FAT NECROSIS SIMULATING RECURRENT NEOPLASIA FOLLOWING EXTERNAL BEAM RADIOTHERAPY IN A DOG

A 4.5-year-old neutered male dog was diagnosed with incompletely excised well-differentiated lymphangiosarcoma in the right inguinal subcutaneous region. The mass had metastasized to the right hypogastric and medial iliac lymph nodes. Surgery followed by definitive radiation therapy was administered to the primary site and the sites of metastasis. The dog had a complete response to radiotherapy, and minimal acute side effects. Doxorubicin was administered after radiotherapy. Approximately 4 months following radiation therapy, the dog developed a mass, presumed recurrent tumor, in the original site. In a biopsy only steatitis and fibrosis were found. The mass continued to grow and conservative surgical excision was elected. Histopathologically the diagnosis was fat necrosis and steatitis, with a microscopic focus of lymphangiosarcoma. Fat necrosis is an uncommon sequelum to breast irradiation in people and also appears to be rare in animals. Fat necrosis should be considered as a differential diagnosis when recurrent tumor is suspected in a previously irradiated subcutaneous site in a dog.     

Multifocal necrotising steatites associated with pancreatic carcinoma in three dogs

Multiple subcutaneous swellings and discharging sinuses were a result of steatitis in three dogs. The steatitis in each case was thought to be associated with a pancreatic carcinoma. The association with pancreatic neoplasia had been suspected in life in only one dog but was confirmed at necropsy in each case. Circulating levels of pancreatic enzymes were increased in the one dog in which they were measured.     

Feline cutaneous and visceral necrotizing panniculitis and steatitis associated with a pancreatic tumour

The association of pancreatic disorders with fat necrosis in domestic animals is rare. This report concerns a case of cutaneous/subcutaneous necrotizing panniculitis and steatitis associated with a pancreatic adenocarcinoma in an 11-year-old male Siamese cat. Clinical investigation revealed variably sized nodules on the trunk, limbs and abdomen. Some of them were ulcerated; others showed a shiny yellow necrotic background featuring irregular sinus tracts. The cat was euthanized at the owner's request before a diagnosis could be made. At necropsy, abundant oily material resembling mustard replaced the subcutaneous tissue and small yellow nodules were disseminated in the omentum, mesentery and serosa of the abdomen. A multilobulated mass arising from the anterior pancreatic head was found along with liver and lymph node metastasis. Histopathology showed wide fistulous tracts draining necrotic fat from the subcutis toward the surface and multifocal areas of necrotic adipocytes replacing the panniculus. Duct-like structures and tubules lined by neoplastic epithelial cells were observed in the primary pancreatic tumour and in the metastatic sites. The aetiology of the fat necrosis was possibly the result of systemic release of lipolytic pancreatic enzymes.     

Ectopic hepatocellular carcinoma in a dog

CASE HISTORY: A 14-year-old neutered male Bearded Collie was presented with a history of recurrent, intermittent urinary incontinence of 7 years duration. CLINICAL FINDINGS: A large, firm, non-painful mass was found in the mid-abdominal region on palpation. Ultrasonography of the mass revealed a compartmentalised structure with mixed echogenicity, and which did not appear to be associated with any of the abdominal organs. Ultrasound-guided fine needle aspirates contained several clusters of epithelial cells with cytological features of hepatocytes. At exploratory laparotomy, the mass was found in the gastrosplenic ligament within the greater omentum. PATHOLOGICAL FINDINGS AND DIAGNOSIS: Histopathologically, the mass consisted of sheets of hepatocytes, but without the characteristic hepatic architecture. The cells showed moderate variation in nuclear size and were sometimes binucleate. A diagnosis of hepatocellular carcinoma (HCC) in the mesentery was made. CLINICAL RELEVANCE: The presence of ectopic hepatic tissue has been reported rarely in man and cats, but not in the dog. Neoplastic transformation of ectopic hepatic tissue is seen in man. This is the first report of the presentation, clinical findings and treatment of a dog with ectopic HCC.     

