TRANSITIONAL CELL CARCINOMA OF THE URETHRA IN FOUR FEMALE DOGS: ITS URETHROGRAPHIC APPEARANCE

ansitional cell urethral carcinoma in four female dogs is reported. Lesion distribution in the proximal two thirds of the urethra and the radiographic appearance with retrograde positive contrast urethrography were similar in each dog. The normally smooth longitudinal urethral striations were replaced by multiple small, poorly marginated intraluminal masses that resulted in a generalized moth-eaten appearance. Extension of contrast medium into the periurethral tissues also occurred. Retrograde urethrography, a simple diagnostic technic, aided in establishing a differential diagnosis in dogs that had urine retention and stranguria.     

ULTRASONOGRAPHIC APPEARANCE OF URETHRAL TRANSITIONAL CELL CARCINOMA IN TEN DOGS

The mucosal margin of the urethra is best assessed by positive contrast urethrography, but ultrasonography offers complementary information such as urethral wall thickness and size of medial iliac lymph nodes. Ultrasonography of the urethra is quick, noninvasive and does not require sedation or general anesthesia. In patients with complete urethral obstruction, ultrasonography may be the only way to image the urethra. Twelve dogs which were presented to Tufts University School of Veterinary Medicine with clinical signs referable to the urinary bladder, urethra or vagina were examined ultrasonographically. Seven were neutered females and five were neutered males. Each dog had a hyperechoic, nonshadowing line at the epithelial surface of the proximal urethra. In the seven female patients and one of the males, the urethral wall was also thick and hypoechoic to surrounding tissue. In the other males, the urethral epithelial changes were at the level of the prostate, and the limits of the urethra were not visible. In six dogs, the urethral change was the only abnormality seen, while in six, bladder wall, bladder luminal and/or prostatic parenchymal changes were also detected. Three patients had hydronephrosis, and one had enlarged medial iliac lyumph nodes. Biopsies were obtained via suction with urinary catheterization (n = 6), exploratory celiotomy (n = 3), urethroscopy (n = 2), or at post-mortem (n = 1). A histopathologic diagnosis of urethral transitional cell carcinoma was obtained in ten dogs. The ultrasonographic appearance was not pathognomonic for transitional cell carcinoma, as one dog with transitional cell dysplasia and one dog with severe ulcerative and necrosupperative cystitis and urethral stricture had similar findings.     

SONOGRAPHIC INVESTIGATION OF TRANSITIONAL CELL CARCINOMA OF THE URINARY BLADDER IN SMALL ANIMALS

This report compares results from imaging of transitional cell carcinoma of the urinary bladder in 15 dogs using intravenous urography, double-contrast cystography, and ultrasonography. Intravenous urography demonstrated filling defects in the urinary bladder in 3 of the 5 cases examined with this modality. Double-contrast cystography identified bladder masses in 8 of 10 animals. Ultrasonography was the only imaging modality which detected bladder masses in all patients.     

THE TECHNIQUE OF PERCUTANEOUS ULTRASOUND GUIDED FINE-NEEDLE ASPIRATION BIOPSY AND AUTOMATED MICROCORE BIOPSY IN SMALL ANIMAL GASTROINTESTINAL DISEASES

Techniques for obtaining percutaneous ultrasound-guided biopsies of the gastrointestinal tract were evaluated. The efficacity of ultrasonographic detection of gastrointestinal lesions has been established in veterinary medicine. Percutaneous ultrasound-guided aspiration biopsies were performed using either a 22 gauge spinal needle or a 20 gauge Westcott needle. The microcore automated biopsy was performed using a 18 gauge Tru-cut-like needle, assisted by an automated biopsy gun. These techniques are rapid, and easily performed. The techniques were considered safe for the patient, no complications such as hemorrhage, peritonitis or abscessation have occured in our study. These techniques are of particular interest when lesion can not be biopsied successfully by endoscopy and when surgical resection is not recommended.     

USE OF ULTRASOUND-GUIDED FINE-NEEDLE ASPIRATION BIOPSY AND AUTOMATED CORE BIOPSY FOR THE DIAGNOSIS OF GASTROINTESTINAL DISEASES IN SMALL ANIMALS

