Clinicopathological,ultrasonographic, and histopathological findings of superficial necrolytic dermatitis with hepatopathy in a cat

This report describes the antemortem diagnosis and antemortem and postmortem findings of superficial necrolytic dermatitis with hepatopathy (i.e., hepatocutaneous syndrome) in a cat. A 5-year-old Maine coon was evaluated because of a history of pruritic alopecia and liver enzyme elevations. Abdominal ultrasonography revealed a reticular pattern to the hepatic parenchyma. Histopathological findings of the liver were nodular regeneration with bands of vacuolated hepatocytes and bile duct hyperplasia, characteristic of the hepatopathy frequently associated with superficial necrolytic dermatitis. Skin histopathology revealed multifocal parakeratosis, midepidermal spongiosis, and basal cell hyperplasia consistent with superficial necrolytic dermatitis.     

Superficial necrolytic dermatitis in 11 dogs with a history of phenobarbital administration (1995-2002)

The clinical records of 11 dogs with histologically confirmed superficial necrolytic dermatitis (SND) and a history of phenobarbital (PB) administration (SND/PB) were evaluated retrospectively (1995-2002). Historical, clinical, clinicopathologic, ultrasonographic, and pathologic findings were compared with those in dogs with SND without prior PB exposure (SND/No PB; n = 9) and with those dogs with PB-associated hepatotoxicity without skin disease (PB/hepatotoxicity). Dogs in the SND/PB group accounted for 44% of all histologically confirmed cases of SND that were evaluated at The Ohio State University Veterinary Teaching Hospital between 1995 and 2002. Median age of dogs in the SND/PB group was 10 years, and median duration of PB therapy was 6 years. Mean alanine aminotransferase (ALT) activity was 239 U/L, and median duration of abnormally high ALT activity was 6.25 months before SND diagnosis. Plasma amino acid concentrations measured in 1 dog were severely decreased. Ultrasonographic findings of hypoechoic nodules with hyperechoic borders corresponded to pathologic findings of nodular areas of normal hepatic tissue surrounded by zones of collapsed parenchyma with vacuolated hepatocytes. Clinical, clinicopathologic, ultrasonographic, and pathologic features of SND/PB and SND/No PB were similar. PB-associated cirrhosis and overt hepatic failure were not features of SND/PB. Different pathogenic mechanisms might induce SND in dogs. Chronic administration of PB requires further examination as a potential risk factor for the development of SND.     

Hepatic Ultrasonography and Pathological Findings in Dogs With Hepatocutaneous Syndrome: New Concepts

In dogs, hepatocutaneous syndrome (superficial neurolytic dermatitis) belongs to a group of syndromes in which cutaneous signs signal the presence of systemic disease. It is characterized by parakeratosis, superficial necrolysis, and basilar hyperplasia of the epidermis, in association with an unusual hepatopathy accompanied by certain metabolic derangements. Hepatocutaneous syndrome was diagnosed in 3 dogs on the basis of typical dermatologic changes and clinicopathologic findings. Hepatic ultrasonography revealed a hyperechoic network surrounding hypoechoic areas of parenchyma, resulting in a Swiss cheese-like appearance. The ultrasonographic image corresponded to the pathological findings. The liver had a nodular appearance, both grossly and microscopically; this was attributed to collapse of the areas of parenchyma surrounding the nodules, rather than to the cirrhosis and/or nodular hyperplasia reported previously.     

Glucagon-producing neuroendocrine tumour associated with hypoaminoacidaemia and skin lesions

A nine-year-old neutered female crossbred Bernese mountain dog was diagnosed with superficial necrolytic dermatitis and a glucagon-producing islet cell tumour. Laboratory findings included hyperglucagonaemia and hypoaminoacidaemia. The dog was euthanased because of progression of the disease, and necropsy revealed liver metastases of a neuroendocrine carcinoma with immunohistochemical expression of glucagon and somatostatin. This report represents a case of canine glucagonoma syndrome; the previously reported cases in dogs are also briefly described.     

ULTRASONOGRAPHIC FEATURES OF CANINE ABDOMINAL MALIGNANT HISTIOCYTOSIS

Ultrasonographic features of canine abdominal malignant histiocytosis (MH) of 16 dogs are reported. The most common finding was the presence of hypoechoic nodules in the spleen, some of which caused distortion of the splenic margin. The liver was the second-most commonly affected organ. Hepatic ultrasonographic features were highly variable, including hypoechoic, hyperechoic, or mixed echogenic lesions. Other common ultrasonographic abnormalities included hypoechoic nodules in the kidneys and mesenteric and medial iliac lymphadenopathy. The results of this study suggest that the ultrasonographic appearance of canine abdominal MH is nonspecific, and definitive diagnosis requires cytologic or histologic examination.     

