Gastrinoma: a retrospective study of four cases (1985-1995)

Medical conditions associated with gastroduodenal ulceration or erosion in 168 dogs: 2008-2018

Background

Many medical conditions are thought to cause gastroduodenal ulceration or erosion (GUE) in dogs. However, evidence for the association between many of these conditions and GUE in dogs is lacking.

Objective

To identify medical conditions associated with GUE in dogs.

Animals

One hundred and sixty‐eight dogs with GUE and 168 randomly selected control dogs without evidence of GUE identified on necropsy between January 2008 and September 2018.

Methods

Patient signalment, blood urea nitrogen (BUN) and serum creatinine concentrations, recently administered ulcerogenic drugs, as well as necropsy findings were recorded. The association between these findings and presence of GUE was assessed by univariable and multivariable analysis.

Results

In the final multivariable model, the following factors were associated with GUE: Nonsteroidal anti‐inflammatory drug (NSAID) administration (odds ratio [OR], 6.3; 95% confidence interval [CI], 2.3‐17.4; P = .0004), glucocorticoid administration (OR, 3.0; 95% CI, 1.5‐5.9; P = .001), gastrointestinal neoplasia (OR, 13.5; 95% CI, 1.7‐108.0; P = .01) and gastrointestinal mechanical disease (foreign bodies, gastric dilatation, and volvulus; OR, 4.8; 95% CI, 1.2‐19.7; P = .03). Additionally, working dog breeds were predisposed to GUE compared to mixed breed dogs (OR, 2.8; 95% CI, 1.1‐7.4; P = .04). Insufficient clinical data was available to either support or refute a role of other putative risk factors evaluated.

Conclusion and Clinical Importance

Administration of NSAID or glucocorticoid and gastrointestinal neoplasia or mechanical disease were associated with GUE in dogs. The potential predisposition of working breed dogs for GUE requires further investigation.

Gastrinoma and Zollinger-Ellison syndrome in canids: a literature review and a case in a Mexican gray wolf

Gastrinoma, an infrequent diagnosis in middle-aged dogs, occurs with nonspecific gastrointestinal morbidity. Laboratory tests can yield a presumptive diagnosis, but definitive diagnosis depends on histopathology and immunohistochemistry. We describe a malignant pancreatic gastrinoma with lymph node metastases and corresponding Zollinger-Ellison syndrome in a Mexican gray wolf ( Canis lupus baileyi) and review this endocrine neoplasm in domestic dogs. A 12-y-old, captive, male Mexican gray wolf developed inappetence and weight loss. Abdominal ultrasonography revealed a thickened duodenum and peritoneal effusion. Two duodenal perforations were noted on exploratory celiotomy and were repaired. Persisting clinical signs led to a second celiotomy that revealed a mesenteric mass, which was diagnosed histologically as a neuroendocrine carcinoma. During the following 16 mo, the wolf received a combination of H₂-receptor antagonists, proton-pump inhibitors, gastroprotectants, and anti-emetics, but had recurrent episodes of anorexia, nausea, acid reflux, and remained underweight. Worsening clinical signs and weakness prompted euthanasia. The antemortem serum gastrin concentration of 414 ng/L (reference interval: 10-40 ng/L) corroborated hypergastrinemia. Autopsy revealed a mass expanding the right pancreatic limb; 3 parapancreatic mesenteric masses; duodenal ulcers; focal duodenal perforation with septic fibrinosuppurative peritonitis; chronic-active ulcerative esophagitis; and poor body condition. The pancreatic mass was diagnosed histologically as a neuroendocrine carcinoma and the parapancreatic masses as lymph node metastases. Immunohistochemistry of the pancreatic mass was positive for gastrin and negative for glucagon, insulin, pancreatic polypeptide, serotonin, somatostatin, and vasoactive intestinal peptide.

Malignant pancreatic gastrinoma in a maned wolf (Chrysocyon brachyurus): case report

ABSTRACT A captive 12-year-old female maned wolf (Chrysocyon brachyurus), previously diagnosed with visceral leishmaniasis, developed severe myiasis in the right ear, followed by prostration and death. A firm solid nodule, measuring 1 x 3cm, was grossly observed in the pancreas. Histologically, there was neoplastic proliferation in the pancreas and pancreatic lymph node. Neoplastic cells had a neuroendocrine pattern, and were positive for gastrin and pancreatic polypeptide by immunohistochemistry. The wolf had also ulcerative gastritis. To the best of our knowledge is the first reported case gastrinoma in this species.

Effect of gastric acid-suppressive therapy and biological variation of serum gastrin concentrations in dogs with chronic enteropathies

BACKGROUND

Serum gastrin concentration can help diagnose gastrinomas in dogs if >3-10× the upper reference limit (URL), but antisecretory therapy and other conditions can also cause hypergastrinemia. Effects of antisecretory therapy (famotidine or ranitidine, omeprazole) on serum gastrin concentration in dogs with chronic enteropathy (CE) and its biological variation (BV) are unknown. Aim of the study was to evaluate serum gastrin in acid-suppressant-treated or -naïve CE dogs; test the association between serum gastrin and histopathologic findings in acid-suppressant-naïve CE dogs; and evaluate the BV of serum gastrin in dogs not receiving any gastric acid suppressive therapy. Samples from 231 dogs were used and serum gastrin was measured by chemiluminescence assay. Gastric and duodenal histologic lesions were evaluated and graded. BV of serum gastrin was evaluated in serial samples.

