of the mass in relation to the great vessels and heart may have been the cause of the hypotension. The patient returned for a second stent placement, and computed tomography of the chest confirmed a cranial mediastinal mass, most suspected to be thymoma based on the results of cytology. The patient was kept in sternal recumbency, but when re-positioning to left lateral recumbency, there was a dramatic blood pressure drop that corrected with a return to sternal positioning. CONCLUSIONS To our knowledge, orthostatic hypotension has not been described in relation to thymoma in dogs. Thymomas are rare; however, they may be associated with disease of autonomic dysfunction, such as myasthenia gravis, that may lead to orthostatic hypotension. This has been described within the human literature, and we hypothesize it was present in the currently described case. Concurrently, thymomas may grow to a substantial size and cause direct compression of the intrathoracic vasculature. As such, it should be on the differential list for poorly-responsive hypotension following a shift in body positioning under anesthesia.
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Affiliation(s)
- Jeremy Hansford
- Department of Small Animal Clinical Sciences, Virginia Maryland College of Veterinary Medicine, Blacksburg, VA, 24061, USA.
| | - Natalia Henao-Guerrero
- Department of Small Animal Clinical Sciences, Virginia Maryland College of Veterinary Medicine, Blacksburg, VA, 24061, USA
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18
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Lanigan LG, Russell DS, Woolard KD, Pardo ID, Godfrey V, Jortner BS, Butt MT, Bolon B. Comparative Pathology of the Peripheral Nervous System. Vet Pathol 2020; 58:10-33. [PMID: 33016246 DOI: 10.1177/0300985820959231] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The peripheral nervous system (PNS) relays messages between the central nervous system (brain and spinal cord) and the body. Despite this critical role and widespread distribution, the PNS is often overlooked when investigating disease in diagnostic and experimental pathology. This review highlights key features of neuroanatomy and physiology of the somatic and autonomic PNS, and appropriate PNS sampling and processing techniques. The review considers major classes of PNS lesions including neuronopathy, axonopathy, and myelinopathy, and major categories of PNS disease including toxic, metabolic, and paraneoplastic neuropathies; infectious and inflammatory diseases; and neoplasms. This review describes a broad range of common PNS lesions and their diagnostic criteria and provides many useful references for pathologists who perform PNS evaluations as a regular or occasional task in their comparative pathology practice.
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19
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Mignan T, Targett M, Lowrie M. Classification of myasthenia gravis and congenital myasthenic syndromes in dogs and cats. J Vet Intern Med 2020; 34:1707-1717. [PMID: 32668077 PMCID: PMC7517852 DOI: 10.1111/jvim.15855] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 06/22/2020] [Accepted: 06/26/2020] [Indexed: 12/19/2022] Open
Abstract
Myasthenia, a syndrome of impaired neuromuscular transmission, occurs as either an acquired or congenital condition. Myasthenia gravis (MG) is an acquired autoimmune disorder with autoantibodies against the neuromuscular junction (NMJ) of skeletal muscle whereas congenital myasthenic syndromes (CMSs) are a clinically heterogeneous group of genetic disorders affecting the NMJ with a young age of onset. Both conditions are diseases for which recognition is important with regard to treatment and outcome. We review the published literature on MG and CMSs in dogs and cats, and by comparison with published classification used in humans, propose a classification system for MG and CMSs in dogs and cats. Myasthenia gravis is first classified based on focal, generalized, or acute fulminating presentation. It then is subclassified according to the autoimmune disease mechanism or seronegativity. Autoimmune disease mechanism relates to the presence or absence of a thymoma, or administration of thiourylene medication in cats. Congenital myasthenic syndromes are classified according to the affected NMJ component, the mechanism of the defect of neuromuscular transmission, the affected protein, and ultimately the mutated gene responsible. In proposing this categorization of MG and CMSs, we hope to aid recognition of the disease groups for both conditions, as well as guide treatment, refine prognosis, and provide a framework for additional studies of these conditions.
