Hello
This is Sunny an 8 year old Golden Doodle. He has had vomiting and diarrhea for 6 months. His stools are rancid.
Hello
This is Sunny an 8 year old Golden Doodle. He has had vomiting and diarrhea for 6 months. His stools are rancid.
We performed endoscopic biopsy but could not get the scope into the SI because of what appeared to be redundant tissue at the pylorus. We passed a biopsy forcep into the pylorus but it would only advance 5-10 cm. We retrieved what appeared to be friable samples. We performed and US because we feared we would not get diagnostic results from the samples and we see hyperechoic walls on the duodenum extending up to and including the pylorus. The walls are hyperechoic and the layers of the bowel are not distinguishable. We are hopeful for a severe IBD but are fearful of lymphoma. The rest of the bowels seemed to have thickened mucosa. I was hoping for some opinions on the images as to what the major rule outs are. Thanks. Brent
Comments
There is also mucosal
There is also mucosal spikling (whitish striations within the submucosal layer), which often is indicative of lymphangectasia. Is there hypoproteinemia/hypoalbuminemia present on bloods?
Other DDx would be dietary hypersenstivity and IBD. With the rancid feces, underlying EPI is also possible.
Im seeing normal layering in
Im seeing normal layering in small intestine and colon but as remo says mucosal specking in the small intestine and chronic thickening in the colon but the layers are still in tact just thickened in the colon which suggests chronicity. Colonoscopy and upper endoscopy after corn oil feeding would be ideal here. See attached images of layers.
Try a PLE diet protocol as well after treating for parasites
Here are some typical GI lymphoma cases form the archive so you can see the difference in true mural layer loss.
http://sonopath.com/members/case-studies/search?text=intestinal+lymphoma&species=All
PLUG: The Curbside Guide (digital and hard copy) has some solid quick reference on this subject in IBD and PLE chapters even though albumin may be ok now watch for a drop in the future.
https://sonopath.com/products/book
Thanks for the comments. We
Thanks for the comments. We have run full GI panel including TLI. We have the dog on a GI diet and hopefully will have biopsy results back on Tuesday. I’ll post the results if they are diagnostic.
Very much appreciated. Brent
Hello
I thought I would post
Hello
I thought I would post the results of the biopsies on this case. I just cut and pasted the histo report in case anyone is interested.
As I’ve always been taught, IBD to Lymphoma is a linear process and after speaking to the pathologist she indicated that Sunny definitely has IBD but because of clusters of Lymphocytes she has concerns about an emerging lymphoma.
Owner has consented to the PCR test for a potentially more accurate differentiation, so when those results arrive I will post them as well.
Thanks. Brent.
SOURCE HISTORY:
A 8-year-old MN Goldendoodle. Inappetence and vomiting for 6 month duration.
Vit B12 decreased, endoscopically could only advance biopsy forceps 10 cm into
intestine. Pylorus appears hypertrophied. US shows marked irregular thickening
of pylorus and ascending duodenum. Stomach biopsies were well formed but
intestinal biopsies were friable.
MICROSCOPIC DESCRIPTION:
Stomach:
Surface epithelial injury: Normal
Gastric pit epithelial injury: Normal
Fibrosis/glandular nesting/mucosal atrophy: Normal
Intraepithelial lymphocytes: Mild
Lamina propria lymphocytes and plasma cells: Mild
Lamina propria eosinophils: Normal
Lamina propria neutrophils: Normal
Gastric lymphofollicular hyperplasia: Mild
Note: Superficial spirochetes are noted.
Duodenum:
Villous stunting: Mild-moderate
Crypt distension: Mild
Lacteal dilation: Normal
Mucosal fibrosis: Normal
Intraepithelial lymphocytes: Moderate-marked
Lamina propria lymphocytes and plasma cells: Moderate-marked
Lamina propria eosinophils: Moderate
Lamina propria neutrophils (normal = none; mild = 5-10 per 400x; moderate =
20-30 per 400x; marked = dominant population):
MICROSCOPIC INTERPRETATION:
Stomach: Gastritis, mild, subacute, diffuse, lymphoplasmacytic with superficial
spirochetes
Duodenum: Enteritis, moderate-marked, subacute, diffuse, lymphoplasmacytic and
eosinophilic (see comments)
COMMENT:
Note: There is concern for possible emerging lymphoma within the small
intestine. Therefore, additional clonality analysis utilizing PCR is
recommended and may be ordered by contacting Laboratory Services directly.
Thanks for the updated and
Thanks for the updated and keep on posting
This histopath makes sense
This histopath makes sense because th elayers are thick but in tact.. suggestive for chronicity and not neoplasia. LSA and similar almost always destroys the submucosal layers focally multifocally or completely. See the abstract we did on this in cats wiht intraoperative ultrasound:
http://sonopath.com/resources/research-publications