Clinical and immunohistochemical differentiation of gastrointestinal stromal tumors from leiomyosarcomas in dogs: 42 cases (1990-2003)

OBJECTIVE: To reexamine (via immunohistochemical techniques) canine tissue samples that had been previously classified as gastrointestinal leiomyosarcomas (GILMSs), identify and differentiate gastrointestinal stromal tumors (GISTs) from GILMSs, and compare the biological behavior and clinical course of GISTs and GILMSs in dogs. DESIGN: Retrospective case series. ANIMALS: 42 dogs. PROCEDURES: Medical records of 42 dogs for which a histologic diagnosis of GILMS was confirmed were reviewed for signalment, clinical signs, physical examination findings, results of initial diagnostic tests, surgical findings, adjunctive treatment, location of the tumor, completeness of resection, and outcome after surgery. Archived tumor tissue specimens from each dog were restained via immunohistochemical techniques to differentiate tumor types. Long-term follow-up information was obtained from the medical record or through telephone interviews with owners and referring veterinarians. RESULTS: On the basis of immunohistochemical findings, 28 of 42 tumors were reclassified as GISTs and 4 were reclassified as undifferentiated sarcomas; 10 tumors were GILMSs. In dogs, GISTs developed more frequently in the cecum and large intestine and GILMSs developed more frequently in the stomach and small intestine. Median survival times for dogs with GISTs and GILMSs were 11.6 and 7.8 months, respectively; if only dogs surviving the perioperative period were considered, median survival times were 37.4 and 7.8 months, respectively. These differences, however, were not significant. CONCLUSIONS AND CLINICAL RELEVANCE: In dogs, many previously diagnosed GILMSs should be reclassified as GISTs on the basis of results of immunohistochemical staining. The biological behavior of these tumors appears to be different.     

ULTRASONOGRAPHIC DIAGNOSIS OF GASTROINTESTINAL SMOOTH MUSCLE TUMORS IN THE DOG

Historical, physical examination, clinicopathologic, radiographic and ultrasonographic findings of 13 dogs with gastrointestinal (GI) smooth muscle tumors (11 leiomyosarcomas, 2 leiomyomas) were reviewed. History, including signalment and chief complaint, physical examination and bloodwork were neither sensitive nor specific for GI neoplasia. Imaging procedures, radiology and ultrasonography, detected the presence of abdominal masses in 12 patients, including 9 animals lacking a palpable mass on initial examination. Survey radiographs of 10 of the 13 dogs revealed a mass effect in 5/10 dogs, evidence of peritoneal effusion or free abdominal gas in 3/10 dogs, and an obstructive pattern with gas and fluid distension of the intestinal tract in 1/10 dogs. Ultrasonography identified an abdominal mass in 12/13 dogs, and peritoneal effusion in 5 animals. Ultrasonography correctly recognized an association of the mass with bowel segments by the presence of intraluminal gas, within or adjacent to the mass effect, in 10 dogs, and strongly suggested an intestinal origin in one additional animal. GI smooth muscle tumors often appeared as large masses, eccentrically projecting from the bowel wall, frequently containing single or multiple hypo/anechoic regions. Based on this study we conclude that ultrasonography is more sensitive than survey radiography in the detection of GI smooth muscle tumors, and may present specific features to distinguish smooth muscle tumors from other types of GI tumors. Ultrasonography is recommended as a screening procedure for cases where GI neoplasia is suspected.     

Three cases of canine gastrointestinal stromal tumors with multiple differentiations and c-kit-expression

Three canine gastrointestinal stromal tumors (GISTs) were examined. Histopathologically, the tumor mass in the jejunum (Case 1) consisted of the proliferation of epithelioid cells with abundant eosinophilic or vacuolated cytoplasm. Gangliocyte-like or multinucleated giant cells were scattered. The tumor cells exhibited neural natures mimicking human gastrointestinal autonomic nerve tumors, which were immunopositive for several neuronal markers. Another jejunal mass (Case 2) was composed by a solid proliferation of spindle-shaped cells, arranging in interlacing fascicles and occasional storiform pattern. The tumor seemed to be classified undifferentiated GISTs, that showed no apparent neural or muscular features by ultrastructural and immunohistochemical examinations. In the pyloric mass (Case 3), the spindle cells having eosinophilic processes and elongated nuclei were arranged in sheets. Immunohistochemically, the tumor cells showed muscular natures as regards alpha smooth muscle actin and desmin expression.     