RESULTS

Serum gastrin concentrations were significantly higher in acid-suppressant-treated than acid-suppressant-naïve dogs (P = 0.0245), with significantly higher concentrations in proton pump inhibitor (PPI)- than H2-antihistamine-treated patients (P = 0.0053). More PPI- than H2-antihistamine-treated dogs had gastrin concentrations above URL (P = 0.0205), but not >3× nor >10× the URL. Serum gastrin concentrations correlated with the severity of gastric antral epithelial injury (P = 0.0069) but not with any other lesions or the presence/numbers of spiral bacteria in gastric biopsies. Intra- and inter-individual BV were 43.4 and 21.6%, respectively, in acid-suppressant-naïve dogs, with a reciprocal individuality index of 0.49 and a critical difference of ≥29.5 ng/L.

CONCLUSIONS

Antisecretory (particularly PPI) treatment leads to hypergastrinemia in CE dogs, but the concentrations seen in this study are unlikely to compromise a diagnosis of gastrinoma. Use of a population-based URL for canine serum gastrin and a URL of ≤27.8 ng/L are appropriate.

Spontaneous gastrointestinal perforation in cats: a retrospective study of 13 cases

OBJECTIVES

The aim of this study was to describe the clinical characteristics and the frequency of malignant vs non-malignant causes for spontaneous gastrointestinal perforation in cats.

METHODS

The medical records of cats diagnosed as having gastrointestinal perforation between August 2010 and July 2013 were reviewed. Diagnosis was confirmed by exploratory surgery. Patients with incomplete records, perforation due to external trauma, leakage at previous enterotomy or anastomotic sites, or foreign bodies were excluded. Each record was examined for different information pertaining to signalment, medical history, clinical and clinicopathological data, imaging findings, abdominal fluid examination, surgical findings, histopathological examination, treatment received after surgery and outcome.

RESULTS

Thirteen cats were included. Five of these cats had concurrent illnesses, including viral upper respiratory tract disease, pancreatitis and chronic kidney disease. Two cats had previously received non-steroidal anti-inflammatory drugs and four had received corticosteroids. Clinical signs and clinicopathological abnormalities were not specific. Six of 13 patients were diagnosed during surgery with gastric perforations, four patients with duodenal perforations and three patients with jejunal perforations. Histopathological examination of the ulcerated wall was performed in 11/13 cats. Alimentary lymphoma was diagnosed in six cats. Non-neoplastic lesions (lymphocytic- plasmacytic inflammatory bowel disease, necrotic suppurative enteritis) were observed in the other five cats. The major limitation of the study was the small sample size.

CONCLUSIONS AND RELEVANCE

Lymphoma may be a frequent cause of spontaneous perforation in cats. Therefore, histological examination of ulceration is essential in all cases. The direct and sole implication of anti-inflammatory administration in a gastrointestinal perforation is not clearly established in this study.

Normal dogs treated with famotidine for 14 days have only transient increases in serum gastrin concentrations

BACKGROUND

In people, serum gastrin concentrations increase in response to administration of H(2) receptor antagonists, but the effect of famotidine administration on serum gastrin concentrations has not been evaluated in dogs.

OBJECTIVES

To determine if serum gastrin concentrations increase in response to 14 days of famotidine treatment and the time needed to return to baseline after discontinuation of famotidine; define stability of gastrin in samples held at room temperature.

ANIMALS

Eleven healthy dogs were included in part A (famotidine treatment) and 7 healthy dogs in Part B (serum gastrin stability). In part A, famotidine (0.5 mg/kg p.o. q12h) was administered for 14 days. Fasting blood samples were collected on days 0, 3, 7, 11, 14, 16, 18, 20, and 22. In part B, blood was collected after a 12-hour fast. Gastrin concentrations in serum samples held at room temperature for ≤30 minutes after sampling were compared to concentrations in samples held at room temperature for 150 minutes after sampling.

RESULTS

Serum gastrin concentrations increased by day 3 of famotidine administration and returned to baseline concentrations in all dogs by day 14 despite continued famotidine administration. Serum gastrin concentrations were lower (20% mean decrease; P = .0005) in samples held at room temperature for 150 minutes.

CONCLUSIONS AND CLINICAL IMPORTANCE

After 14 days of famotidine administration, clinically healthy dogs have normal serum gastrin concentrations. In a dog with clinical features consistent with gastrinoma, chronic famotidine administration is unlikely to contribute to increases in serum gastrin concentrations.

Canine gastrinoma: a case study and literature review of therapeutic options

CASE HISTORY

A 6.2 kg, 8-year-old, spayed female Australian Terrier was presented with weight loss, inappetence, lethargy and a 2-day history of intermittent vomiting.

CLINICAL FINDINGS

The dog had cranial abdominal pain and there was melaena present on digital rectal examination. Haematology revealed a marked, acute leucogram.

