DIAGNOSTIC IMAGING IN CANINE PHEOCHROMOCYTOMA

The diagnosis of pheochromocytoma is challenging due to the variable presentations of patients affected with this neoplasm. This report describes four dogs with pheochromocytoma in which radiography, ultrasonography and computed tomography (CT) were key diagnostic tools. Computed tomography was the most useful imaging modality for assessment of size, shape and margination of the tumor. CT findings for the pheochromocytoma included a large, irregularly shaped mass in the dorsal midabdomen with multiple foci of low attenuation dispersed in hyperdense, highly vascular tissue. This neoplasm often invades the caudal vena cava and other surrounding organs therefore, although a pheochromocytoma may be identified in the absence of clinical signs, it should not be considered an incidental lesion. The unpredictable growth rate and potential for invasion of major vessels warrants serious consideration. Follow-up ultrasound and CT examinations are recommended for patients with adrenal masses that do not undergo surgical excision.     

Malignant granulosa-theca cell tumor in a two-year-old Miniature Horse.

A 2-year-old female Miniature Horse that presented with a history of progressive weight loss, depression, and diarrhea was diagnosed at necropsy with a highly malignant abdominal neoplasm involving the left ovary, kidneys, adrenal glands, intestines, and various abdominal and thoracic lymph nodes. Microscopic examination of these masses revealed large pleomorphic cells that stained positive for vimentin and inhibin and negative for epithelial membrane antigen and placental alkaline phosphatase. Ultrastructural examination of the cells revealed a high nucleocytoplasmic ratio and indented euchromatic nuclei with large nucleoli. Based on the gross, microscopic, immunohistochemical, and ultrastructural features, the neoplasm was identified as a malignant granulosa-theca cell tumor, a rare neoplasm in young horses.     

Spontaneous complex pheochromocytoma in a Fischer 344 rat

A spontaneous complex pheochromocytoma was diagnosed in the adrenal gland of an aged female Fischer 344 rat. This expansile neoplasm consisted of pheochromocytoma and areas of ganglioneuroma. The supporting stroma of both neoplastic components contained spindle-shaped cells, which also formed large fascicles. Immunohistochemically, pheochromocytoma cells stained for synaptophysin and chromogranin, scattered ganglioneuroma cells stained for neurofilament protein, and the spindle-shaped stromal cells were positive for S-100 protein. Special stains demonstrated Nissl substance in the ganglioneuroma cells and nerve fibers in the fascicles.     

Immunohistochemical evaluation of a malignant phecochromocytoma in a wolfdog

A malignant pheochromocytoma with multiple metastases was diagnosed in a 7-year-old male wolfdog that resulted from a cross between an eastern timber wolf (Canis lupus lycaon) and an Alaskan malamute. A yellowish white neoplastic mass approximately 10 cm diameter was found in the right adrenal gland. The neoplasm penetrated through the wall of the caudal vena cava. A diagnosis of pheochromocytoma was established by histopathologic and immunohistochemical procedures. Immunohistochemically, the neoplastic cells expressed chromogranin A, substance P, synaptophysin, Leu-7, protein gene product 9.5, methionine-enkephalin, S100 protein, and galanin. Multiple metastatic tumors were found in the kidneys, spleen, lungs, heart, and liver.     

Pheochromocytoma in dogs: 13 cases (1980-1985)

Thirteen cases of canine pheochromocytoma seen at the University of Minnesota Veterinary Teaching Hospital between 1981 and 1985 were reviewed. In 8 cases, the neoplasms were locally invasive; in the remaining cases, they were confined to the adrenal gland. Clinical signs compatible with fatal cardiovascular collapse secondary to a hypertensive or arrythmic episode were observed in 6 of 8 dogs with invasive neoplasms that died during examination or shortly thereafter. The remaining 2 dogs with invasive neoplasms had antemortem diagnoses of adrenal gland neoplasm with metastases and were euthanatized. Invasion or encroachment of the caudal vena cava in 6 dogs and encroachment of the aorta and other regional vasculature in 2 dogs were discovered at necropsy. In 5 dogs, the noninvasive pheochromocytoma was found incidentally during necropsy.     

