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.

Congenital extrahepatic portosystemic deviation of gastric vein with azygos in a bitch

Background: Portosystemic shunt (PSS), an alteration commonly found in toy dogs, is caused by an anastomosis between the systemic and portal circulation, interfering with the metabolism of several toxins. It can be of congenital or acquired origin and is classified as intra- or extrahepatic. Clinical signs include the gastrointestinal tract, nervous system, and urinary system according to the fraction of the shunt. It is diagnosed by several imaging tests and exploratory laparotomy. Therapy involves drug therapy and/or surgical correction of the anomalous vessels. Thus, the aim is to present an unusual case of extrahepatic cPSS originating from the left gastric vein and insertion into the azygos vein. Case: A 2-year-old female toy poodle, spayed, weighing 2.7 kg was treated with a history of recurrent cystitis and neurological signs such as focal seizures, ataxia, tremors, blindness, lethargy, head pressing, and compulsive gait. Complementary tests revealed normochromic microcytic anemia, neutrophilia-induced leukocytosis, monocytosis, and lymphopenia. Biochemical analysis revealed hypoproteinemia due to hypoglobulinemia, an increase in alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase, and gamma-glutamyl transferase, and a decrease in urea. In the urinalysis, ammonium biurate crystals were detected, and Doppler ultrasound revealed microhepathy and the presence of an anomalous gastrosplenic vein inserted into the azygos vein, a finding compatible with the congenital extrahepatic PSS. Abdominal tomography confirmed vascular deviation with a sinuous path originating from the left gastric and splenic veins, inserting into the azygos vein, measuring approximately 5.95 cm in length. Cranial tomography revealed changes consistent with hepatic encephalopathy. Drug therapy was performed with hydration, liver chow, lactulose, probiotics, metronidazole, S-adenosyl-L-methionine, and ursodeoxycholic acid, and after 15 days, surgery was performed to place a 3.5 mm ameroid constrictor ring for gradual occlusion of the anomalous vessel. The animal recovered well, and a control abdominal ultrasound was repeated 30 days after the procedure, noting that the constrictor had not yet fully occluded the deviation. Doppler imaging revealed a favorable evolution with an increase in the diameter of the portal vein in the hepatopetal direction. The patient was followed-up for a year and had a normal and healthy life. Discussion: Extrahepatic PSS is frequently diagnosed in purebred and toy dogs, commonly occurring between the portal vein and one of its tributaries, with a lower frequency of anomalous vessels between the azygos veins, as in the present report. The patient's age and clinical signs were compatible with the disease, in addition to ammonia biurate crystals and hematological and biochemical alterations. The neurological clinical signs observed were compatible with hepatic encephalopathy secondary to congenital PSS. The imaging examinations facilitated the identification of the extrahepatic vascular anomaly, with the tomography being more accurate and helping in proper surgical planning. Clinical treatment should be performed for presurgical stabilization, and occlusion can be performed by placing cellophane bands or an ameroid constrictor, which is the technique of choice for congenital PSS, as it allows for slow constriction to avoid acute portal hypertension, as in this case, emphasizing that anesthesia in animals with portosystemic shunts must be performed with care.

Metastatic gallbladder adenocarcinoma in a cat

Biliary neoplasms are uncommon in cats and affect older animals. A 12-year-old female crossbreed cat showed prostration, lethargy, apathy, and severe jaundice. Ultrasonography showed distention of the gallbladder associated with severe obstruction of the bile ducts with thickening of the biliary wall, forming amorphous masses of irregular contour and heterogeneous appearance directed to the lumen measuring up to 2 cm. Necropsy showed a gallbladder with a yellowish and soft nodule measuring 3 × 3 cm, compressing the extrahepatic bile duct, occluding the passage of bile. There were also firm, yellowish multifocal to coalescing nodules in the liver, ranging from 0.5 to 1 cm, affecting 10% of the organ, in addition to lungs with firm, yellowish multifocal nodules ranging from 0.2 to 0.5 cm, affecting 20% of the organ. Histologically, gallbladder and bile ducts had malignant epithelial neoplastic proliferation, which was organized into multiple papillary and ductal projections, separated by moderate fibrovascular stroma compatible with gallbladder adenocarcinoma. The liver and lungs also contained neoplastic structures with a ductal appearance and papilliform projections identical to those observed in the gallbladder. The immunohistochemical examination (IHC) showed intense positive staining of epithelial neoplastic cells for pan-cytokeratin (AE1/AE3) and no staining for vimentin (Clone V9). The diagnosis of gallbladder adenocarcinoma with metastasis in the liver and lungs was established based on the clinical, macroscopic, histopathological, and immunohistochemical findings.(AU)

Avaliação ultrassonográfica das vias biliares em cães e gatos: coletas e análises de registros médicos veterinários / Ultrasonographic evaluation of the bile ducts in dogs and cats: Collections and analyses of veterinary medical records

Este estudo teve como objetivo avaliar achados ultrassonográficos de cães e gatos diagnosticados com colestase, correlacionando alterações concomitantes com espécies, sexo, idade, peso, sinais clínicos e dilatação das vias biliares. O sistema biliar de pequenos animais é composto pela vesícula biliar e a árvore biliar. Desta forma, os felinos apresentam mais alterações nestas estruturas devido à anatomia diferenciada. A redução do fluxo biliar, conhecida como colestase, ocorre por inúmeras situações, sendo o ultrassom o principal exame diagnóstico empregado na medicina veterinária. Ductos biliares de 4 e 3mm de diâmetro são considerados normais para felinos e caninos, respectivamente. Neste estudo, os sistemas biliares de 41 animais, incluindo felinos e caninos, foram avaliados por ultrassonografia no Setor de Diagnóstico por Imagem do Hospital Veterinário de janeiro de 2019 a fevereiro de 2020, demonstrando a presença de cálculos vesicais em ambas as populações, assim como alterações em ducto cístico associados à pancreatite em cães.

