Primary epitheliotropic T-cell lymphoma of the urinary bladder in a dog

A 7-year-old, intact female mixed-breed dog was presented for evaluation of hematuria. Physical examination revealed a suprapubic mass. Ultrasonographic examination showed a large lobular mass occupying the urinary bladder. At the owners' request, the dog was euthanatized and a postmortem examination was performed. Necropsy confirmed the presence of a lobular mass of about 5- to 6-cm diameter protruding into the lumen of the bladder. Histologically, the mass was composed of a large number of atypical lymphoid cells in the lamina propria and mucosal epithelium. Immunohistochemically, the neoplastic cells expressed CD3 but not CD79alpha or keratin and vimentin, supporting a diagnosis of T-cell lymphoma.     

Treatment of canine cutaneous epitheliotropic T-cell lymphoma with oclacitinib: a case report

Canine cutaneous epitheliotropic T-cell lymphoma (CETL) is associated with a poor prognosis and without consistently beneficial treatment options. This case report describes a 9-year-old Staffordshire bull terrier with CETL treated with oclacitinib (0.7 mg/kg twice daily), resulting in partial remission that was maintained for three months. Further studies are warranted.     

Hypertrichosis in a horse with alimentary T-cell lymphoma and pituitary involvement.

A 13-year-old Quarterhorse mare had a 6-month history of diarrhea, progressive weight loss, and lethargy. At presentation the mare was hirsute, had hyperhidrosis, and abnormal fat distribution in addition to severe diarrhea. A presumptive clinical diagnosis of protein-losing enteropathy and pituitary pars intermedia dysfunction was made. T-cell lymphoma was diagnosed in a rectal biopsy specimen. The owner elected to euthanize the mare because of poor prognosis and the severity of the disease. At necropsy, the mare had hypertrichosis and the pituitary gland was diffusely enlarged. Histologically, neoplastic lymphocytes infiltrated the gastrointestinal mucosa, mesenteric lymph nodes, and the pituitary gland. In addition, there was hyperplasia of the pituitary gland pars intermedia. Pituitary adenoma was not present. Hypertrichosis in this case could have been triggered by a combination of adenomatous hyperplasia of pars intermedia and lymphoma resulting in disruption of the hypothalamic dopaminergic tone or disruption of the hypothalamic thermoregulatory center.     

Multisystemic eosinophilic epitheliotropic disease (MEED) in a horse

Extract

A 6-year-old Thoroughbred-cross gelding was presented with ulcerative coronitis and sloughing of chestnuts and ergots. The horse was mildly lame and its faeces were soft and formless. Laboratory findings included a mild eosinophilia, mild hyperglobuli-naemia and a marked elevation of gamma glutamyl transferase and glutamate dehydrogenase. There was a general deterioration of the horse's condition over a 3-week period and the dermatitis became generalised and the diarrhoea severe. It was euthanised. At necropsy, the pancreas was pale, multinodular and firm. The liver had a lobular appearance and there was generalised thickening of the descending colon. Histologically, there was a marked, predominantly eosinophilic infiltrate of the pancreas, liver and colon. There was a superficial and deep perivascular dermatitis of the coronet, characterised by dense infiltrates of eosinophils in association with marked acanthosis and hyperkeratosis. The combination of clinical findings, haematology, serum biochemistry and gross changes in conjunction with the histology confirmed MEED. The aetiology of MEED has not been established.     

Canine cutaneous epitheliotropic T-cell lymphoma with vesiculobullous lesions resembling human bullous mycosis fungoides

The broad spectrum of clinical signs in canine cutaneous epitheliotropic T-cell lymphoma mimics many inflammatory skin diseases and is a diagnostic challenge. A 13-year-old-male castrated golden retriever crossbred dog presented with multifocal flaccid bullae evolving into deep erosions. A shearing force applied to the skin at the periphery of the erosions caused the epidermis to further slide off the dermis suggesting intraepidermal or subepidermal separation. Systemic signs consisted of profound weight loss and marked respiratory distress. Histologically, the superficial and deep dermis were infiltrated by large, CD3-positive neoplastic lymphocytes and mild epitheliotropism involved the deep epidermis, hair follicle walls and epitrichial sweat glands. There was partial loss of the stratum basale. Bullous lesions consisted of large dermoepidermal and intraepidermal clefts that contained loose accumulations of neutrophils mixed with fewer neoplastic cells in proteinaceous fluid. The lifted epidermis was often devitalized and bordered by hydropic degeneration and partial epidermal collapse. Similar neoplastic lymphocytes formed small masses in the lungs associated with broncho-invasion. Clonal rearrangement analysis of antigen receptor genes in samples from skin and lung lesions using primers specific for canine T-cell receptor gamma (TCRγ) produced a single-sized amplicon of identical sequence, indicating that both lesions resulted from the expansion of the same neoplastic T-cell population. Macroscopic vesiculobullous lesions with devitalization of the lesional epidermis should be included in the broad spectrum of clinical signs presented by canine cutaneous epitheliotropic T-cell lymphoma.     