Newly reported skin disease syndromes in the dog

Several recently recognized canine dermatoses are described. Syndromes discussed include superficial necrolytic dermatitis, Malasezzia dermatitis, sebaceous adenitis, nodular dermatofibrosis in German shepherd dogs, solar-induced dermatitis, and acrodermatitis.     

Correlation of ultrasonographic and patho-morphological findings in canine hepatic diseases

Findings of hepatic ultrasonography were analysed in 22 dogs with liver disease and compared with the results of final morphological diagnoses. Ultrasonographic appearance of the liver demonstrated focal alterations in 11 dogs (50 per cent): multifocal lesions in hepatic neoplasia (six), hepatic cirrhosis (one), generalised mycosis (one) and unifocal lesions in haemangiosarcoma (one), nodular hyperplasia (one) and misdiagnosed intestinal invagination (one), Diffuse ultrasonographic alterations were found in 11 dogs (50 per cent): hyperechoic liver of normal/enlarged size in lymphosarcoma (four) and hepatic lipidosis (two); hyperechoic ‘bright’ but small liver in atrophic cirrhosis (two); hypoechoic to normal intensity liver of normal size in liver dystrophy (two) and hepatic venous distension (one). Gallbladder abnormalities were detected in 14 of 20 dogs (70 per cent). Correct ultrasonographic diagnoses were made in 11 dogs (50 per cent). The best results were achieved by combining the clinicolaboratory and ultrasonographic findings, providing a correct diagnosis in 17 dogs (77-3 per cent).     

Resolution of skin lesions and long-term survival in a dog with superficial necrolytic dermatitis and liver cirrhosis

A nine-year-old, neutered female Shetland sheepdog was presented with crusted, ulcerative skin lesions affecting the footpads, commissures of the lips and the lateral canthi of the eyes. Histopathological examination of skin biopsies revealed changes consistent with superficial necrolytic dermatitis and biochemical analysis demonstrated elevated liver enzymes. Abdominal radiography revealed a small liver which, on ultrasonography, appeared diffusely mottled and showed changes suggestive of periportal fibrosis. On exploratory laparotomy, the pancreas appeared normal, but the liver was small and had multiple nodules throughout the parenchyma. This appearance was confirmed as cirrhosis on histopathological examination. The dog was placed on a hepatic support diet and treated with colchicine, essential fatty acid supplementation and raw egg yolks. After four weeks, the skin lesions had resolved and the dog remained free of clinical signs over a 22-month follow-up period.     

ULTRASONIC PATTERNS OF CANINE HEPATIC LYMPHOSARCOMA

Three ultrasonic patterns of canine hepatic lymphosarcoma were found. The first pattern reflected a normal hepatic parenchymal appearance or a slight reduction in echogenicity. The second pattern consisted of anechoic or hypoechoic, poorly marginated lesions. A third pattern was characterized by multiple, round echodensities surrounded by areas of sonolucency. It was concluded that ultrasound is helpful for diagnosis and staging of canine lymphosarcoma with liver involvement and is useful for monitoring the response to chemotherapy.     

Superficial necrolytic dermatitis and a pancreatic endocrine tumour in a dog

A 13-year-old dog was referred for a severe dermatological problem of 12 months duration. Skin biopsy results were compatible with superficial necrolytic dermatitis. The only laboratory abnormalities were hyperglycaemia and hyperglucagonaemia. These findings suggested a pancreatic endocrine tumour in association with superficial necrolytic dermatitis. Abdominal ultrasound examination was unremarkable. The dog was euthanased due to the lack of clinical improvement following symptomatic therapy. Postmortem examination revealed a pancreatic endocrine tumour with liver metastases. Pancreatic endocrine tumour cells were immunoreactive for glucagon, insulin and islet amyloid polypeptide.     

Ultrasonographic features of splenic lymphosarcoma in dogs: 12 cases (1980-1986)

The ultrasonographic appearance of the spleen and adjacent organs in 12 dogs with splenic lymphosarcoma was reviewed. Poorly marginated hypoechoic to anechoic nodules (4 mm to 3 cm in diameter) were found in all dogs. The anechoic nodules did not result in reflective shadowing or acoustic enhancement of the underlying tissues. The remainder of the splenic parenchyma appeared relatively hypoechoic when compared with the liver or renal cortices in 9 dogs. Recognition of this ultrasonographic pattern appears to be a useful diagnostic tool. Needle aspiration guided ultrasonographically will then enable histologic confirmation of lymphosarcoma.     