This study aimed to evaluate ultrasound findings of dogs and cats diagnosed with cholestasis, correlating concomitant alterations with species, sex, age, weight, clinical signs, and dilation of bile ducts. The biliary system of small animals is composed of the gallbladder and the biliary tree. Thus, the felines show more alterations in these structures due to their differentiated anatomy. The reduction of the bile flow, known as cholestasis, occurs as a result of numerous situations, with ultrasound being the main diagnostic exam applied in veterinary medicine. Bile ducts of 4 and 3mm diameter are considered normal for felines and canines, respectively. In this study, the biliary systems of 41 animals, including felines and canines, were evaluated using ultrasound at the Diagnostic Imaging Sector of the Veterinary Hospital from January 2019 to February 2020, demonstrating the presence of bladder stones in both populations, as well as changes in the cystic duct associated with pancreatitis in dogs.

Hematological and biochemical changes in a cow with metastatic cholangiocarcinoma

We describe here hematological and biochemical findings in a cow with metastatic cholangiocarcinoma. On physical examination, apathy with congested mucous membranes, tachycardia and enlarged abdomen; hypoperistalsis in rumen, abomasum and intestines. In hematological examination, icteric plasma with leukocytosis by neutrophilia with regenerative left shift and inversion of the proportion between lymphocytes and segmented neutrophils, and hypofibrinemia. In serum biochemistry: hyperproteinemia, hypoalbuminemia, hyperglobulinemia, low albumin/globulin ratio and high levels of aspartate aminotransferase, gamma-glutamyltransferase. The cow died and in necropsy was observed a severe and diffuse increase in volume predominantly on the hepatic right lobe and moderate increase of volume in mesenteric lymph nodes. Which was diagnosed microscopically as a cholangiocarcinoma, characterized by arrangements in irregular and coalescent ducts. In conclusion, cholangiocarcinoma may cause important hematological and biochemical changes in cattle.(AU)

Biliary cystadenoma in a lion (Panthera leo)

Animals in human care often exceed the life expectancy of animals in the wild when they have veterinarian follow-ups, no competition for space or food, and continuous care. Advanced age favors the development of mutations that often trigger cancer, which sometimes causes death. There are reports in the literature on neoplasms in lions in the liver, which are one of the main organs affected. A 20-year-old lion specimen was received for necropsy at the Federal University of Paraná, Curitiba, Brazil. Multiple cystic dilations were observed in the liver. Histologically, they were internally covered by a simple cuboidal epithelium, similar to that observed in the bile ducts, without cellular atypia. The adjacent liver parenchyma presented with mild disorganization of the hepatocyte cords. Biliary cystadenomas are benign growths formed by a thin opaque capsule filled with a slightly yellowish translucent fluid compressing the adjacent liver parenchyma, as highlighted in this case. The epithelium of the cysts was positive for anti-cytokeratin (CK) (EIA/A3E) and anti-CK7, confirming histogenesis in the bile ducts. This study reports a case of biliary cystadenoma in a Panthera leo specimen.(AU)

Caroli syndrome in a dog / Síndrome de Caroli em um cão

Caroli syndrome is characterized by a combination of intrahepatic biliary ductal ectasia and congenital ductal fibrosis due to the failure of involution of ductal plates and large intrahepatic ducts. This study aims to report Caroli syndrome in a dog, with emphasis on clinical characteristics, complementary examinations, and diagnostic approach. A 1-year-old mixed-breed intact male dog was presented with a 7-day history of acute vomiting and anorexia. Clinical evaluation revealed severe jaundice, abdominal pain, dehydration, lethargy, and abdominal distension. Ultrasonography revealed hepatic cysts filled with fluid. Exploratory laparotomy was performed to clarify the imaging findings; however, the dog died shortly after surgery. Postmortem examination revealed that the liver was reduced in size and had multiple interconnected and distended saccular dilations. The bile ducts were markedly dilated and replaced a large part of the liver parenchyma. Multiple small cysts were also observed in the kidneys. Microscopically, the hepatic lesions were characterized by extensive bridging fibrosis associated with proliferating and ectatic bile ducts contiguous with the biliary tree. Marked fibrosis and small cysts were observed in the kidneys. Therefore, a final diagnosis of Caroli syndrome was made. While uncommon, this syndrome should be considered as a differential diagnosis for young dogs with biliary cysts and hepatic fibrosis.

A síndrome de Caroli é caracterizada pela combinação de ectasia biliar intra-hepática e fibrose ductal congênita, que se devem a falha na involução das placas ductais dos grandes ductos intra-hepáticos. Esse trabalho tem a intenção de reportar um caso de síndrome de Caroli em um canino, com ênfase em suas características clínicas, exames complementares, e abordagem diagnóstica. Um canídeo de um ano de idade, sem raça definida, apresentou um histórico clínico de sete dias de vômito agudo e anorexia. A avaliação clínica revelou severa icterícia, dor abdominal, desidratação, letargia e distensão abdominal. A ultrassonografia foi sugestiva de cistos hepáticos preenchidos por fluido. Uma laparotomia exploratória foi realizada para esclarecer os achados de imagem, porém, o cão morreu logo após a cirurgia. O cão foi submetido a exame de necropsia, onde se observou fígado diminuído em tamanho e com múltiplas dilatações saculares distendidas e interconectadas entre si. Os ductos biliares estavam acentuadamente dilatados e substituíam grande parte do parênquima hepático. Nos rins, múltiplos pequenos cistos eram observados. Microscopicamente as lesões hepáticas eram caracterizadas por extensa fibrose em ponte, associada a ductos biliares ectáticos e proliferados, que eram contíguos a árvore biliar. Nos rins, marcada fibrose e pequenas formações císticas foram observadas. Baseado na associação dos achados clínicos e patológicos, o diagnóstico de síndrome de Caroli foi feito. Mesmo que incomum, essa síndrome deve ser considerada como um diagnóstico diferencial para cães jovens com ductos biliares císticos e fibrose hepática.

