Case # 85154: Bone marrow impression from a lame dog

1. Case # 85154:Bone marrow impression from a lame dog Presenter: Katie Boes Authors: Laurie O’Rourke, Geoffrey Saunders, Natalie Durrett Crawford, Nic Lambrechts, Jonathan Miller, Kurt Zimmerman Presented at SEVPAC 2008 – Permission granted for use on SEVPAC website only

2. Signalment & History • Signalment • 2-year-old • Castrated male • Golden Retriever • History • Chronic weight loss • Progressive left thoracic leg lameness Presented at SEVPAC 2008 – Permission granted for use on SEVPAC website only

3. Physical Examination • BCS 3/9 • Left front limb • Grade 3/4 lameness • Muscle atrophy • Pain with shoulder flexion • Solid scapular mass • Enlarged liver • Abdominal distension Presented at SEVPAC 2008 – Permission granted for use on SEVPAC website only

4. Imaging: Left Shoulder • Radiographs • Well-circumscribed area of bony lysis at the scapular neck, surrounded by a soft tissue mass • Ultrasound • Cortical lysis • Loss of echogenic interface • Loss of the
distal acoustic shadowing Presented at SEVPAC 2008 – Permission granted for use on SEVPAC website only

5. Imaging: Metastasis Check • Abdominal ultrasound • Several soft tissue masses • Thoracic radiographs • Enlarged heart • Unremarkable lung fields Presented at SEVPAC 2008 – Permission granted for use on SEVPAC website only

6. Gross Findings Presented at SEVPAC 2008 – Permission granted for use on SEVPAC website only

7. Samples Collected • Cytopathology • Bone marrow impressions from the left scapula • Histopathology • Perirenal mass, small intestine, liver, pancreas, spleen, kidney, lung • Not the left scapular mass Presented at SEVPAC 2008 – Permission granted for use on SEVPAC website only

8. Left scapular bone marrow impression, Modified Wright’s Presented at SEVPAC 2008 – Permission granted for use on SEVPAC website only

9. Left scapular bone marrow impression, Modified Wright’s Presented at SEVPAC 2008 – Permission granted for use on SEVPAC website only

10. Perirenal mass, H&E Presented at SEVPAC 2008 – Permission granted for use on SEVPAC website only

11. Presented at SEVPAC 2008 – Permission granted for use on SEVPAC website only Perirenal mass, H&E

12. Perirenal mass, H&E Presented at SEVPAC 2008 – Permission granted for use on SEVPAC website only

13. Special Stains & Immunohistochemistry Presented at SEVPAC 2008 – Permission granted for use on SEVPAC website only

14. Diagnosis • Cytopathologic opinion of bone marrow • Consistent with metastatic neuroendocrine neoplasia • Histopathologic diagnosis • Perirenal mass: malignant pheochromocytoma with metastases to the liver, pancreas, spleen, kidney, lung, and scapula bone, canine Presented at SEVPAC 2008 – Permission granted for use on SEVPAC website only

15. Review: Neuroendocrine Cytologic Appearance • Highly cellular • Many free nuclei • Cells exfoliate in loosely attached sheets • Round to polygonal cells • Indistinct cell borders • Occasionally distinct • Nuclei are round to indented Presented at SEVPAC 2008 – Permission granted for use on SEVPAC website only

16. Comments • Histopathologic sections of the scapular mass were not taken, however… • Antemortem FNAs of the scapular mass and several intraabdominal masses revealed similar neoplastic cells as described in the postmortem bone marrow impression smear Presented at SEVPAC 2008 – Permission granted for use on SEVPAC website only

17. Pheochromocytomas:Cell Origin & Signalment • Type of paraganglioma tumor of the chromaffin cells arising from the adrenal medulla • Uncommon tumor of older dogs • 0.1% to 0.01% of all tumors in dogs • Mean age of 11 yrs (range of 1-15 yrs) • No breed or sex predilection Presented at SEVPAC 2008 – Permission granted for use on SEVPAC website only

18. Pheochromocytomas:Presenting Complaints • None (incidental finding) • 48-57% • Non-specific • Excessive catecholamine production • 23-43% • Signs associated with hypertension • Panting, dyspnea, coughing, weakness, exercise intolerance Presented at SEVPAC 2008 – Permission granted for use on SEVPAC website only

19. Pheochromocytomas:Clinical Diagnosis • Routine blood and urine analysis • Variable and non-specific • Measure catecholamines and their metabolites in blood and urine • Low availability • High technical difficulty and expense • False negatives due to cyclical excretion • Catecholamine stimulation and suppression tests • Dangerous due to profound changes in blood pressure Presented at SEVPAC 2008 – Permission granted for use on SEVPAC website only

20. Pheochromocytomas:Treatment & Survival • Surgery is the treatment of choice • Mortality rates: 22-29% • Survival with complete removal: Up to 3.25 years • Survival • No correlation between prognosis and histologic appearance in dogs • Neurologic disease, abdominal distension, and weight loss associated with advanced tumor stages Presented at SEVPAC 2008 – Permission granted for use on SEVPAC website only

21. Acknowledgements • VMRCVM’s Department of Biomedical Sciences • Dr. Eric Schultze, Eli Lilly & Co. • Dr. Christopher Ober, VMRCVM Presented at SEVPAC 2008 – Permission granted for use on SEVPAC website only

22. References • Barthez PY, Marks, SL, Woo J, Feldman EC, Matteucci M. Pheochromocytoma in dogs: 61 cases (1984-1995). J Vet Intern Med. 1997;11:272-278. • Bouayad H, Feeney DA, Caywood DD, Hayden DW. Pheochromocytoma in dogs: 13 cases (1980-1985). J Am Vet Med Assoc. 1987;191:1610-1615. • Capen CC. Tumors of the adrenal gland. In: Moulton JE, ed. Tumors in Domestic Animals. 3rd ed. Berkeley, CA: University of California Press; 1990:576-583. • Gilson SD, Withrow SJ, Wheeler SL, Twedt DC. Pheochromocytoma in 50 dogs. J Vet Intern Med. 1994;8:228-232. • Raskin RE, Meyer DJ. Atlas of Canine and Feline Cytology. Philadelphia, PA: W. B. Saunders; 2001: 31-32. Presented at SEVPAC 2008 – Permission granted for use on SEVPAC website only

23. Questions? Presented at SEVPAC 2008 – Permission granted for use on SEVPAC website only