CD99 Expression and Prognostic Impact in Glioblastoma: A Single-Center Cohort Study

Glioblastoma is the most frequent and aggressive brain tumor in adults. This study aims to evaluate the expression and prognostic impact of CD99, a membrane glycoprotein involved in cellular migration and invasion. In a cohort of patients with glioblastoma treated with surgery, radiotherapy and temozolomide, we retrospectively analyzed tumor expression of CD99 by immunohistochemistry (IHC) and by quantitative real-time polymerase chain reaction (qRT-PCR) for both the wild type (CD99wt) and the truncated (CD99sh) isoforms. The impact on overall survival (OS) was assessed with the Kaplan-Meier method and log-rank test and by multivariable Cox regression. Forty-six patients with glioblastoma entered this study. Immunohistochemical expression of CD99 was present in 83%. Only the CD99wt isoform was detected by qRT-PCR and was significantly correlated with CD99 expression evaluated by IHC (rho = 0.309, p = 0.037). CD99 expression was not associated with OS, regardless of the assessment methodology used (p = 0.61 for qRT-PCR and p = 0.73 for IHC). In an exploratory analysis of The Cancer Genome Atlas, casuistry of glioblastomas CD99 expression was not associated with OS nor with progression-free survival. This study confirms a high expression of CD99 in glioblastoma but does not show any significant impact on survival. Further preclinical studies are needed to define its role as a therapeutic target in glioblastoma.

Esophago-Gastric Tube (EG Tube) in Debilitated Sea Turtle Rehabilitation: Insight in 195 Loggerheads Caretta caretta, Southern Italy

Efficient nutritional support plays a pivotal role in the rehabilitation of sea turtles, ensuring a positive, swift, and successful recovery from clinical conditions for their reintroduction into the wild. For sea turtles in severely emaciated and underweight condition, the primary objective is to facilitate weight gain in terms of both muscle mass and fat reserves. Traditionally, many sea turtle rehabilitators have employed the practice of force-feeding, which also involves the daily insertion of an orogastric tube from the mouth to the stomach. However, this technique may be highly stressful for the animals, carrying the risks of regurgitation and potential harm, requiring the removal of the animal from the water, and subjecting it to uncomfortable and potentially dangerous handling. The procedure may also involve risks for operators. In this study, we explore the utilization of a permanent esophago-gastric tube (EG tube) in sea turtles as an alternative to force-feeding, providing a respectful and appropriate approach to meeting the nutritional needs of patients. The administration of food, essential medications, and fluids is performed directly with the turtle in its tank, minimizing the stress associated with handling, while ensuring the safety of operators. The study involves 195 marine turtles that underwent surgery for the placement of a permanent EG tube between 2008 and 2022. Of these, 116 animals were treated at the Sea Turtle Clinic of the Department of Veterinary Medicine at the University of Bari, South Adriatic Sea, Puglia (IT), and 79 patients were admitted to the Sea Turtle Rescue Center of Lampedusa, Central Mediterranean Sea, Sicily (IT). The loggerhead turtles (Caretta caretta) required EG tube placement due to their poor condition related to various diseases, which were systematically categorized. The duration of EG tube placement was analyzed regarding the specific condition of the animals and the nature of their injuries, considering any complications or differences between the two facilities. The results of the study will provide valuable information for the ongoing care and treatment of marine turtles in rehabilitation facilities.

Stereotactic prostate radiotherapy with or without androgen deprivation therapy, study protocol for a phase III, multi-institutional randomized-controlled trial

Objective

The therapeutic landscape for localized prostate cancer (PC) is evolving. Stereotactic radiotherapy (SRT) has been reported to be at least not inferior to standard radiotherapy, but the effect of androgen deprivation therapy (ADT) in this setting is still unknown and its use is left to clinical judgment. There is therefore the need to clarify the role of ADT in association with SRT, which is the aim of the present study.

Methods

We present a study protocol for a randomized, multi-institutional, Phase III clinical trial, designed to study SRT in unfavorable intermediate and a subclass of high-risk localized PC. Patients (pts) will be randomized 1:1 to SRT + ADT or SRT alone. SRT will consists in 36.25 Gy in 5 fractions, ADT will be a single administration of Triptorelin 22.5 mg concurrent to SRT. Primary end point will be biochemical disease-free survival. Secondary end points will be disease-free survival, freedom from local recurrence, freedom from regional recurrence, freedom from distant metastasis and overall survival (OS); quality of life QoL and patient reported outcomes will be an exploratory end point and will be scored with EPIC-26, EORTC PR 25, IPSS, IIEF questionnaires in SRT + ADT and SRT alone arms. Moreover, clinician reported acute and late toxicity, assessed with CTCAE v. 5.0 scales will be safety end points.