Paraneoplastic hypereosinophilia in a dog with intestinal T-cell lymphoma

A 9-year-old, intact male Doberman Pinscher was examined because of anorexia and weakness. Results of a CBC showed severe, microcytic, hypochromic anemia with mild eosinophilia (2944 cells/microL, reference interval 100-1250/microL) and thrombocytosis. Hypoferremia, hypoferritinemia, and a positive fecal occult blood test supported a diagnosis of iron deficiency anemia secondary to chronic intestinal hemorrhage. Abdominal ultrasound evaluation showed a thickened small intestinal loop, of which representative specimens were obtained during exploratory laparotomy. Histologically, the intestinal wall was infiltrated by a neoplastic population of large, round, lymphoid cells with vesicular chromatin, 1 or more prominent nucleoli, and a high number of mitotic figures. The cells were closely admixed with mature eosinophils, but were negative for metachromatic granules with toluidine blue. Immunohistochemically, tumor cells were positive for CD3, and negative for CD21, Pan B, and CD79a. A diagnosis of intestinal T-cell lymphoma was made. Chemotherapy was begun, with 30 mg/m;2 of doxorubicin administered intravenously every 3 weeks. Eosinophil concentration was 880/microL 2 weeks after surgery (on day 15 after presentation) but increased markedly to 62,914/microL on day 30, 62,400/microL on day 37, and 39,444/microL on day 58 after presentation. An association between hypereosinophilia and T-cell lymphoma is well established in human patients, in whom production of IL-5 by neoplastic T cells has been demonstrated. Hypereosinophilia has been reported only rarely with intestinal lymphoma in cats and horses, and with T-cell lymphoma in dogs.     

T-cell lymphocytic leukaemia and lymphoma in a horse (abstract)

A 10-year-old Thoroughbred gelding showed rapid weight loss over about 1 week. Clinically, it had increased respiration and heart rates, dark red mucous membranes with petechial haemorrhages, and a bilateral keratitis. Routine haematological examination showed a lymphocytosis with increased numbers of small hyperchromatic lymphocytes in circulation, but no anaemia. On necropsy, many enlarged abdominal lymph nodes were seen and there was a large amount of fluid in the peritoneal cavity and pericardial sac. Histopathologically, small lymphocytes in- filtrated most tissues including the bone marrow, lymph nodes, liver, gastrointestinal tract and cornea. These were identified as T-lymphocytes by the use of immunohistochemistry and CD3 (positive), CD20 (negative) and CD 79a (negative) markers. A T-cell lymphocytic leukaemia and multi-centric lymphoma with generalised tissue infiltration were therefore diagnosed.     

Dexamethasone for treatment of multisystemic eosinophilic epitheliotropic disease in a horse

A 4-year-old Paint mare was examined because of respiratory tract infection, dermatitis, and weight loss of 2 months' duration. Initial examination revealed generalized pruritic dermatitis, ocular and nasal discharges, and stranguria. Laboratory abnormalities included leukopenia and hypoalbuminemia. Further examination of the respiratory tract revealed grade III of IV pharyngitis and pyogranulomatous pneumonia. Endoscopic examination of the bladder revealed a prolific mass at the junction of the bladder and urethra. Hypoproteinemia was suspected to be caused by protein-losing enteropathy. On histologic examination, skin, rectal, pharyngeal, and urethral biopsy specimens were characterized by infiltration of eosinophils and lymphocytes, and a diagnosis of multisystemic eosinophilic epitheliotropic disease was made. The horse improved following treatment with dexamethasone, trimethoprim-sulfamethoxazole, and an antihistamine and was discharged after 19 days of hospitalization. Treatment with dexamethasone was continued for 4 weeks after hospitalization but was then discontinued. Eight months after discharge, the horse was performing as a pleasure horse and did not require any medical treatment. Multisystemic eosinophilic epitheliotropic disease is typically associated with a poor prognosis in horses. The dermatitis, protein-losing enteropathy, and lower respiratory tract disease in this horse were consistent with previous reports; however, pharyngitis and urethritis have not, to our knowledge, been previously reported in horses with this disease.     

Severe pulmonary disease due to multisystemic eosinophilic epitheliotropic disease in a horse

Multisystemic eosinophilic epitheliotropic disease was diagnosed histologically in a 17-year-old Quarter Horse intact mare that was presented with a chronic history of respiratory distress. At necropsy, the lungs were poorly collapsed and the pulmonary parenchyma contained innumerable, discrete, spherical nodules in a miliary pattern. A few similar nodules were scattered in the liver and the renal lymph nodes. Histologically, these nodules consisted of fibrosing eosinophilic granulomas. Based on histologic findings and the absence of an etiologic agent, a diagnosis of multisystemic eosinophilic epitheliotropic disease was made.     

Feline epitheliotropic intestinal malignant lymphoma: 10 cases (1997-2000)

The clinical, histopathologic, and immunohistochemical features of 10 cats with epitheliotropic intestinal malignant lymphoma (EIL) are described. Intestinal biopsy samples were reviewed by 3 pathologists to confirm the diagnosis of EIL. These samples (n = 10) were compared to the intestinal biopsies of normal cats (n = 11), cats with inflammatory bowel disease (IBD; n = 7), and cats with non-EIL (n = 9) for quantification and immunophenotyping of intraepithelial lymphocytes. Immunophenotypic studies were performed with CD3 and CD79a antibody stains to assess for T- and B-cell immunoreactivity, respectively. EIL biopsies had markedly more intraepithelial lymphocytes than normal intestine (NRL) and samples from cats with IBD. However, no marked difference was observed in the number of intraepithelial lymphocytes in cats with non-EIL compared to cats with EIL. Regardless of the histologic diagnosis, the intraepithelial lymphocytes in all cats were small- to intermediate-sized T cells. Clinical findings and imaging studies in the cats identified minimal or nonspecific findings in affected cats. Most cats fit the typical profile of cats with IBD or alimentary malignant lymphoma. Nine of 10 cats with EIL were treated with prednisone with or without additional chemotherapy. Four cats were refractory to chemotherapy and were euthanized within 3.5 months. The remaining 5 cats had long-term survival times of 11 months or greater. The median survival time was 11 months. Additional studies are warranted to better characterize EIL and its relationship to IBD in cats and non-EIL and to identify optimal treatment strategies for this disease.