Gastrointestinal stromal tumors and leiomyomas in the dog: a histopathologic,immunohistochemical, and molecular genetic study of 50 cases

Fifty canine gastrointestinal (GI) mesenchymal tumors were examined to determine the occurrence of leiomyomas (LM) and GI stromal tumors and to compare their clinicopathologic features. Twenty-one tumors (42%) were histologically reclassified as gastrointestinal stromal tumors (GISTs) and 29 tumors (58%) as LMs on the basis of their histologic similarity with homologous human tumors. The GISTs occurred equally in males and females, with a mean age of 11 years (range 5-14 years). Five GISTs (24%) were associated with clinical signs and six (29%) had metastasis in liver or abdominal cavity. The GISTs occurred in large intestine (10, 48%), small bowel (six, 29%), stomach (four, 19%), and mesentery of small intestine (one, 5%). Histologically, they were highly cellular spindle, or less commonly epithelioid tumors with mitotic rates ranging from 0 to 19 per 10 HPF. Eleven tumors (52%) were positive for CD117 (KIT); seven (33%) were positive for smooth muscle actin but none for desmin and S-100 protein. Sequences of KIT exon 11, often mutated in human GISTs, were evaluated from four GISTs. Deletion of Try556-Lys557 coexisting with duplication of Gln555 in one case of GIST and T to C transition resulting in substitution of Pro for Leu575 in another were identified. The LMs occurred predominantly in males (82%) with a mean age of 11 years (range 8-17 years). Nine tumors (31%) had associated clinical signs. They occurred in the stomach (22, 76%), esophagus (four, 14%), and intestines (three, 10%); all were paucicellular, had no mitoses, and were composed of mature smooth muscle cells. Twenty-eight (97%) were positive for smooth muscle actin and 18 (62%) for desmin but none for CD117 and S-100. Both GISTs and true LMs occur in the GI tract of dogs. Both tumors have distinctive pathologic features.     

Prognostic factors for dogs with surgically resected gastrointestinal stromal tumors

Few reports have investigated prognosis of canine gastrointestinal stromal tumor (GIST) cases treated by surgical resection alone. In the present study, we investigated the overall survival (OS) and prognostic factors for dogs with GIST treated by surgical complete resection alone. Fifty-three dogs were included, and the median OS was 18 months. Multivariate analysis showed that primary tumors in small intestine (P=0.04) is significantly associated with shorter OS, and median OS of the cases with cecum lesion and those with small intestine lesion was 22 and 6 months, respectively. The present study suggested primary tumor site was a novel prognostic factor for dogs with GIST treated by surgical complete resection alone.     

Contrast-enhanced CT features of pyloric lesions in 17 dogs: Case series

Pyloric outflow obstructions can be caused by several types of lesions. When a thickened gastric wall and pyloric mass are detected, malignant neoplasia must be differentiated from chronic hypertrophic pyloric gastropathy. CT can characterize gastric tumors. However, based on the authors’ review of the literature, there is limited information about the CT findings of pyloric lesions. The purpose of this retrospective case series study was to assess the CT findings of canine pyloric lesions. The following CT parameters were recorded: anatomical area, involved area, lesion shape, growth patterns of wall thickening lesions, enhancement pattern of the lesion in the early and delayed phases, lymphomegaly, and pulmonary metastasis. Seventeen dogs were included in this study and had the following final diagnoses: hyperplasia (five dogs), adenoma (five dogs), adenocarcinoma (three dogs), gastrointestinal stromal tumor (GIST; two dogs), polyposis (one dog), and pyogenic granuloma (one dog). Hyperplasia, adenoma, and polyposis formed mass lesions that involved the mucosal layer. Lymphomegaly was detected in two Jack Russell terriers with hyperplasia; however, the causes were unknown because we did not perform biopsies. All adenocarcinomas formed wall-thickened lesion that involved the outer layer, with lymphomegaly. All GISTs formed mass lesion that involved the outer layer. The pyogenic granulomas formed symmetric wall-thickened lesion that involved the mucosal and outer layers. CT facilitated the characterization of canine pyloric lesions using contrast enhancement, based on the involved area and lesion shape. However, polyposis may require caution in diagnosis based on CT findings alone.     