The purpose of this study was to evaluate the usefulness of ultrasound-guided fine-needle aspiration biopsy and core biopsy in the diagnosis of infiltrative gastrointestinal diseases. Six dogs and seven cats with clinical signs of gastrointestinal disease underwent ultrasonography and intestinal lesions were identified. One or more ultrasound-guided fine-needle aspiration biopsy and/or core biopsy procedures were performed in each patient. Each patient also underwent one of the following additional procedures for comparison of results: 1) surgery (n=4), 2) endoscopy (n=2), 3) post mortem exam (n=3), and, 4) for lymphoma diagnosed with ultrasound-guided procedures, response to chemotherapy (n=4). Correct diagnoses were obtained in nine of the 13 patients, incorrect diagnoses in two of the 13 patients, and inconclusive diagnoses in two of the thirteen patients. Of the 16 total ultrasound-guided procedures performed, ten were confirmed as correct, three as incorrect, and three were non-diagnostic. Intestinal lesions with bowel wall thickness greater than 2.0 cm had a higher percentage of correct diagnoses than lesions of lesser wall thickness. Gastric lesions had a higher percentage of correct diagnoses than small and large intestinal lesions. Malignant lesions had a higher percentage of correct diagnoses than benign lesions. There were no complications. Ultrasound-guided gastrointestinal fine-needle aspiration biopsy and core biopsy appears to be a safe, accurate, and rapid procedure for use in the diagnosis of infiltrative gastrointestinal disease.     

FLUOROSCOPICALLY GUIDED PERCUTANEOUS FINE-NEEDLE ASPIRATION BIOPSY OF THORACIC LESIONS IN DOGS AND CATS

Forty-eight fine-needle aspiration biopsy specimens of intrathoracic lesions were obtained with a Westcott needle by localizing needle placement using TV-monitored, image-amplified fluoroscopy and by detecting changes in tactile sensation. Thiryt-five lesions were pulmonary in origin and 13 were within the mediastinum. Most biospy specimens were obtained with the patients sedated, however, general anesthesia was used in one patient to prevent movement that could have resulted in puncture of a critical structure. The only clinical and radiographic complication from this procedure was pneumothorax, occurring in eight dogs and resulting in one death. Definitive diagnoses were made from tissue obtained from 37 of the 48 lesions sampled for a sensitivity rate of 77.1%. Fine-needle aspiration biopsy was found to be a simple, safe, and accurate diagnostic technique.     

ULTRASONOGRAPHIC FINDINGS RELATED TO PROGNOSIS IN CANINE TRANSITIONAL CELL CARCINOMA

In human bladder cancer patients, ultrasonography is extensively used not only to identify tumor masses but also to evaluate tumor size, shape, echogenicity, location, and degree of tumor invasion into the bladder wall. The information revealed by ultrasonography delineates the tumor's biological features and facilitates prediction of prognosis. However, in veterinary medicine the feasibility of using ultrasonography for these purposes has not been fully investigated. In this retrospective study, we reviewed cases of dogs with histologically confirmed bladder mass lesions, including transitional cell carcinoma (n = 22) and polypoid cystitis (n = 5), to determine whether ultrasonography could reliably predict bladder wall involvement. By following patients with transitional cell carcinoma until death, we also determined whether ultrasonographic tumor size, shape, echogenicity, and mass location were related to prognosis. Wall involvement as revealed by ultrasound was significantly (P = 0.00005) associated with histological muscular layer involvement with a sensitivity of 93% (95% Confidence interval, 79–98%) and specificity of 92% (95% Confidence interval, 76–98%). Ultrasonographic wall involvement (P = 0.03, vs. noninvolvement), heterogeneous mass (P = 0.02, vs. homogeneous mass), and trigone location (P = 0.01, vs. other locations) characteristics were significantly associated with shorter survival times in transitional cell carcinoma cases. Findings indicated that ultrasonographic characteristics such as wall involvement, heterogeneous mass, and trigone location could be reliable prognostic indicators in canine transitional cell carcinoma.     

TOLERABILITY AND TUMOR RESPONSE OF A NOVEL LOW‐DOSE PALLIATIVE RADIATION THERAPY PROTOCOL IN DOGS WITH TRANSITIONAL CELL CARCINOMA OF THE BLADDER AND URETHRA

Previously reported radiation protocols for transitional cell carcinoma of the canine lower urinary tract have been ineffective or associated with increased side effects. Objectives of this retrospective, cross‐sectional study were to describe safety of and tumor responses for a novel palliative radiation protocol for transitional cell carcinoma in dogs. Included dogs had cytologically or histologically confirmed transitional cell carcinoma of the bladder or urethra, and were treated with 10 once‐daily fractions (Monday–Friday) of 2.7 Gy. Thirteen dogs were sampled, with six treated using radiation as first‐line (induction) therapy and seven treated using radiation as rescue therapy after failing previous chemotherapy. Within 6 weeks of radiation, 7.6% (1/13) dogs had a complete response, 53.8% (7/13) partial response, 38.5% (5/13) stable disease, and none had progressive disease. Three patients presenting with urethral obstruction had spontaneous micturition restored during the treatment protocol. A single patient with unilateral ureteral obstruction was patent at recheck examination. Median survival time from time of initial diagnosis was 179 days. Median survival time from start of radiation was 150 days. Acute radiation side effects occurred in 31% (4/13) patients and were classified as grade 1 or 2. No significant late side radiation side effects were reported. No variables examined were identified as prognostic factors. Findings indicated that the reported radiation protocol was safe in this sample of dogs with bladder and urethral transitional cell carcinoma. Future prospective studies are needed to determine utility of this treatment as a rescue therapy in patients with complete urinary tract obstruction.     