Mesenteric strangulation by pedunculated lipomas without involvement of associated intestine in four horses

An unusual form of strangulation of mesentery only by pedunculated lipoma was identified as the cause of moderate to severe colic in four horses. The small intestinal mesentery was involved in three horses and the small colon mesentery in the fourth horse, but the associated intestine was not strangulated, haemorrhagic, nor obviously obstructed in any horse. In all horses, a patch of haemorrhagic mesentery of variable size was evident around the origin of a mesenteric lipoma and a major mesenteric vessel. One horse was subjected to euthanasia at the owner's request and the remaining three had surgery from which they made a complete recovery after the removal of the lipoma. Intestinal resection was not performed in any of the three horses undergoing surgery. An isolated mesenteric strangulation by lipoma is an uncommon cause of colic in older horses that have the typical presentation of a strangulating lipoma. The removal of the involved lipoma without mesenteric or intestinal resection can be associated with complete recovery.     

Mesenteric rents as a source of small intestinal strangulation in horses: 15 cases (1990-1997)

OBJECTIVE: To describe the clinical findings in horses with small intestinal strangulation through mesenteric rents, and to determine the recurrence and survival rates after surgery. DESIGN: Retrospective study. ANIMALS: 15 horses with small intestinal obstruction via a mesenteric rent. PROCEDURE: Medical records of horses with obstruction of the small intestine via a mesenteric rent between January 1990 and December 1997 were reviewed. The signalment, history, initial physical examination findings, results of abdominocentesis, and clinical laboratory values were recorded. Surgical findings, including location of the mesenteric rent and surgical procedure performed, were recorded. Short- and long-term survival rates were calculated. RESULTS: Most mesenteric rents were located in the mesentery of the small intestine (13 horses). Two horses had multiple mesenteric defects. Seven horses were euthanatized at surgery because of an inability to reduce the entrapped intestine (3 horses), uncontrollable hemorrhage (2), inability to close the rent (1), and the amount of compromised intestine involved (1). Seven horses required intestinal resection and anastomosis. The median length of intestine resected was 2.6 m (range, 0.6 to 4.5 m). The mesenteric rents created during resection were not closed in 2 horses. One of these 2 horses subsequently developed a strangulating obstruction through the open rent. Seven of 15 horses in our study were discharged from the hospital (i.e., short-term survival rate of 47% [7/15]). Long-term follow-up information was available for 5 of the 7 horses (follow-up duration of 5 months to 9 years), of which 2 died as a result of colic, and 1 horse was euthanatized because of severe arthritis (i.e., long-term survival rate of 40% [2/5]). CONCLUSIONS AND CLINICAL RELEVANCE: Inability to reduce the intestinal obstruction, severe hemorrhage from the mesentery, and the length of intestine involved are the main factors that decrease survival rates in horses with small intestinal strangulation caused by mesenteric rents.     

Ectopic hepatocellular carcinoma in a dog

CASE HISTORY: A 14-year-old neutered male Bearded Collie was presented with a history of recurrent, intermittent urinary incontinence of 7 years duration.

CLINICAL FINDINGS: A large, firm, non-painful mass was found in the mid-abdominal region on palpation. Ultrasonography of the mass revealed a compartmentalised structure with mixed echogenicity, and which did not appear to be associated with any of the abdominal organs. Ultrasound-guided fine needle aspirates contained several clusters of epithelial cells with cytological features of hepatocytes. At exploratory laparotomy, the mass was found in the gastrosplenic ligament within the greater omentum.

PATHOLOGICAL FINDINGS AND DIAGNOSIS: Histopathologically, the mass consisted of sheets of hepatocytes, but without the characteristic hepatic architecture. The cells showed moderate variation in nuclear size and were sometimes binucle- ate. A diagnosis of hepatocellular carcinoma (HCC) in the mesentery was made.

