05-00077 Shades A Pancreatic carcinoma—-NEEDS OB—-NO IMAGES—

Case Study

05-00077 Shades A Pancreatic carcinoma—-NEEDS OB—-NO IMAGES—

A 9 year old NM DSH was presented for evaluation of ascites. On physical examination a distended abdomen and weight loss was evident. Fluid analysis revealed a moderate neutrophilic exudate – suspected bacterial sepsis. CBC showed neutrophilia, monocytosis, and mild anemia whereas serum chemistry was within normal limits.

A 9 year old NM DSH was presented for evaluation of ascites. On physical examination a distended abdomen and weight loss was evident. Fluid analysis revealed a moderate neutrophilic exudate – suspected bacterial sepsis. CBC showed neutrophilia, monocytosis, and mild anemia whereas serum chemistry was within normal limits.

Sonographic Differential Diagnosis

Bicavity effusion. Nodular pancreatic and hepatic changes. This is highly suggestive for dual cavity neoplasia such as carcinomatosis or possible feline infectious peritonitis. An abdominocentesis with cytospin and immediate slide preparation would be recommended for a definitive diagnosis. Alternatively, fine-needle aspirates of the pancreas and liver nodules would be warranted. Very poor long term prognosis.

Image Interpretation

The abdomen in this patient presented moderate amount of echogenic free fluid. Multiple heterogenous nodular changes were noted with hypoechoic and hyperechoic throughout the liver. This is suggestive for metastatic event. Some internal structure deviation was noted. The deep right liver revealed a collapsed gallbladder with surrounding parenchymal nodular changes with impingement upon the gallbladder. The vena cava was normal. The hepatic veins were subnormal in size. The left kidney presented a loss of corticomedullary detail and was subnormal in size at 3.1 cm. This is consistent with chronic nephrosis. The right kidney presented mildly swollen contour and excessive size at 4.2 cm with multiple, hyperechoic cortical changes that may be consistent with granulomatous disease. This is indicative of an increased possibility of feline infectious peritonitis. The pancreatic region revealed multiple nodular hypoechoic changes with irregular surrounding omentum.

DX

Pancreas: carcinoma. Liver: carcinoma (suspected metastatic).

Clinical Differential Diagnosis

Bacterial peritonitis. Feline infectious peritonitis. Neoplasia – intra-abdominal, liver, spleen, kidney, pancreas, mesenteric lymph node. Chemical – urine, bile.

Sampling

Liver: The five slides varied in cellularity. The two most cellular slides had moderate to high numbers of nucleated cells with small amounts of blood. Hepatocytes were present in low to moderate numbers, arranged in cohesive clusters, sometimes entrapped within clot-like aggregates. They often had small amounts of blue-green lipofuscin pigment. There were also moderate numbers of round to cuboidal cells arranged in cohesive clusters, sometimes closely associated with hepatoyte clusters. The cells had round nuclei and small amount of lightly basophilic cytoplasm. Nuclei had coarse chromatin patterns with 2-4 prominent nucleoli that varied in shape and size. There was mild to moderate anisocytosis and mild ankisokaryosis among these cells. Clots containing hepatocytes often exhibited increased proportions of neutrophils and numbers may have been mildly overrepresented in other areas of the slides. Macrophages were present in low to moderate numbers and were typically highly vacuolated and often contained hemosiderin. Pancreas: One slide had small amount of blood with low numbers of nucleated cells. The other two slides had moderate numbers of nucleated cells with little blood and small to moderate amounts of a slightly fibrinous pale eosinophilic material. There were low to moderate numbers of epithelial cells arranted in cohesive clusters and similar in appearance to the atypical cells described above. Some clusters of these cells exhibited mild to moderate cytoplasmic vacuolation. Anisokaryosis was moderate within this population. No pancreatic epithelial cells containing zymogen granules were found. Remaining nucleatecells consisted of low numbers of blood leucotyes and occasional macrophages. Small to moderate amounts of granular basophilic material suggestive of deteriorated cells were also noted. Interpretation: liver: carcinoma (suspected metastatic). Pancreas: carcinoma. Comments: Given the appearance of the slides as well as the sonographic description, the pancreas is likely the site of primary neoplasia, with metastases to the liver. The neoplastic cells appear epithelial but do not contain zymogen granules typical of normal pancreatic cells. This could be because the cells are sufficiently anaplastic as to have lost this feature, but other sources should be considered as well. Histopathology would be required for confirmation.

Patient Information

Type of Imaging : Ultrasound
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