Cholangiocarcinoma in a bitch - multimodal diagnosis

Background: Hepatic tumors of primary origin account for 0.6% to 2.9% of cases in canine species, less common than hepatic metastases. The hepatic tumors are divided into hepatocellular tumors, neuroendocrine tumors, bile duct tumors or cholangiocarcinomas, and mesenchymal tumors. Cholangiocarcinomas, are classified according to their origin, being intrahepatic, extrahepatic, or gallbladder type. Cholangiocarcinomas are considered rare in dogs and cats with a ratio of 29% to 71% compared to hepatocellular carcinomas, accounting for 9% of the hepatic tumors. The present study aims to describe a case of cholangiocarcinoma in a bitch, focusing on the diagnostic approach. Case: A 10-year-old castrated bitch Poodle was attended presenting hypoglycemia and seizure crisis. The patient had previous exams of hemogram and serum biochemical profile, showing a discrete increase of the hepatic enzymes alanine aminotransferase (ALT) and aspartate aminotransferase (AST), besides hypoglycemia. Previous ultrasound exam revealed the presence of a hepatic mass located between the right and square lobes, immeasurable, and significant splenomegaly. Abdominal palpation revealed the presence of immeasurable abdominal formation of undetermined origin. Abdominal computerized tomography (CT), glycemic curve, and insulin dosage were requested. Tomography exam showed an increase in hepatic volume with the presence of a heterogeneous formation in the right lateral lobe topography; increase in spleen dimensions and the presence of multiple nodules; and the presence of a nodule in the right lung, at the caudal thoracic region. The glycemic curve showed acute variations, and insulin dosage was between normal values. The animal was referred for surgery, as in abdominocentesis, it was observed the presence of hemorrhagic fluid, confirming active bleeding by ultrasonography. The owners chose for euthanasia. In the post-mortem evaluation the main lesion was confirmed of hepatic origin, with a massive, irregular, cavitary presentation, involving multiple hepatic lobes, and a single nodule was observed in the right caudal lobe of the right lung. Histopathological evaluation was considered inconclusive. Immunohistochemistry was performed and the association of the immunohistochemical profile with the morphological characteristics indicated diagnosis of cholangiocarcinoma. Discussion: The related symptomatology, in hepatic neoplasms, is generally considered non-specific, with reports of lethargy, vomiting, dyspnea, anorexia and weight loss, however, the dog in this study presented a unique manifestation of hypoglycemia and one episode of convulsive crisis resulting from it. The clinical manifestation observed was extremely unspecific making initial diagnosis difficult. The ultrasonographic examination was effective in evidencing the abdominal mass. In addition, abdominal CT was also performed, which confirmed the hepatic origin, detailing the macroscopic aspect. Biochemical analyses of ALT and AST showed a discrete increase. Biochemical changes may occur in dogs with hepatic neoplasms, although they are not specific. Functional pancreatic beta-cell tumors producing insulin are the most common cause of paraneoplastic hypoglycemia, although in the case the insulin dosage was within normal limits. In cases of nonislet cell tumor the mechanism is frequently associated with the production of insulin-like growth factor (IGF). In most cases the definitive diagnosis of cholangiocarcinoma can be obtained by histopathological examination, although in the present report the result obtained was inconclusive, requiring an immunohistochemical examination. Due to the aggressive and metastatic character of this neoplastic type, early detection becomes extremely important in order to maximize therapeutic chances, however, diagnosis may be difficult.

Avaliação lectino-histoquímica de fígado e linfonodo mesentérico de búfalos mantidos em pastagens de Brachiaria spp / Lectin histochemistry evaluation of liver and mesenteric lymph node of buffaloes kept on Brachiaria spp. pastures