Results

Sample size is estimated of 310 pts. For acute toxicity and quality of life results are awaited after 6 months since last patient in, whereas, for efficacy end points and late toxicity mature results will be available 3-5 years after last patient in.

Conclusion

Evidence is insufficient to guide decision making concerning ADT administration in the new scenario of prostate ultra-hypofractionation. Hence, the need to investigate the ADT role in SRT specific setting.

Advances in knowledge

The stereotactic prostate radiotherapy with or without ADT trial (SPA Trial) has been designed to establish a new standard of care for SRT in localized unfavorable intermediate and a subclass of localized high risk PC.

Canine Parainfluenza Virus Infection in a Dog with Acute Respiratory Disease

Simple Summary

A one-day history of dry paroxysmal cough, associated with retching, induced by canine parainfluenza virus without the simultaneous presence of other pathogens, has been reported in a vaccinated household dog. The dog did not show nasal discharge or fever, but it was possible to evoke a dry cough through the palpation of the trachea. Radiographic findings of the thorax showed a diffuse unstructured interstitial pattern with the involvement of multiple lung lobes. Trachea-bronchoscopy and broncho-alveolar lavage were carried out. Edema without exudate and congested mucosa from the larynx to bronchi were observed. Cytological evaluation was negative for the presence of inflammatory or infectious processes. Nucleic acids were extracted from the collected specimens; biomolecular investigations tested positive only for canine parainfluenza virus and negative for all other pathogens associated with “kennel cough”. At first, the afebrile onset and the coughing fits suggested the presence of a foreign body, a common occurrence in Southern Italy during summer. The clinical signs and the absence of findings by cytology have directed the clinicians towards the correct diagnosis, with the support of biomolecular assays, which are fundamental to avoid underestimating the circulation of this virus, even in owned dogs.

Abstract

The canine infectious respiratory disease complex (CIRDC) is an endemic respiratory syndrome caused by different bacterial and viral pathogens. This report describes a case of canine parainfluenza virus infection in a vaccinated household dog with an acute respiratory symptom (dry cough), who underwent clinical and endoscopic investigations for a suspected foreign body. Cytological investigations carried out on the broncho-alveolar lavage fluid (BALF) tested negative for the presence of inflammatory or infectious processes and could have been misleading the clinicians. By the molecular analyses (PCR) carried out on the BALF, canine parainfluenza virus was exclusively detected without the simultaneous presence of other respiratory pathogens associated to CIRDC. This case report emphasizes the role of molecular diagnostics in the differential diagnosis of respiratory diseases, in order to avoid underestimating the circulation of the parainfluenza virus in the canine population.

Appetite Stimulant and Anti-Emetic Effect of Mirtazapine Transdermal Ointment in Cats Affected by Lymphoma Following Chemotherapy Administration: A Multi-Centre Retrospective Study

Simple Summary

Feline cancer patients’ owners are increasingly willing to undertake oncologic treatment, such as chemotherapy. Concerns regarding worsening quality of life are common since chemotherapy could cause toxicities, such as vomiting, nausea, anorexia, and consequently weight loss. In humans, mirtazapine effectively prevents chemotherapy-induced nausea and vomiting, improving the quality of life in people receiving chemotherapy. Recently, the use of mirtazapine transdermal ointment has been evaluated in cats with non-cancer diseases. This study describes the use of transdermal mirtazapine administration in cats diagnosed with lymphoma and receiving chemotherapy. Patients included in the study did not receive any prophylactic anti-emetics other than transdermal mirtazapine. Data regarding patients, type of chemotherapy, and incidence of weight loss and gastrointestinal toxicities were retrospectively evaluated. Transdermal mirtazapine was well tolerated, and substantial weight loss was not observed in the 14 days following chemotherapy administration. These results support further studies assessing the impact of mirtazapine in preventing chemotherapy-induced gastrointestinal toxicity in cats.