Platinossomose em felino doméstico no município de Pelotas, RS, Brasil / Platinosomosis in feline domestic in the municipality of Pelotas, RS, Brazil / Platinosomosis en felinos domésticos en el municipio de Pelotas, RS, Brasil

Platynosomum spp. é um trematódeo, da família Dicrocoeliidae, que tem como hospedeiros definitivos, os felídeos, mas também pode parasitar primatas e aves silvestres. Animais que possuem o hábito de se alimentar de répteis ou anfíbios, são mais susceptíveis. Acomete principalmente o fígado e os ductos biliares, mas pode ser eventualmente encontrado também no intestino delgado, ductos pancreáticos, pulmões e outros tecidos. A fisiopatologia inclui quadro de colangite crônica, podendo se estender e acometer o parênquima hepático e culminar com colangiohepatite, fibrose biliar, cirrose e obstrução biliar. Os sinais clínicos variam conforme a gravidade do caso e duração da infecção. As manifestações clínicas incluem anorexia, letargia, perda de peso, hepatomegalia, distensão abdominal e vômitos, podendo ocorrer, ainda, icterícia e alteração de consistência das fezes. Os gatos adultos, não domiciliados ou domiciliados com acesso à rua que possuem hábitos de caça, são mais predispostos. O diagnóstico definitivo pode ser feito pela pesquisa parasitológica e presença de ovos em análise coproparasitológica, pela identificação de ovos na bile e mais frequentemente por histopatologia hepática. O tratamento consiste no uso de anti-helmínticos, sendo que o mais eficaz é o praziquantel. Além disso, medidas preventivas devem ser adotadas, como evitar que os gatos tenham acesso aos hospedeiros intermediários. O presente relato, consiste no diagnóstico coproparasitológico de platinossomose em dois felinos domésticos, no município de Pelotas, RS, Brasil.

Platynosomumspp. is a trematode, from the family Dicrocoeliidae, which has felids as its definitive host, but can also parasite primates and wild birds. Animals that have a habit of feeding on reptiles or amphibians are more susceptible. It mainly affects the liver and bile ducts, but it can eventually be found also in the small intestine, pancreatic ducts, lungs and other tissues. Pathophysiology includes chronic cholangitis, which may extend and affect the liver parenchyma and culminate in cholangiohepatitis, biliary fibrosis, cirrhosis and biliary obstruction. Clinical signs vary according to the severity of the case and the duration of the infection. Clinical manifestations include anorexia, lethargy, weight loss, hepatomegaly, bloating and vomiting, and jaundice and alteration of stool consistency may also occur. Adult cats, homeless or homeless with access to the street who have hunting habits, are more predisposed. The definitive diagnosis can be made through parasitological research and presence of eggs in coproparasitological analysis, by identifying eggs in the bile and more often through hepatic histopathology. Treatment consists of the use of anthelmintics, the most effective of which is praziquantel. In addition, preventive measures must be adopted, such as preventing cats from having access to intermediate hosts. The present report consists of the coproparasitological diagnosis of platinosomosis in two domestic cats, in the municipality of Pelotas, RS, Brazil.

Platynosomum spp. es un trematodo, de la familia Dicrocoeliidae, que tiene a los felinos como hospedadores definitivos, pero también puede parasitar primates y aves silvestres. Los animales que tienen la costumbre de alimentarse de reptiles o anfibios, sonmás susceptibles. Afecta principalmente al hígado y los conductos biliares, pero eventualmente también se puede encontrar en el intestino delgado, los conductos pancreáticos, los pulmones y otros tejidos. La fisiopatología incluye la colangitis crónica, que puede extenderse y afectar el parénquima hepático y culminar en colangiohepatitis, fibrosis biliar, cirrosis y obstrucción biliar. Los signos clínicos varían según la gravedad del caso y la duración de la infección. Las manifestaciones clínicas incluyen anorexia, letargo, pérdida de peso, hepatomegalia, distensión abdominal y vómitos, e ictericia y alteración de la consistencia de las heces. Los gatos adultos, sin hogar o sin hogar con acceso a la calle que tienen hábitos de caza, están más predispuestos. El diagnóstico definitivo se puede realizar mediante la investigación parasitológica y la presencia de huevos en el análisis coproparasitológico, mediante la identificación de los huevos en la bilis y más a menudo mediante la histopatología hepática. El tratamiento consiste en el uso de antihelmínticos, el más eficaz de los cuales es el praziquantel. Además, se deben adoptar medidas preventivas, como evitar que los gatos tengan acceso a huéspedes intermediarios. El presente informe consiste en el diagnóstico coproparasitológico de platinosomosa en dos gatos domésticos, en el municipio de Pelotas, RS, Brasil.

