Exocrine Pancreatic Neoplasia in the Cat: A Case Series

Computed tomographic features of exocrine pancreatic carcinomas in dogs and cats

Exocrine pancreatic carcinomas are uncommon in dogs and cats, and diagnosis with diagnostic imaging can be challenging. This retrospective, multi-institutional, descriptive study was performed to evaluate the CT features of exocrine pancreatic carcinomas. The CT examinations of 18 dogs and 12 cats with exocrine pancreatic carcinomas diagnosed by cytology or histopathology were reviewed. The CT features of exocrine pancreatic carcinomas included a well-defined mass in 28/30 (93%) with contrast enhancement in 27/30 (90%), commonly heterogeneous 22/30 (73%); often with a nonenhancing fluid to soft tissue attenuating center 12/30 (40%). The right lobe of the pancreas was the most common location, 14/30 (47%), then the left lobe, 10/30 (33%), and the body, 6/30 (20%). Extrahepatic biliary duct dilation was present in six animals; 5/6 (83%) of the masses were located in the right pancreatic lobe. Additional findings included peripancreatic fat-stranding 17/30 (57%), lymphadenopathy 16/30 (57%), peripancreatic soft tissue nodules 12/30 (40%), and free fluid 10/30 (33%). When comparing the imaging features of dogs and cats, there was a large overlap in imaging characteristics. There was a significant difference between the height of the masses, with dogs having larger masses (P-value.0028). Lymphadenopathy was more likely in larger masses [increased height (P-value.029)]. Cats were significantly older than dogs (P-value.0355). Pancreatic carcinomas were commonly identified as masses with heterogeneous contrast enhancement and a nonenhancing fluid to soft tissue attenuating center with concurrent peripancreatic changes (fat-stranding and/or soft tissue nodules) and lymphadenopathy.

Laparoscopic partial pancreatectomy in a cat with exocrine pancreatic carcinoma

Case summary

Minimally invasive surgery is an increasingly popular alternative to open surgery in veterinary medicine. Compared with traditional surgical approaches, laparoscopic pancreatectomy provides a less invasive approach and has several potential benefits, including improved visualization, reduced infection rate and decreased postoperative pain. Laparoscopic partial pancreatectomy has been described in humans, dogs and pigs but not cats. Pancreatectomy with or without chemotherapy is a treatment option for exocrine pancreatic carcinoma, a rare but malignant cancer in cats. We report the case of a 16-year-old male neutered domestic longhair cat diagnosed with exocrine pancreatic carcinoma that was treated with laparoscopic partial pancreatectomy, carboplatin and toceranib phosphate. A three-port technique using a 5 mm 0º telescope and bipolar vessel sealing device was performed to remove the entire left limb of the pancreas. No intra- or postoperative complications occurred, and the patient was discharged the following day. Forty days postoperatively, the patient received its first of five doses of carboplatin, which were given every 4-5 weeks over a period of 4 months. A maintenance protocol of toceranib phosphate was started after completion of carboplatin treatment. At the time of this article being submitted, the patient had survived for more than 221 days.

Relevance and novel information

This is the first report of a laparoscopic partial pancreatectomy performed on a feline patient for pancreatic carcinoma.

Pathological and immunohistochemical characterization of pancreatic carcinoma in cats

The aim of this study was to characterize the pathological and immunohistochemical aspects of pancreatic carcinoma in cats, through a retrospective study. From January 2010 to December 2021, 1,908 cat necropsies were performed, in which 20 cases of exocrine pancreatic neoplasia were diagnosed (1.04%). Affected cats were mature adults and seniors, except for one 1-year-old cat. In 11 cases the neoplasm was a soft, focal nodule on the left (8/11) or right (3/11) lobe. In nine cases there were multifocal nodules throughout the pancreatic parenchyma. The size of the single masses ranged from 2 to 12 cm, and the multifocal masses from 0.5 to 2 cm. The most frequent tumour type was acinar carcinoma (11/20), followed by ductal carcinoma (8/20), undifferentiated carcinoma (1/20) and carcinosarcoma (1/20). On immunohistochemical evaluation, all the neoplasms were remarkably reactive to pancytokeratin antibody. The ductal carcinomas were strongly reactive for cytokeratins 7 and 20, which proved to be a good marker for pancreatic ductal carcinoma in cats. The main form of metastasis was abdominal carcinomatosis, with a marked invasion of blood and lymphatic vessels by neoplastic cells. Our findings reinforce the fact that pancreatic carcinoma should be rated highly in the differential diagnosis in mature adult and senior cats with abdominal masses, ascites and/or jaundice.

