Comparison of endoscopic and full-thickness biopsy specimens for diagnosis of inflammatory bowel disease and alimentary tract lymphoma in cats

OBJECTIVE: To evaluate the accuracy of endoscopic biopsy (EB) specimens for diagnosis of alimentary tract lymphosarcoma in cats. DESIGN: Prospective study. ANIMALS: 22 cats with inflammatory bowel disease (IBD) or alimentary tract lymphosarcoma. PROCEDURES: Endoscopic biopsy specimens were obtained during endoscopy of the stomach and duodenum immediately prior to laparotomy or laparoscopic surgery, during which full-thickness biopsy (FTB) specimens were obtained. Accuracy of histopathologic diagnoses was compared between EB and FTB specimens. RESULTS: Lymphosarcoma was diagnosed in 10 cats on the basis of FTB specimens. Lymphosarcoma was detected in the jejunum and ileum in all 10 cats, in the duodenum in 9 cats, and in the stomach in 4 cats. In the same 10 cats, EB findings indicated a diagnosis of lymphosarcoma in 3 cats and were suggestive but inconclusive for lymphosarcoma in 3 cats. Lymphosarcoma was correctly diagnosed via gastric EB specimens in 3 of the 4 cats with gastric lymphosarcoma but evaluation of EB specimens led to an incorrect diagnosis of IBD in 4 cats with small intestinal lymphosarcoma. CONCLUSIONS AND CLINICAL RELEVANCE: EB specimens were useful for diagnosis of gastric lymphosarcoma but were not adequate for differentiating between IBD and lymphosarcoma in the small intestine. Because the most common sites of alimentary tract lymphosarcoma in cats are the jejunum and ileum, FTB specimens of those sites should be obtained via laparotomy or laparoscopy for accurate diagnosis. Laparoscopy may be a minimally invasive alternative to endoscopy and laparotomy for obtaining diagnostic biopsy specimens.     

Cutaneous lymphosarcoma in a stallion

Multiple cutaneous lymphosarcomas were diagnosed in an 8-year-old Thoroughbred stallion presented for evaluation of lumps on its scrotum. Histological examination of skin biopsy samples showed a homogenous pattern of lymphoid tissue suggestive of a T-cell lymphosarcoma. Immuno-histochemical tests showed a positive reaction to Rabbit/Anti-Human T-Cell, CD3 antibodies confirming T-cell lymphosarcoma. The animal was not treated and was subsequently euthanased.     

Abnormal hematologic findings in an African hedgehog (Atelerix albiventris) with gastrointestinal lymphosarcoma

A 4-year-old African hedgehog (Atelerix albiventris) was examined for weight loss and hematochezia, and was subsequently diagnosed with gastrointestinal lymphosarcoma. Abnormal hematological findings included marked leukocytosis with lymphocytosis and atypical circulating lymphocytes. This report represents the first documentation of hemogram abnormalities associated with gastrointestinal lymphosarcoma in this species.     

Trichosporonosis in two cats

Infection with Trichosporon spp was diagnosed in 2 cats. In one cat, infection consisted of a granulomatous dermatitis and was concurrent with disseminated lymphoblastic lymphosarcoma. In another cat, urinary cystitis caused by T beigelii was diagnosed.     

Lymphosarcoma and cryptococcosis in a cat

Cryptococcosis and lymphosarcoma were diagnosed in a 3-year-old Domestic Shorthair cat. The cat was studied immunologically, and abnormal findings included absolute lymphopenia, with a low percentage of the lymphocytes having cell surface markers of normal T and B cells, decreased responsiveness to mitogens, and low immunoglobulin concentrations in serum. Necropsy revealed cryptococcal lesions in the facial area. The cortex of the left kidney was replaced by a diffuse pattern of undifferentiated large cells compatible with those of histiocytic cell type lymphosarcoma.     

Ataxia due to lymphosarcoma in a young horse

A 20-month-old, Standard-bred colt was presented with an acute onset of hindlimb ataxia. Clinical and radiographic examination identified a compressive lesion affecting the spinal cord at the level of the 17th to 18th thoracic vertebrae. After euthanasia, post-mortem examination revealed a tumour in the epidural space, diagnosed histologically as a lymphosarcoma. Neoplastic lymphoid cells were also present in the abdominal lymph nodes and brain. Because of the disseminated nature of lymphosarcoma in the horse, involvement of the central nervous system is likely to be more common than is presently recognised.     

Bilateral lymphosarcoma of the nictitating membrane in a Quarter Horse

A 21-year-old Quarter Horse mare presented for a mass of the right nictitating membrane. The entire right nictitating membrane was surgically removed and diagnosed as a mixed cell lymphosarcoma and squamous cell carcinoma. The horse had no systemic signs of lymphosarcoma. Approximately 1.5 years later, the horse presented with a similar mass in the left nictitating membrane. The entire left nictitating membrane was surgically removed and diagnosed as a mixed cell lymphosarcoma. In this case, complete surgical removal of the masses resulted in a cure. The horse has remained free of systemic lymphosarcoma for over 3 years.