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Affiliation(s)
| | - Mike Targett
- School of Veterinary Medicine and Science, University of Nottingham, Leicestershire, UK
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20
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Smith A, Warren‐Smith C. Approach to imaging a thoracic mass in cats and dogs. IN PRACTICE 2019. [DOI: 10.1136/inp.l5939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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21
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Reeve EJ, Mapletoft EK, Schiborra F, Maddox TW, Lamb CR, Warren-Smith CMR. Mediastinal lymphoma in dogs is homogeneous compared to thymic epithelial neoplasia and is more likely to envelop the cranial vena cava in CT images. Vet Radiol Ultrasound 2019; 61:25-32. [PMID: 31574584 DOI: 10.1111/vru.12812] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 07/11/2019] [Accepted: 07/11/2019] [Indexed: 11/28/2022] Open
Abstract
In order to identify CT signs that could be used to distinguish cranial mediastinal lymphoma and thymic epithelial neoplasia, a retrospective case-control study was done. Associations between CT signs and diagnosis were tested using binary logistic regression and results expressed as odds ratio and 95% confidence interval. Sixty-two dogs that had thoracic CT and confirmed diagnosis of lymphoma (n = 33) or thymic neoplasia (n = 29) were sampled. Thymic neoplasms included 24 thymomas and five thymic carcinomas. Dogs with thymic epithelial neoplasia were significantly older than dogs with lymphoma (median age 8.6 years versus 6.0 years, P = .007), but there were no significant differences in prevalence of clinical signs. Diagnosis of thymic epithelial neoplasia was associated with heterogeneous attenuation in pre- (odds ratio 23.3, 95% confidence interval, 4.5-121.1) and post-contrast (odds ratio 30.7, 95% confidence interval, 3.6-265.0) images. Conversely, envelopment of the cranial vena cava by the mass was less likely with thymic epithelial neoplasia than lymphoma (odds ratio 0.07, 95% confidence interval, 0.007-0.66). Greater standard deviation of Hounsfield unit values in post-contrast images was associated with thymic epithelial neoplasia (P = .005). Based on ROC analysis, SD > 17HU of the mass in post-contrast images had a sensitivity of 72% and specificity of 79% for thymic epithelial neoplasia. There were no significant differences in morphology, prevalence of calcification, mediastinal lymphadenopathy, cranial vena cava invasion, collateral vessels, or pleural fluid associated with these tumors. Thymic epithelial neoplasms tended to occur in older dogs and were heterogeneous in CT images, whereas mediastinal lymphoma was more homogeneous and more likely to envelop the cranial vena cava.
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Affiliation(s)
| | - Emma K Mapletoft
- Department of Clinical Sciences and Services, The Royal Veterinary College, University of London, London, UK
| | | | - Thomas W Maddox
- Institute of Veterinary Science, University of Liverpool, Liverpool, UK
| | - Christopher R Lamb
- Department of Clinical Sciences and Services, The Royal Veterinary College, University of London, London, UK
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22
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Brückner M, Henrich M. Giant Thymoma with Benign Central Cystic Lesions in a 1-Year-Old Pug. J Am Anim Hosp Assoc 2019; 55:e55601. [PMID: 31525087 DOI: 10.5326/jaaha-ms-6723] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
A 14 mo old pug was referred because of a large space occupying mass within the thoracic cavity. The patient was worked up with thoracic radiographs, cytology, and computed tomography. The most likely differential diagnosis was thymoma; therefore, a median sternotomy was performed, and the mass was bluntly dissected from the adjacent tissues. The patient recovered uneventfully from surgery and was discharged the next day. Histopathology diagnosed a thymoma with central cystic lesions. Thymomas usually occur in elderly patients and these patients are usually presented because of paraneoplastic signs. The age and signs at presentation, as well as the histopathologic appearance of the presented patient is quite atypical. According to telephone follow-ups, the patient was doing well 9 mo postoperatively.