Contrast-enhanced ultrasound features of focal pancreatic lesions in cats

A large overlap in the ultrasound (US) features of focal pancreatic lesions (FPLs) in cats is reported. Furthermore, only a small number of studies describing the contrast-enhanced ultrasound (CEUS) features of FPLs in cats have been conducted today. The aim of this study is to describe the B-mode US and CEUS features of FPLs in cats. Ninety-eight cats cytologically diagnosed with FPL were included. The lesions were classified as adenocarcinoma (n = 40), lymphoma (n = 11), nodular hyperplasia (n = 17), other benign lesion (OBL) (n = 20), cyst (n = 4) or other malignant lesion (OML) (n = 6). Several qualitative and quantitative B-mode and CEUS features were described in each case. OMLs and cysts were not included in the statistical analysis. A decision tree to classify the lesions based on their B-mode and CEUS features was developed. The overall accuracy of the cross-validation of the decision tree was 0.74 (95% CI: 0.63–0.83). The developed decision tree had a very high sensitivity and specificity for nodular hyperplasia (1 and 0.94, respectively) as well as good sensitivity and specificity for both adenocarcinomas (0.85 and 0.77, respectively) and OBLs also (0.70 and 0.93, respectively). The algorithm was unable to detect any specific feature for classifying lymphomas, and almost all the lymphomas were classified as adenocarcinomas. The combination between CEUS and B-mode US is very accurate in the classification of some FPLs, especially nodular hyperplasia and adenocarcinomas. Cytopathology and or histopathology is still a fundamental step FPL diagnostic workflow.

Identification of potential plasma protein biomarkers for feline pancreatic carcinoma by liquid chromatography tandem mass spectrometry

In both humans and cats, pancreatic carcinoma is an aggressive cancer with a grave prognosis. Proteomics techniques have successfully identified several blood-based biomarkers of human pancreatic neoplasia. Thus, this study aims to investigate whether similar biomarkers can be identified in the plasma of cats with FePAC by using liquid chromatography tandem mass spectrometry (LC-MS/MS). To facilitate evaluation of the low abundance plasma proteome, a human-based immunodepletion device (MARS-2) was first validated for use with feline plasma. Marked reduction and/or complete removal of albumin and immunoglobulins was confirmed by analysis of electrophoretograms and mass spectral data. Subsequently, plasma collected from 9 cats with pancreatic carcinoma (FePAC), 10 cats with symptomatic pancreatitis, and 10 healthy control cats was immunodepleted and subjected to LC-MS/MS. Thirty-seven plasma proteins were found to be differentially expressed (p < .05 in one-way ANOVA, FC >2 in fold change analysis). Among these proteins, ETS variant transcription factor 4 (p < .05) was overexpressed, while gelsolin (p < .01), tryptophan 2,3-dioxygenase (p < .05), serpin family F member 1 (p < .01), apolipoprotein A-IV (p < .01) and phosphatidylinositol-glycan-specific phospholipase D (p < .05) were down-regulated in cats with FePAC. Further studies on these potential biomarkers are needed to investigate their diagnostic value.

Perioperative outcomes in dogs and cats undergoing pancreatic surgery: 81 cases (2008-2019)

OBJECTIVES

To identify and describe the type and frequency of perioperative factors in dogs and cats undergoing pancreatic surgery under referral care.

METHODS

Medical records from a small animal surgical referral practice were retrospectively reviewed to identify dogs and cats that underwent pancreatic surgery between 2008 and 2019. Inclusion criteria included complete medical record, histopathology results and follow-up of at least 14 days postoperatively or until death. Variables collected included signalment, history, presenting complaint, preoperative diagnostic results, intraoperative complications, surgical findings/procedures, postoperative complications and histopathology results. Cases were excluded if pertinent information or a histopathology report was missing from the medical record. The frequency of these variables was reported.

