Unit 4 - Pancreas Labs Flashcards
History: Tissue from a 0.25 year old cat that was adopted from the humane society two weeks ago. This animal had a history of lethargy, anorexia and a distended abdomen
Describe this lesion:
Throughout the serosal surface of the intestine, there are numerous, multifocal white to cream-colored, 1-3mm diameter firm, tan foci which occasionally track along blood vessels. Similar firm, 1-2 mm in diameter tan foci are scattered throughout the mesentery.
History: Tissue from a 0.25 year old cat that was adopted from the humane society two weeks ago. This animal had a history of lethargy, anorexia and a distended abdomen
Microscopically, foci on the serosal surfaces of the intestine are composed of large numbers of macrophages admixed with neutrophils and fibrin. Based on the microscopic description, provide an appropraite morphologic diagnosis for the intestinal lesions:
Intestinal serosa & mesentery: Chronic, multifocal, fibrinous and pyogranulomatous serositis/peritonitis
History: Tissue from a 0.25 year old cat that was adopted from the humane society two weeks ago. This animal had a history of lethargy, anorexia and a distended abdomen.
Name the disease.
Feline infectious peritonitis (FIP) – wet form (would have an effusion in the abdomen)
History: Tissue from a 0.25 year old cat that was adopted from the humane society two weeks ago. This animal had a history of lethargy, anorexia and a distended abdomen.
What type of virus causes this disease & what is the long term prognosis?
Caused by a coronavirus. The disease is invariably fatal.
History: Tissue from a 0.25 year old cat that was adopted from the humane society two weeks ago. This animal had a history of lethargy, anorexia and a distended abdomen.
What Clin Path findings would provide support for your diagnosis?
Total serum protein will be greater than 7.8 g/dl
A:G ratio will be greater than 0.8
History: Tissue from a 1 year old CM siamese mix. Healthy kitten for the first half of his life, but has had a chronic history of diarrhea, weight loss, and lethargy for the last 4 months.
Describe the lesions:
Liver: The liver has multifocal poorly demarcated random pale foci 2-5 mm in diameter scattered thoughout the parenchyma.
Kidney: The peri-renal fat of the left and right kidney had multifocal to coalescing yellow prominent foci through-out. The cortical surface of both kidneys also contained multifocal to coalescing small yellow foci that were approximately 1-3 mm in diameter.
History: Tissue from a 1 year old CM siamese mix. Healthy kitten for the first half of his life, but has had a chronic history of diarrhea, weight loss, and lethargy for the last 4 months.
Provide an appropriate morphological diagnosis:
Liver: moderate, chronic, multifocal nodules
Kidney: mild, multifocal renal nodules.
History: Tissue from a 1 year old CM siamese mix. Healthy kitten for the first half of his life, but has had a chronic history of diarrhea, weight loss, and lethargy for the last 4 months.
What is your top differential for these lesions?
Dry form of FIP
History: Tissue from a 1 year old CM siamese mix. Healthy kitten for the first half of his life, but has had a chronic history of diarrhea, weight loss, and lethargy for the last 4 months.
This form of this disease is called the great mimicker, because it is on our differential list for clinical signs in multiple organ systems. In young cats, list the organ systems for which this disease is one of our differentials.
- Abdominal effusion
- Renal dz
- CNS dz
- Ocular dz
- Liver dz
- Respiratory dz
History: Tissue from a 13 year old cat with cranial abdominal pain, vomiting, and weight loss.
Describe this lesion:
Omentum: The omentum was diffusely showered with round, firm, cream-colored nodules that varied in size from 1-8 mm in diameter. Similar nodules were focally present on the serosal surface of the adjacent intestine. The omentum is diffusely red in color (hyperemic)
History: Tissue from a 13 year old cat with cranial abdominal pain, vomiting, and weight loss.
Provide a morphological diagnosis:
Chronic, multifocal omental and serosal masses
History: Tissue from a 13 year old cat with cranial abdominal pain, vomiting, and weight loss.