Hep atop athy and dermatitis in a dog associated with the ingestion of mycotoxins

A five-year-old German shepherd dog was presented with a severe scrotal dermatitis of four weeks duration which had failed to respond to antibiotic and corticosteroid therapy. Dermato-histopathology indicated that the lesion was a necrolytic process suggestive of the hepatocuta-neous syndrome. Clinical biochemistry investigations indicated the presence of acute hepatocellular damage and cholestasis. The animal was fed a biscuit meal which was damp and mouldy. Penicillium vindication was grown from this feedstuff and three mycotoxins, citrinin, ochratoxin A and sterigmatocystin, were found; substances which have been associated with renal and hepatic lesions in dogs and laboratory animals. Symptomatic therapy and nutritional management, led to rapid clinical improvement. Subsequent plasma biochemistry confirmed that hepatic enzyme activities were returning to normal levels.     

SONOGRAPHIC FEATURES OF HISTIOCYTIC NEOPLASMS IN THE CANINE ABDOMEN

The purpose of this retrospective study was to describe the ultrasonographic features of malignant histiocytosis (MH), malignant fibrous histiocytoma, and histiocytic sarcoma in abdominal organs of dogs. The medical records of 18 dogs that had undergone abdominal sonography and had a histopathologic diagnosis of abdominal MH, malignant fibrous histiocytoma, and histiocytic sarcoma were reviewed. The organ most commonly affected was the spleen. MH was the most common followed by histiocytic sarcoma and malignant fibrous histiocytoma. In the spleen there were often multiple hypoechoic nodules with well-defined borders. In one dog, without focal lesions, the spleen was enlarged and hypoechoic. The liver was the second most commonly affected organ. MH was most common followed by histiocytic sarcomas and malignant fibrous histiocytoma. The most common sonographic feature in the liver was the presence of multiple hypoechoic nodules with well-defined borders. One dog without hepatic nodules had a liver that was ultrasonographically enlarged and hypoechoic. MH in the abdominal lymph nodes resulted in hypoechoic lymphadenopathy. Malignant fibrous histiocytoma was the only neoplastic type in the kidneys appearing as a single heteroechoic renal mass with well-defined borders. MH was observed in the stomach of one dog. Sonographically there was a single well circumscribed hypoechoic mass with well-defined borders and abnormal stomach layers. In this study it was not possible to differentiate between MH, malignant fibrous histiocytoma, and histiocytic sarcoma using sonography.     

Canine prostatic disease--comparison of ultrasonographic appearance with morphologic and microbiologic findings: 30 cases (1981-1985)

A retrospective analysis was made of 30 cases of canine prostatic disease, with the objective of identifying (via a prepubic approach) the 2-dimensional, gray-scale ultrasonographic appearance most often associated with the various spontaneous prostatic diseases. Ultrasonography was of value in characterizing the parenchymal architecture as normal vs focally hyperechoic and diffusely hyperechoic (associated with chronic inflammation and neoplasia) or focally hypoechoic or anechoic (either accompanied by distant enhancement), which was associated with retention cyst or abscess. Further specificity based only on abnormal echotexture was not possible. Ultrasonography facilitated the differentiation of radiographically identifiable prostatomegaly attributable to abscess or neoplasia from apparent prostatomegaly attributable to paraprostatic cyst. An imaging protocol consisting of distention retrograde urethrocystography and prepubic ultrasonography was recommended, as a distended bladder aided ultrasonographic identification of the prostate gland. In addition, the combination of urethral morphologic features and urethroprostatic reflux appearance complemented the ultrasonographic appearance for differentiation of prostatic abscess from prostatic carcinoma. A classification scheme for spontaneous canine prostatic disease combining germane imaging morphologic features with microscopic and microbiologic findings was proposed.     

Ultrasonographic characteristics of splenic and hepatic lymphosarcoma in three horses.

Splenic and hepatic ultrasonography were beneficial for diagnosis of lymphosarcoma in 3 horses with anorexia, weight loss, and lethargy. Ultrasonographic abnormalities of the spleen included a large, complex, hypoechoic mass in 1 horse, multiple well-marginated, hypoechoic nodules in 1 horse, and diffuse hyperechogenicity in another horse. Ultrasonographic abnormalities of the liver included a spherical, hypoechoic nodule in 1 horse and diffuse hyperechogenicity in another. Histologic examination of ultrasound-guided biopsy specimens or aspirates revealed lymphosarcoma. Necropsy findings confirmed diagnosis of lymphosarcoma in all horses. Necropsy findings of the liver and spleen correlated well with antemortem ultrasonographic images.     

Superficial necrolytic dermatitis associated with extrapancreatic glucagonoma in a dog

An 11-year-old Shih Tzu presented with crusting and erythema, mainly on the abdomen and the root of the tail. Based on histopathological findings, blood examinations and necropsy findings, the condition was diagnosed as superficial necrolytic dermatitis associated with a glucagon-secreting extrapancreatic neuroendocrine tumour. Gross necropsy revealed tumour invasion into the spleen, liver, adrenal glands and mesenteric lymph nodes. Immunohistochemical analysis of the neoplastic cells revealed that the tumour was a glucagonoma, consistent with earlier findings of persistent glucagonaemia and hypoaminoacidaemia.     