RESULTS

There were 81 client-owned animals identified that met the inclusion criteria (57 dogs and 24 cats). The most common pancreatic procedure performed in dogs was partial pancreatectomy 63.2% (36/57) and in cats was pancreatic biopsy 62.5% (15/24). The most common histologic diagnosis in dogs was pancreatic islet cell carcinoma 50.9% (29/57) and in cats was pancreatitis 41.7% (10/24). The overall mortality rate was 13.6% (11/81), with a 10.5% (6/57) mortality rate in dogs and a 20.8% (5/24) mortality rate in cats.

CLINICAL SIGNIFICANCE

In this series of dogs and cats, pancreatic surgery under referral care carried a low to moderate mortality rate.

Pancreatic leiomyosarcoma in a domestic shorthair cat

Case summary

A 7-year-old female neutered domestic shorthair cat was presented with weight loss, abdominal distension, lethargy, pyrexia and hyporexia. Haematology and biochemistry were unremarkable. Abdominal ultrasound revealed a cystic mass within the left cranial abdominal quadrant, adjacent to the pancreas, stomach and spleen. CT revealed a 10.5 cm, rounded, well-encapsulated, hypodense mass arising from the left pancreatic lobe. The remaining organs of the abdominal and thoracic cavity were unremarkable. A partial left lobe pancreatectomy and splenic lymph node removal were performed. Histopathology of the pancreatic mass reported a proliferating population of neoplastic spindle cells most consistent with a preliminary diagnosis of soft tissue sarcoma. Immunohistochemistry characteristics, together with the morphological findings, were consistent with a diagnosis of leiomyosarcoma. The patient recovered without any concerns after receiving routine postoperative care. Clinical examination and abdominal ultrasound 5 months postoperatively revealed no abnormalities.

Relevance and novel information

To our knowledge, this is the first report of pancreatic leiomyosarcoma in a cat. Pancreatic leiomyosarcoma should be considered as one of the possible differential diagnoses for cats presenting with a pancreatic mass.

Use of stereotactic body radiation therapy for treatment of a pancreatic tumor in a cat

CASE DESCRIPTION

A 16-year old castrated male domestic shorthair cat was evaluated at a veterinary teaching hospital because of polyuria, polydipsia, and weight loss of 2 months' duration.

CLINICAL FINDINGS

Hematologic and biochemical examination results were within respective reference ranges except for moderately high pancreas-specific lipase concentration. Ultrasonographic and cytologic evaluation revealed a hepatic mass with findings consistent with mild cholestasis and inflammation and a pancreatic mass that was initially identified as a neuroendocrine tumor.

TREATMENT AND OUTCOME

The cat underwent additional CT assessment and stereotactic body radiation therapy (SBRT; 3 fractions of 8 Gy, administered every other day) for treatment of the pancreatic tumor. Follow-up ultrasonographic and CT examinations indicated a partial response to SBRT, with a maximum CT-measured size reduction from 3.6 × 4.8 × 4.0 cm at the time of treatment planning to 2.0 × 2.0 × 1.9 cm 8 months later. Increased pancreatic tumor size and signs of carcinomatosis were detected 15 months after SBRT treatment; the initial cytologic diagnosis was changed to exocrine pancreatic carcinoma on reevaluation of the slides by another veterinary pathologist. Carboplatin treatment was elected, and signs of carcinomatosis resolved. The cat was euthanized without further testing because of weakness 589 days after SBRT was started.

CLINICAL RELEVANCE

To the authors' knowledge, this is the first report of SBRT for suspected exocrine pancreatic carcinoma in a cat. Further investigation is needed to determine optimal fractionation schedules for SBRT of pancreatic tumors and utility of SBRT of exocrine pancreatic carcinoma in cats.

Pancreatic adenosquamous carcinoma with invasion to the spleen in a cat

A four-and-a-half-year-old female Scottish Fold cat underwent partial pancreatectomy with en-bloc splenectomy. The resected specimen was a biphasic tumor that was diagnosed histologically and immunohistochemically as pancreatic adenosquamous carcinoma (ASC), a ductal carcinoma variant according to the WHO classification of tumors in humans. There was a gradual transition between the adenocarcinoma component and the squamous cell carcinoma component. The squamous cell carcinoma component comprised approximately 30–40% of the tumor. A pancreatic tumor infiltrated into the gastrosplenic ligament and spleen with regional lymph node and mesenteric metastases. Pancreatic ASC has not been reported in animals. This is a case report of feline pancreatic ASC with splenic involvement.