Abstract

In humans, mirtazapine can prevent chemotherapy-induced nausea and vomiting (CINV) and improve cancer patients’ quality of life (QoL). This drug is being increasingly used as an appetite stimulant in cats. The hypothesis of this retrospective study was that mirtazapine could reduce the incidence of CINV and weight loss in feline patients affected by lymphoma. The objectives were to report the use of mirtazapine transdermal ointment and assess the incidence of gastrointestinal (GI) toxicity and weight loss in cats diagnosed with lymphoma and receiving chemotherapy. Transdermal mirtazapine was topically administered to the inner surface of the pinna (2 mg/cat/daily) for 14 days following chemotherapy administration. Data recorded from 20 patients were collected. Different grades of GI toxicity were shown in 8/20 (40%) patients. Body weight (BW), body condition score (BCS), and muscle condition score (MCS) improved in 12/20 (60%), 6/20 (30%), and 2/20 (10%) cats, respectively. Mirtazapine-induced adverse events (AEs) occurred in 4/20 (20%) cats and did not require mirtazapine discontinuation. Substantial weight loss was not encountered, suggesting that patients had an adequate food intake after chemotherapy administration. Transdermal mirtazapine ointment was considered safe and well tolerated.

Natural Bovine Coronavirus Infection in a Calf Persistently Infected with Bovine Viral Diarrhea Virus: Viral Shedding, Immunological Features and S Gene Variations

Simple Summary

The evolution of a bovine coronavirus (BCoV) natural infection in a calf persistently infected with bovine viral diarrhea virus (BVDV) was described. The infected calf developed intermittent nasal discharge, diarrhea and hyperthermia. The total number of leukocytes/mL and the absolute differential number of neutrophils and lymphocytes resulted within the normal range, but the monocytes increased at T28 (time 28 post-infection) and the CD8⁺ subpopulation increased at T7 and between T28 and T35. BCoV shedding in nasal discharges and feces was detected up to three weeks post infection (p.i.) and high antibody titers persisted for up to 8 weeks p.i. Virus shedding increased until T14, contrary to what was observed in a previous study where BCoV was detected with a lower load in the co-infected (BCoV/BVDV) calves than in the calves infected with BCoV only. We can suppose that BVDV may have exacerbated the long viral excretion, as well as favoring the onset of mutations in the genome of BCoV. An extensive study was performed to verify if the selective pressure in the S gene could be a natural mode of variation of BCoV.

Abstract

The evolution of a bovine coronavirus (BCoV) natural infection in a calf persistently infected with bovine viral diarrhea virus (BVDV) was described. The infected calf developed intermittent nasal discharge, diarrhea and hyperthermia. The total number of leukocytes/mL and the absolute differential number of neutrophils and lymphocytes resulted within the normal range, but monocytes increased at T28 (time 28 post-infection). Flow-cytometry analysis evidenced that the CD8⁺ subpopulation increased at T7 and between T28 and T35. BCoV shedding in nasal discharges and feces was detected up to three weeks post infection and high antibody titers persisted up to T56. The RNA BCoV load increased until T14, contrary to what was observed in a previous study where the fecal excretion of BCoV was significantly lower in the co-infected (BCoV/BVDV) calves than in the calves infected with BCoV only. We can suppose that BVDV may have modulated the BCoV infection exacerbating the long viral excretion, as well as favoring the onset of mutations in the genome of BCoV detected in fecal samples at T21. An extensive study was performed to verify if the selective pressure in the S gene could be a natural mode of variation of BCoV, providing data for the identification of new epidemic strains, genotypes or recombinant betacoronaviruses.

Salmonella enterica Subsp. houtenae Associated with an Abscess in Young Roe Deer (Capreolus capreolus)

BACKGROUND

S. enterica subsp. houtenae has been rarely documented, and very limited genomic information is available. This report describes a rare case of primary extraintestinal salmonellosis in a young roe deer, associated with Salmonella enterica subsp. houtenae. Methods: A traditional cultural-based analysis was carried out from the contents of a neck abscess; biochemical identification and PCR assay were performed to isolate and identify the pathogen. Through whole-genome sequencing (WGS), multilocus sequence typing (MLST), core genome MLST (cgMLST), and the Salmonella pathogenicity islands (SPIs) survey, resistome and virulome genes were investigated to gain insight into the virulence and antimicrobial resistance of S. houtenae.