An impression smear of the lesions reveals a bizarre population of epithelial cells. What is your most likely diagnosis?
These are likely peritoneal implantation metastasis of a carcinoma
History: Tissue from a 13 year old cat with cranial abdominal pain, vomiting, and weight loss.
Describe the process that can result in these lesions and list three primary tumor sites that may have led to these lesions.
Invade through serosa ⇒ small clusters of tumor cells exfoliate into peritoneum ⇒ implant on the serosa of a variety of peritoneal viscera (diaphragm, omentum, mesentery, spleen, liver, intestinal serosa, etc.).
Peritoneal implantation metastases are most commonly identified in association with pancreatic, hepatic, and gastrointestinal tumors.
History: Tissue from a 12.04 year old obese female miniature Schnauzer with an acute history of vomiting, anorexia, and abdominal pain.
Describe the lesions:
Pancreas: The distal limb of the pancreas was diffusely firm, cream/white in color, and had a nodular surface. There were extensive adhesions between the pancreas and omentum that could not be easily broken down by manual manipulation. An approximately 4.5 cm region in the central portion of the pancreas was dark red in color (hemorrhagic) and covered by tan friable material (fibrin). When this region in sectioned, centrally there is irregular grey tan friable tissue (necrosis) There were small foci that were soft and tan in color within the areas of hemorrhage (necrosis). These areas of hemorrhage and necrosis involved approximately 40% of the pancreas.
History: Tissue from a 12.04 year old obese female miniature Schnauzer with an acute history of vomiting, anorexia, and abdominal pain.
Provide appropriate morphologic diagnoses:
- Severe, diffuse, chronic, fibrosing pancreatitis
- Acute, focally extensive fibrinous and necrohemorrhagic pancreatitis
- . Acute, severe, multifocal paripancreatic fat necrosis
History: Tissue from a 12.04 year old obese female miniature Schnauzer with an acute history of vomiting, anorexia, and abdominal pain.
Outline the pathogenesis for the development of the acute pancreatic lesions.
Initiating event ⇒ Zymogen granules fuse with lysosomes à trypsinogen activated to trypsin ⇒ pancreatic secretory trypsin inhibitor overwhelmed ⇒ trypsin activates additional digestive enzymes in pancreas ⇒ autodigestion ⇒ inflammation
History: Tissue from a 14 year old mixed breed canine that had progressive hind end weakness.
Describe the lesion:
The pancreas has low numbers of randomly spaced pale, slightly elevated, tan nodules scattered throughout the parenchyma. These nodules vary in size from 1-3 mm in diameter. When sectioned, they are homogeneous in color and texture.
History: Tissue from a 14 year old mixed breed canine that had progressive hind end weakness.
Provide an appropriate morphological diagnosis.
Chronic, multifocal pancreatic nodules/masses.
History: Tissue from a 14 year old mixed breed canine that had progressive hind end weakness.
This animal did not have any clinical signs of an abdominal problem prior to necropsy. List potential differentials for these pancreatic nodules.
Multifocal nodular hyperplasia
Neoplasia
Granulomas/pyogranulomas (such as you might see with FIP if this were a cat).
History: Tissue from a 14 year old mixed breed canine that had progressive hind end weakness.
Speculate on the clinical significance of these nodules.
This is an example of exocrine nodular pancreatic hyperplasia, which is a common incidental finding in old dogs and cats. There is a positive correlation with age regardless of the presence or absence of pancreatic inflammation, necrosis, or fibrosis
History: Tissue from a 7 year old spayed female cat with a history of intermittent vomiting and not eating. Currently, the cat has a 1 week history of vomiting, lethargy, inappetence, and has a painful abdomen on palpation. On physical exam, the cat is moderately icteric and she had elevated ALP (383), ALT (928) and bilirubin (13.5). Tissue from a 9.67 year old fat female English Springer with a history of not eating and a painful abdomen
Describe this lesion:
Both pancreases are diffusely micronodular, shrunken, firm and pale. In between the pseudolobules on the cat pancreas, the tissue is diffusely red in color.