Successful treatment of canine necrolytic migratory erythema (superficial necrolytic dermatitis) due to metastatic glucagonoma with octreotide

Necrolytic migratory erythema (NME; also known as superficial necrolytic dermatitis) is a syndrome most often associated with certain chronic liver diseases or pancreatic glucagonomas. In humans with glucaconoma‐associated NME, skin lesions usually respond to octreotide, a somatostatin analogue that inhibits glucagon release. In this report an 11‐year‐old golden retriever dog with pancreatic glucononoma and metastasis to the regional lymph nodes, spleen and liver was diagnosed with NME. The dog exhibited erosions, ulcers and crusts on the paws, pressure points, muzzle, periocular area and prepuce. The dog was also anorexic and had difficulty walking. Because metastasis precluded surgery, treatment was initiated with subcutaneous octreotide (2 μg/kg twice daily). Skin lesions and systemic clinical signs improved markedly within 5 days. The dosage was increased to nearly 3 μg/kg twice daily and signs almost completely resolved within 10 days. Anorexia was the major adverse effect observed. During the following month, both dosage (1–3.7 μg/kg) and frequency (two to four times daily) of the octreotide injections were adjusted to permit control of clinical signs while maintaining adequate appetite. Temporary cessation of octreotide administration resulted in the rapid recurrence of skin lesions. Resuming injections led to improvement of clinical signs within 48 h. The dog was later euthanized because of progressive metastatic disease. In conclusion, subcutaneous octreotide injections were beneficial in this dog with glucagonoma‐associated NME. This somatostatin analogue could be a valuable option to treat canine patients with non‐resectable or relapsing pancreatic glucagonoma‐associated NME.     

B-MODE AND DOPPLER ULTRASOUND IMAGING OF THE SPLEEN WITH CANINE SPLENIC TORSION: A RETROSPECTIVE EVALUATION

The ultrasonographic appearance of splenic torsion has been described; the splenic parenchyma can be normal, hypoechoic or anechoic with interspersed linear echoes (coarse/"lacy" appearance). The ultrasonographic parenchymal appearance of 15 dogs in this report with splenic torsion varied: mottled hypoechoic regions (n=2), diffusely hypoechoic (n=11) and normal (n=2). Because splenic torsion causes vascular congestion due to splenic vein compression and eventual thrombosis, visible splenic vein intraluminal echogenicities compatible with thrombi were seen in 13 dogs using B-mode. Using spectral Doppler and color Doppler imaging of the splenic veins, no measurable flow velocities were detected in any of the 15 dogs. The varied B-mode ultrasonographic appearance of the splenic veins for intraluminal echoes and spectral or color Doppler evaluation for absent velocity flow.     

Statistical relevance of ultrasonographic criteria in the assessment of diffuse liver disease in dogs and cats

OBJECTIVE: To determine whether objectively applied ultrasonographic interpretive criteria are statistically useful in differentiating among 7 defined categories of diffuse liver disease in dogs and cats. SAMPLE POPULATION: Ultrasonographic images of 229 dogs and 104 cats. PROCEDURES: Liver parenchymal or related sonographic criteria established by the authors were retrospectively and independently applied by 3 radiologists who were not aware of patient status or patient laboratory data. Seven histologic or cytologic categories of diffuse (infiltrative but not nodular) liver diseases were jointly established by the authors and included normal liver; inflammation; round-cell neoplasia; non-round-cell infiltrative, prenodular (early) metastatic neoplasia; lipidosis; vacuolar hepatopathy; and other. Liver parenchymal sonographic criteria included parenchymal sound attenuation with increasing depth, comparative organ echogenicity (liver, spleen, and kidneys), diffuse or patchy hyperechoic or hypoechoic echotexture, uniform or coarse echotexture, portal venous clarity, and liver lobe geometry. Related extrahepatic criteria included gallbladder wall thickness, bile duct diameter, amount and character of gallbladder precipitate, nondependent shadowing in the gallbladder, hepatic vein diameter versus caudal vena cava diameter, peritoneal fluid, spleen echotexture (normal vs abnormal [characterized]), and kidney echotexture. Ultrasonographic criteria were statistically compared to the 7 categories of diffuse liver disease in search of clinically exploitable relationships. RESULTS: Statistical evaluation of the applied ultrasonographic criteria did not yield clinically acceptable accuracy for discrimination among the 7 categories of diffuse liver diseases (including normal liver) in either species. CONCLUSIONS AND CLINICAL RELEVANCE: Criterion-based ultrasonographic appearance was insufficient to discriminate among canine and feline diffuse infiltrative liver diseases.