Paresis in an Asian small clawed otter (Aonyx cinereus) associated with vertebral and ischial osteolysis caused by a malignant lymphangiosarcoma

A 10-yr-old male intact Asian small clawed otter (Aonyx cinerus) was presumptively diagnosed by histopathology and immunohistochemistry with lymphangiosarcoma after bony destruction of the ischium and spinal column from local tumor invasion had caused progressive signs of hind limb lameness and paresis/paralysis, which led to humane euthanasia. At necropsy, the primary tumor was identified as a flocculent mass present under the caudal lumbar vertebrae. Multiple nerves were seen to run from the spinal cord into the wall of the mass. This mass had locally invaded the surrounding muscle, vertebral column, and spinal cord, which led to the clinical signs noted at presentation. Bony destruction was severe with almost complete obliteration of the right ischium and osteolysis of L6, exposing the spinal cord beneath. The tumor had metastasized to at least two different sites within the spleen. The abdominal tumor was confirmed to be of endothelial origin by the use of immunohistochemical staining for factor VIII-related antigen and was confirmed as lymphatic origin versus vascular origin because of the lack of red blood cells within the vessels. The length of time from initial presentation with hind limb lameness to euthanasia because of hind limb paralysis was 4 mo. This is the first report of lymphangiosarcoma, an uncommon malignant neoplasm of lymphatic origin, in a mustelid and the first report of neoplastic disease in an Asian small clawed otter. In addition, the presentation of hind limb paresis associated with bony lysis because of local tumor invasion has not been previously reported with lymphangiosarcoma in humans, domestic animals, or nondomestic animals.     

Three neoplasms in a Eurasian otter (Lutra lutra): malignant melanoma,trichoblastoma and mammary gland adenoma

An eighteen-year-old female Eurasian otter became emaciated and died. Necropsy examination revealed nose and thoracic cutaneous masses, abdominal subcutaneous mass, and multiple nodules in the liver and lungs. Malignant melanoma was found in the nose cutaneous mass and to have metastasized to the liver, lungs, kidneys, adrenal glands, mammary glands and left mandibular lymph node. The neoplastic cells were labeled for vimentin, melanoma, and S100. The cutaneous mass in the thoracic area consisted of spindle shaped neoplastic epithelial cells and was diagnosed as trichoblastoma. Mammary gland adenoma was observed in the abdominal subcutaneous mass. This is the first report of primary three neoplasms of malignant melanoma, trichoblastoma and mammary gland adenoma in a Eurasian otter.     

Pheochromocytoma in the horse and measurement of norepinephrine levels in horses

Ten cases of pheochromocytoma in horses were obtained from the literature and a computer search of medical records. The clinical, laboratory and pathological features of pheochromocytoma in horses were reviewed. Pheochromocytoma is a catecholamine secreting tumor which tends to occur in older horses without breed or sex predisposition. It is usually unilateral adrenal medullary in location and benign. Malignancy was present in one horse. The most common clinical signs were sweating, tachycardia, tachypnea, muscle tremor and anxiety; however the tumor may be asymptomatic. Clinical signs were nonspecific and could be confused with other diseases, especially abdominal pain. Hyperglycemia is a consistent finding. Venous norepinephrine levels were measured in normal horses. Norepinephrine measurements may prove to be a diagnostic aid in horses with pheochromocytoma.     

Malignant pheochromocytoma presenting as a bradyarrhythmia in a dog

Objective: To describe a case of atrioventricular block and syncope secondary to systemic hypertension in a dog with malignant pheochromocytoma. Case Summary: A 13‐year‐old spayed female mixed‐breed dog presented following an acute onset of collapse. The dog was hypertensive and had paradoxical high‐grade second‐degree atrioventricular block with concurrent syncope. Initial emergent therapy included a nitroprusside infusion for the systemic hypertension and vagolytic therapy for the bradyarrhythmia. A left adrenal mass was seen on abdominal ultrasound and was further characterized by MRI. Following medical stabilization with phenoxybenzamine and propantheline, a left adrenalectomy was performed. Histological diagnosis was consistent with a malignant pheochromocytoma. Following tumor removal there has been no further hypertension, atrioventricular block or syncope. Unique information provided: This is the first documented case of a malignant pheochromocytoma presenting as syncope secondary to hypertension induced atrioventricular block.     

Nontraumatic rupture of an adrenal gland tumor causing intra-abdominal or retroperitoneal hemorrhage in four dogs

Diagnosis and surgical management of intra-abdominal or retroperitoneal hemorrhage in 4 dogs with rupture of an adrenal gland tumor were determined. All 4 dogs were lethargic and weak with pale mucous membranes on initial examination. Three dogs did not have any history of clinical signs of hyperadrenocorticism or pheochromocytoma prior to examination. In 3 of the dogs, a mass in the area of the adrenal gland was identified with ultrasonography prior to surgery. All dogs developed ventricular premature contractions before or during anesthesia. Three dogs survived adrenalectomy; 1 dog was euthanatized during surgery because of an inability to achieve adequate hemostasis. The remaining 3 dogs all survived more than 5 months after surgery; 1 was euthanatized 9 months after surgery because of rupture of a hepatic mass. On the basis of these results, we suggest that hemodynamic stabilization followed by adrenalectomy is the treatment of choice for dogs with nontraumatic rupture of an adrenal gland tumor and resulting life-threatening hemorrhage.     