CLINICAL RELEVANCE: The presence of ectopic hepatic tissue has been reported rarely in man and cats, but not in the dog. Neoplastic transformation of ectopic hepatic tissue is seen in man. This is the first report of the presentation, clinical findings and treatment of a dog with ectopic HCC.     

A Retrospective Study of Inguinal Hernia in 35 Dogs

Inguinal hernia was associated with trauma in five dogs and was considered nontraumatic in 30 dogs. There were 11 males, 13 intact females, and six spayed females with nontraumatic inguinal hernia. Six dogs had bilateral hernias. Five dogs were younger than 4 months at the time of diagnosis. In 11 older dogs with nontraumatic inguinal hernia, the hernias were identified less than 7 days before surgical repair; in 14 older dogs, the hernias had been recognized for 1 to 60 months. Clinical signs in dogs without small intestinal incarceration were usually limited to a visible or palpable mass without pain or systemic illness. Hemiorrhaphy approaches included inguinal, midline with contralateral ring evaluation, and celiotomy with or without inguinal exposure. Fat and omentum were the most common hernial contents. Small intestine was within the hernias of 12 dogs. Six dogs had nonviable small intestine. Postoperative complications included two incisional infections, one incisional dehiscence, two cases of peritonitis and sepsis associated with bowel leakage after intestinal resection and anastomosis, and one hernia recurrence. The overall prevalence of postoperative complications was 17%, and the mortality rate was 3%. Vomiting for 2 to 6 days was predictive of nonviable small intestine. Dogs younger than 2 years were at 11 times greater risk for nonviable small intestine than dogs older than 2 years. Four of five dogs with nontraumatic inguinal hernia and nonviable small intestine were intact males, whereas none of 13 intact females were affected. Only one of 14 dogs with longstanding hernias had nonviable small intestine.     

Equine histoplasmosis presenting as a tumor in the abdominal cavity.

A 3.5-year-old Thoroughbred mare presented at necropsy with a large mass at the root of the mesentery and multiple smaller mesenteric masses. The mucosa of the small intestine contained numerous raised nodules. Histologic examination revealed severe granulomatous mesenteric lymphadenitis and enteritis. Epithelioid macrophages and multinucleated giant cells frequently contained numerous intracytoplasmic yeast organisms, which were strongly positive on immunohistochemical staining when using a polyclonal antibody against Histoplasma spp. A diagnosis of abdominal histoplasmosis was made based on the gross, microscopic, and immunohistochemical findings.     

Hepatocellular toxicosis associated with the alternate administration of carprofen and meloxicam in a siberian husky

A 4-year-old female Siberian Husky was diagnosed with pyogranulomatous steatitis at the site of a recurrence of left anal sac rupture (day 1). Carprofen and orbifloxacin were given for 13 days without improvement. A single dose of meloxicam was administered prior to surgical resection of the anal sac, and based on elevated liver enzyme activity, liver supportive therapy was initiated. The dog received carprofen and orbifloxacin orally on the evening of day 14. The dog became anorectic the following morning, and began vomiting. Despite supportive therapy, the dog was unresponsive to treatment and died on day 16. Postmortem examination revealed severe vacuolar change and acute necrosis of hepatocytes consistent with carprofen and meloxicam induced-toxicosis.     

Intestinal fibrosis with partial obstruction in five horses and two ponies.

Fibrosis of the small intestine led to recurrent colic and weight loss in 2 ponies and 5 horses. There was a reduction in the length of the small intestine to one-half normal in horses 4 to 7. Histologic examination revealed substantial small intestinal submucosal fibrosis and arteriole sclerosis. The cause was not determined, but an environmental factor was suspected because 3 horses were from the same farm and the other animals were from within a 10-mile radius of the farm. The submucosal fibrosis appeared to be secondary to sclerosis of arterioles in the submucosa and mesentery, with low blood flow state or altered vessel permeability.     

