Multifocal Hepatocellular Carcinoma in a Malayan Wreathed Hornbill (Rhyticeros undulatus)

A 30-year-old female intact Malayan wreathed hornbill (Rhyticeros undulatus) was presented for presumed nesting behavior, progressive anorexia, dropping food, and coelomic distension. A complete blood count and plasma biochemistry analysis revealed marked inflammation, severe electrolyte abnormalities, elevated liver enzyme activities and bile acids, and normal plasma iron concentrations. Radiographic images of the patient were consistent with hepatomegaly and loss of serosal detail in the coelomic cavity. A computed tomography study revealed multiple poorly contrast-enhancing hepatic nodules, hepatoperitoneal and intestinal peritoneal fluid and gas, and a contrast-enhancing mass in the ventral coelom. Cytologic samples of the liver were consistent with necrosis, and the coelomic effusion was characterized as an aseptic suppurative exudate. An exploratory coeliotomy was performed and biopsy samples of the liver and a mesenteric mass were histologically interpreted as a tubular carcinoma with metastasis to the liver and secondary portal hepatitis. Euthanasia was elected and multiple liver masses and a peripancreatic mass were identified on necropsy. Histopathological samples collected during the postmortem gross examination showed multiple well-demarcated hepatic masses consisting of neoplastic hepatocytes encapsulated by fibrous tissue and proliferation of dysplastic biliary ductules, as well as a peripancreatic heterophilic granuloma with adjacent pancreatic atrophy and ductular proliferation. Ultimately, the patient was diagnosed with multifocal hepatocellular carcinoma and chronic granulomatous and heterophilic pancreatitis, steatitis, and coelomitis with intralesional bacteria. Malignant hepatobiliary neoplasia has been poorly documented in hornbills despite high anecdotal incidence in this and other avian species predisposed to iron storage disease. This report illustrates clinical and pathological information, including advanced imaging, which could aid in the diagnosis of this condition in hornbills and other avian species.

Large T-cell extradural lymphoma with concurrent marked cerebrospinal fluid eosinophilia in a dog

A 3-year-old male pit bull terrier was presented for a 4-day history of progressive tetraparesis and cervical pain. Magnetic resonance imaging confirmed an extradural mass within the left lateral vertebral canal extending from caudal C5 to mid-T2. Lumbar cerebrospinal fluid (CSF) demonstrated marked (90%) eosinophilic inflammation. A C6-7 dorsal laminectomy and C7-T2 left hemilaminectomy were done, with gross disease remaining. Histopathology revealed a large T cell lymphoma with marked eosinophilic infiltration. The dog underwent CHOP-based chemotherapy with resolution of clinical signs, with a similar course of therapy performed at recurrence 37 months after initial presentation. The dog was euthanized 39 months after presentation for multiorgan failure secondary to neutropenic sepsis and aspiration pneumonia. This represents a positive long-term response to multimodal treatment of extradural T-cell lymphoma within the vertebral canal associated with a marked CSF eosinophilia.

Radiographic evidence of metaphyseal sclerosis secondary to canine distemper virus: 4 cases in juvenile dogs

Background

Metaphyseal sclerosis secondary to canine distemper virus has been described histopathologically, but its radiographic appearance has not been described.

Objectives

Describe the radiographic appearance of metaphyseal sclerosis secondary to canine distemper virus in juvenile dogs as distinct from metaphyseal osteopathy (formerly called hypertrophic osteodystrophy).

Animals

Four dogs (2 intact females and 2 intact males) between 2.5 and 4 months of age presented to 2 different veterinary teaching hospitals.

Methods

Retrospective case series in which definitive diagnosis of canine distemper virus based on antemortem positive reverse transcription‐polymerase chain reaction (RT‐PCR) result or necropsy was required.

Results

All 4 dogs were presented for evaluation of neurologic abnormalities, respiratory signs, and lethargy; 2 dogs had gastrointestinal signs and ocular abnormalities. Radiographs on all patients featured multifocal, symmetric, metaphyseal sclerosis, with no evidence of lysis or changes to the adjacent growth plate. The metaphyseal sclerosis was most apparent at the proximal humeral diaphyses and other included long bones. Diagnosis of distemper was confirmed by necropsy (2 of 4 dogs) or positive RT‐PCR results (2 of 4 dogs). Three dogs were euthanized because of progressive illness, and 1 dog was lost to follow‐up.