Platinossomose em felino doméstico no município de Pelotas, RS, Brasil / Platinosomosis in feline domestic in the municipality of Pelotas, RS, Brazil / Platinosomosis en felinos domésticos en el municipio de Pelotas, RS, Brasil

Platynosomum spp. é um trematódeo, da família Dicrocoeliidae, que tem como hospedeiros definitivos, os felídeos, mas também pode parasitar primatas e aves silvestres. Animais que possuem o hábito de se alimentar de répteis ou anfíbios, são mais susceptíveis. Acomete principalmente o fígado e os ductos biliares, mas pode ser eventualmente encontrado também no intestino delgado, ductos pancreáticos, pulmões e outros tecidos. A fisiopatologia inclui quadro de colangite crônica, podendo se estender e acometer o parênquima hepático e culminar com colangiohepatite, fibrose biliar, cirrose e obstrução biliar. Os sinais clínicos variam conforme a gravidade do caso e duração da infecção. As manifestações clínicas incluem anorexia, letargia, perda de peso, hepatomegalia, distensão abdominal e vômitos, podendo ocorrer, ainda, icterícia e alteração de consistência das fezes. Os gatos adultos, não domiciliados ou domiciliados com acesso à rua que possuem hábitos de caça, são mais predispostos. O diagnóstico definitivo pode ser feito pela pesquisa parasitológica e presença de ovos em análise coproparasitológica, pela identificação de ovos na bile e mais frequentemente por histopatologia hepática. O tratamento consiste no uso de anti-helmínticos, sendo que o mais eficaz é o praziquantel. Além disso, medidas preventivas devem ser adotadas, como evitar que os gatos tenham acesso aos hospedeiros intermediários. O presente relato, consiste no diagnóstico coproparasitológico de platinossomose em dois felinos domésticos, no município de Pelotas, RS, Brasil.(AU)

Platynosomumspp. is a trematode, from the family Dicrocoeliidae, which has felids as its definitive host, but can also parasite primates and wild birds. Animals that have a habit of feeding on reptiles or amphibians are more susceptible. It mainly affects the liver and bile ducts, but it can eventually be found also in the small intestine, pancreatic ducts, lungs and other tissues. Pathophysiology includes chronic cholangitis, which may extend and affect the liver parenchyma and culminate in cholangiohepatitis, biliary fibrosis, cirrhosis and biliary obstruction. Clinical signs vary according to the severity of the case and the duration of the infection. Clinical manifestations include anorexia, lethargy, weight loss, hepatomegaly, bloating and vomiting, and jaundice and alteration of stool consistency may also occur. Adult cats, homeless or homeless with access to the street who have hunting habits, are more predisposed. The definitive diagnosis can be made through parasitological research and presence of eggs in coproparasitological analysis, by identifying eggs in the bile and more often through hepatic histopathology. Treatment consists of the use of anthelmintics, the most effective of which is praziquantel. In addition, preventive measures must be adopted, such as preventing cats from having access to intermediate hosts. The present report consists of the coproparasitological diagnosis of platinosomosis in two domestic cats, in the municipality of Pelotas, RS, Brazil.(AU)

Platynosomum spp. es un trematodo, de la familia Dicrocoeliidae, que tiene a los felinos como hospedadores definitivos, pero también puede parasitar primates y aves silvestres. Los animales que tienen la costumbre de alimentarse de reptiles o anfibios, sonmás susceptibles. Afecta principalmente al hígado y los conductos biliares, pero eventualmente también se puede encontrar en el intestino delgado, los conductos pancreáticos, los pulmones y otros tejidos. La fisiopatología incluye la colangitis crónica, que puede extenderse y afectar el parénquima hepático y culminar en colangiohepatitis, fibrosis biliar, cirrosis y obstrucción biliar. Los signos clínicos varían según la gravedad del caso y la duración de la infección. Las manifestaciones clínicas incluyen anorexia, letargo, pérdida de peso, hepatomegalia, distensión abdominal y vómitos, e ictericia y alteración de la consistencia de las heces. Los gatos adultos, sin hogar o sin hogar con acceso a la calle que tienen hábitos de caza, están más predispuestos. El diagnóstico definitivo se puede realizar mediante la investigación parasitológica y la presencia de huevos en el análisis coproparasitológico, mediante la identificación de los huevos en la bilis y más a menudo mediante la histopatología hepática. El tratamiento consiste en el uso de antihelmínticos, el más eficaz de los cuales es el praziquantel. Además, se deben adoptar medidas preventivas, como evitar que los gatos tengan acceso a huéspedes intermediarios. El presente informe consiste en el diagnóstico coproparasitológico de platinosomosa en dos gatos domésticos, en el municipio de Pelotas, RS, Brasil.(AU)

Cholelithiasis, choledocholithiasis and hepatolithiasis with secondary necrotizing hepatitis and cholangiohepatitis in a dairy cow

Biliary calculi are rare in cattle and occur usually in the gallbladder, without clinical signs. In humans, cholelithiasis is a common cause of hepatic abscess due calculi microbiota. Here is described a case of cholelithiasis, choledocholithiasis and hepatolithiasis in a 10-year-old female mixed breed dairy cow. The animal died during physical examination with signs as cachexia, icterus, and fever. At necropsy, a large number of green calculi were observed in the gallbladder, common duct lumen and in markedly distended biliary ducts. The liver was firm and decreased in volume with multiple abscess and multiple red foci measuring 0.5 cm in diameter in the hepatic parenchyma. Microscopically in the liver, marked ductal proliferation and abscedative cholangiohepatitis with abundant fibrosis and multiple foci of hepatocytes necrosis. In conclusion, choledocholithiasis and hepatolithiasis may occur in cattle and cause significant clinical signs and pathological alterations.(AU)

Cholelithiasis, choledocholithiasis and hepatolithiasis with secondary necrotizing hepatitis and cholangiohepatitis in a dairy cow

Biliary calculi are rare in cattle and occur usually in the gallbladder, without clinical signs. In humans, cholelithiasis is a common cause of hepatic abscess due calculi microbiota. Here is described a case of cholelithiasis, choledocholithiasis and hepatolithiasis in a 10-year-old female mixed breed dairy cow. The animal died during physical examination with signs as cachexia, icterus, and fever. At necropsy, a large number of green calculi were observed in the gallbladder, common duct lumen and in markedly distended biliary ducts. The liver was firm and decreased in volume with multiple abscess and multiple red foci measuring 0.5 cm in diameter in the hepatic parenchyma. Microscopically in the liver, marked ductal proliferation and abscedative cholangiohepatitis with abundant fibrosis and multiple foci of hepatocytes necrosis. In conclusion, choledocholithiasis and hepatolithiasis may occur in cattle and cause significant clinical signs and pathological alterations.