Reclassification of small intestinal and cecal smooth muscle tumors in 72 dogs: clinical, histologic, and immunohistochemical evaluation

Objectives— To reclassify canine small intestinal and cecal leiomyoma (LM) and leiomyosarcoma (LMS) into smooth muscle and gastrointestinal stromal tumors (GIST) using histologic and immunohistochemical (IH) analysis and to report clinical findings and survival data.
Study Design— Retrospective review of cases.
Animals— Dogs (n=47) with small intestinal (40 LMS; 7 LM) and 25 dogs with cecal tumors (23 LMS; 2 LM).
Methods— Clinical and survival data were reviewed. Tissue sections were reevaluated for light-microscopic malignancy criteria and examined for expression of SMA, desmin, vimentin, S-100, and CD117 (KIT) by immunohistochemistry.
Results— Reclassification resulted in 2 LM, 9 LMS, 19 GIST, and 17 GIST-like tumors in the small intestine and 23 GIST and 2 GIST-like tumors in the cecum. GIST-like tumors were morphologic and IH identical to GIST but lacked KIT expression. No significant difference in survival was observed for tumor type, location, histologic, or IH characteristics; however, dogs with cecal tumors were significantly older in age, presented more commonly with intestinal perforation and peritonitis, and less commonly with weight loss. Cecal tumors had more histologic malignancy criteria than small intestinal tumors. After excision, 1 and 2 year recurrence-free periods were 80.1% and 67.2% for small intestinal and 83.3% and 61.9% for cecal tumors.
Conclusion— Prognosis for intestinal tumors with histologic smooth muscle appearance is good after excision and not related to tumor type, location, histologic, or IH characteristics.
Clinical Relevance— Clinical importance could not be demonstrated for reclassification, but may be for future treatment, of intestinal smooth muscle or stromal tumors.     

Imatinib mesylate treatment in a dog with gastrointestinal stromal tumors with a c-kit mutation

A 13-year-old spayed mixed-breed dog was diagnosed with a gastrointestinal stromal tumor (GIST) after histopathological examination of an abdominal mass. Five months after surgical resection of the tumor, we detected the recurrence of GIST with multiple disseminated abdominal lesions. A sequence analysis of cDNA obtained from a biopsy of the recurrent tumors revealed a mutation within exon 9 of the c-kit gene (1523A>T, Asn⁵⁰⁸Ile), which has been shown to cause ligand-independent phosphorylation of the KIT protein in GISTs and canine mast cell tumors (MCTs). Upon detection of the recurrent tumors, we initiated treatment with imatinib mesylate (10 mg/kg, q 24 hr). After 2 months, the dog achieved complete remission. Our findings indicate that canine GIST, and possibly MCT, may be responsive to molecular-targeted therapy.     