DIAGNOSIS AND TREATMENT

Fasting serum gastrin levels were markedly elevated and gastrinoma was suspected. Treatment was initiated with omeprazole, ranitidine and sucralfate. The dog remained clinically normal for 26 months, at which time exploratory surgery was undertaken and the dog subsequently euthanised due to extensive metastases. Histopathology and immunocytochemistry confirmed the diagnosis of metastatic gastrinoma.

CLINICAL RELEVANCE

This is a rare condition infrequently reported. Although the number of cases treated with omeprazole are too few to draw firm conclusions, it would appear that proton pump inhibitors are useful and should be considered for cases of gastrinoma managed medically. Long-term prognosis is poor, and survival times range from 1 to 147 weeks. Many treatment options are discussed in the medical literature though not all are feasible in veterinary patients.

Common bile duct obstruction due to a duodenal gastrinoma in a dog

In dogs gastrinomas are rare endocrine neoplasms that have always been reported to arise from the pancreas. We report here what we believe to be the first case of a duodenal gastrinoma in a dog. A nine-year-old, male, Pekinese dog was presented with a three-day history of anorexia, vomiting and mucous diarrhoea. Clinical examination and laboratory findings suggested the presence of a severe hepatobiliary disorder. Abdominal ultrasonography showed a diffuse increase in echogenicity of the liver, with severe gallbladder dilation and marked dilation of the cystic duct, common bile duct and extrahepatic bile ducts. Based on these findings, an extrahepatic biliary tract obstruction (EBTO) of unknown cause was suspected. At laparotomy, the gallbladder and the extrahepatic bile ducts appeared severely dilated. The gallbladder was tense and could not be compressed suggesting an outflow obstruction. The duodenum at the level of the common duct orifice appeared slightly thickened and severely hardened for a length of 1 cm. Biopsies from the duodenum and liver were obtained and a cholecystoduodenostomy was performed. The duodenal biopsy revealed severe fibrosis of the submucosa and a infiltrate of small pockets and cords of round to polygonal cells with granular cytoplasm. Based on this appearance the differential diagnoses included neuroendocrine tumours and poorly differentiated carcinoma. Despite surgery and supportive therapy the dog continued to be anorexic and to vomit 3-6 times daily. After euthanasia and necropsy, histopathology showed the presence of a neuroendocrine neoplasia involving the duodenal wall with focal invasion of the adjacent pancreas and small liver metastases. On immunohistochemistry, the cytoplasm of approximately 90% of neoplastic cells intensely expressed neuron specific enolase and gastrin. These findings were consistent with a diagnosis of gastrinoma.

A case of canine gastrinoma

The dog of this case was a 10-year-old Shih Tzu with refractory vomiting, diarrhea and anorexia. Endoscopy revealed an unclear at gastric angle, a stenosis at pyloric antrum and congestion in duodenal mucosa. Since abnormal shadows of irregular echo-levels were disclosed by pancreas ultrasonography, serum gastrin level was determined with a suspect of gastrinoma. And an increase of serum gastrin was demonstrated. In addition, postmortem histological examination revealed that the pancreatic cells were positive for gastrin. Based on these findings, the dog was diagnosed as pancreatic gastrinoma.

A Case of Gastrinoma in a Shih-Tzu Dog

A five-year-old male Shih-Tzu dog presented with severe vomiting and weight loss. The clinical signs were successfully improved by an eight-day treatment with an H(2)-receptor antagonist, gastrointestinal protectant and antibiotics. Ten days later, however, recurrence of vomiting was seen despite continuous medical treatment. Based on clinical signs and the results of various diagnostic tests including CBC, biochemical analysis, contrast radiography, and endoscopy, a duodenal or pancreatic neoplasm was suspected and exploratory laparotomy was conducted. Some swollen pancreatic regions were found, and biopsy of the pancreas indicated the diagnosis of a gastrin-secreting tumor. Consequently, based on a high serum gastrin level as well as clinical signs and immunohistological findings, we diagnosed the disease as canine gastrinoma, a rare tumor of the pancreas.

Pneumoperitoneum secondary to a perforated gastric ulcer in a cat

A 7-year-old domestic cat was examined because of a history of weight loss, intermittent diarrhea, and anorexia of 6 months' duration. Results of physical examination were normal except for marked abdominal tension. Results of a CBC and serum biochemistry profile were unremarkable. Severe pneumoperitoneum was noted radiographically, and abdominocentesis yielded 640 mL of air. Abdominal distension recurred 1 day after abdominocentesis. Exploratory laparotomy was performed 3 days after recurrence of abdominal distension and revealed a gastric perforation along the greater curvature of the stomach with omental and pancreatic adhesions at the site of perforation. Mild local peritoneal inflammation was also noted. A partial gastrectomy was performed to resect the lesion, and histologic examination confirmed a severe perforating ulcer. The gastric wall adjacent to the ulcer was histologically normal. Aerobic and anaerobic bacteriologic cultures of abdominal swab specimens were negative for bacterial growth. The cat was discharged 4 days after surgery and clinically normal at suture removal.