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Pancreatic adenoma in a 14 year old FS Bengal cat

Case Study

Pancreatic adenoma in a 14 year old FS Bengal cat

A 14-year-old FS Bengal cat with history of polycystic kidneys was presented for hematuria. Physical exam was unremarkable. Blood chemistry revealed slight hyperamylasemia. CBC was within normal limits. In-house urinalysis showed normal pH, specific gravity and a full field of RBCs on microscopic evaluation. Patient was presented several weeks later for vocal changes, including loss of voice, accompanied by wheezing. Physical exam at that time found the patient to be febrile. Her throat palpated normally. Blood chemistry revealed only high triglycerides.

A 14-year-old FS Bengal cat with history of polycystic kidneys was presented for hematuria. Physical exam was unremarkable. Blood chemistry revealed slight hyperamylasemia. CBC was within normal limits. In-house urinalysis showed normal pH, specific gravity and a full field of RBCs on microscopic evaluation. Patient was presented several weeks later for vocal changes, including loss of voice, accompanied by wheezing. Physical exam at that time found the patient to be febrile. Her throat palpated normally. Blood chemistry revealed only high triglycerides. CBC found leukocytosis and neutrophilia. T4 was within normal range. Urinalysis showed normal pH and specific gravity, a turbid red appearance, proteinuria (3+), hematuria (3+), WBC (4-10), RBC (51-100), and moderate amorphous debris. Urine microalbumin was high. Urine culture yielded no growth. Antibiotic injection and subcutaneous fluids were given, and patient was discharged. Upon recheck exam a few days later, patient was BAR, with slightly tacky mucous membranes, prominent kidneys, mild ocular discharge, heart and lungs clear with no overt murmurs or wheezes ausculted. Thoracic radiographs showed no abnormalities. Patient received subcutaneous fluids, an antibiotic injection, and was referred for ultrasound.

Sonographic Differential Diagnosis

Pancreatic mass, possible pancreatic carcinoma or lymphoma, possible sequestrum or necrosis. Ultrasound guided biopsy performed.

Image Interpretation

A 2.5 x 4.4cm pancreatic mass was present which occupied the pancreatic base and extended over to the right limb through the portal vein. The mass could also be seen in minimal portions of the left limb. This is highly suggestive for infiltrative disease such as pancreatic lymphoma or carcinoma, however pancreatic sequestrum is also a possibility.

DX

Pancreatic adenoma consisting of acinar cells

Outcome

Owner was advised to have follow-up ultrasound performed if patient became icteric.

Comments

A good prognosis was given. Surgical removal of the mass was not recommended, although if it increased in size could lead to possible bile duct obstruction.

Clinical Differential Diagnosis

Hematuria – pyelonephritis, renal hemorrhage, low grade urinary tract infection, cystitis, cystic calculi, urinary bladder neoplasia, polycystic kidneys. Hyperamylasemia – decreased renal clearance, intestinal inflammation (IBD), pancreatitis.

Sampling

A coagulation panel revealed PT of 18 seconds and PTT that was slightly elevated (biopsy was not clinically contraindicated). An 18 gauge ultrasound guided Tru-cut® biopsy was performed of the pancreatic lesion. Biopsy results taken from the pancreatic mass revealed a pancreatic adenoma consisting of acinar cells.

Patient Information

Patient Name : Friend B
Gender : Female, Spayed
Species : Feline
Type of Imaging : Ultrasound
Status : Complete
Liz Wuz Here : Yes
Code : 05_00041

Clinical Signs

  • Hematuria
  • Voice changes
  • Wheezing

History

  • Polycystic kidneys

Exam Finding

  • Dehydration
  • Fever
  • Large Kidneys
  • Ocular Discharge

Images

Friend_1_12062009060110

Blood Chemistry

  • Amylase, High
  • Hypertriglyceridemia

CBC

  • Neutrophils, High
  • WBC, High

Clinical Signs

  • Hematuria
  • Voice changes
  • Wheezing

Urinalysi

  • Albumin Present
  • Appearance Turbid
  • Blood Present
  • Protein Present
  • WBCs Present