Immunohistochemical Differentiation and Clinicopathological Features of Canine Gastrointestinal Stromal Tumors and Leiomyosarcomas

Introduction:  Gastrointestinal stromal tumors (GIST) and leiomyosarcomas (LMS) have recently been differentiated by immunohistochemical staining techniques and have been shown to have different biological behaviors in humans. Expression of the c‐kit protein, a transmembrane tyrosine kinase receptor, occurs in nearly all GISTs. The aim of this study was to differentiate canine GIST from LMS, and to compare their clinicopathological features.
Methods:  Archived blocks of previously diagnosed LMS were analyzed. Immunohistochemical staining using antibodies against c‐kit, smooth muscle actin (SMA), desmin, vimentin and S100 was performed. GISTs were diagnosed based on positive c‐kit staining. LMS were diagnosed based on absence of c‐kit staining and positive SMA staining. Follow‐up information was obtained from medical records and telephone interviews with owners.
Results:  Forty‐two dogs were included in the study. Mean age was 10.9 yrs (range 5–15 yrs). There were 18 females and 24 males. Twenty‐eight tumors were GISTs, 10 were LMS and 4 stained negatively for c‐kit, SMA and S100 (sarcomas). GISTs were more likely to occur in the large intestine and LMS were more common in the small intestine (p = 0.01). All were surgically excised and only two were treated with adjunctive chemotherapy. Only two GISTs and one sarcoma had metastasized at the time of surgery. Survival time in dogs discharged after surgery for GIST, LMS and sarcomas was 1123, 233 and 88 days respectively (p = 0.08).
Conclusions:  Many previously diagnosed LMS should be reclassified as GIST based on the results of immunohistochemical staining. The biological behavior of these tumors appears to be different.     

Identification of matrix metalloproteinases in canine cutaneous mast cell tumors

Presence of matrix metalloproteinases has been associated with tumor invasion and metastasis in human neoplasia. The presence of matrix metalloproteinase 2 and matrix metalloproteinase 9 was determined in canine mast cell tumor tissue and normal stromal tissue from 24 dogs with spontaneously occurring cutaneous mast cell tumors. Seventeen of the mast cell tumors were of histologic grade 2, and 7 were of histologic grade 3. Gelatin zymography and computer assisted densitometry image analysis were used to quantify matrix metalloproteinase concentration. Bands from canine tissues migrated in the same location as human proenzyme and active enzyme matrix metalloproteinase 2 and matrix metalloproteinase 9 standards. A semiquantitative value for each patient sample was obtained by comparing the optical assessment density of each unknown band to the optical density of the human standard. The presence of matrix metalloproteinase 2 and matrix metalloproteinase 9 in histologic grade 2 mast cell tumors and histologic grade 3 mast cell tumors was compared, as was presence of matrix metalloproteinases in tumor and stromal tissue. There was dramatically more proenzyme matrix metalloproteinase 9 activity in histologic grade 3 mast cell tumors when compared to grade 2 tumors (P = .03). There was also dramatically more active enzyme matrix metalloproteinase 2 and active enzyme matrix metalloproteinase 9 activity in tumor tissue compared to stromal tissue (P = .02, P < .0001). This study demonstrates that the proenzyme and active enzyme forms of matrix metalloproteinase 2 and matrix metalloproteinase 9 are present in canine mast cell tumors. This appears to be related to the degree of histologic malignancy, although histologic grade 1 tumors were not evaluated.     

ULTRASONOGRAPHIC FEATURES OF CANINE GASTROINTESTINAL PYTHIOSIS

Pythiosis is a chronic pyogranulomatous infection of the gastrointestinal tract or skin caused by the water borne pathogen Pythium insidiosum. The ultrasonographic features of nine dogs with gastrointestinal pythiosis are reported. The stomach, duodenum, jejunum or colon were affected. All dogs had thickening of the gastrointestinal wall and areas with obliteration of the normal layered appearance. In one dog an eccentric mass was found arising from the serosal surface of the wall of the colon with mild diffuse wall thickening. Regional lymph node enlargement was seen in seven of the nine dogs. One dog had invasion of the pancreas and signs compatible with extrahepatic biliary obstruction. When compared to previous reports of gastrointestinal neoplasia, the features of wall thickening, loss of layering and regional lymphadenopathy are not considered specific for gastrointestinal pythiosis. Histological examination of tissue specimens is required for diagnosis.     