Cardiac and renal effects of liver cirrhosis in a growing animal model

ABSTRACT Purpose: To assess the biochemical, histological, histomorphometric and molecular effects of biliary duct ligation (BDL) induced liver cirrhosis in the heart and kidneys. Methods: Thirty-two weaning rats (21 days old, 50-70 g) underwent BDL and were divided in four groups (euthanasia after two, four, six, and eight weeks, respectively) and compared to control groups. Results: The animals' hearts of group 3 were bigger than those of the control group (p=0.042), including thinner right ventricle wall, decreased internal diameter of ventricles, and increased perivascular collagen deposition in left ventricle, as well as increased interstitial collagen in right ventricle after six weeks. In the kidneys of groups 3 and 4, bilirubin impregnation in the tubules, hydropic degeneration, loss of nuclei and lack of plasmatic membrane limits were noted. Nitric oxide synthase (NOS) gene expressions were higher in group 1 (p=0.008), and endothelial nitric oxide synthase (eNOS) gene expressions were elevated in all experimental groups (p=0.008, p=0.001, p=0.022, and p=0.013, respectively). In the heart, a decreased expression of eNOS in group 1 (p=0.04) was observed. Conclusions: Liver cirrhosis leads to histological and histomorphometric alterations in the heart and kidneys, with changes in the NOS and eNOS gene expressions, that may suggest a role in the associated myocardial and renal manifestations.

Immune response in Santa Inês sheep during Fasciola hepatica infection / Resposta imune em ovinos da raça Santa Inês durante a infecção por Fasciola hepatica

In the present study, we describe the proliferative response and the IFN-γ, IL-10, IL-4 cytokine expression profiles in peripheral blood, and IgG production, after the experimental infection of Santa Inês sheep with 250 Fasciola hepatica metacercariae that were evaluated at 60 and 210 days post-infection(dpi). The cytokine expression profile at 60 dpi was characterized by the production of IFN-γ and IL-10, which is indicative of an initial mixed Th1/Th2 response. The modulation of the response occurred at 210 dpi with a predominance of IL-10 and IL-4 over IFN-γ. Mononuclear cells from peripheral blood stimulated with F. hepatica antigen exhibited proliferative capacity at 60 dpi, whereas the response was consistent with modulation from Th1 to Th2 in the chronic phase. The IgG antibody response was more marked at 60 days than at 210 dpi, confirming the mixed-response profile. The late modulation of the T lymphocyte response in association with the predominance of IL-10 and IL-4 at 210 dpi suggests the involvement of these cytokines after the establishment of the parasites in the bile ducts. The transition from a mixed to a regulatory response in the chronic phase was also accompanied by a reduced number of eggs per gram of feces.(AU)

No presente estudo, observou-se a resposta proliferativa e os perfis de expressão de citocinas IFN-γ, IL10, IL-4 no sangue periférico, e a produção de IgG, aos 60 e 210 dias após infecção (dpi) experimental de ovinos Santa Inês com 250 metacercárias de Fasciola hepatica. O perfil de expressão de citocinas aos 60 dpi foi caracterizado pela produção de IFN-γ e IL-10, o que é indicativo de uma resposta mista inicial Th1/ Th2. A modulação da resposta ocorreu aos 210 dpi, com predominância de IL-10 e IL-4 sobre IFN-γ. As células mononucleares do sangue periférico estimuladas com antígeno total de F. hepatica adulta exibiram capacidade proliferativa aos 60 dpi, enquanto a resposta foi consistente com uma modulação de Th1 para Th2 na fase crônica. A resposta do anticorpo IgG foi maior aos 60 dpi do que aos 210 dpi. A modulação tardia da resposta dos linfócitos T em associação com a predominância de IL-10 e IL-4 aos 210 dpi sugere o envolvimento dessas citocinas após o estabelecimento dos parasitos nos ductos biliares. A transição de uma resposta mista para uma resposta com pefil regulador na fase crônica também foi acompanhada por redução dos ovos por grama de fezes.(AU)

