Case Study

Pancreatic carcinoma with carcinomatosis in a 16 year old MN DSH cat

A 16-year-old MN DSH presented for anorexia, vomiting, and urinary calculi. Radiographs showed a mass caudal to the stomach. Bloodwork and urinalysis were not performed owing to economic concerns so the patient went right to ultrasound, which is not ideal, but strictly the choice of the owner.

A 16-year-old MN DSH presented for anorexia, vomiting, and urinary calculi. Radiographs showed a mass caudal to the stomach. Bloodwork and urinalysis were not performed owing to economic concerns so the patient went right to ultrasound, which is not ideal, but strictly the choice of the owner.

DX

Pancreatic carcinoma deriving from nodular hyperplasia. Contiguous spread to duodenum and peritoneum.

Sonographic Differential Diagnosis

Owing to the dramatic loss of structure within the small intestine as well as the pancreas, intestinal +/- pancreatic neoplasia is suspected. Aggressive inflammatory or granulomatous disease is less likely. Primary concerns are carcinoma, lymphoma, mast cell disease, or dry form FIP involving the small intestine and/or pancreas.

Image Interpretation

A portion of small intestine demonstrates loss of mural detail and dramatic hypoechoic wall with destruction of the thin hyperechoic sub mucosal layering from right to left in the near field. The sub mucosa is nonexistent in the far field. The near field thin hyperechoic serosal layer is lost at the 10 oвЂ™clock position. Video 1 and 2: Video of the same area demonstrating the progressive loss of the hyperechoic serosal and sub mucosal layers owing to the expansive hypoechoic transmural pathology. Image 2: Complex destruction of the small intestine with surrounding hyperechoic omental adhesions and fluid accumulation within the wall in the far field. Video 3: Video of the left pancreatic base medial to the spleen in the near field in the left region of the image. The dramatic hypoechoic tissue is greater than 1 cm in width and loses linear structure within the pancreatic parenchyma suggestive for aggressive underlying pathology.

Outcome

Upon opening the midline, tumor metastasis were discovered throughout the entire peritoneal surface, a 5-6 cm mass was seen in the intestines, and the pancreas was massively invaded with tumor, possibly primary. The decision was made to humanely euthanize the patient.

Clinical Differential Diagnosis

G.I. clinical signs- neoplasia; lymphoma of GI tract, pancreas. Kidney clinical signs- cyst, hydronephrosis.

Sampling

Prior to surgery an US-guided FNA was highly suggestive for adenocarcinoma. Postmortem biopsies confirmed pancreatic carcinoma deriving from nodular hyperplasia and adenoma with contiguous spread to the duodenum and peritoneum; pancreatic carcinomatosis.