Case Study

Adrenal carcinoma with CVC invasion in a 13 year old FS Miniature Schnauzer

A 13 year old FS Miniature Schnauzer dog was presented due to clinical signs of recurrent urinary tract infections. CBC found a decreased hemoglobin and a high platelet count. In-house urinalysis showed a low specific gravity, high WBCs, high RBCs, and the presence of mucous strands. Blood chemistry revealed an increased ALT enzyme activity, hyperphosphatemia, elevated urea, elevated cholesterol, and elevated triglycerides.

DX

Adrenocortical carcinoma with CVC invasion. Metastasis to liver and spleen.

Sonographic Differential Diagnosis

Invasive right adrenal mass. Functional adenocarcionoma is likely due to vena caval invasion and clinical signs of hyperadrenocorticism.

Image Interpretation

A large hypoechoic and distinctly vascular right adrenal mass is visible with invasion into the vena cava. A second set of images shows progression of the mass 14 months after initial diagnosis of Cushing`s disease. Metastatic lesions were present in the liver and spleen at the time of the second sonogram.

Outcome

Patient was euthanized owing to poor quality of life.

Clinical Differential Diagnosis

Hyperadrenocorticism (pituitary or adrenal gland dependent). If adrenal gland dependent, differential diagnoses include an adenoma or adenocarcinoma. Urinary tract infection (possibly secondary to hyperadrenocorticism,) hyperlipidemia.

Sampling

Post mortem biopsies: Right adrenal cortical carcinoma with invasion of the caudal vena cava. Concurrent biopsy of gallbladder found minimal cholecystitis with cystic mucosal-mucinous hyperplasia with no evidence of malignant cells. The splenic biopsy was consistent with metastatic adrenal cortical carcinoma. Metastatic adrenal carcinoma was also evident in the liver biopsy, in addition to the presence of numerous pigment granulomas and mild multifocal portal and capsular fibrosis.