Animais que se alimentam em pastos de Brachiaria spp. comumente apresentam macrófagos espumosos isolados ou agrupados no fígado, além de cristais no interior de ductos biliares. A patogênese da formação e a natureza do material armazenado nestas células, contudo, ainda não são completamente conhecidas. Através da avaliação lectino-histoquímica, saponinas esteroidais (metabólitos glicosilados secundários) têm sido identificadas nos cristais e no citoplasma das células espumosas, e provavelmente são responsáveis por danificar o fígado e levar ao acúmulo de filoeritrina. Por meio deste trabalho, objetivou-se padronizar e caracterizar a utilização da lectino-histoquímica na detecção de metabólitos glicosilados nos tecidos de búfalos mantidos em diferentes pastos de Brachiaria spp. no Brasil. Fragmentos de fígado e linfonodo mesentérico de 40 animais foram analisados: 10 búfalos mantidos em pastagem predominante de B. decumbens por aproximadamente 12 meses; 10 búfalos mantidos em pastagem predominante de B. brizantha por aproximadamente 18 meses; 10 búfalos mantidos em pastagem de B. brizantha por aproximadamente quatro anos; e, como controle negativo, 10 búfalos mantidos em pastagem livre de Brachiaria spp. desde o nascimento. Quatorze lectinas foram testadas (Con-A, SBA, WGA, DBA, UEA, RCA, PNA, GSL-I, PSA, LCA, PHA-E, PHA-L, SJA e SWGA), em um total de 1120 fragmentos avaliados. Estudos anteriores demonstraram que a lectina PNA possui marcada reatividade para macrófagos espumosos de bovinos e ovinos. No presente estudo, a lectina SWGA apresentou acentuada reatividade e alta especificidade para macrófagos espumosos; WGA, GSL, PHA-E e PHA-L mostraram moderada a acentuada reatividade, mas baixa especificidade aos macrófagos espumosos; as outras lectinas não apresentaram reatividade ou especificidade relevantes. Além disso, não houve diferença relevante de marcação entre os fragmentos coletados de animais que se alimentaram de B. decumbens por 12 meses e B. brizantha por 18 meses. Porém, a diminuição da presença e marcação lectino-histoquímica dos macrófagos espumosos nos tecidos dos búfalos que ingeriram Brachiaria brizantha durante mais tempo indica que os animais podem passar por um processo de adaptação de acordo com o tempo de ingestão da planta. A avaliação lectino-histoquímica pode ser utilizada para caracterizar o material armazenado em macrófagos espumosos presentes no fígado e linfonodo mesentérico de búfalos que se alimentam em pastagens de Brachiaria spp. e ajuda na compreensão da patogênese de formação destas células.(AU)

Animals grazing Brachiaria spp. commonly present foamy macrophages isolated or grouped in the liver, and crystals within biliary ducts. The pathogenesis of formation and the nature of the material stored in these cells however are not completely known. Through lectin histochemistry evaluation, steroidal saponins (secondary glycosylated metabolites) have been identified in the crystals and within the cytoplasm of the foam cells, which are probably liable for damaging the liver, leading to accumulation of phylloerythrin. This study aims to standardize and characterize the use of lectin histochemistry to detect glycosylated metabolites in tissues of buffaloes kept on different Brachiaria spp. pastures in Brazil. Fragments of liver and mesenteric lymph node from 40 buffaloes were analyzed: 10 buffaloes that were kept in predominant pasture of B. decumbens for 12 months; 10 buffaloes that were kept in pasture with a predominance of B. brizantha for 18 months; 10 buffaloes that were kept on pasture of B. brizantha for about four years; and as a negative control, 10 buffaloes that were maintained on native pasture without Brachiaria spp. since birth. Fourteen lectins were tested (Con-A, SBA, WGA, DBA, UEA, RCA, PNA, GSL-I, PSA, LCA, PHA-E, PHA-L, SJA and SWGA), in a total of 1120 evaluated samples. Previous studies demonstrated that PNA showed great binding reactivity for foamy macrophages in cattle and sheep. In the present study, SWGA showed high specificity and marked binding reactivity for foamy macrophages; WGA, GSL, PHA-E and PHA-L showed moderate to marked reactivity, but low specificity for foamy macrophages. The other lectins had not relevant reactivity or specificity. Moreover there was no relevant reactivity difference between the collected samplesd from buffaloes that grazed B. decumbens for 12 months and Brachiaria brizantha for 18 months. However the decreased presence of foamy macrophages and its lectin histochemical binding in animals that fed on B. brizantha for a longer time, indicates that the buffaloes can pass through an adaptation process according to the plant intake time. Lectin histochemistry analysis can be used to characterize the material stored in foamy macrophages present in liver and mesenteric lymph node of buffaloes that graze on Brachiaria spp. pastures and helps to clarify the pathogenesis of these cells.(AU)

Avaliação lectino-histoquímica de fígado e linfonodo mesentérico de búfalos mantidos em pastagens de Brachiaria spp. / Lectin histochemistry evaluation of liver and mesenteric lymph node of buffaloes kept on Brachiaria spp. pastures