Long-term survival in a cat with pancreatic adenocarcinoma treated with surgical resection and toceranib phosphate

Case summary

Primary pancreatic adenocarcinoma is an uncommon neoplasm seen in cats and often has a poor prognosis. We report a case of an 8-year-old male neutered domestic shorthair cat weighing 5.8 kg diagnosed with pancreatic adenocarcinoma treated with surgical resection and toceranib phosphate, which had a progression-free interval of 1148 days and survived for more than 1436 days. The treatment was well tolerated; however, the cat developed generalised coat hypopigmentation.

Relevance and novel information

To our knowledge, the cat in our report has the longest progression-free interval and survival time post-surgical resection of pancreatic carcinoma treated with toceranib. Hypopigmentation as a side effect of toceranib has been reported in dogs, but this is the first case reported in cats.

Clinical and Pathological Data of 17 Non-Epithelial Pancreatic Tumors in Cats

Tumors of mesenchymal origin are rarely reported in the pancreas. Therefore, this study characterized 17 feline non-epithelial pancreatic tumors, including clinical data, histopathology, and immunohistochemistry. Seventeen feline pancreatic tissue samples were investigated histopathologically and immunohistochemically. Selected pancreatic and inflammatory serum parameters, e.g., feline pancreatic lipase immunoreactivity (fPLI), 1,2-o-dilauryl-rac-glycero-3-glutaric acid-(6'-methylresorufin) ester (DGGR) lipase and serum amyloid A (SAA), were recorded, when available. The neoplasms were characterized as round (n = 13) or spindle (n = 4) cell tumors. Round cell tumors included 12 lymphomas and one mast cell tumor in ectopic splenic tissue within the pancreas. Lymphomas were of T-cell (n = 9) or B-cell (n = 3) origin. These cats showed leukocytosis (3/3) and increased fPLI (5/5), DGGR lipase (3/5) and SAA (4/5) values. Spindle cell tumors included two hemangiosarcomas, one pleomorphic sarcoma and one fibrosarcoma. The cat with pleomorphic sarcoma showed increased SAA value. Overall survival time was two weeks to seven months. These are the first descriptions of a pancreatic pleomorphic sarcoma and a mast cell tumor in accessory spleens within feline pancreas. Although rare, pancreatic tumors should be considered in cats presenting with clinical signs and clinical pathology changes of pancreatitis. Only histopathology can certainly distinguish solitary pancreatitis from a neoplasm with inflammation.

Feline abdominal ultrasonography: What's normal? What's abnormal? The pancreas

PRACTICAL RELEVANCE

Abdominal ultrasound plays a vital role in the diagnostic work-up of many cats presenting to general and specialist practitioners. Ultrasound examination of the pancreas is a vital part of the investigation into feline pancreatic disease.

CLINICAL CHALLENGES

Despite ultrasonography being a commonly used modality, many practitioners are not comfortable performing an ultrasound examination or interpreting the resulting images. Even for the experienced ultrasonographer, differentiating between incidental findings such as nodular hyperplasia and pathological changes such as neoplasia can be challenging.

AIM

This review, part of an occasional series on feline abdominal ultrasonography, discusses the ultrasonographic examination and appearance of the normal and diseased pancreas. Aimed at general practitioners who wish to improve their knowledge of and confidence in feline abdominal ultrasound, this review is accompanied by high-resolution images and videos available online as supplementary material.

EQUIPMENT

Ultrasound facilities are readily available to most practitioners, although use of ultrasonography as a diagnostic tool is highly dependent on operator experience.

EVIDENCE BASE

Information provided in this article is drawn from the published literature and the author's own clinical experience.