History: Tissue from a 7 year old spayed female cat with a history of intermittent vomiting and not eating. Currently, the cat has a 1 week history of vomiting, lethargy, inappetence, and has a painful abdomen on palpation. On physical exam, the cat is moderately icteric and she had elevated ALP (383), ALT (928) and bilirubin (13.5). Tissue from a 9.67 year old fat female English Springer with a history of not eating and a painful abdomen
Provide an appropriate morphologic diagnosis
Cat: Chronic/active fibrosing pancreatitis with pseudolobule formation and hyperemia
Dog: Chronic fibrosing pancreatitis with pseudolobule formation
History: Tissue from a 7 year old spayed female cat with a history of intermittent vomiting and not eating. Currently, the cat has a 1 week history of vomiting, lethargy, inappetence, and has a painful abdomen on palpation. On physical exam, the cat is moderately icteric and she had elevated ALP (383), ALT (928) and bilirubin (13.5). Tissue from a 9.67 year old fat female English Springer with a history of not eating and a painful abdomen
What sort of process do you believe led to these lesions and what is a potential long term consequence.
The cat and dog likely suffered from chronic (Relapsing) Pancreatitis.Recurrent, intermittent attacks of pancreatitis led to progressive destruction of the gland.
Necrotic/inflamed foci are liquefied,sequestered, or replaced by fibrous connective tissue ⇒ Loss of Pancreatic parenchyma + fibrosis ⇒ ↓ pancreatic mass with pseudolobular formation ⇒ potentially leading to: Exocrine pancreatic insufficiency and or Diabetes mellitus.
The tissue in between the pseudolobules is red because the cat had chronic pancreatitis with an acute flair-up (explaining the red color and clinical signs) in the cat
History: Tissue from a 7 year old spayed female cat with a history of intermittent vomiting and not eating. Currently, the cat has a 1 week history of vomiting, lethargy, inappetence, and has a painful abdomen on palpation. On physical exam, the cat is moderately icteric and she had elevated ALP (383), ALT (928) and bilirubin (13.5). Tissue from a 9.67 year old fat female English Springer with a history of not eating and a painful abdomen
Provide theories as to why the cat was moderately icteric with elevated ALP (383), ALT (928) and bilirubin (13.5).
- Bile duct obstruction ⇒ post-hepatic jaundice
- Anorexia and vomiting ⇒ hepatic lipidosis (cats)
- Hepatic Necrosis: Activated enzymes cause autodigestion of adjacent liver ⇒ elevated liver enzymes
History: Tissue from a 11 year old French lop (rabbit) that had a history of weight loss and an abdominal effusion.
Describe the lesion
Pancreas: The stomach contained a firm, pale, irregular. multilobulated mass located at the base of the stomach, and extending in between the stomach and the duodenum (the pancreas was unable to be visualized). The mass measured approximately 8 cm x 5 cm. The mass does not infiltrate into the stomach mucosa.There are small, widely-scattered 2-5 mm in diameter cream colored nodules on the serosal surface of the small and large intestine
History: Tissue from a 11 year old French lop (rabbit) that had a history of weight loss and an abdominal effusion.
Provide an appropriate morphologic diagnosis.
Pancreas: Severe, chronic focally extensive pancreatic mass
Intestinal serosa: multifocal serosal nodules.
History: Tissue from a 11 year old French lop (rabbit) that had a history of weight loss and an abdominal effusion.
What is the expected biologic behavior of this tumor?
This is an exocrine panxcreatic adenocarcinoma.Would expect…
- Marked local tissue invasion
- Duodenum, stomach, ascending and transverse colon
- Transcoelomic (intraperitoneal) metastasis (as was observed in this case)
- Mets to lung, liver, spleen, kidney