Multiple endocrine neoplasias in a dog: Corticotrophic tumour,bilateral adrenocortical tumours,and pheochromocytoma

Summary

In a 10‐year‐old ovariohysterectomized standard Schnauzer, the finding of dexamethasone‐resistant hypersecretion of cortisol, the results of computed tomography, and elevated plasma concentrations of ACTH suggested the presence of both adrenocortical tumour and pituitary‐dependent hyperadrenocorticism. The dog made an uneventful recovery after bilateral adrenalectomy and remained in good health for 31/2 years with substitution for the induced hypoadrenocorticism. Then the enlarged pituitary caused neurological signs and eventually euthanasia was performed. The surgically excised right adrenal contained a well‐circumscribed tumour of differentiated adrenocortical tissue and in the left adrenal there were two adrenocortical tumours and a pheochromocytoma. The unaffected parts of the adrenal cortices were well developed and without regressive transformation. At necropsy there were no metastatic lesions. The cells of the pituitary tumour were immunopositive for ACTH and had characteristics of malignancy.

The present combination of corticotrophic tumour, adrenocortical tumours, and pheochromocytoma may be called ‘multiple endocrine neoplasia’ (MEN), but does not correspond to the inherited combinations of diseases known in humans as the MEN‐1 and the MEN‐2 syndromes. It is suggested that the co‐existence of hyperadrenocorticism and pheochromocytoma may be related to the vascular supply of the adrenals. Some chromaffin cells of the adrenal medulla are directly exposed to cortical venous blood, and intra‐adrenal cortisol is known to stimulate catecholamine synthesis and may promote adrenal medullary hyperplasia or neoplasia.     

Pheochromocytoma Presenting as Acute Retroperitoneal Hemorrhage in a Dog

Objective: This report describes the perioperative management of a dog with a right adrenal pheochromocytoma that presented with acute retroperitoneal hemorrhage, cardiac arrhythmia and hypertension. Additionally, a summary of pheochromocytoma and the idiosyncrasies of perioperative management of a pheochromocytoma are provided.
Summary: A 7-year old male, neutered, Dalmation was presented for acute collapse, abdominal pain and tachycardia. Physical examination findings were consistent with hypoperfusion concurrent with multiple cardiac arrhythmias and hypertension. Abdominal ultrasound revealed retroperitoneal effusion and a right adrenal mass intimately associated with the caudal vena cava. Incomplete right adrenalectomy was performed. Histopathology confirmed a pheochromocytoma.
Unique information provided: To the authors' knowledge, this is the first definitive report of acute retroperitoneal hemorrhage as the initial clinical manifestation of histologically confirmed adrenal pheochromocytoma in the dog. ( J. Vet Emerg Crit Care 2001; 11(3): 221–227 )     

Two unusual tumours in a ferret (Mustela putorius furo)

This case report describes the clinical history, diagnosis and treatment of a ferret with a tumour of the right adrenal gland and insulinomas of the pancreas. Histopathology of both lesions confirmed the diagnoses. Clinical signs of the adrenal gland tumour were a swollen vulva, overgrooming, sexual activity and pruritus. The clinical signs suggesting insulinomas were collapse of the ferret, disorientation and ptyalism. A low blood glucose level assisted the diagnosis of insulinomas. This is believed to be the first reported case of concurrent insulinomas and adrenal gland tumour in a ferret in the United Kingdom.     

Fibrosarcoma with sarcomatosis and metastasis in a FeLV-negative cat

A 6-year-old, spayed female, mixed shorthair cat presented to the emergency service at The Ohio State University Veterinary Medical Center for evaluation of hypercalcemia, a right eye mass, and multiple intrathoracic and intra-abdominal masses. Cytologic evaluation of one of the abdominal masses revealed a uniform population of large, anaplastic mesenchymal cells found individually, in loose aggregates, and occasionally associated with pink, extracellular matrix. The cytology was consistent with a malignant mesenchymal neoplasm, with primary consideration given to fibrosarcoma and hemangiosarcoma. The cat was euthanized and histopathology confirmed disseminated fibrosarcoma. Fibrosarcoma comprises 12%-41% of feline cutaneous tumors and affects cats at a mean age of 9.6 years. Three manifestations of fibrosarcoma predominate in cats: spontaneous solitary fibrosarcoma, vaccine-induced/injection site fibrosarcoma, and oncogene-induced (FSV) fibrosarcoma. The history, signalment, and results from diagnostics performed did not support solitary fibrosarcoma or injection-induced sarcoma. Although some criteria fit with virally induced fibrosarcoma, such as age and the presence of multiple fibrosarcomas, the neoplastic population was negative for FeLV IHC. The presence of fibrosarcomas throughout the pleural and peritoneal cavity was most compatible with sarcomatosis and the distant metastasis of an unidentified primary neoplasm. To the authors’ knowledge, this is the first reported case of sarcomatosis in a FeLV-negative cat.     