Conclusion and Clinical Importance

Identification of metaphyseal sclerosis on radiographs during diagnostic evaluation of young dogs should lead to a clinical suspicion of canine distemper virus infection. Sclerosis identified secondary to canine distemper virus is distinct from the necrosis and inflammation of metaphyseal osteopathy.

Case Report: MRI, Clinical, and Pathological Correlates of Bromethalin Toxicosis in Three Dogs

Bromethalin toxicosis is an increasingly common clinical presentation in dogs that may be fatal depending on the extent of intoxication. Antemortem diagnosis of bromethalin toxicosis was achieved in three dogs by demonstration of the active metabolite desmethylbromethalin in fat or serum. Magnetic resonance imaging (MRI) findings were consistent with a diffuse leukoencephalopathy with restricted diffusion and prominent involvement of the corticospinal motor tracts on T2-weighted and diffusion-weighted sequences. Imaging findings were confirmed in one non-surviving dog at necropsy. Resolution of MRI abnormalities was demonstrated in one surviving dog that was consistent with the associated resolution of clinical signs. Initial findings in these dogs support further investigation of specific MRI patterns in cases of leukoencephalopathy to aid differential diagnosis. While antemortem detection of bromethalin and its metabolites confirms exposure, quantitation may be informative as a prognostic biomarker.

Comparison of 18F-sodium fluoride positron emission tomography and CT: An exploratory study in 12 dogs with elbow pain

18F-Sodium Fluoride (18F-NaF) positron emission tomography (PET) provides high resolution functional information about bone activity and can be fused with CT images to improve three-dimensional localization and characterization of lesions. This prospective, observational study assessed 18F-NaF PET-CT for imaging of canine elbows, compared PET with CT findings, and assessed correlation with lameness. Twelve patients with elbow pain were included. Cases included primarily young, large breed dogs. A three-level clinical lameness score was assigned to each forelimb. All dogs had bilateral elbow joints imaged with CT and PET under general anesthesia, approximately 1.5 h after intravenous injection of 3 MBq/kg of 18F-NaF. Imaging findings were independently reviewed by two radiologists using a three-level scoring scheme over nine anatomical regions in the elbow. PET imaging identified areas of bone activity where minimal change was identified on CT. PET imaging also demonstrated absence of uptake in areas where modeling was present on CT. A stronger correlation was observed between clinical grades and PET scores (r2  = 0.38, P = .001) than between clinical grades and CT scores (r2  = 0.17, P = .048). The total PET scores were significantly different for each clinical grade (P = .013) but total CT scores did not differ (P = .139). This exploratory study suggests that PET improves the ability to detect lesions and to determine the clinical significance of CT findings in dogs with elbow pain.

A prospective controlled quantitative study of ultrastructural changes in the underactive detrusor

PURPOSE

We quantify and compare ultrastructural changes seen at high power on electron microscopic examination of detrusor biopsies from underactive and control bladders.

MATERIALS AND METHODS

The detrusor underactivity group consisted of 14 patients (mean age 64.0 years) with post-micturition residuals greater than 300 ml., impaired contractility and no obstruction on urodynamics. A total of 17 patients who voided normally voiders with residual volume less than 50 ml. served as the control group. Bladder biopsies were obtained endoscopically using cold cup technique and processed using standard methods. All specimens were randomized and studied at high power (x12,000 to x24,000) by an examiner who was blinded to the groups. All complete cells within each random grid field were counted up to a total of 500. The number of disrupted cells per 500 cells was noted.

RESULTS

Disruptive cell profiles were found in all biopsies. Median cell count was 20 cells/500 in 14 controls and 96.5 cells/500 in the underactive detrusor group (p <0.001). The number of disruptive cell profiles did not correlate with age in the control group (r = 0.34, p = 0.18).

CONCLUSIONS

There were distinct morphological changes in the detrusor associated with bladder dysfunction with approximately 4 times more disruptive cells in patients with an underactive bladder. However, there was no correlation between age and number of disruptive cells, suggesting that this is not a process of aging per se. Ultrastructure studies may have a role as an adjunct to urodynamics in the diagnosis of bladder dysfunction.