Hepatogenous photosensitization in steer by Brachiaria decumbens

Background: Although the etiology of hepatogenous photosensitization has not yet been fully elucidated, it is known that hepatotoxic substances (saponins) present in grasses of the genus Brachiaria spp. are responsible for intoxication of ruminants and horses, causing great economic losses in the whole world. Since this grass is the source of food for the herd in Brazil, and other countries of the world, the aim of this paper is to describe the epidemiological, clinical, laboratory and anatomopathological aspects of a steer with this disease. Case: A 3-year-old Nellore steer was referred to veterinary care at a property in Bahia, with a 3-week history of swelling, loss of cutaneous tissue in the ear and scrotum region, and dry faeces. The animal was raised in pasture with Brachiaria decumbens along with five animals of different age and sex; however, it was the only one to present symptoms. Although the animal had been treated at the farm, there was no clinical improvement. On clinical examination, the steer was apathetic with jaundiced mucous membranes, nasal and ocular discharge, epiphora, and ulcers on the labial and gum commissure. The steer had leukocytosis with neutrophilia, anemia, and hyperfibrinogemia. The body condition score (BCS) was 2 (BCS ranges from 1 to 5), and the skin lesions observed were bedsores, necrosis and scabs in several regions. The increase in liver enzymes (GGT, AST) indicated hepatic impairment, suggesting a case of hepatogenous photosensitization. The therapeutic protocol instituted was enteral hydration, electrolyte replacement, topical application of ointment in the injured areas. In addition, it was recommended to maintain the animal in the shade, supply of good quality grass, and a new clinical evaluation in seven days. On new examination, it was observed that there was no satisfactory clinical improvement of the animal, and persistence of laboratory changes. Despite the poor prognosis, treatment was continued for another month with the same recommendations. However, in view of the severe clinical condition and unfavorable prognosis, the animal was submitted euthanasia. Necropsy revealed extensive areas of bedsores, erythema, severe jaundice in the mucous membranes, eyeballs and opaque corneas. The liver had an enlarged volume with bulging edges and a greenish color. The kidneys had a pale brownish color, with an irregular and mottled subcapsular surface, with blackened and depressed spots. Histologically, the cytoplasm of the hepatocytes was finely vacuolated, sometimes refringent and with an abundant presence of bile pigment. It was also observed in the middle of the liver parenchyma, multiple foci of accumulation of macrophages filled with vacuoles of different sizes containing saponins and crystals of saponins inside bile ducts. Furthermore, it was possible to observe hypertrophy and hyperplasia of Kupffer cells, disarrangement of hepatocytes with individual necrosis of hepatocytes. Discussion: The diagnosis of hepatogenous photosensitization was based on history, clinical, laboratory and anatomopathological findings. Serum biochemistry was important to measure hepatic impairment and possible secondary lesions, which were confirmed by the necropsy. Although hepatogenous photosensitization is less common in adult cattle, it must be considered in the differential diagnosis of skin lesions, reduced appetite, and jaundice. Since it was a sporadic case, individual predisposition is probably a preponderant factor.

A practical new strategy to prevent bile duct injury during laparoscopic cholecystectomy. A single-center experience with 5539 cases

Purpose; Bile duct injury (BDI) is a catastrophic complication of cholecystectomy, and misidentification of the cystic anatomy is considered to be the main cause. Although several techniques have been developed to prevent BDI, such as the “critical view of safety”, the infundibular technique, the rates remain higher during laparoscopic cholecystectomy (LC) than during open surgery. We, here, propose a practical new strategy for ductal identification, that can help to prevent laparoscopic bile duct injury.; Methods; A retrospective study of 5539 patients who underwent LC from March 2007 to February 2019 at a single institution was conducted. The gallbladder infundibulum was classified by its position located on an imaginary clock with the gallbladder neck as the center point of the dial, 3-oclock position as cranial, 6-oclock as dorsal, 9-oclock as caudal, and 12-oclock as ventral, as well as the axial position. Patient demographics, pathologic variables and infundibulum classification were evaluated. Detailed analysis of ductal identification based on gallbladder infundibulum position was performed in this study. All infundibulum positions were recorded by intraoperative laparoscopic video or photographic images.; Results; All the patients successfully underwent LC during the study period. No conversion or serious complications such as biliary injury occurred. Gallbladders with infundibulum of 3-oclock position, 6-oclock position, 9-oclock position, 12-oclock position, axial position were 12.3%, 23.4%, 28.0%, 4.2%, and 32.1%, respectively. The 3-oclock and 12-oclock position were pitfalls that might cause biliary injury.; Conclusion; The gallbladder infundibulum as a navigator is useful for ductal identification to reduce BDI and improve the safety of LC.(AU)

Pathological and immunohistochemical aspects of primary hepatobiliary neoplasms in cats / Aspectos patológicos e imuno-histoquímicos de neoplasias hepatobiliares primárias em gatos

Primary hepatobiliary neoplasms (PHN) are uncommon in cats, and originate in hepatocytes, intra- and extrahepatic bile ducts, mesenchymal cells, and cells of neuroendocrine origin. The aim of this study was to determine the frequency of PHN in cats diagnosed in the metropolitan region of Porto Alegre (RS), Brazil, for a period of 17 years, determining their epidemiological, anatomopathological and immunohistochemical aspects. Necropsy reports of 2.090 cats were analyzed, 125 were diagnosed with primary hepatobiliary diseases, of which 15 were cases of PHN, representing 12% of the specific hepatobiliary conditions and 0.7% of the necropsies. All PHN were malignant, of which 93.3% had epithelial origin and 6.7% presented mesenchymal origin. Cholangiocarcinoma was the most commonly diagnosed neoplasm, followed by hepatocellular carcinoma and hemangiosarcoma. In general, cats with no defined breed were the most affected. Concerning sex, 60% were females and 40% males. Age ranged from five to 18 years, with a mean age of 10.5 years (median of ten years). Grossly, cholangiocarcinoma and hemangiosarcoma were multinodular and hepatocellular carcinoma was massive. Microscopically, cholangiocarcinomas were arranged in acini and ducts, whereas hepatocellular carcinomas were arranged in solid sheets or trabeculae. On immunohistochemistry, cholangiocarcinomas, hepatocellular carcinomas, and hemangiosarcomas were positive for the antibodies CK 7, Hep Par-1, and vimentin and von Willebrand factor, respectively.(AU)