RESULTS

Biochemical identification and PCR confirmed the presence of Salmonella spp. in the swelling. The WGS analysis identified Salmonella enterica subspecies houtenae serovar 43:z4,z23:- and ST 958. The virulence study predicted a multidrug resistance pattern with resistance shown against aminoglycosides, tetracycline, beta-lactamase, fluoroquinolones, fosfomycin, nitroimidazole, aminocoumarin, and peptide. Fifty-three antibiotic-resistant genes were identified. No plasmids were detected.

CONCLUSION

This study demonstrates the importance of continuous surveillance of pathogenic salmonellae. Biomolecular analyses combined with epidemiological data can provide important information about poorly described Salmonella strains and can help to improve animal welfare.

Detection of multi-drug resistance and AmpC β-lactamase/extended-spectrum β-lactamase genes in bacterial isolates of loggerhead sea turtles (Caretta caretta) from the Mediterranean Sea

Sea turtles are useful sentinels to monitor the dissemination of antimicrobial resistance (AMR) in the marine coastal ecosystems. Forty Gram negative bacteria were isolated from wounds of 52 injured Caretta caretta, living in the Mediterranean Sea. Bacteria were identified using 16S rRNA gene sequencing and tested for susceptibility to 15 antibiotics. In addition, NGS amplicon sequencing was performed to detect the presence of AmpC β-lactamase genes (bla_AmpC) and extended-spectrum β-lactamase (ESBL) genes (bla_CTX-M,bla_SHV,bla_TEM). Seventy-five percent of the isolates (30/40 isolates) exhibited multidrug resistance (MDR) phenotypes and 32.5% (13/40 isolates) were confirmed to be positive for at least one gene. The variants of ESBLs genes were bla_CTX-M-3,bla_TEM-236 and bla_SHV-12. Variants of the bla_AmpCβ-lactamase gene i.e., bla_ACT-24, bla_ACT-2, bla_ACT-17, bla_DHA-4 and bla_CMY-37, were also detected. In addition, 4 isolates were found simultaneously harboring CTX and AmpC genes while 2 strains harbored 3 genes (bla_{ACT-2+TEM-236+SHV-12}, and bla_{CTX-M-3+ACT-24+TEM-236}).

Gastrointestinal ultrasonographic findings in cats with Feline panleukopenia: a case series

Background

Feline panleukopenia virus (FPV) is very resistant and highly contagious and infects domestic cats and other felids. FPV is particularly widespread among sheltered cats, and is associated with high morbidity and mortality, causing severe gastroenteritis characterized by anorexia, lethargy, fever, dehydration, hemorrhagic diarrhea, and vomiting. There is currently no data on the ultrasonographic features of cats affected with FPV. This case series describes abdominal ultrasonographic findings in shelter cats with naturally-occurring FPV, and assesses whether are associated with clinical and laboratory findings. Cats affected by FPV were enrolled in the study if an abdominal ultrasound was performed within 12 hours of diagnosis. Clinical, laboratory and survival data were collected from medical records. Ultrasonographic examinations were reviewed for gastrointestinal abnormalities and their associations with the above data were explored.

Results

Twenty-one cats were included. Nine cats (42.9%) died and 12 (57.1%) recovered. Based on ultrasonography, the duodenum and jejunum showed thinning of the mucosal layer in 70.6% and 66.6% of cats, thickening of the muscular layer in 52.9% and 57.1% of cats, and hyperechogenicity of the mucosa in 41.2% and 33.3%. Jejunal hyperechoic mucosal band paralleling the submucosa and irregular luminal surface were both observed in 33.3% of the cats. Survival was positively associated with increased jejunal mucosal echogenicity (P = 0.003) and hyperechoic mucosal band (P = 0.003). Peritoneal free fluid was positively associated with vomiting (P = 0.002).

Conclusions

This study provides ultrasonographic features of naturally-occurring FPV in cats, which, as expected, are compatible with gastroenteropathy. The most frequent findings were diffuse small intestine mucosal layer thinning, muscular layer thickening and mucosal hyperechogenicity, jejunal hyperechoic mucosal band and irregular luminal surface. Ultrasonographic features may be useful to complete the clinical picture and assess the severity of the gastroenteropathy in FPV cats. Prospective studies are needed to confirm ultrasonographic prognostic factors.