Animals grazing Brachiaria spp. commonly present foamy macrophages isolated or grouped in the liver, and crystals within biliary ducts. The pathogenesis of formation and the nature of the material stored in these cells however are not completely known. Through lectin histochemistry evaluation, steroidal saponins (secondary glycosylated metabolites) have been identified in the crystals and within the cytoplasm of the foam cells, which are probably liable for damaging the liver, leading to accumulation of phylloerythrin. This study aims to standardize and characterize the use of lectin histochemistry to detect glycosylated metabolites in tissues of buffaloes kept on different Brachiaria spp. pastures in Brazil. Fragments of liver and mesenteric lymph node from 40 buffaloes were analyzed: 10 buffaloes that were kept in predominant pasture of B. decumbens for 12 months; 10 buffaloes that were kept in pasture with a predominance of B. brizantha for 18 months; 10 buffaloes that were kept on pasture of B. brizantha for about four years; and as a negative control, 10 buffaloes that were maintained on native pasture without Brachiaria spp. since birth. Fourteen lectins were tested (Con-A, SBA, WGA, DBA, UEA, RCA, PNA, GSL-I, PSA, LCA, PHA-E, PHA-L, SJA and SWGA), in a total of 1120 evaluated samples. Previous studies demonstrated that PNA showed great binding reactivity for foamy macrophages in cattle and sheep. In the present study, SWGA showed high specificity and marked binding reactivity for foamy macrophages; WGA, GSL, PHA-E and PHA-L showed moderate to marked reactivity, but low specificity for foamy macrophages. The other lectins had not relevant reactivity or specificity. Moreover there was no relevant reactivity difference between the collected samplesd from buffaloes that grazed B. decumbens for 12 months and Brachiaria brizantha for 18 months. [...](AU)

Animais que se alimentam em pastos de Brachiaria spp. comumente apresentam macrófagos espumosos isolados ou agrupados no fígado, além de cristais no interior de ductos biliares. A patogênese da formação e a natureza do material armazenado nestas células, contudo, ainda não são completamente conhecidas. Através da avaliação lectino-histoquímica, saponinas esteroidais (metabólitos glicosilados secundários) têm sido identificadas nos cristais e no citoplasma das células espumosas, e provavelmente são responsáveis por danificar o fígado e levar ao acúmulo de filoeritrina. Por meio deste trabalho, objetivou-se padronizar e caracterizar a utilização da lectino-histoquímica na detecção de metabólitos glicosilados nos tecidos de búfalos mantidos em diferentes pastos de Brachiaria spp. no Brasil. Fragmentos de fígado e linfonodo mesentérico de 40 animais foram analisados: 10 búfalos mantidos em pastagem predominante de B. decumbens por aproximadamente 12 meses; 10 búfalos mantidos em pastagem predominante de B. brizantha por aproximadamente 18 meses; 10 búfalos mantidos em pastagem de B. brizantha por aproximadamente quatro anos; e, como controle negativo, 10 búfalos mantidos em pastagem livre de Brachiaria spp. desde o nascimento. Quatorze lectinas foram testadas (Con-A, SBA, WGA, DBA, UEA, RCA, PNA, GSL-I, PSA, LCA, PHA-E, PHA-L, SJA e SWGA), em um total de 1120 fragmentos avaliados. Estudos anteriores demonstraram que a lectina PNA possui marcada reatividade para macrófagos espumosos de bovinos e ovinos. No presente estudo, a lectina SWGA apresentou acentuada reatividade e alta especificidade para macrófagos espumosos; WGA, GSL, PHA-E e PHA-L mostraram moderada a acentuada reatividade, mas baixa especificidade aos macrófagos espumosos; as outras lectinas não apresentaram reatividade ou especificidade relevantes. [...](AU)

Pathological Findings of Cholelithiasis in Two Horses

Despite of being a relatively rare disease in horses, cholelithiasis is the most common cause of biliary obstructionin this species. Simultaneous intrahepatic and extrahepatic gallstones are the most frequent presentation. Usually, there areno clinical signs associated with this condition, although biliary obstruction could occur as a consequence. Two cases ofcholelithiasis in horses, including gross and histopathological findings are described. In one of the cholelithiasis cases therewas no association with clinical signs or cause of death, but in the other one, chronic loss of weight may have been causedby cholelithiasis.

Pathological Findings of Cholelithiasis in Two Horses

Despite of being a relatively rare disease in horses, cholelithiasis is the most common cause of biliary obstructionin this species. Simultaneous intrahepatic and extrahepatic gallstones are the most frequent presentation. Usually, there areno clinical signs associated with this condition, although biliary obstruction could occur as a consequence. Two cases ofcholelithiasis in horses, including gross and histopathological findings are described. In one of the cholelithiasis cases therewas no association with clinical signs or cause of death, but in the other one, chronic loss of weight may have been causedby cholelithiasis.(AU)