ULTRASOUND-GUIDED BIOPSY OF THE CANINE LIVER, KIDNEY, AND PROSTATE

Sixty-nine hepatic, 25 renal, and 16 prostatic biopsies were performed under ultrasound guidance using a biopsy guide. The majority (98 of 110) were tissue-core biopsies. Multiple attempts at obtaining a sample were required; however, in the kidney, the number of attempts was restricted to two. Adequate samples were obtained in 94% (65/69) hepatic, 88% (22/25) renal, and 94% (5/6) prostatic biopsies. Postbiopsy scanning did not demonstrate parenchymal hemorrhage. In three renal and one prostatic biopsy, gross hematuria, noted immediately following biopsy, resolved in 2–3 days. Animals with prostatic disease frequently had hematuria, making evaluation for this complication difficult. One animal died acutely 2 days following prostatic biopsy due to an unrelated problem, a ruptured aortic àneurysm. Complications were not encountered with the liver biopsy procedure. Animals biopsied under sedation tolerated the procedure well. The authors preferred to anesthetize uncooperative animals and those needing kidney biopsy to minimize the likelihood of complications. Problems encountered during the procedure, overlying bowel gas obscuring the target organ or poor visualization of the biopsy needle, were corrected by changing patient or transducer position or the procedure was postponed. The usefulness of the biopsy procedure is illustrated in four case reports.     

DIAGNOSIS AND SURGICAL TREATMENT OF A TRANSITIONAL CELL CARCINOMA IN THE BLADDER APEX OF A PET RABBIT (ORYCTOLAGUS CUNICULUS)

A 6-year-old, 1.9-kg female spayed lop-eared European rabbit (Oryctolagus cuniculus) was evaluated for acute hematuria and inappropriate urination and defecation of less than 12-hours duration. Abdominal ultrasonography revealed a suspected bladder mass. Ultrasound-guided cystocentesis was performed and the results of the urinalysis were unremarkable. An abdominal exploratory surgery revealed a nodular cystic mass at the cranial ventral apex of the bladder wall which measured 0.5 cm × 0.5 cm. Based on histopathologic evaluation, excision of the neoplasm was complete and the mass was diagnosed as transitional cell carcinoma of the bladder. This case suggests that urinary bladder transitional cell carcinoma should be considered in pet rabbits presenting with similar clinical signs.     

SAFETY AND CORRELATION OF TEST RESULTS OF COMBINED ULTRASOUND‐GUIDED FINE‐NEEDLE ASPIRATION AND NEEDLE CORE BIOPSY OF THE CANINE SPLEEN

The safety and diagnostic value of combined splenic fine‐needle aspiration (FNA) and needle core biopsy (NCB) is unknown. Forty‐one dogs with splenic lesions were studied prospectively. Safety was assessed in 38 dogs and no complications were encountered. Initially, clinical and anatomic pathologists reviewed each FNA and NCB sample, respectively, without knowledge of the other's results. Diagnoses were categorized as neoplastic, benign, inflammatory, normal, or nondiagnostic. The level of agreement between sampling methods was categorized as complete, partial, disagreement, or not available. Test correlation was performed in 40 dogs. Nondiagnostic results occurred in 5/40 NCB (12.5%) and no FNA samples. Neoplasia was diagnosed in 17/40 dogs (42.5%), benign changes in 20/40 dogs (50%), inflammatory disorders in 0/40 dogs, and normal 2/40 dogs (5%). One of the 40 dogs (2.5%) had a diagnosis that was equivocal for neoplasia on both tests and therefore was not categorized. Of the 35 dogs that had diagnostic samples, cytopathologic and histopathologic diagnoses agreed completely in 18/35 dogs (51.4%), partially in 3/35 dogs (8.6%), and were in disagreement in 14/35 dogs (40.0%). Pathologists collaboratively reviewed diagnoses that were in disagreement or partial agreement and altered their individual diagnoses in 6/17 dogs (35.3%) to be within partial or complete agreement, respectively. Percutaneous FNA and NCB can be performed safely in dogs with sonographic splenic changes. Results suggest that adding NCB to FNA provides complementary information in dogs with suspected splenic neoplasia. This combined protocol may improve detection of splenic neoplasia and provide neoplastic subclassification.