This 11 year old FS Shetland Sheepdog presented with a three month history of PU/PD.
Physical exam: wnl
CBC: wnl
Chemistry: ALP 269, ALT 234, AST 90. Urine Analysis: USG 1.006. Normal ACTH stimulation test.
This 11 year old FS Shetland Sheepdog presented with a three month history of PU/PD.
Physical exam: wnl
CBC: wnl
Chemistry: ALP 269, ALT 234, AST 90. Urine Analysis: USG 1.006. Normal ACTH stimulation test.
CT of the abdomen, plain and post contrast- There is a left-sided adrenal mass with irregular margination, multifocal mineralization
and surrounding fat stranding. The diameter of the mass is more than 3 cm. The caudal
aspect of the mass is not included in the study.
The mass invades the caudal vena cava via the left phrenicoabdominal vein. The
phrenicoabdominal vein is completely occluded and expanded by the tumor thrombus.
30 % of the vascular lumen are occupied by the tumor thrombus. The tumor thrombus
length within the caudal vena cava is 1 cm.
There is a large left-sided liver mass with severe non-uniform contrast enhancement.
At least two hypoattenuating and hypoenhancing nodules are seen centrally within the
liver. The liver is not fully included in the study.
Blood pressure should be monitored in this patient.
Although the primary malignancy cannot be ascertained here it appears to be more likely that the adrenal mass is the primary tumor with secondary seeding to the liver
parenchyma. Possible differential diagnoses include adenocarcinoma (which is not
necessarily functional), pheochromocytoma or other secondary neoplasia.
Surgical removal of the tumor would require venotomy of the caudal vena cava. The
mortality rate of this procedure has been reported to be at 22 % and does not
necessarily differ from the mortality rate in adrenal tumors without thrombi (Kyles et
al. Surgical management of adrenal gland tumors with and without associated tumor
thrombi in dogs: 40 cases (1994–2001), JAVMA 2003). But the overall prognosis is
poor because of the multifocal distribution of the malignancy.
Confirmation of diagnosis would warrant sampling, which may be done under
ultrasound guidance for both the adrenal tumor and the liver mass/nodules. Full tumor
staging would further require 3 view chest radiographs and cursory echocardiographic
examination to rule out heart base masses.