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Affiliation(s)
- Michael Brückner
- From Evidensia Specialist Animal Hospital, Strömsholm, Sweden (M.B.); and Institute of Veterinary Pathology, Justus Liebig University Giessen, Giessen, Germany (M.H.)
| | - Manfred Henrich
- From Evidensia Specialist Animal Hospital, Strömsholm, Sweden (M.B.); and Institute of Veterinary Pathology, Justus Liebig University Giessen, Giessen, Germany (M.H.)
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23
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von Stade L, Randall EK, Rao S, Marolf AJ. CT imaging features of canine thymomas. Vet Radiol Ultrasound 2019; 60:659-667. [PMID: 31397033 DOI: 10.1111/vru.12798] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 06/17/2019] [Accepted: 06/19/2019] [Indexed: 01/15/2023] Open
Abstract
Canine thymomas have been evaluated based on clinical features, treatment options, surgical excision, and outcomes with limited information on specific CT features. The objective of this retrospective, descriptive, cross-sectional study was to describe the CT characteristics of confirmed thymomas and to compare these imaging features to outcome. A total of 22 dogs met the inclusion criteria of histologically confirmed thymomas with concurrent CT imaging. Tumor size varied widely ranging from small and well-circumscribed to large and invasive. Delayed-phase, contrast-enhanced CT studies were best for determining the degree of contrast enhancement in tumors. Of these, 19 of 22 masses had heterogeneous enhancement and three of 22 masses had homogeneous enhancement. Vascular invasion was present in seven of 22 cases. Larger tumors were associated with vascular invasion (height: P = .04; width and volume: P = .02). On precontrast CT, larger tumors (16/21) were heterogeneous and cystic, with smaller tumors (5/21) being more homogeneous (all values P < .05). A larger size was associated with recurrence in fully resected masses (height: P = .03), but not a shorter outcome (P > .3 for all size dimensions). Postoperative complications and incomplete tumor resection were associated with shorter outcome (both values P < .01). Metastasis was confirmed in four cases. There were six cases with lymphadenopathy noted on CT; five of the six cases did not have evidence of metastasis. Larger tumors were more likely to be cystic and associated with vascular invasion.
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Affiliation(s)
| | - Elissa K Randall
- Department of Environmental and Radiological Health Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, Colorado
| | - Sangeeta Rao
- Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, Colarado
| | - Angela J Marolf
- Department of Environmental and Radiological Health Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, Colorado
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24
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Oura TJ, Hamel PE, Jennings SH, Bain PJ, Jennings DE, Berg J. Radiographic Differentiation of Cranial Mediastinal Lymphomas from Thymic Epithelial Tumors in Dogs and Cats. J Am Anim Hosp Assoc 2019; 55:187-193. [PMID: 31099608 DOI: 10.5326/jaaha-ms-6907] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
In both dogs and cats, the most common cranial mediastinal masses (CMMs) are lymphoma and thymic epithelial tumors (TETs). Pretreatment differentiation of these tumors using fine needle aspiration or biopsy is essential because lymphomas are treated medically, whereas TETs are treated surgically. The purpose of this retrospective study was to determine whether thoracic radiographic findings can be used to aid clinicians in preliminarily differentiating the two tumor types before cytology or histopathology results become available. Medical records, available cytologic or histologic samples, and thoracic radiographs were evaluated for 62 dogs and 28 cats. Seventeen radiographic criteria were assessed by two examiners, and regression modeling was performed to test for significant predictors of tumor type. In dogs, CMMs with at least two well-defined radiographic margins on a lateral view and CMMs causing a rightward shift of the cardiac silhouette on a ventrodorsal or dorsoventral view were significantly more likely to be TETs than lymphomas (P < .001 and P < .01, respectively). No significant predictive variables were identified in cats. Radiographic findings do not eliminate the need for invasive sampling, but in dogs, they may guide the clinician in providing preliminary information to owners regarding the staging and therapeutic measures that may eventually be recommended.