犬常见肿瘤流行病学调查及组织病理学诊断

为探讨犬常见肿瘤的发病规律，试验收集哈尔滨地区2016-2017年宠物医院部分犬肿瘤病例71例，采用组织病理学方法对犬肿瘤进行病理学诊断，并对患病动物的品种、性别、年龄、发生部位和饮食情况与肿瘤发生关系进行统计分析。结果显示，71例确诊肿瘤病例中，恶性肿瘤28例，包括鳞状上皮细胞癌3例，基底细胞癌5例，乳腺癌14例，淋巴瘤2例，肾母细胞瘤、精原细胞癌、生殖细胞癌、侵袭性血管黏液瘤各1例；良性肿瘤43例，包括良性乳腺肿瘤15例，纤维瘤10例，平滑肌瘤5例，乳头状瘤和精原细胞瘤各3例，造釉细胞瘤、耵聍腺瘤、脂肪瘤、结节样增生、性索间质细胞瘤、颗粒细胞瘤、肛周腺瘤各1例。上述病例中，乳腺和皮肤是犬肿瘤的高发部位，分别占全部患犬的40.8%和34.0%；患病犬年龄1~16岁不等，平均发病年龄为9.1岁，7岁以后是肿瘤的高发期，中老年犬仍为主要发病群体，但低龄犬发病数量上升；各品种犬均可发生肿瘤，其中杂种犬发病率最高，其次是贵宾犬和京巴犬，且主要为乳腺肿瘤；饮食习惯主要以剩饭剩菜类和肉拌饭类为主，分别占患犬总数的39%和30%；部分肿瘤类型与犬的性别、是否绝育有关，如乳腺肿瘤多发生于未绝育的老年母犬。本研究结果为犬肿瘤的流行病学及诊断提供了参考依据，对犬肿瘤的预防和诊断有一定的借鉴意义。     

Immunohistochemical evaluation of canine ovarian tumors

Canine ovarian tumors (epithelial tumor, sex-cord stromal tumor, germ cell tumor) classifying into 9 histological types were examined immunohistochemically using placental alkaline phosphatase (PLAP), cytokeratin7 (CK7), desmin, S100, AE1/AE3, inhibin alpha, vimentin, and alfa feto-protein (AFP). The papillary and tubular types observed in epithelial tumors were immunoreactive for desmin and AE1/AE3. The papillary type was also immunoreactive for PLAP and CK7. The solid type, nest type, cord type, palisade type, cystic type and spindle type, which were observed in sex-cord stromal tumors, showed a positive immunoreaction for S100 but little or no positive immunoreaction for inhibin alpha with an exception of positive result in the palisade type. Most of the sex-cord stromal tumors were AE1/AE3-positive except for the palisade type. In the cobblestone type observed in germ cell tumors, only vimentin and AFP were positive. The present study elucidated the detailed histological and immunohistochemical characteristics of canine ovarian tumors.     

REIRRADIATION OF RECURRENT CANINE NASAL TUMORS

Canine nasal tumors are typically treated with radiation therapy but most patients develop local recurrence. Our purpose was to evaluate tumor and normal tissue response to reirradiation in nine dogs. The median dose delivered with the first protocol was 50 Gy (range 44–55 Gy) and the median fraction number was 18 (range 15–20). For the second protocol, the median dose was lower intentionally, median of 36 Gy (range 23–44 Gy), without changing the median fraction number of 18 (range 14–20) to avoid late effects. The median time between protocols was 539 days (range 258–1652 days). Median survival was 927 days (95% confidence interval [CI] 423–1767 days). Median time to progression following the first and second courses was 513 days (95% CI 234–1180 days) and 282 days (95% CI 130–453 days), respectively. These were not significantly different (P=0.086). The qualitative response assessment was better for the first course compared with the second (P=0.018). Severity and timing of skin, mucous membrane, and ocular effects were similar for early side effects between the two courses (P>0.05 for all comparisons). All dogs experienced some late side effects, with two out of nine being classified as severe. These severe effects were blindness in each dog, possibly related to tumor recurrence. Reirradiation of canine nasal tumors resulted in a second clinical remission in eight of nine dogs, although the second response was less complete. Acute and late effects for seven of nine patients were not life threatening, indicating that reirradiation of canine nasal tumors may be a viable treatment option after recurrence.     