A prospective evaluation of detrusor ultrastructural changes in bladder outlet obstruction

OBJECTIVES

To characterize the ultrastructure of detrusor smooth muscle from the bladders of symptomatic men with bladder outlet obstruction (BOO) caused by benign prostatic enlargement (BPE) and compare this with a matched control group; to determine how detrusor morphology relates to urodynamic findings and to develop a better understanding of the natural development of bladder dysfunction related to BOO.

PATIENTS AND METHODS

Twelve men (mean age 66 years, range 52-77) with urodynamically confirmed BOO caused by BPE and 12 age-matched asymptomatic normally voiding controls (mean age 67.8 years, undergoing cystoscopy for other conditions) had detrusor biopsies taken endoscopically. The biopsies were processed for electron microscopy using standard methods. The specimens were randomized and examined at medium power (x 4000) by an examiner unaware of the urodynamic findings. Any ultrastructural patterns identified subjectively were noted.

RESULTS

In the BOO group eight of the 12 men had a myohypertrophic pattern, half of which were associated with a degenerative pattern of hypocontractility. Of the remaining four patients, two had the degenerative pattern alone and two were normal. The six men whose biopsies had a degenerative pattern had consistent postvoid residual volumes of > 150 mL; the remainder all had volumes of < 150 mL. There were no ultrastructural abnormalities in the control patients.

CONCLUSIONS

There are interesting qualitative ultrastructural changes in the obstructed detrusor, but they are not consistent enough to provide a reliable diagnostic tool. However, there may be an important relationship between the degenerative pattern and postvoid residual volume in BOO.

A qualitative ultrastructural study of the hypocontractile detrusor

PURPOSE

It has been proposed that precise and specific ultrastructural patterns exist in the dysfunctional human detrusor. We evaluated ultrastructural changes in the hypocontractile detrusor and examined the technique of detrusor muscle biopsy and its clinical application.

MATERIALS AND METHODS

After clinical and urodynamic evaluation 19 male and 2 female patients with severe hypocontractility were entered into this prospective study. All patients had a post-void residual urine volume of consistently greater than 300 ml. and were classified as weak or very weak according to the Schäfer nomogram. Multiple biopsies were obtained with the patient under general anesthesia using the cold cup technique. Subsequent specimens were processed for electron microscopy using standard methods. Biopsies were also obtained from 6 controls with normal voiding parameters.

RESULTS

Cold cup detrusor biopsy provided muscle of sufficient quality for detailed electron microscopic analysis in 26 of the 27 specimens obtained. Previously described criteria of the degeneration pattern were present in all cases of severe hypocontractility. These criteria include widespread disruptive muscle cell profiles with sarcoplasmic vacuolation, disruption of cell organelles and ultimately cell lysis. These features were evident in more than half of the randomly studied fields. In addition, 7 patients had an indistinct muscle fascicle cell arrangement with excessive deposits of collagen and elastic fibers between widely separated muscle cells and in the interstitium. It was suggested that these features represent the hyperelastosis pattern in the chronically over distended bladder. These morphological appearances were not present in any controls.

CONCLUSIONS

This early study would appear to support a morphological basis for detrusor hypocontractility and it reinforces the feasibility of electron microscopy as a potential diagnostic tool. The hypocontractile detrusor has distinct ultrastructural appearances that are easily distinguishable from those of the normal age matched detrusor.

Peyronie's disease-the Plymouth experience of extracorporeal shockwave treatment

OBJECTIVE

To describe our experience of the use of extracorporeal shockwave treatment (EST) for Peyronie's disease. Patients and methods The study included 28 patients (mean age 57 years, range 34-72) with stable Peyronie's disease who were treated with 3.9 (3-5) sessions of EST to the Peyronie's plaque. The patients' erectile function, pain and penile angle were assessed before and after treatment with EST.

RESULTS

Of the 28 patients, 20 felt that their erection improved after the procedure; 11 patients were able to recommence sexual intercourse and the index of erectile function increased in all but one patient. Conclusion EST produces a significant improvement in pain and penile angle, with no serious complications.