Superficial angiomyxoma in a pregnant cow

A 3-year-old, pregnant, Alpine Brown cow showed a rapidly growing, pedunculated, skin mass located at the umbilical region, reaching 8 kg in weight over a 3-month period after its initial detection. Six days after parturition, the mass was completely surgically excised. During the follow-up period, the cow remained in good health, without signs of recurrence, and showed increased milk production. Histological examination of the mass revealed a loose proliferation of spindle-shaped or stellate cells, immersed in an abundant myxoid matrix with admixed numerous thin-walled blood vessels. Immunohistochemically, the tumour cells were positive for vimentin, α-smooth muscle actin, and desmin. Gross and histopathological features were compatible with superficial angiomyxoma, a subtype of angiomyxoma rarely described in humans, but not in the veterinary literature. The tumour did not infiltrate into the surrounding tissues, and there was no post-excision recurrence after 3 months. The possibility of hormonal dependence of the tumour during pregnancy is discussed based on such findings in some human cases.

Treatment of rectovaginal endometriosis with the etonogestrel-releasing contraceptive implant

This study aimed to investigate the efficacy of the etonogestrel (ENG)-releasing implant in treating patients with rectovaginal endometriosis. The study was based on the retrospective analysis of a prospectively collected database, including symptomatic women who had ultrasonographic diagnosis of rectovaginal endometriosis. Patients were follow-up at 6, 12 and 24 months from the insertion of the ENG-releasing implant. The intensity of pain symptoms was evaluated using a visual analog scale. The volume of the nodules was estimated by virtual organ computer-aided analysis. The Endometriosis Health Profile (EHP-30) was used to evaluate quality of life. Overall, 43 women were included in the study. The 2-year continuation rate for the ENG-releasing implant was 93.0%. The treatment quickly improved the intensity of non-menstrual pelvic pain, deep dyspareunia, dysmenorrhea, and dyschezia. At 6-month follow-up, there were improvements in all domains of the EHP-30 compared with baseline. Further improvements in the EHP-30 results were observed only in pain sub score at 12-month follow-up and in emotional well-being sub score at 24-month follow-up. At 6-month follow-up the volume of the rectovaginal nodules was significantly lower compared with baseline; a further decrease was observed at 12- and 24-month follow-up. The treatment was well tolerated.

ASSESSMENT OF RESIDUAL VASCULARIZATION OF THE LIMB AS A PROGNOSTIC FACTOR TO AVOID SEA TURTLE FLIPPER AMPUTATION

Entanglement occurs when a marine turtle becomes trapped within anthropogenic materials such as debris or fishery gear, inducing strangulation of anatomical parts such as flippers or the neck, causing deep lacerations, maiming, amputation, or choking. Often, severely entangled flippers in captured or stranded turtles are removed surgically. Turtles with flipper impairment have difficulty in swimming, diving, and feeding. Our aim was to use color Doppler ultrasound and multi-detector computer tomography to evaluate residual vascularization or neovascularization in severely entangled flippers of loggerhead sea turtles (Caretta caretta) to assess viability of flippers, even in the absence of limb sensation. We studied 12 turtles with either unilateral (n=8) or bilateral (n=4) involvement. A total of 14 flippers were severely entangled and two flippers were spontaneously amputated. Only two of the 14 entangled flippers had to be removed surgically. For 12 entangled flippers, after surgical curettage, the treatment protocol was based on the use of a plant-derived commercial dressing. The animals were monitored and treated for 1-3 mo, until the soft tissue defects were completely healed by secondary intention. Interestingly, in the treated animals the healing flippers steadily recovered motility and sensation, restoring the complete functionality of the flipper. Vascularization of the limb was found to be critical to prevent amputation of entangled flippers, preserving the flipper and its functionality with conservative therapy and avoiding amputation as much as possible. Our study showed that in cases of entanglement, amputation does not need to be performed immediately but can wait for nonviability to declare itself following conservative therapy and should be reserved as a last-resort treatment.

Deep inspiration breath-hold intensity modulated radiation therapy in a large clinical series of 239 left-sided breast cancer patients: a dosimetric analysis of organs at risk doses and clinical feasibility from a single center experience

OBJECTIVE

To evaluate dose to organs at risk, target coverage and treatment compliance in left-sided breast cancer patients (LSBCP) treated with deep inspiration breath-hold (DIBH) and intensity modulated radiation therapy (IMRT) technique in a contest of daily clinical practice.