Neoplasias hepatobiliares primárias (NHP) são incomuns em gatos e se originam de hepatócitos, células dos ductos biliares intra e extra-hepáticos, células mesenquimais e ainda células de origem neuroendócrina. O objetivo do trabalho foi determinar a frequência das NHP em gatos diagnosticados na Região Metropolitana de Porto Alegre, no período de 17 anos, abordando seus aspectos epidemiológicos, anatomopatológicos e imuno-histoquímicos (IHQ). Foram analisados os laudos de necropsia de 2.090 gatos sendo que 125 foram diagnosticados com doenças hepatobiliares primárias, destes 15 foram casos de NHP, representando 12% das condições hepatobiliares específicas e 0,7% do total de necropsias. Todos os diagnósticos de NHP eram malignos, destes 93,3% apresentaram origem epitelial e 6,7% mesenquimal. Colangiocarcinoma foi a neoplasia mais diagnosticada, seguido do carcinoma hepatocelular e hemangiossarcoma. De uma maneira geral, os gatos sem raça definida foram os mais acometidos. Em relação ao sexo 60% eram fêmeas e 40% machos. A idade variou de cinco a 18 anos, com a idade média de 10,5 anos (mediana de 10 anos). Macroscopicamente o colangiocarcinoma e hemangiossarcoma eram multinodulares, e o carcinoma hepatocelular, maciço. À histologia, houve predomínio do arranjo acinar e ductal nos colangiocarcinomas e sólido, no carcinoma hepatocelular. Na IHQ os colangiocarcinomas foram reativos para CK 7, carcinoma hepatocelular para Hep Par-1 e hemangiossarcoma para vimentina e fator de von Willebrand.(AU)

Pathological and immunohistochemical aspects of primary hepatobiliary neoplasms in cats / Aspectos patológicos e imuno-histoquímicos de neoplasias hepatobiliares primárias em gatos

Primary hepatobiliary neoplasms (PHN) are uncommon in cats, and originate in hepatocytes, intra- and extrahepatic bile ducts, mesenchymal cells, and cells of neuroendocrine origin. The aim of this study was to determine the frequency of PHN in cats diagnosed in the metropolitan region of Porto Alegre (RS), Brazil, for a period of 17 years, determining their epidemiological, anatomopathological and immunohistochemical aspects. Necropsy reports of 2.090 cats were analyzed, 125 were diagnosed with primary hepatobiliary diseases, of which 15 were cases of PHN, representing 12% of the specific hepatobiliary conditions and 0.7% of the necropsies. All PHN were malignant, of which 93.3% had epithelial origin and 6.7% presented mesenchymal origin. Cholangiocarcinoma was the most commonly diagnosed neoplasm, followed by hepatocellular carcinoma and hemangiosarcoma. In general, cats with no defined breed were the most affected. Concerning sex, 60% were females and 40% males. Age ranged from five to 18 years, with a mean age of 10.5 years (median of ten years). Grossly, cholangiocarcinoma and hemangiosarcoma were multinodular and hepatocellular carcinoma was massive. Microscopically, cholangiocarcinomas were arranged in acini and ducts, whereas hepatocellular carcinomas were arranged in solid sheets or trabeculae. On immunohistochemistry, cholangiocarcinomas, hepatocellular carcinomas, and hemangiosarcomas were positive for the antibodies CK 7, Hep Par-1, and vimentin and von Willebrand factor, respectively.(AU)

Neoplasias hepatobiliares primárias (NHP) são incomuns em gatos e se originam de hepatócitos, células dos ductos biliares intra e extra-hepáticos, células mesenquimais e ainda células de origem neuroendócrina. O objetivo do trabalho foi determinar a frequência das NHP em gatos diagnosticados na Região Metropolitana de Porto Alegre, no período de 17 anos, abordando seus aspectos epidemiológicos, anatomopatológicos e imuno-histoquímicos (IHQ). Foram analisados os laudos de necropsia de 2.090 gatos sendo que 125 foram diagnosticados com doenças hepatobiliares primárias, destes 15 foram casos de NHP, representando 12% das condições hepatobiliares específicas e 0,7% do total de necropsias. Todos os diagnósticos de NHP eram malignos, destes 93,3% apresentaram origem epitelial e 6,7% mesenquimal. Colangiocarcinoma foi a neoplasia mais diagnosticada, seguido do carcinoma hepatocelular e hemangiossarcoma. De uma maneira geral, os gatos sem raça definida foram os mais acometidos. Em relação ao sexo 60% eram fêmeas e 40% machos. A idade variou de cinco a 18 anos, com a idade média de 10,5 anos (mediana de 10 anos). Macroscopicamente o colangiocarcinoma e hemangiossarcoma eram multinodulares, e o carcinoma hepatocelular, maciço. À histologia, houve predomínio do arranjo acinar e ductal nos colangiocarcinomas e sólido, no carcinoma hepatocelular. Na IHQ os colangiocarcinomas foram reativos para CK 7, carcinoma hepatocelular para Hep Par-1 e hemangiossarcoma para vimentina e fator de von Willebrand.(AU)

A practical new strategy to prevent bile duct injury during laparoscopic cholecystectomy. A single-center experience with 5539 cases

Purpose Bile duct injury (BDI) is a catastrophic complication of cholecystectomy, and misidentification of the cystic anatomy is considered to be the main cause. Although several techniques have been developed to prevent BDI, such as the critical view of safety, the infundibular technique, the rates remain higher during laparoscopic cholecystectomy (LC) than during open surgery. We, here, propose a practical new strategy for ductal identification, that can help to prevent laparoscopic bile duct injury. Methods A retrospective study of 5539 patients who underwent LC from March 2007 to February 2019 at a single institution was conducted. The gallbladder infundibulum was classified by its position located on an imaginary clock with the gallbladder neck as the center point of the dial, 3-oclock position as cranial, 6-oclock as dorsal, 9-oclock as caudal, and 12-oclock as ventral, as well as the axial position. Patient demographics, pathologic variables and infundibulum classification were evaluated. Detailed analysis of ductal identification based on gallbladder infundibulum position was performed in this study. All infundibulum positions were recorded by intraoperative laparoscopic video or photographic images. Results All the patients successfully underwent LC during the study period. No conversion or serious complications such as biliary injury occurred. Gallbladders with infundibulum of 3-oclock position, 6-oclock position, 9-oclock position, 12-oclock position, axial position were 12.3%, 23.4%, 28.0%, 4.2%, and 32.1%, respectively. The 3-oclock and 12-oclock position were pitfalls that might cause biliary injury. Conclusion The gallbladder infundibulum as a navigator is useful for ductal identification to reduce BDI and improve the safety of LC.(AU)