MAGNETIC RESONANCE IMAGING FEATURES OF INTRACRANIAL GRANULAR CELL TUMORS IN SIX DOGS

Magnetic resonance (MR) imaging characteristics of intracranial granular cell tumors (GCTs) have been previously reported in three dogs. The goal of this retrospective study was to examine a larger number of dogs and determine whether distinctive MR characteristics of intracranial GCTs could be identified. Six dogs with histologically confirmed intracranial GCTs and MR imaging were included. Tumor location, size, mass effect, T1‐ and T2‐weighted signal intensity, and peritumoral edema MR characteristics were recorded. In all dogs, GCTs appeared as well‐defined, extra‐axial masses with a plaque‐form, sessile distribution involving the meninges. All tumors were located along the convexity of the cerebrum, the falx cerebri, or the ventral floor of the cranial vault. All tumors were mildly hyperintense on T1‐weighted images, and iso‐ to hyperintense on T2‐weighted images. A moderate‐to‐severe degree of peritumoral edema and mass effect were evident in all dogs. Findings indicated that, while several MR imaging characteristics were consistently identified in canine cerebral GCTs, none of these characteristics were unique or distinctive for this tumor type alone.     

Gastrointestinal stromal tumors of the equine cecum

Ten cecal tumors were identified during the postmortem examination of seven horse carcasses at slaughter (one horse had three tumors). The multinodular and hemorrhagic tumors ranged from 1 to 10 cm in diameter and consisted of spindle cells arranged in thin, interconnected trabeculae that were often separated by sinuses filled with mucinous fluid, erythrocytes, and siderophages. Spindle cells of all tumors were immunopositive for vimentin, neuron-specific enolase, and c-kit protein but lacked reactivity with antibodies to glial fibrillary acidic protein, S100 protein, and desmin. In one tumor, spindle cells diffusely bound antibodies to synaptophysin. Most tumors contained focal reactivity to smooth muscle actin antibodies; one tumor reacted diffusely. Ultrastructurally, tumor cells were connected by desmosome-like structures and exhibited extended cell processes; some contained dense core neurosecretory granules. These equine stromal tumors appeared to share some characteristics with human gastrointestinal stromal tumors.     

DYNAMIC COMPUTED TOMOGRAPHY TO MEASURE TISSUE PERFUSION IN SPONTANEOUS CANINE TUMORS

Dynamic computed tomography (CT) is widely used in humans to determine tumor perfusion via time–attenuation curves. Five types of time–attenuation curves have been identified and shown to have prognostic relevance in humans. The goal of our study was to assess the feasibility of this technology in spontaneous canine tumors and to determine time–attenuation curves and perfusion patterns in different tumor types. Thirty-one dogs with tumors accessible for biopsy were evaluated (15 carcinomas, 16 sarcomas). Dynamic CT was performed at the level of the largest tumor cross-section. Time–attenuation curves were calculated and ratios from the tumor to a contralateral artery were derived for wash-in, peak attenuation, time to peak attenuation, wash-out, and perfusion. Median perfusion was significantly higher and median time to peak ratio was significantly shorter in carcinomas and bone sarcomas compared with soft tissue sarcomas ( P =0.03 and 0.01). There was a trend of lower median upslope and wash-out ratio in soft tissue sarcomas in comparison with carcinomas ( P =0.06 and 0.09). Although peak ratio was lowest in soft tissue sarcomas, differences were not significant ( P =0.3). The most common type of time–attenuation curve for all tumors had a slow to moderately rapid wash-in with a low to moderate attenuation peak followed by a plateau phase. In conclusion, dynamic CT is feasible and time-activity curve-derived measurements differed between spontaneous canine tumors. More data has to be collected in a larger number of patients and correlated with response to treatment and outcome.     