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Affiliation(s)
- Trisha J Oura
- From the Department of Clinical Sciences (T.J.O., P.E.H., J.B.), and Department of Biomedical Sciences (S.H.J., P.J.B.), Cummings School of Veterinary Medicine, Tufts University, Grafton, Massachusetts; and Independent Consultant, Libertyville, Illinois (D.E.J.)
| | - Philip E Hamel
- From the Department of Clinical Sciences (T.J.O., P.E.H., J.B.), and Department of Biomedical Sciences (S.H.J., P.J.B.), Cummings School of Veterinary Medicine, Tufts University, Grafton, Massachusetts; and Independent Consultant, Libertyville, Illinois (D.E.J.)
| | - Samuel H Jennings
- From the Department of Clinical Sciences (T.J.O., P.E.H., J.B.), and Department of Biomedical Sciences (S.H.J., P.J.B.), Cummings School of Veterinary Medicine, Tufts University, Grafton, Massachusetts; and Independent Consultant, Libertyville, Illinois (D.E.J.)
| | - Perry J Bain
- From the Department of Clinical Sciences (T.J.O., P.E.H., J.B.), and Department of Biomedical Sciences (S.H.J., P.J.B.), Cummings School of Veterinary Medicine, Tufts University, Grafton, Massachusetts; and Independent Consultant, Libertyville, Illinois (D.E.J.)
| | - Dennis E Jennings
- From the Department of Clinical Sciences (T.J.O., P.E.H., J.B.), and Department of Biomedical Sciences (S.H.J., P.J.B.), Cummings School of Veterinary Medicine, Tufts University, Grafton, Massachusetts; and Independent Consultant, Libertyville, Illinois (D.E.J.)
| | - John Berg
- From the Department of Clinical Sciences (T.J.O., P.E.H., J.B.), and Department of Biomedical Sciences (S.H.J., P.J.B.), Cummings School of Veterinary Medicine, Tufts University, Grafton, Massachusetts; and Independent Consultant, Libertyville, Illinois (D.E.J.)
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26
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Wiles V, Haddad J, Leibman N, Avery AC, Hughes KL. Metastatic thymoma in the liver of a dog. J Vet Diagn Invest 2018; 30:774-778. [PMID: 30117785 DOI: 10.1177/1040638718791222] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
A 12-y-old neutered male Portuguese Water dog was presented because of a 1-y history of persistent hyporexia, diarrhea, and recurrent pyelonephritis. Abdominal ultrasound revealed hepatic nodules and diffuse splenomegaly, and radiographs revealed a mediastinal mass. Fine-needle aspirates of the liver, spleen, and mediastinal mass were suspicious for lymphoma. Flow cytometry identified small T cells that co-expressed CD4 and CD8 at all sites, most suspicious for thymoma, but lymphoma could not be ruled out. PCR for antigen receptor rearrangements analysis identified polyclonal amplification of the T-cell receptor genes, more consistent with thymoma than lymphoma. Histopathology of the liver and thymic mass confirmed thymoma with hepatic metastasis.
