Case Study

Insulinoma with hepatic metastasis in a 10 year old FS Labrador mix dog

A 10-year-old FS Labrador mix dog was presented after having had a possible seizure lasting 20 minutes. Preliminary blood work performed in-house showed hypoglycemia, hypoalbuminemia, an elevated ALP enzyme activity, hypercalcemia, hyperphosphatemia, hypernatremia, and hypokalemia. An insulin blood concentration was decreased. An ACTH stimulation test was normal. The patient continued having seizures due to hypoglycemia for several weeks. Recheck blood chemistry sent out to a laboratory revealed hypoglycemia, hyperphosphatemia, elevated CK, hypokalemia, and hypernatremia.

A 10-year-old FS Labrador mix dog was presented after having had a possible seizure lasting 20 minutes. Preliminary blood work performed in-house showed hypoglycemia, hypoalbuminemia, an elevated ALP enzyme activity, hypercalcemia, hyperphosphatemia, hypernatremia, and hypokalemia. An insulin blood concentration was decreased. An ACTH stimulation test was normal. The patient continued having seizures due to hypoglycemia for several weeks. Recheck blood chemistry sent out to a laboratory revealed hypoglycemia, hyperphosphatemia, elevated CK, hypokalemia, and hypernatremia.

Sonographic Differential Diagnosis

Nodular pancreatic and target liver lesions with mesenteric root lymphadenopathy. In light of persistent hypoglycemia metastatic insulinoma is likely.

Image Interpretation

A solitary target nodule is noted in the left liver in the near field adjacent to the falciform fat. Ultrasound guided core biopsy is performed positioned in a way to obtain normal and abnormal tissue. Image 3 and Video 3 reveal nodular pancreatic tissue in the left pancreatic base that may represent the primary neoplastic origin. Image 4 and video 2 reveal enlarged and echogenic mesenteric lymph nodes suggestive for metastatic or neoplastic manifestation.

DX

Epithelial neoplasm of endocrine origin (insulinoma,) possible hepatic metastases and hepatopathy

Outcome

The patient was humanely euthanized 10 days post diagnosis due to clinical decline.

Clinical Differential Diagnosis

Paraneoplastic disease; certain hepatic neoplasms may be associated with hypoglycemia, such as a leiomyoma or leiomyosarcoma. Primary brain tumor causing prolonged seizure activity, which in turn led to hypoglycemia, is unlikely as the seizures continued following the original seizure.

Sampling

U/S-guided Tru-cut® biopsies. Biopsies of the liver, pancreas, and mesenteric lymph node showed a presumptive diagnosis of an epithelial neoplasm of endocrine origin (insulinoma) also affecting the mesenteric root with possible hepatic metastases, as well as moderate vacuolar and pigment hepatopathy.