Oncologic outcome after curative-intent treatment in 39 dogs with primary chest wall tumors (1992-2005)

Objective— To describe the clinical features and determine oncologic outcome and prognostic factors for dogs with primary tumors of the osseous chest wall. Study Design— Historical cohort. Animals— Dogs (n=39) with spontaneous tumors involving the chest wall. Methods— Medical records were reviewed for dogs with rib and/or sternal tumors treated by chest wall resection and reconstruction. Signalment, preoperative clinical features, reconstruction technique, and oncologic outcome (local tumor recurrence, metastasis, and survival time) were determined from medical records and by telephone contact with owners and referring veterinarians. Oncologic outcome and prognostic factors were determined using Kaplan–Meier survival analysis and Cox proportional hazards. Logistic regression was used to determine if increased serum alkaline phosphatase (ALP) concentration was associated with tumor type. Results— Of the 39 dogs with tumors arising from the chest wall, 25 had osteosarcoma, 12 had chondrosarcoma, and 2 dogs had hemangiosarcoma. Median survival time (MST) for dogs with rib osteosarcoma was 290 days. Increased activity of total ALP significantly decreased survival in dogs with osteosarcoma (210 days versus 675 days, P=.0035). MST for dogs with rib chondrosarcoma was not reached (mean 1301 days) and survival was significantly greater than all other types of rib tumors (P=.0321). Conclusion— Rib tumors should be resected with wide margins to decrease the risk of incomplete excision, because local tumor recurrence has a significant impact on the survival time. The prognosis for dogs with rib chondrosarcoma is very good, but guarded for other types of tumors. Clinical Relevance— Osteosarcoma and chondrosarcoma are the most common primary tumors of the chest wall. Prognosis for dogs with primary rib chondrosarcoma is very good with surgery alone, but surgery and adjunctive chemotherapy is recommended for dogs with primary rib osteosarcoma and the prognosis remains guarded.     

ULTRASONOGRAPHIC FINDINGS IN DOGS AND CATS WITH GASTROINTESTINAL PERFORATION

A retrospective study was performed to evaluate the sonographic features of gastrointestinal (GI) perforation in dogs and cats. Sonographic findings in 19 animals (14 dogs and 5 cats) included regional bright mesenteric fat (19), peritoneal effusion (16), fluid-filled stomach or intestines (12), GI wall thickening (11), presence of free air (9), loss of GI wall layering (9), regional lymphadenopathy (8), reduced GI motility (7), pancreatic changes (4), corrugated intestines (4), presence of a mass (3), presence of a foreign body (3), and mineralization of the gastric wall (1). In 14 patients, "perforation" was listed as a differential diagnosis by the sonographer. Abdominal radiographs and radiographic reports were available for 14 patients. Radiographic findings were decreased serosal detail (12), free air (8), peritoneal contrast medium (1), and suspected foreign body (1). GI perforation was listed as radiographic diagnosis in eight patients, seven of which had evidence of pneumoperitoneum, and one had leakage of contrast material on an upper GI study. In 9/14 patients with radiography, "GI perforation" was listed as a sonographic diagnosis. In three patients in which free air was diagnosed sonographically, radiographs were either not available (2) or the presence of free air was not detected at presentation (1). Peritoneal fluid analysis was performed in nine patients, five of which were identified as septic inflammation, and the remaining four were classified as neutrophilic inflammation with no etiologic agent identified. The histologic or surgical diagnoses were as follows: three intestinal surgical dehiscence; one percutaneous endoscopic gastrostomy tube site leakage; one duodenal adenocarcinoma; one ileocolic lymphoma; one trichobezoar; one ascarid impaction; and one bobby pin foreign body. In the remaining 10 patients, a focal area of gastric/intestinal ulceration or transmural necrosis with perforation was identified without evidence of an underlying cause.