METHODS

A total of 280 consecutive LSBCP referred for adjuvant radiotherapy were systematically screened for suitability of DIBH technique. 239 were able to comply with the requirement for DIBH. Whole breast or chest wall were irradiated in DIBH, monitored by Varian RPM^™ Respiratory Gating System, and two tangential inverse-planned beams with dynamic dose delivery. Dose prescription was 42.4 Gy/16 fractions in 205 patients and 50 Gy/25 fractions in 34. 23 patients received local and nodal treatment. Boost to tumor bed, of 10 Gy/5 fractions was used in 135 patients. Relevant dose metrics for heart, left anterior descending (LAD) coronary artery, lungs, contralateral breast and planning target volume were retrospectively analyzed.

RESULTS

The average mean heart dose (MHD) for all patients was 0.94 Gy and mean maximum LAD dose was 13.82 Gy. MHD and LAD maximum dose were significantly higher in patients treated with conventional fractionation whether expressed in absolute dose (1.44 vs 0.85 Gy, p < 0.0005 and 20.78 vs 12.45 Gy, p < 0.0005 respectively) or in equivalent doses of 2 Gy fractionation (0.88 vs 0.52 Gy, p =< 0.0005 and 17.68 vs 10.63 Gy, p = 0.0002 respectively). In 57 patients (23.8%) the maximum LAD dose was >20 Gy. Mean V20 ipsilateral lung dose was 8.5%. Mean doses of contralateral breast and lung were 0.13 Gy and 0.09 Gy respectively. Mean planning target volume V95% coverage was 96.1%. Compliance rate of DIBH technique was 84.5% (239/280).

CONCLUSION

DIBH and IMRT in daily clinical practice are feasible in high percentage of unselected patients and allows low levels of irradiation of organs at risk without compromising target coverage. However, despite low MHD a significant proportion of patients receives a maximum LAD dose superior to 20 Gy.

ADVANCES IN KNOWLEDGE

The value of MHD used exclusively is not able to describe entirely the risk of late heart toxicity, which can be better evaluated with the joint analysis of the maximum dose to LAD region. The vast majority of LSBCP referred to adjuvant radiotherapy in the setting of routine practice are able to comply with the requirement of DIBH.

A formulation of neem and hypericum oily extract for the treatment of the wound myiasis by Wohlfahrtia magnifica in domestic animals

Untreated, traumatic, or wound myiases can cause severe consequences to animal health and welfare as well as economic losses to livestock productions. For healing myiasis-caused wounds, disinfectant such as creolin is wrongly but currently used in association with insecticides. Though effective, creolin is highly toxic to the patients, is inadequate with respect to the repellent effect, and may delay the healing of treated wounds. In this uncontrolled study, the efficacy of the patented plant-derived formulation 1 Primary Wound Dressing© (1-PWD), composed of neem oil (Azadirachta indica A. Juss.) and the oily extract of Hypericum perforatum (L.) flowers, has been investigated. Forty-four domestic animals of different species suffering from wound myiasis lasting for up to 25 days, at different parts of the body, were enrolled in the study. No systemic or local antibiotic or disinfectants' treatment was administered. Larvae recovered on open wounds and adults reared from mature larvae were identified as Wohlfahrtia magnifica. All the treated wounds healed in a range of 10 to 32 days without further infestation. None of the recruited animals presented bacterial complications. Data herein presented indicate that the tested natural plant-derived formulation is able to manage the infestation caused by W. magnifica larvae and the healing process of traumatic infested wounds in several domestic animal species, without any side effect on the living tissue and without the need to use local or systemic chemical or other products.

The CT dorsolateral subluxation index is a feasible method for quantifying laxity in the feline hip joint

The dorsolateral subluxation index of the femoral head is a good proxy of hip dysplasia in dogs. An exploratory, prospective, descriptive study was carried out in order to assess whether the dorsolateral subluxation index may also be useful to improve diagnosis of hip dysplasia in cats. The dorsolateral subluxation index was determined by CT scans simulating the loading position, and compared with measurements of the Norberg-Olsson angle. A total of 82 cats were subjected to radiographic examination of the pelvis, in the standard ventro-dorsal projection, and to CT scans of the pelvis and hips. The Norberg-Olsson angle of each hip was calculated radiographically, while the dorsolateral subluxation index of the femur was calculated on CT images according to a technique recently developed for evaluation of hip dysplasia in dogs. Using the Norberg-Olsson angle a total of 52 hips (31,7%) were diagnosed as dysplastic, 74 (45,1%) as non-dysplastic, and 38 (23,1%) as borderline. Using the dorsolateral subluxation index, values ranged from a minimum of 34.6% to a maximum of 66.6% and four distribution classes were proposed. Findings indicated that the dorsolateral subluxation index previously described as method for quantifying hip dysplasia in dogs is also a feasible method for quantifying hip dysplasia in cats. Future studies are needed to more definitively determine the diagnostic sensitivity of this method.

