Case # 85154: Bone marrow impression from a lame dog Presenter: Katie Boes Authors: Laurie...
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Transcript of Case # 85154: Bone marrow impression from a lame dog Presenter: Katie Boes Authors: Laurie...
Case # 85154:Bone marrow impression from a lame dog
Presenter: Katie BoesAuthors: Laurie O’Rourke, Geoffrey Saunders, Natalie Durrett Crawford, Nic Lambrechts, Jonathan Miller, Kurt Zimmerman
Presented at SEVPAC 2008 – Permission granted for use on
SEVPAC website only
Signalment & History
Signalment– 2-year-old– Castrated male – Golden Retriever
History– Chronic weight loss– Progressive left thoracic leg lameness
Presented at SEVPAC 2008 – Permission granted for use on
SEVPAC website only
Physical Examination
BCS 3/9 Left front limb
– Grade 3/4 lameness– Muscle atrophy– Pain with shoulder flexion– Solid scapular mass
Enlarged liver Abdominal distension
Presented at SEVPAC 2008 – Permission granted for use on
SEVPAC website only
Imaging: Left Shoulder
Radiographs– Well-circumscribed area
of bony lysis at the scapular neck, surrounded by a soft tissue mass
Ultrasound– Cortical lysis
• Loss of echogenic interface
• Loss of thedistal acoustic shadowing
Presented at SEVPAC 2008 – Permission granted for use on
SEVPAC website only
Imaging: Metastasis Check
Abdominal ultrasound– Several soft tissue
masses
Thoracic radiographs– Enlarged heart– Unremarkable lung
fields
Presented at SEVPAC 2008 – Permission granted for use on
SEVPAC website only
Samples Collected
Cytopathology– Bone marrow impressions from the left
scapula Histopathology
– Perirenal mass, small intestine, liver, pancreas, spleen, kidney, lung
– Not the left scapular mass
Presented at SEVPAC 2008 – Permission granted for use on
SEVPAC website only
Left scapular bone marrow impression, Modified Wright’sPresented at SEVPAC 2008 – Permission granted for use on
SEVPAC website only
Left scapular bone marrow impression, Modified Wright’sPresented at SEVPAC 2008 – Permission granted for use on
SEVPAC website only
Special Stains & Immunohistochemistry
Stain ResultSignificance &
Cell Origin
Grimelius silver stain Strong (+) Chromaffin cell
Vimentin (-) Not mesenchymal
Cytokeratin AE1/3 (-) Not epithelial
Synaptophysin Strong (+) Neuroendocrine
Chromatogranin A Weak (+) Neuroendocrine
Presented at SEVPAC 2008 – Permission granted for use on
SEVPAC website only
Diagnosis
Cytopathologic opinion of bone marrow– Consistent with metastatic neuroendocrine
neoplasia Histopathologic diagnosis
– Perirenal mass: malignant pheochromocytoma with metastases to the liver, pancreas, spleen, kidney, lung, and scapula bone, canine
Presented at SEVPAC 2008 – Permission granted for use on
SEVPAC website only
Review: Neuroendocrine Cytologic Appearance Highly cellular Many free nuclei Cells exfoliate in loosely
attached sheets Round to polygonal
cells Indistinct cell borders
– Occasionally distinct Nuclei are round to
indented
Presented at SEVPAC 2008 – Permission granted for use on
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Comments
Histopathologic sections of the scapular mass were not taken, however…– Antemortem FNAs of the scapular mass
and several intraabdominal masses revealed similar neoplastic cells as described in the postmortem bone marrow impression smear
Presented at SEVPAC 2008 – Permission granted for use on
SEVPAC website only
Pheochromocytomas:Cell Origin & Signalment Type of paraganglioma tumor of the
chromaffin cells arising from the adrenal medulla
Uncommon tumor of older dogs– 0.1% to 0.01% of all tumors in dogs– Mean age of 11 yrs (range of 1-15 yrs)
No breed or sex predilection
Presented at SEVPAC 2008 – Permission granted for use on
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Pheochromocytomas:Presenting Complaints None (incidental finding)
– 48-57% Non-specific Excessive catecholamine production
– 23-43%– Signs associated with hypertension– Panting, dyspnea, coughing, weakness,
exercise intolerance
Presented at SEVPAC 2008 – Permission granted for use on
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Pheochromocytomas:Clinical Diagnosis Routine blood and urine analysis
– Variable and non-specific Measure catecholamines and their metabolites in
blood and urine– Low availability– High technical difficulty and expense– False negatives due to cyclical excretion
Catecholamine stimulation and suppression tests– Dangerous due to profound changes in blood pressure
Presented at SEVPAC 2008 – Permission granted for use on
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Pheochromocytomas:Treatment & Survival Surgery is the treatment of choice
– Mortality rates: 22-29%– Survival with complete removal: Up to 3.25 years
Survival– No correlation between prognosis and histologic
appearance in dogs– Neurologic disease, abdominal distension, and
weight loss associated with advanced tumor stages
Presented at SEVPAC 2008 – Permission granted for use on
SEVPAC website only
Acknowledgements
VMRCVM’s Department of Biomedical Sciences
Dr. Eric Schultze, Eli Lilly & Co. Dr. Christopher Ober, VMRCVM
Presented at SEVPAC 2008 – Permission granted for use on
SEVPAC website only
References
1. Barthez PY, Marks, SL, Woo J, Feldman EC, Matteucci M. Pheochromocytoma in dogs: 61 cases (1984-1995). J Vet Intern Med. 1997;11:272-278.
2. Bouayad H, Feeney DA, Caywood DD, Hayden DW. Pheochromocytoma in dogs: 13 cases (1980-1985). J Am Vet Med Assoc. 1987;191:1610-1615.
3. Capen CC. Tumors of the adrenal gland. In: Moulton JE, ed. Tumors in Domestic Animals. 3rd ed. Berkeley, CA: University of California Press; 1990:576-583.
4. Gilson SD, Withrow SJ, Wheeler SL, Twedt DC. Pheochromocytoma in 50 dogs. J Vet Intern Med. 1994;8:228-232.
5. Raskin RE, Meyer DJ. Atlas of Canine and Feline Cytology. Philadelphia, PA: W. B. Saunders; 2001: 31-32.
Presented at SEVPAC 2008 – Permission granted for use on
SEVPAC website only