Primary Solid and Cystic Tumours of the Exocrine Pancreas in Cats

Tumours of the exocrine pancreas are rare in cats and few cases are described in the literature. Cystic tumours of the pancreas are not included in the World Health Organization (WHO) international histological classification of tumours of domestic animals. The aim of this study was to characterize the pathology of primary epithelial tumours of the feline exocrine pancreas, with emphasis on cystic tumours. We reviewed tumours of the exocrine pancreas in 70 cats, including complete tumours or the entire pancreas (n = 18) and excisional biopsy samples of pancreatic tumours (n = 52). Macroscopically, the tumours were grouped as solid (n = 45) or cystic (n = 25). Solid tumours were subdivided into adenomas (n = 5) and carcinomas (n = 40) and cystic neoplasms into adenomas (n = 15), carcinomas (n = 7) and cases with diverse growth patterns (n = 3). All five grossly solid adenomas had acinar morphology, while the macroscopically solid carcinomas showed acinar (n = 17), tubular (n = 14) or mixed (n = 9) growth microscopically. Cystic adenomas had acinar (n = 2), tubular (n = 12) or mixed (n = 1) growth, while cystic carcinomas had exclusively tubular growth (n = 7). Three cases with cystic lesions showed diverse histopathological growth patterns. The clinical outcome was available in 57 cases. The majority of cats with carcinomas died or were humanely destroyed during or shortly after surgery (n = 32). However, 2/7 animals with cystic carcinomas showed longer survival times. Cats with cystic adenomas had survival times of up to 5 years. The results of this study show that cystic pancreatic tumours should be considered a differential diagnosis in cats with cystic intra-abdominal masses, even though these are not yet described in the WHO classification. Based on the relatively long survival times of cats with cystic adenomas, complete resection with subsequent histopathological examination is recommended.

Postsurgical Outcome in Cats with Exocrine Pancreatic Carcinoma: Nine Cases (2007–2016)

Feline exocrine pancreatic carcinoma has been reported to be an aggressive tumor with a high metastatic rate and poor prognosis. Studies reporting long-term outcome of cats after surgical removal of solitary pancreatic carcinomas are rare, due to the uncommon diagnosis and paucity of cats who undergo treatment. In this study, nine cases of feline exocrine pancreatic carcinoma from seven academic and private practice veterinary hospitals were reviewed to examine the outcome in cats undergoing surgical removal of the mass. The median postsurgical survival time for the nine cats was 316.5 days (range, 25–964 days), with three cats alive at a median follow-up time of 309 days. This study demonstrates that surgical removal of pancreatic exocrine tumors in cats with localized disease can result in survival times of over 300 days.

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.

KRAS Mutations in Canine and Feline Pancreatic Acinar Cell Carcinoma

Companion animals may serve as valuable models for studying human cancers. Although KRAS is the most commonly mutated gene in human ductal pancreatic cancers (57%), with mutations frequently occurring at codons 12, 13 and 61, human pancreatic acinar cell carcinomas (ACCs) lack activating KRAS mutations. In the present study, 32 pancreatic ACC samples obtained from 14 dogs and 18 cats, including seven metastases, were analyzed for six common activating KRAS mutations located in codons 12 (n = 5) and 13 (n = 1) using Sequenom MassARRAY. No KRAS mutations were found, suggesting that, similar to human pancreatic ACC, KRAS mutations do not play a critical role in feline or canine pancreatic ACC. Due to the similarity of the clinical disease in dogs and cats to that of man, this study confirms that companion animals offer potential as a suitable model for investigating this rare subtype of pancreatic carcinoma.

Cyclooxygenase-2 Expression in Feline Pancreatic Adenocarcinomas

Cyclooxygenase-2 (COX-II) is an inducible enzyme that is responsible for the production of prostaglandin E2 (PGE2), which is often upregulated in neoplastic conditions. Expression of COX-II is documented in the majority of human pancreatic adenocarcinomas and in many epithelial neoplasms in humans and animals. The purpose of this study was to assess a series of feline pancreatic adenocarcinomas for the expression of COX-II. Eight feline pancreatic adenocarcinomas (5 poorly differentiated ductular variants and 3 well-differentiated acinar variants) were included. Immunohistochemical staining showed that COX-II was expressed in 2 (both poorly differentiated ductular variants) of the 8 neoplasms (25%). Approximately 10% of the epithelial cells from these 2 neoplasms expressed intense cytoplasmic staining. However, because feline pancreatic adenocarcinoma does not appear to consistently express COX-II, it is not a useful prognostic indicator for this group of feline neoplasma. In addition, COX-II inhibitors are not likely to be effective therapeutics for cats with this neoplasm.