Pathological and immunohistochemical aspects of primary hepatobiliary neoplasms in cats

ABSTRACT: Primary hepatobiliary neoplasms (PHN) are uncommon in cats, and originate in hepatocytes, intra- and extrahepatic bile ducts, mesenchymal cells, and cells of neuroendocrine origin. The aim of this study was to determine the frequency of PHN in cats diagnosed in the metropolitan region of Porto Alegre (RS), Brazil, for a period of 17 years, determining their epidemiological, anatomopathological and immunohistochemical aspects. Necropsy reports of 2.090 cats were analyzed, 125 were diagnosed with primary hepatobiliary diseases, of which 15 were cases of PHN, representing 12% of the specific hepatobiliary conditions and 0.7% of the necropsies. All PHN were malignant, of which 93.3% had epithelial origin and 6.7% presented mesenchymal origin. Cholangiocarcinoma was the most commonly diagnosed neoplasm, followed by hepatocellular carcinoma and hemangiosarcoma. In general, cats with no defined breed were the most affected. Concerning sex, 60% were females and 40% males. Age ranged from five to 18 years, with a mean age of 10.5 years (median of ten years). Grossly, cholangiocarcinoma and hemangiosarcoma were multinodular and hepatocellular carcinoma was massive. Microscopically, cholangiocarcinomas were arranged in acini and ducts, whereas hepatocellular carcinomas were arranged in solid sheets or trabeculae. On immunohistochemistry, cholangiocarcinomas, hepatocellular carcinomas, and hemangiosarcomas were positive for the antibodies CK 7, Hep Par-1, and vimentin and von Willebrand factor, respectively.

RESUMO: Neoplasias hepatobiliares primárias (NHP) são incomuns em gatos e se originam de hepatócitos, células dos ductos biliares intra e extra-hepáticos, células mesenquimais e ainda células de origem neuroendócrina. O objetivo do trabalho foi determinar a frequência das NHP em gatos diagnosticados na Região Metropolitana de Porto Alegre, no período de 17 anos, abordando seus aspectos epidemiológicos, anatomopatológicos e imuno-histoquímicos (IHQ). Foram analisados os laudos de necropsia de 2.090 gatos sendo que 125 foram diagnosticados com doenças hepatobiliares primárias, destes 15 foram casos de NHP, representando 12% das condições hepatobiliares específicas e 0,7% do total de necropsias. Todos os diagnósticos de NHP eram malignos, destes 93,3% apresentaram origem epitelial e 6,7% mesenquimal. Colangiocarcinoma foi a neoplasia mais diagnosticada, seguido do carcinoma hepatocelular e hemangiossarcoma. De uma maneira geral, os gatos sem raça definida foram os mais acometidos. Em relação ao sexo 60% eram fêmeas e 40% machos. A idade variou de cinco a 18 anos, com a idade média de 10,5 anos (mediana de 10 anos). Macroscopicamente o colangiocarcinoma e hemangiossarcoma eram multinodulares, e o carcinoma hepatocelular, maciço. À histologia, houve predomínio do arranjo acinar e ductal nos colangiocarcinomas e sólido, no carcinoma hepatocelular. Na IHQ os colangiocarcinomas foram reativos para CK 7, carcinoma hepatocelular para Hep Par-1 e hemangiossarcoma para vimentina e fator de von Willebrand.

Congenital hepatic fibrosis associated with ascites in a nellore calf / Fibrose hepática congênita associada à ascite em um bezerro nelore

Congenital hepatic fibrosis (CHF) is an autosomal recessive malformation characterized by a variable degree of fibrosis and bile duct proliferation, mainly described in people and rarely reported in bovine European breeds. In addition to liver fibrosis, this syndrome has been associated with ascites and subcutaneous edema in calves. This paper described the pathological findings of the first report of CHF in a Nelore bovine fetus. A stillborn calf was removed by cesarean section because of dystocia. At necropsy, characteristic changes of CHF were observed, such as a large increase in abdominal volume associated with hepatic fibrosis and marked subcutaneous edema. Histological examination of liver revealed periportal and port-portal islands of fibrosis separating the parenchyma into nodules of variable sizes and containing numerous abnormally shaped bile ducts. The CHF should be considered in the differential diagnosis in young calves that present with ascites.(AU)

A fibrose hepática congênita (FHC) é uma malformação autossômica recessiva, caracterizada por um variável grau de fibrose e proliferação de ductos biliares, descrita principalmente em pessoas, e raramente relatada em bovinos de raças europeias. Além da fibrose hepática em bezerros, esta síndrome tem sido associada à ascite e edema subcutâneo. O presente trabalho apresenta os achados anatomopatológicos do primeiro relato de FHC em um feto bovino da raça nelore. O bezerro natimorto foi retirado por meio de cesariana devido à distocia. Na necropsia foram verificadas alterações características da FHC, como grande aumento de volume abdominal associado à fibrose hepática e marcado edema subcutâneo. O exame histológico do fígado revelou ilhas de fibrose periportal e porto-portal, separando o parênquima em nódulos de tamanhos variáveis e contendo numerosos ductos biliares irregulares de tamanhos anormais.(AU)