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Affiliation(s)
- Valerie Wiles
- Veterinary Cancer Group, Woodland Hills, CA (Wiles).,IDEXX Laboratories Inc., Westbrook, ME (Haddad).,Department of Oncology, The Animal Medical Center, New York, NY (Leibman).,Clinical Immunology Laboratory, Department of Microbiology, Immunology and Pathology, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, CO (Avery, Hughes)
| | - Jamie Haddad
- Veterinary Cancer Group, Woodland Hills, CA (Wiles).,IDEXX Laboratories Inc., Westbrook, ME (Haddad).,Department of Oncology, The Animal Medical Center, New York, NY (Leibman).,Clinical Immunology Laboratory, Department of Microbiology, Immunology and Pathology, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, CO (Avery, Hughes)
| | - Nicole Leibman
- Veterinary Cancer Group, Woodland Hills, CA (Wiles).,IDEXX Laboratories Inc., Westbrook, ME (Haddad).,Department of Oncology, The Animal Medical Center, New York, NY (Leibman).,Clinical Immunology Laboratory, Department of Microbiology, Immunology and Pathology, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, CO (Avery, Hughes)
| | - Anne C Avery
- Veterinary Cancer Group, Woodland Hills, CA (Wiles).,IDEXX Laboratories Inc., Westbrook, ME (Haddad).,Department of Oncology, The Animal Medical Center, New York, NY (Leibman).,Clinical Immunology Laboratory, Department of Microbiology, Immunology and Pathology, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, CO (Avery, Hughes)
| | - Kelly L Hughes
- Veterinary Cancer Group, Woodland Hills, CA (Wiles).,IDEXX Laboratories Inc., Westbrook, ME (Haddad).,Department of Oncology, The Animal Medical Center, New York, NY (Leibman).,Clinical Immunology Laboratory, Department of Microbiology, Immunology and Pathology, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, CO (Avery, Hughes)
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27
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O'Connell E, Harper A, Blundell R, Batchelor D. Paraneoplastic immune-mediated neutropenia in a dog following thymoma excision with later development of metastatic thymic carcinoma treated with toceranib phosphate. VETERINARY RECORD CASE REPORTS 2018. [DOI: 10.1136/vetreccr-2017-000548] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
A thymoma was an incidental finding in a seven-year-old, female neutered, crossbred dog referred for an acute hepatopathy. Excision of the thymoma was performed via median sternotomy, and 11 weeks later the dog presented with severe neutropenia. The bone marrow was hypercellular, and paraneoplastic immune-mediated neutropenia was diagnosed following exclusion of other causes. The neutrophil count increased to normal within seven days of treatment with prednisolone, which was subsequently tapered. A caudal mediastinal mass was documented 17 months following initial thymoma excision, and pleural and mediastinal metastases were evident on CT. Cytology was consistent with carcinoma. Following the prescription of toceranib phosphate, there was stable disease on CT at eight weeks and six months. At 12 months there was severe locoregional progression and the dog died nine days thereafter. Postmortem examination showed diffuse metastatic carcinoma of the caudal mediastinum, parietal pleura and diaphragm, and histopathology/immunohistochemistry was most consistent with thymic carcinoma.
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28
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Loewen JM, Cianciolo RE, Zhang L, Yaeger M, Ward JL, Smith JD, LeVine DN. Concurrent renal amyloidosis and thymoma resulting in a fatal ventricular thrombus in a dog. J Vet Intern Med 2018; 32:1160-1165. [PMID: 29485186 PMCID: PMC5980280 DOI: 10.1111/jvim.15062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Revised: 10/31/2017] [Accepted: 01/15/2018] [Indexed: 11/27/2022] Open
Abstract
Thymoma-associated nephropathies have been reported in people but not in dogs. In this report, we describe a dog with thymoma and concurrent renal amyloidosis. A 7-year-old castrated male Weimaraner was presented for progressive anorexia, lethargy, and tachypnea. The dog was diagnosed with azotemia, marked proteinuria, and a thymoma that was surgically removed. Postoperatively, the dog developed a large left ventricular thrombus and was euthanized. Necropsy confirmed the presence of a left ventricular thrombus and histopathology revealed renal amyloidosis. We speculate that the renal amyloidosis occurred secondary to the thymoma, with amyloidosis in turn leading to nephrotic syndrome, hypercoagulability, and ventricular thrombosis. This case illustrates the potential for thymoma-associated nephropathies to occur in dogs and that dogs suspected to have thymoma should have a urinalysis and urine protein creatinine ratio performed as part of the pre-surgical database.