Safety of ultrasound-guided fine-needle aspiration of the feline pancreas: a case-control study

The safety of fine-needle aspiration (FNA) of the feline pancreas has not been reported. The incidence of complications following ultrasound-guided pancreatic FNA in 73 cats (pancreatic aspirate [PA] cats) with clinical and ultrasonographic evidence of pancreatic disease was compared with complications in two groups of matched control cats also diagnosed with pancreatic disease that either had abdominal organs other than the pancreas aspirated (control FNA, n = 63) or no aspirates performed (control no FNA, n = 61). The complication rate within 48 h of the ultrasound and/or aspirate procedure did not differ among the PA cats (11%), control FNA (14%) or control no FNA (8%) cats. There was no difference in rate of survival to discharge (82%, 84% and 83%, respectively) or length of hospital stay among groups. The cytologic recovery rate for the pancreatic samples was 67%. Correlation with histopathology, available in seven cases, was 86%. Pancreatic FNA in cats is a safe procedure requiring further investigation to establish diagnostic value.

Practical Interpretation and Application of Exocrine Pancreatic Testing in Small Animals

The pancreas remains a difficult organ to evaluate using laboratory methods alone. No single laboratory test is diagnostic of pancreatitis (chronic or acute) without other diagnostic modalities concurring with the diagnosis or ruling out other diseases. The diagnosis of pancreatitis is particularly difficult in cats, and pancreatitis often occurs with other diseases. The use of pancreatic cytology may be useful in diagnosing both inflammation and neoplasia. Exocrine pancreatic insufficiency (EPI) can be relatively easily diagnosed when clinically manifested by the measurement of trypsinlike immunoreactivity. Diagnosis is more difficult when EPI is subclinical.

Acinar cell carcinoma of exocrine pancreas in two horses

Two horses were presented with non-specific clinical signs of several weeks' duration and were humanely destroyed due to a poor prognosis. At necropsy examination, both horses had multiple small, white nodules replacing pancreatic tissue and involving the serosal surface of the abdominal cavity, the liver and the lung. Microscopically, neoplastic cells were organized in acini and contained abundant (case 1) or sparse (horse 2) intracytoplasmic zymogen granules. Immunohistochemically, both tumours expressed amylase and pan-cytokeratin, but not insulin or neuron-specific enolase. In case 2, a low percentage of neoplastic cells expressed glucagon and synaptophysin. The presence of zymogen granules was confirmed in both cases by electron microscopy and occasional fibrillary or glucagon granules were observed in cases 1 and 2, respectively. A diagnosis of pancreatic acinar cell carcinoma was established in both horses.

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.

Long-Term Survival in a Cat with Pancreatic Carcinoma and Splenic Involvement after Surgical Excision

A thirteen-year-old female spayed with a history of hydronephrosis was presented for a routine abdominal ultrasonographic exam. The imaging exam showed a mass involving the pancreas and a large mass affecting the spleen. Exploratory laparotomy evidenced a mass in the pancreas and another involving one-third of the spleen. The patient had partial pancreatectomy and splenectomy. The histopathology report came back with a diagnosis of pancreatic carcinoma. Adjuvant chemotherapy was declined. The cat is still free of gross tumor recurrence and metastatic disease after twenty-six months. Early diagnosed and aggressively treated feline pancreatic carcinoma might yield a favorable prognosis.