Case report

A 21-year-old gray Quarter Horse mare was presented to the Kansas State University Veterinary Medical Teaching Hospital for evaluation of a mass involving the right nictitating membrane. The mass was first noticed 5 weeks before presentation and had been treated by the referring veterinarian with a topical steroid solution twice daily. Administration of the topical steroid caused some decrease in the swelling, but it quickly returned once medication was discontinued. The horse had no other medical complaints and appeared to be otherwise healthy. On ocular examination, chemosis of the third eyelid and conjunctiva of the right eye was evident. Direct and indirect pupillary light reflexes, Schirmer tear test, and intraocular pressures were normal in both eyes. Fluorescein stain uptake was negative in both corneas. Cranial nerve and vision examinations did not reveal any abnormalities. On further examination of the right nictitating membrane, a firm mass was palpated under and protruding from the palpebral conjunctiva (Fig 1). No other abnormalities were found on physical examination.     

A cat with Corynebacterium equi lymphadenitis clinically simulating lymphosarcoma.

A cat with granulomatous lymphadenitis due to Corynebacterium equi is described. Clinically the cat was diagnosed as having lymphosarcoma. Bacteria were cultured from the lymph nodes.     

Diffuse intestinal T-cell lymphosarcoma in a yellow-naped Amazon parrot (Amazona ochrocephala auropalliata)

A 10-year-old, intact, female yellow-naped Amazon parrot was examined because of anemia, lymphocytic leukocytosis, regurgitation, and weight loss. A positive fecal occult blood and monoclonal globulinopathy were present. A distended proventriculus and diffusely thickened loops of small intestine with irregular luminal surfaces were identified with contrast radiography and contrast computed tomography. A micro positron emission tomography scan was performed with (18)F-fluorodeoxyglucose. Diffuse intestinal T-cell lymphosarcoma was diagnosed based on histopathology and immunohistochemistry of full thickness small intestinal biopsies. The patient was treated with a multidrug chemotherapy protocol with little to no effect. Euthanasia was elected, and intestinal lymphosarcoma was confirmed on histopathology of necropsy intestinal samples; no other organs demonstrated neoplastic infiltration. To the authors' knowledge, no reports are currently available detailing the clinical presentation or diagnosis of diffuse intestinal T-cell lymphosarcoma in any avian species.     

Chronic intermittent vomiting in a cat: a case of chronic lymphocytic-plasmacytic gastritis

A 3-year-old cat presented for chronic intermittent vomiting was diagnosed with chronic lymphocytic-plasmacytic gastritis via histological examination of an endoscopic gastric biopsy. The condition was effectively managed with prednisone. The author cautions against missing a diagnosis of alimentary lymphosarcoma without a full-thickness gastric biopsy.     

Epididymal swelling attributable to generalized lymphosarcoma in a stallion.

Aspermia was diagnosed in a 12-year-old Thoroughbred stallion with generalized lymphosarcoma. Invasion of the epididymus by neoplastic cells caused thickening and enlargement of both epididymes. The testes were not affected. The nodular ultrasonographic architecture was similar to that in previously reported cases of infectious epididymitis.     

Benign cranial mediastinal lesions in three cats

Cranial mediastinal lesions were detected in three cats, associated with respiratory impairment (case one), spontaneous pneumothorax (case two) and myasthenia gravis (case three), respectively. On gross and histological examination, the first case was considered either a lymphangioma or a branchial cystic mass of the thymic region of the mediastinum; a cystic lesion was suggested by sonographic detection of multiple anechoic cavitations within a circumscribed mass, while fine needle aspiration cytology excluded lymphosarcoma. The second case was diagnosed histologically as a cystic thymoma, but the third case was not examined microscopically. The masses were amenable to surgical excision in the first two cats, while this proved unnecessary in the third case because of resolution following treatment with dexamethasone. Corticosteroid responsiveness was unhelpful in distinguishing between these benign lesions and lymphosarcoma, as in two cases there was a partial or complete response to dosing with prednisolone or dexamethasone. These cases are presented to emphasise that conditions other than lymphosarcoma can produce cranial mediastinal lesions in cats, and that the prognosis for surgical treatment of lymphangiomas, multilocular thymic cysts and cystic thymomas can be excellent.     

Lymphosarcoma with disseminated skeletal involvement in a pup

Lymphoblastic lymphosarcoma with disseminated skeletal involvement was diagnosed in a 15-week-old Golden Retriever. The skeletal disease was characterized by diffuse, irregular areas of radiolucency most evident in the diaphyseal portion of long bones and was associated with gait abnormalities and signs of pain. Necropsy also revealed involvement of the spleen, liver, kidneys, and mesenteric lymph nodes.     

Multicentric lymphosarcoma with ovarian involvement in a Nubian goat.

Multiple lymph node enlargement and an intra-abdominal mass were diagnosed in a 6-year-old doe. Necropsy revealed lymphosarcoma involving multiple organs, including the ovaries. Lymphosarcoma is rare in goats; ovarian involvement has not previously been reported.     