Feline endocrinopathies.

Feline endocrinopathies (excluding diabetes mellitus) include hyperthyroidism, hypothyroidism, acromegaly, hyposomatotropism, diabetes insipidus, hyperadrenocorticism, primary sex hormone-secreting adrenal tumors, primary hyperaldosteronism, pheochromocytoma, hypoadrenocorticism, hyperparathyroidism, and hypoparathyroidism. Each of these conditions will be discussed including their prevalence, cause, clinical signs, diagnosis, treatment options, and prognosis.     

Extramedullary plasmacytoma in a horse with ptyalism and dysphagia.

A Clydesdale mare was examined for weight loss, inappetence, ptyalism, and dysphagia. The main abnormality revealed by serum biochemistry was a marked hyperglobulinemia, and protein electrophoresis revealed a monoclonal gammopathy in the gamma region. The urine was positive for Bence Jones proteins. These findings suggested a plasma cell tumor. The neoplasm could not be located with extensive antemortem examination. At postmortem, neoplastic cells morphologically compatible with plasma cells and positive for equine IgG with imunoperoxidase staining infiltrated the pericardium, mediastinal stromal tissues, adrenal glands, meninges, atrioventricular valves, aorta, abdominal and thoracic fat, and nerves, including the trigeminal nerve. The neoplastic cells invading the cranial nerves were responsible for many of the presenting signs.     

Olfactory neuroblastoma in a cat

CASE SUMMARY: A 12.5-year-old castrated male domestic shorthair cat was presented for evaluation of dyspnea. Physical examination suggested upper airway disease. Computed tomography revealed the presence of a nasopharyngeal mass. Biopsies obtained via rhinoscopy led to a diagnosis of olfactory neuroblastoma. CLINICAL CHALLENGES: Olfactory neuroblastoma (or esthesioneuroblastoma) is a rare malignant neoplasm that arises from olfactory neuroepithelium. It was first described in human medicine in 1924. Clinical signs are variable, and diagnosis may prove challenging as this tumor, which is a differential for spontaneous intranasal tumors in cats, may be mistaken for poorly differentiated carcinomas or round cell tumors. Given its rarity, treatment options for this neoplasm have not been thoroughly evaluated and there is no standard treatment protocol. LITERATURE REVIEW: A review of veterinary and human literature is provided, encompassing clinical signs, staging and grading systems, treatment options and prognostic factors.     

Palliative intravenous cisplatin treatment for concurrent peritoneal and pleural mesothelioma in a dog

A 10-year-old Maltese dog was presented with abdominal distention and dyspnea. Cytological examination of pleural and peritoneal effusion was suggestive of malignant effusion of glandular origin. Numerous, multifocal, tan to white nodules were disseminated throughout the surface of the abdominal organs and peritoneum at biopsy. Histologically, the tumors were revealed to be an epithelial type of mesothelioma. Neoplastic cells co-expressed cytokeratin and vimentin. Intravenous administration of cisplatin was chosen as the treatment. During treatment, the dog's overall body condition improved and the clinical signs were relieved without significant side effects. The survival time from diagnosis to sudden death by unknown cause was 153 days.     

Simultaneous occurrence of multiple neoplasms and hyperplasias in the adrenal and thyroid gland of the horse resembling multiple endocrine neoplasia syndrome: case report and retrospective identification of additional cases

Neoplastic and hyperplastic disorders that affect multiple endocrine tissues in a single individual are well described in humans but less so in domestic animals. Multiple endocrine neoplasia (MEN) in humans is a genetically determined syndrome characterized by the appearance of benign or malignant proliferations within two or more endocrine glands. The primary endocrine tumors that are characteristic of MEN arise from cells that share the capacity for amine precursor uptake and decarboxylation. Here we describe the case of a 22-year-old Thoroughbred mare that died during an unattended parturition and subsequently was presented for necropsy at the University of California, Davis, Veterinary Medical Teaching Hospital. A C-cell (medullary) thyroid adenoma, pheochromocytoma, and multicentric bilateral nodular hyperplasia of the adrenal medulla were present, findings that are remarkably similar to those of human MEN syndrome. Mortality during pregnancy in women with undiagnosed pheochromocytoma is high (approximately 50%), typically because of hypertension and/or hemorrhage associated with catecholamine release from the tumor. Similarly, the mare in this report died of hemorrhage subsequent to parturition. A retrospective evaluation of endocrine tumors in horses that underwent necropsy at the Veterinary Medical Teaching Hospital from 1987 to 1997 was undertaken to identify additional possible cases of MEN in horses. Data from this retrospective evaluation suggest that coexistence of hyperplasias and neoplasias of the thyroid and adrenal glands, similar to MEN syndrome of humans, also occurs with some frequency in the horse.