Marked hyperphosphatasemia associated with an acute leukemia in a Great Dane

This is the report of a 5‐year‐old male neutered Great Dane with an extreme leukocytosis (544.9 × 10⁹ cells/L; RI 5.2–13.9 × 10⁹ cells/L) characterized by highly atypical round cells. Cellular morphologic features such as cytoplasmic membrane blebs, a high nuclear‐to‐cytoplasmic ratio, and nuclear indentations and irregularities and large nucleoli, as well as immunocytochemistry for CD3 and CD79, myeloperoxidase cytochemistry, and clonality testing were not conclusive for myeloid or lymphoid origin. Marked alkaline hyperphosphatasemia was present at the first visit (2783.0 U/L; RI 6–80.0 U/L), followed by a 5‐fold increase (14,000 U/L) a week later, identified as being mostly contributed by the bone‐ALP isoform (11,062 U/L; RI 0–30 U/L). In addition, the atypical leukocytes were strongly positive for cytoplasmic ALP activity. In vitro lysis of a heparin blood sample resulted in a 1.7‐fold increase of ALP activity, supporting the origin of the hyperphosphatasemia at least in part from the leukemic cell population. To the authors’ knowledge, this is a unique case of alkaline hyperphosphatasemia, due at least to a leukemic cell population producing a bone‐ALP isoform, regardless of the exact nature of the leukemia.     

Magnetic Resonance Imaging of the Dorsal Proximal Synovial Plica of the Equine Metacarpo‐/Metatarsophalangeal Joint

A synovial plica is present at the dorsoproximal aspect of the fetlock joint. The objective of this study was to describe the location of the synovial plica during induced hyperextension using Magnetic Resonance Imaging. For this study 20 cadaver limbs from five Warmblood horses were used. Measurements were made of the dorsal; palmar/plantar length and the thickness of the plica with the joint in a normal position. During induced hyperextension of the joint, the position of the plica was described; the dorsal angle of extension and angle of contact between the proximal phalanx (P1) and the condyle were measured. The dorsal length differed between front/hind limbs and between the medial/lateral aspect of the joint. The angle of contact between P1 and condyle differed between front/hind limbs; between the lateral and medial aspect of the joint and between different positions of the plica. Four different positions of the plica were observed: shortened with the tip curved towards palmar/plantar; projecting distally; projecting towards dorsal and projecting distally with the tip interposed between P1 and the condyle. During induced hyperextension, a close relation is present between the synovial plica, P1 and the condyle with a variable position of the plica; which is suggestive for a contact interface between P1 and the metacarpal/metatarsal bone. However the plica does not seem to act consistently as a cushioning surface.