Diagnostic peritoneal lavage for identification of blastomycosis in a dog with peritoneal involvement

A 6-year-old castrated male Dalmatian was evaluated because of hematemesis. The dog had lived its entire life in South Dakota and Wyoming and had never traveled outside of these states. Results of laboratory testing were compatible with iatrogenic acute renal failure and gastrointestinal tract ulceration secondary to previous nonsteroidal anti-inflammatory drug and corticosteroid administration. Differential diagnoses for clinical signs and laboratory abnormalities that existed prior to these treatments included multisystemic infectious or inflammatory disease and neoplasia. Four-quadrant abdominocentesis did not yield any fluid, but because intra-abdominal disease was still suspected, diagnostic peritoneal lavage was performed. Fluid that was obtained was markedly cellular, and there were numerous extracellular structures with a round to oval shape; a 1-microm-thick, clear-staining capsule; a basophilic interior; and broad-based budding. Organisms were consistent with Blastomyces spp, and fungal culture yielded Blastomyces dermatitidis. Treatment with liposomal amphotericin B and itraconazole was recommended but could not be initiated because of the client's financial constraints. At necropsy, disseminated blastomycosis involving the stomach, small intestines, urinary bladder, omentum, mesentery of the small intestine, and abdominal wall musculature was seen. To our knowledge, peritoneal involvement has not been reported in dogs with blastomycosis, and gastrointestinal tract involvement has only rarely been reported. Findings in this dog suggest that diagnostic peritoneal lavage may be a useful technique in determining the cause of infectious peritonitis when the amount of abdominal fluid is below the limit of detection for abdominocentesis.     

Chronic diarrhea associated with intestinal anomalies in a six-year-old dog.

A 6-year-old mixed-breed dog was referred because of chronic diarrhea, which had begun after antibiotic treatment for pulmonary disease. Intestinal bacterial overgrowth was presumptively diagnosed on the basis of intestinal mucosal cytologic examination and low serum cobalamin concentration. When the diarrhea did not respond to treatment, contrast radiography was performed and a short small intestine was found. The diarrhea could not be managed by medical treatment, and the dog was euthanatized. Necropsy revealed 2 blind intestinal pouches attached to a 46-cm length of small intestine connecting the stomach and colon. The dog's deteriorating condition was attributable to necrosis and rupture of 1 of the pouches.     

Acute renal failure following Bull ant mass envenomation in two dogs

Acute renal failure was diagnosed in a German Short Haired Pointer bitch and a Kelpie cross-bred dog following envenomation by Bull ants. Both dogs had been tethered over a Bull ant nest and had experienced mass envenomation. There was local reaction at the envenomation sites and each dog had experienced vomiting that was poorly controlled by symptomatic therapy. Intensive treatment of renal failure was successful in the German Short Haired Pointer and the bitch remains well 19 months after envenomation. The Kelpie cross-bred deteriorated despite intensive treatment and was euthanased 36 hours after presentation. Necropsy examination revealed haemorrhage and necrosis of the small intestine and myocardium, bilateral nephrosis with tubular necrosis, and patchy haemorrhage of the lung alveoli, pancreas and adrenal cortices. Electron microscopy revealed necrosis of the small intestine and hydropic swelling of proximal renal tubules with necrosis of medullary tubules.     

COMPARATIVE ORGAN IMAGING: THE GASTROINTESTINAL TRACT

Diagnostic radiology of the esophagus, stomach, small and large intestine, mesentery, and pancreas is reviewed. Survey and contrast radiography remain the principal imaging methods used to evaluate gastrointestinal diseases in animals. Of the other imaging techniques, scintigraphy has potential in assessment of esophageal and gastric motility disorders, and detection of intestinal hemorrhage. Ultrasonography is useful for imaging the pancreas and gastrointestinal mass lesions.     

Caecal impaction and chronic intestinal pseudo-obstruction in a dog

A 10-year-old female neutered cross-breed dog presented with a 4-month history of chronic intermittent diarrhoea and vomiting. Abdominal ultrasound showed dilated loops of small intestine and a suspected faecolith. Exploratory surgery revealed a caecal impaction and a typhlectomy was performed. Histopathological examination of caecal and full thickness small intestine sections demonstrated atrophy of smooth muscle fibres as well as an influx of plasma cells, lymphocytes and macrophages, and mild lymphoplasmacytic and eosinophilic enteritis. This combination of caecal impaction and chronic intestinal pseudo-obstruction has not been reported previously in the dog.     