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Affiliation(s)
- Jennifer M Loewen
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Iowa State University, Ames, Iowa
| | - Rachel E Cianciolo
- Department of Veterinary Biosciences and International Veterinary Renal Pathology Service, College of Veterinary Medicine, The Ohio State University, Columbus, Ohio
| | - Liwen Zhang
- Mass Spectrometry and Proteomics Facility, Campus Chemical Instrument Center, The Ohio State University, Columbus, Ohio
| | - Michael Yaeger
- Department of Veterinary Pathology, College of Veterinary Medicine, Iowa State University, Ames, Iowa
| | - Jessica L Ward
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Iowa State University, Ames, Iowa
| | - Jodi D Smith
- Department of Veterinary Pathology, College of Veterinary Medicine, Iowa State University, Ames, Iowa
| | - Dana N LeVine
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Iowa State University, Ames, Iowa
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29
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Rohrer Bley C, Meier V, Schneider U. Dosimetric benefit of adaptive radiotherapy in the neoadjuvant management of canine and feline thymoma-An exploratory case series. Vet Comp Oncol 2018; 16:324-329. [PMID: 29316134 DOI: 10.1111/vco.12382] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Revised: 10/10/2017] [Accepted: 12/11/2017] [Indexed: 11/28/2022]
Abstract
While surgery is the treatment of choice for thymomas, complete excision is not possible in a significant proportion of cases. For these patients, radiotherapy can be used as neoadjunctive, post-operative adjunctive or sole therapy. During radiotherapy, rapid biological clearance of tumour cells is often observed, requiring adaptation of the treatment plan. Adaptive radiation therapy (RT) is a dynamic process, whereby the treatment plan is altered throughout the treatment course due to changes in morphologic, functional or positioning changes. With the hypothesis, that individually adapted replanning will massively reduce the dose to organs at risk (OAR) in a fast-changing environment such as a rapidly responding thymoma, the dosimetric impact of adaptive treatment planning in 5 patients with large thymoma was measured. In all patients rapid tumour-shrinkage of the gross tumour volume was observed after 1 week of therapy, with a mean shrinkage of 31.0% ± 15.2%, or a tumour regression of 5.2% per day. In consequence, there was a considerable change in position of organs such as heart and lung, both of them moving cranially into the high dose area upon tumour regression. After mid-therapy replanning, the dose to OAR was significantly reduced, with -18.2% in the mean heart dose and -27.9% in the V20 lung dose. Adaptive planning led to a significantly reduced radiation dose and hence protection of OAR for these patients. It can be concluded that adaptive replanning should be considered for canine and feline thymoma patients receiving fractionated RT.
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Affiliation(s)
- C Rohrer Bley
- Division of Radiation Oncology, Vetsuisse Faculty University of Zurich, Zurich, Switzerland
| | - V Meier
- Division of Radiation Oncology, Vetsuisse Faculty University of Zurich, Zurich, Switzerland
| | - U Schneider
- Division of Radiation Oncology, Vetsuisse Faculty University of Zurich, Zurich, Switzerland.,Radiation Oncology, Hirslanden Clinic, Zurich, Switzerland
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Moller CA, Bender H. Pathology in Practice. Metastatic lymphocyte-rich thymoma in a dog. J Am Vet Med Assoc 2017; 250:387-390. [PMID: 28165310 DOI: 10.2460/javma.250.4.387] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Hill JA, Fubini SL, Hackett RP. Clinical features, treatment, and outcome in goats with thymomas: 13 cases (1990–2014). J Am Vet Med Assoc 2017; 251:829-834. [DOI: 10.2460/javma.251.7.829] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Goto S, Murakami M, Kawabe M, Iwasaki R, Heishima K, Sakai H, Mori T. Hypofractionated radiation therapy in the treatment of canine thymoma: Retrospective study of eight cases. Vet Radiol Ultrasound 2017; 58:613-620. [DOI: 10.1111/vru.12525] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Revised: 04/10/2017] [Accepted: 04/14/2017] [Indexed: 12/25/2022] Open