Sonographic Evaluation of the Normal and Abnormal Pancreas

Pancreatic disorders in dogs and cats are recognized with increasing frequency, and abdominal ultrasonography has assumed an important role in their diagnosis. The normal pancreas is a small, inconspicuous organ of comparable echogenicity to surrounding mesentery and may be difficult to identify. Therefore, knowledge of anatomic landmarks such as portal vein and contributing vessels, duodenum, and stomach is necessary to facilitate identification and examination. Pancreatic diseases and abnormalities frequently investigated by means of ultrasonography include pancreatitis, pseudocysts, abscesses, neoplastic lesions, and nodular hyperplasia. Disorders less commonly seen include exocrine pancreatic insufficiency, pancreatolithiasis, congenital anomalies, and pancreatic edema. Unfortunately, ultrasonographic findings in various pancreatic disorders overlap, and incidental findings or age-related changes may mimic pancreatic disease. On the other hand, pancreatic disorders may not cause changes in ultrasonographic appearance. Ultrasonographic findings, therefore, have to be judged in light of signalment, history, and laboratory data. Cytology or histopathology may be needed to establish a definite diagnosis. Despite these limitations, ultrasonography is useful in diagnosing pancreatic disease, guiding aspirates and biopsies, and monitoring response to treatment.

IMAGING FINDINGS IN PANCREATIC NEOPLASIA AND NODULAR HYPERPLASIA IN 19 CATS

Pancreatic neoplasia in cats is rare and associated with a poor prognosis, but pancreatic nodular hyperplasia is a common incidental finding. The purpose of this study was to describe radiographic and ultrasonographic findings in cats with pancreatic neoplasia or nodular hyperplasia. Fourteen cats (age 3-18 years) were diagnosed with malignant pancreatic tumors: carcinoma/adenocarcinoma (n = 11), lymphoma (n = 1), squamous cell carcinoma (n = 1), and lymphangiosarcoma (n = 1). The most common radiographic findings were an abdominal mass or mass effect (6/6) and lack of serosal margin detail (4/6). On ultrasound, the most common finding was a focal pancreatic mass or nodule, with a size range from 0.4 cm to more than 7.0 cm (8/14). Lymphadenopathy (7/14) and abdominal effusion (7/14) were frequently seen. Five cats (age 10-16 years) with adenomatous/nodular hyperplasia had an abdominal mass or mass effect as the most common radiographic finding (3/3). On ultrasound, all cats had multiple hypoechoic nodules between 0.3 and 1.0 cm associated with the pancreas. Other common findings were pancreatic thickening (2/5), lymphadenopathy (2/5), and abdominal effusion (2/5). The only imaging finding unique to malignant pancreatic tumors was the presence of a single pancreatic nodule or mass exceeding 2cm in at least one dimension (4/14). Although there was a tendency for neoplastic lesions to manifest as single larger lesions and for nodular hyperplasia to manifest as multiple smaller lesions, there was overlap of the imaging findings in both entities. Radiographs and ultrasound can complement but not replace cytology and histopathology in the diagnosis of feline pancreatic neoplasia.

Cholecystoenterostomy for treatment of extrahepatic biliary tract obstruction in cats: 22 cases (1994–2003)

OBJECTIVE

To identify factors associated with outcome in cats with extrahepatic biliary tract obstruction (EHBTO) that undergo biliary diversion surgery.

DESIGN

Retrospective case series.

ANIMALS

22 cats.

PROCEDURES

Medical records of cats with surgically confirmed EHBTO that underwent cholecystoenterostomy were reviewed.

RESULTS

Clinical signs and physical examination findings included vomiting, anorexia, icterus, lethargy, weakness, and weight loss. Common clinicopathologic abnormalities included high serum hepatic enzyme activities and serum bilirubin concentration. Abdominal ultrasonography was performed in 21 cats, and all 21 had findings consistent with EHBTO. Eleven of 15 cats in which blood pressure was monitored had intraoperative hypotension. Eighteen cats had anemia following surgery, and 14 cats had persistent hypotension. Extrahepatic biliary tract obstruction was a result of neoplasia in 9 cats and chronic inflammatory disease in 13. Fourteen cats survived long enough to be discharged from the hospital, but only 6 survived > 6 months after surgery, all of which had chronic inflammatory disease. Median survival time for cats with neoplasia (14 days) was significantly shorter than that for cats with inflammatory disease (255 days). No other variable was associated with outcome.

CONCLUSIONS AND CLINICAL RELEVANCE

Results suggest that cats with EHBTO secondary to neoplasia have a poorer prognosis than cats with EHBTO secondary to chronic inflammatory disease. However, the overall prognosis for cats with EHBTO undergoing cholecystoenterostomy must be considered guarded to poor, and the incidence of perioperative complications is high.