ULTRASONOGRAPHIC FEATURES OF INTESTINAL ENTRAPMENT IN DOGS

The clinical and ultrasonographic features of postoperative intestinal entrapment were assessed in five dogs. Four had vomiting and lethargy, and one had peracute collapse and hematochezia. Ultrasonographic findings in four of five dogs were similar, being characterized by focally hyperechoic mesentery and abdominal effusion, surrounding a single loop of amotile and dilated intestine. In some dogs, the affected intestinal loop had a thickened or corrugated wall, or alteration of wall layering. In one dog, the site of entrapment could be directly visualized. In the most severely affected dog, a large volume of echogenic peritoneal effusion was present, as well as fluid dilation of multiple intestinal loops. The ultrasonographic appearance of intestinal entrapment is similar to that of intestinal perforation or infarction by other causes.     

Pythiosis of the digestive tract in dogs from Oklahoma

Enteric pythiosis was diagnosed in nine dogs in Oklahoma. Eight dogs had anorexia and weight loss. Two of these dogs had diarrhea; two dogs exhibited vomiting and diarrhea; and one dog had vomiting. One dog presented with dysphagia. Seven dogs had either a palpable or radiographically visible abdominal mass. These seven dogs had localized regions of mucosal ulceration and thickened gastric or intestinal walls with some involvement of the adjacent mesentery or omentum. Two dogs had enlarged regional mesenteric lymph nodes. One dog that presented with dysphagia had an oropharyngeal mass involving the larynx and cranial esophagus. Microscopically, there was transmural chronic sclerosing and granulomatous to pyogranulomatous inflammation with arteritis. Pythium spp. were identified in all specimens by immunohistochemistry.     

Successful treatment of hypereosinophilic syndrome in a dog

An 11-year-old crossbred dog was presented with a history of episodic vomiting, diarrhoea, abdominal discomfort and coughing. These signs had been present for several years. Marked peripheral eosinophilia (10.3 x 10(9)/L) was found. No underlying cause of reactive eosinophilia was apparent. Bone marrow aspiration biopsy showed hyperplasia of the eosinophilic cell line, with some increase in immaturity, although all cells were morphologically normal. There were numerous eosinophils in bronchial wash fluid and eosinophilic infiltrates were evident in biopsies of pancreas, liver, small intestine and colon but not stomach. Hypereosinophilic syndrome was diagnosed. The dog responded well to twice daily treatment with hydroxyurea and prednisolone. Clinical signs are well-controlled 16 months later.     

Omeprazole in a Dog With Gastrinoma

A 9-year-old male German Shepherd Dog was presented with the primary complaints of vomiting, profuse watery diarrhea, anorexia, and severe weight loss. The dog developed hematemesis and melena, which were unresponsive to treatment with an H₂-receptor antagonist and a gastrointestinal protectant. A marked neutrophilia, panhypoproteinemia, hypokalemia, and mildly increased activities of alkaline phosphatase and alanine aminotransferase were the only relevant abnormalities found on a CBC, serum biochemical profile, and urinalysis. An exploratory laparotomy revealed several small nonresectable masses at the root of the mesentery, which were identified histologically as a neuroendocrine neoplasm. Immunohistochemical staining of the neoplasm was positive for gastrin and negative for insulin, glucagon, pancreatic polypeptide, and vasoactive intestinal polypeptide. Fasting serum gastrin concentrations were high. Zollinger-Ellison syndrome was diagnosed, and the dog was treated with omeprazole, an H+, K+-ATPase inhibitor. All clinical signs resolved, and the dog remains asymptomatic 2 years later. Omeprazole may be the gastric acid antisecretory drug of choice for dogs with gastrinoma.