Affiliation(s)
- Sho Goto
- Animal Medical Center; Gifu University; Yanagido Gifu-shi Gifu 501-1193 Japan
| | - Mami Murakami
- Department of Veterinary Clinical Oncology; Gifu University; Yanagido Gifu-shi Gifu 501-1193 Japan
| | - Mifumi Kawabe
- Department of Veterinary Clinical Oncology; Gifu University; Yanagido Gifu-shi Gifu 501-1193 Japan
| | - Ryota Iwasaki
- Animal Medical Center; Gifu University; Yanagido Gifu-shi Gifu 501-1193 Japan
| | - Kazuki Heishima
- Department of Veterinary Clinical Oncology; Gifu University; Yanagido Gifu-shi Gifu 501-1193 Japan
| | - Hiroki Sakai
- Department of Pathology; Gifu University; Yanagido Gifu-shi Gifu 501-1193 Japan
| | - Takashi Mori
- Department of Veterinary Clinical Oncology; Gifu University; Yanagido Gifu-shi Gifu 501-1193 Japan
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MacIver MA, Case JB, Monnet EL, Hunt GB, Mayhew PD, Oblak ML, Runge JJ, Singh A, Smeak DD, Steffey MA, Boston SE. Video-assisted extirpation of cranial mediastinal masses in dogs: 18 cases (2009–2014). J Am Vet Med Assoc 2017; 250:1283-1290. [DOI: 10.2460/javma.250.11.1283] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Case JB. Advances in Video-Assisted Thoracic Surgery, Thoracoscopy. Vet Clin North Am Small Anim Pract 2016; 46:147-69. [DOI: 10.1016/j.cvsm.2015.07.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Alwen SGJ, Culp WTN, Szivek A, Mayhew PD, Eckstrand CD. Portal site metastasis after thoracoscopic resection of a cranial mediastinal mass in a dog. J Am Vet Med Assoc 2015; 247:793-800. [DOI: 10.2460/javma.247.7.793] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Garneau MS, Price LL, Withrow SJ, Boston SE, Ewing PJ, McClaran JK, Liptak JM, Berg J. Perioperative Mortality and Long-Term Survival in 80 Dogs and 32 Cats Undergoing Excision of Thymic Epithelial Tumors. Vet Surg 2014; 44:557-64. [PMID: 25367336 DOI: 10.1111/j.1532-950x.2014.12304.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Accepted: 07/01/2014] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To examine perioperative mortality, long-term survival, causes of death, and prognostic factors for dogs and cats undergoing surgical excision of thymic epithelial tumors (TETs). STUDY DESIGN Multi-institutional case series. ANIMALS Eighty dogs and 32 cats. METHODS Follow-up information was obtained for dogs and cats that underwent surgical excision of a TET between 2001 and 2012. RESULTS Perioperative mortality was 20% in dogs and 22% in cats. No independent risk factors for perioperative mortality were identified. The estimated median survival time for all dogs was 1.69 years (95% CI 0.56-4.32) and the 1- and 4-year survival rates were 55% (95% CI 44-67) and 44% (95% CI 32-56). The estimated median survival time for all cats was 3.71 years (95% CI 0.56-unestimatable) and the 1- and 4-year survival rates were 70% (95% CI 53-87) and 47% (95% CI 0-100). Of animals that survived to discharge, 42% of dogs and 20% of cats eventually died of TET-related causes. The presence of paraneoplastic syndromes (hazard ratio [HR] 5.78, 95% CI 1.64-20.45, P = .007) or incomplete histologic margins (HR 6.09, 95% CI 1.50-24.72, P = .01) were independently associated with decreased survival in dogs. No significant predictors of survival were identified in cats. Conclusions regarding the effect of chemotherapy or radiation therapy could not be made. CONCLUSIONS While there is substantial risk of perioperative death in dogs and cats undergoing surgery for TETs, many animals that survive to discharge have prolonged survival. Survival is significantly decreased in dogs with paraneoplastic syndromes or incomplete histologic margins.
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Affiliation(s)
- Mark S Garneau
- Tufts Cummings School of Veterinary Medicine, North Grafton, Massachusetts
| | | | - Stephen J Withrow
- Colorado State University Veterinary Teaching Hospital, Fort Collins, Colorado
| | | | | | | | | | - John Berg
- Tufts Cummings School of Veterinary Medicine, North Grafton, Massachusetts
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