Systemic mastocytoma associated with lymposarcoma in an aged cat

Systemic mastocytoma was diagnosed in a 16 year old cat. Prednisone therapy was initiated but discontinued after 11 months because of development of a duodenal ulcer. Twenty months after the initial diagnosis the cat developed dyspnea, due to enlarged pharyngeal lymph nodes. Euthanasia was performed; systemic mastocytoma and lymphosarcoma were found at necropsy.     

Cranial vena caval thrombosis secondary to invasive mediastinal lymphosarcoma in a cat

A 12-year-old female cat was diagnosed with a cranial vena caval thrombosis in association with a mediastinal lymphosarcoma. The cause of the cranial vena caval thrombosis was thought to be invasion of the venous wall by neoplastic lymphoid cells. Clinical signs of cranial vena caval thrombosis, such as swelling and oedema of the submandibular area, the ventral part of the neck and the forelimbs, were related to a space-occupying mediastinal lymphosarcoma, which also induced respiratory distress and cyanosis. Non-selective angiocardiography demonstrated the occlusion of the cranial vena cava and abnormal venous collateral vessels feeding the heart which are accepted as the venographic hallmark of clinically overt cranial vena caval syndrome. At postmortem examination, an intracaval thrombus, 5 cm in length, was seen extending from the costocervical vein to the sulcus terminalis of the right atrium.     

Follow-up studies by large intestinal biopsies and necropsy in dogs with clinical signs of large bowel disease.

The results of follow-up studies in 77 dogs with clinical signs of large bowel disease are presented. In 32 dogs colonic and/or rectal biopsy follow-up studies were done, combined with necropsy in seven dogs. In 45 dogs a follow-up necropsy only was done. The time between the first and the last series of biopsies varied from three to 729 days and between the first series of biopsies and necropsy from one to 980 days. Colitis found in 45 dogs in the initial biopsies was still present in 29 cases in the follow-up biopsy studies and/or at necropsy. Eleven cases showed hystiocytic ulcerative colitis. In general, adenoma, carcinoma and lymphosarcoma were confirmed in the follow-up examination, except for one adenoma, which appeared to be a carcinoma at necropsy. In cases in which the differential diagnosis was adenoma or carcinoma, the necropsy diagnosis was always carcinoma and in cases of a differential diagnosis of lymphosarcoma and/or colitis, lymphosarcoma was always diagnosed at necropsy. Several dogs without colonic changes in the initial biopsies had other gastric or small intestinal lesions at necropsy such as gastritis and enteritis of the small intestine, or tumors, in these areas.     

ASSOCIATION BETWEEN RENAL HYPOECHOIC SUBCAPSULAR THICKENING AND LYMPHOSARCOMA IN CATS

The purpose of this study was to investigate the association between renal hypoechoic subcapsular thickening observed ultrasonographically and the presence of renal lymphosarcoma in cats. The ultrasonography database was retrospectively searched for cats that underwent ultrasound examination and ultrasound guided needle renal aspirate, renal biopsy, or necropsy. One radiologist unaware of the final diagnosis evaluated the images for the presence of hypoechoic subcapsular thickening and other abnormal findings. Fifty-four cats met the inclusion criteria. Hypoechoic subcapsular thickening was found in 21 cats of which 17 had lymphosarcoma; the remaining four cats had a different diagnosis. Eleven out of 33 cats without hypoechoic subcapsular thickening were positive for lymphosarcoma, and the rest had a different diagnosis. There was a significant association between hypoechoic subcapsular thickening and renal lymphosarcoma (P = 0.001). The positive predictive value of hypoechoic subcapsular thickening for lymphosarcoma was 80.9% and the negative predictive value was 66.7%. The sensitivity and specificity of hypoechoic subcapsular thickening for the diagnosis of renal lymphosarcoma were 60.7% and 84.6%, respectively. The results of this study indicate that the presence of hypoechoic subcapsular thickening in feline kidneys is associated with renal lymphosarcoma.     

Diagnosis and treatment of chylothorax associated with lymphoblastic lymphosarcoma in four cats

Chylothorax was diagnosed in 4 cats with lymphoblastic lymphosarcoma. Clinical findings included dyspnea, muffled heart sounds, and noncompressibility of the cranial portion of the thorax. All cats had high pleural fluid triglyceride concentration. Lymphosarcoma was diagnosed by cytologic evaluation of pleural fluid in 3 cats and by histologic evaluation of a cranial cervical lymph node in 1 cat. Two cats were euthanatized prior to any treatment, and the other 2 cats were managed by thoracic drainage, chemotherapy, and/or irradiation.     

Asparaginase-associated pancreatitis in a dog

A dog with lymphosarcoma was evaluated for vomiting, lethargy, and abdominal pain 48 h after treatment with L-asparaginase. Based on drug administration, clinical signs, bloodwork, and elevated canine pancreatic lipase immunoreactivity, L-asparaginase-associated pancreatitis was diagnosed. This is an acknowledged toxicity; however, its pathophysiology and incidence rate in veterinary patients are unknown and sparsely documented.