Unilateral renal cystadenocarcinoma and nodular dermatofibrosis in a mixed-breed dog carrying a FLCN gene mutation

BACKGROUND

Renal cystadenocarcinoma and nodular dermatofibrosis (RCND) is a rare inherited cancer syndrome observed predominantly in the German shepherd dog breed, known to be associated with dominant autosomal transmission of mutation H255R of the encoding folliculin gene (FLCN). The syndrome usually features bilateral, multifocal kidney tumours and skin nodules, consisting of dense collagen fibres, with previous reports showing a poor prognosis. Although historically nodular dermatofibrosis (ND) has been considered a paraneoplastic syndrome associated with renal cystadenocarcinoma; this hypothesis has been questioned.

OBJECTIVES

To report a case of unilateral renal adenocarcinoma in a dog with RCND syndrome, with 40-month follow-up.

ANIMAL

A neutered 5-year-old female, mixed-breed dog.

METHODS AND MATERIALS

Nodular dermatofibrosis was confirmed with histopathological evaluation. Contrast-enhanced ultrasound (CEUS) supported a presumptive diagnosis of unilateral renal neoplasia and the kidney was removed.

RESULTS

Nodular dermatofibrosis with unilateral RC was confirmed by histopathological evaluation and DNA sequencing; this was positive for the heterozygous form for the H255R mutation in the FLCN gene. Follow-up at 40 months after nephrectomy showed progressive increase in the size and number of nodular lesions.

CONCLUSION AND CLINICAL IMPORTANCE

This case supports the hypothesis that nodular dermatofibrosis is not a paraneoplastic syndrome associated with cystadenocarcinoma. It may be instead an independent dermatological feature of the same genetic disease, linked to the mutation of FLCN given that the cutaneous nodules in this dog increased in size and number after removal of the adenocarcinoma.

Light and shadows of a new technique: is photon total-skin irradiation using helical IMRT feasible, less complex and as toxic as the electrons one?

BACKGROUND

Radiotherapy is one of the standard treatments for cutaneous lymphoma and Total Skin Electrons Beam Irradiation (TSEBI) is generally used to treat diffuse cutaneous lymphoma and some cases of localized disease. Helical IMRT (HI) allows to treat complex target with optimal dose distribution and organ at risk sparing, so helical tomotherapy has been proposed as alternative technique to TSEBI but only one preliminary report has been published.

METHODS

Three patients treated (from May 2013 to December 2014) with Helical IMRT, with a total dose between 24 and 30 Gy, were retrospectively evaluated. Data about dosimetric features, response and acute toxicity were registered and analyzed. Planned target coverage was compared with daily in vivo measures and dose calculation based on volumetric images used for set up evaluation as well.

RESULTS

The patients had a mean measured surface fraction dose ranging from 1.54 Gy up to 2.0 Gy. A planned target dose ranging from 85 to 120% of prescription doses was obtained. All doses to Organs At Risk were within the required constraints. Particular attention was posed on "whole bone marrow" planned V10Gy, V12Gy and V20Gy values, ranging respectively between 23 and 43%, 20.1 and 38% and 9.8 and 24%. A comparison with the theoretical homologous values obtained with TSEBI has shown much lower values with TSEBI. Even if treatment was given in sequence to the skin of the upper and lower hemi-body, all the patients had anaemia, requiring blood transfusions, leukopenia and thrombocytopenia.

CONCLUSION

Based on our limited results TSEBI should still be considered the standard method to treat total skin because of its pattern of acute and late toxicities and the dose distribution. In this particular case the better target coverage obtained with HI can be paid in terms of worse toxicity. Helical IMRT can instead be considered optimal in treating large, convex, cutaneous areas where it is difficult to use multiple electrons fields in relation with the clinical results and the limited and reversible toxicities.