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.

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)

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.

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.

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)

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)

Cholangiocarcinoma in an Australian goose

Cholangiocarcinomas are neoplasms originating from the biliary epithelium. This report describes the gross, microscopic, and immunohistochemical findings in a case of cholangiocarcinoma in an Australian goose (Cereopsisnovaehollandiae). The animal had cachexia and ascites. The liver and gallbladder had cystic masses that was diagnosed as acholangiocarcinoma.(AU)

Cholangiocarcinoma in an Australian goose

Cholangiocarcinomas are neoplasms originating from the biliary epithelium. This report describes the gross, microscopic, and immunohistochemical findings in a case of cholangiocarcinoma in an Australian goose (Cereopsisnovaehollandiae). The animal had cachexia and ascites. The liver and gallbladder had cystic masses that was diagnosed as acholangiocarcinoma.

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)

Protective effect of Echinochrome against intrahepatic cholestasis induced by alpha-naphthylisothiocyanate in rats / Efeito protetor de Echinochrome contra colestase intra-hepática induzida por isotiocianato de alfa-naftilo em ratos

The present study was designed to evaluate the protective effects of echinochrome (Ech) on intrahepatic cholestasis in rats induced by a single (i.p.) injection of alpha-naphthylisothiocyanate (ANIT) (75 mg/kg body weight). The rats were pre-treated orally for 48hr (one dose / 24hr) with Ech (1, 5 and 10 mg/kg body weight) or ursodeoxycholic acid (UDCA) 80 mg/kg body weight drug then, injected with ANIT. ANIT markedly increased serum activities of alanine amino transaminase (ALT), aspartate amino transaminase (AST) and alkaline phosphatase (ALP), which was accompanied by a massive inflammation of epithelial cells on bile duct at 24h after ANIT injection. ANIT also increased the levels of total protein (TP), total bilirubin (TB), direct bilirubin (DB), indirect bilirubin (IB), however decrease albumin content (ALB). In addition ANIT increased hepatic MDA and NO level and decreased GSH level and GST activity. The Ech exerted hepatoprotective and anticholestatic effects as assessed by a significant decrease in the activities of serum AST, ALT and ALP, and the levels of TP, TB, DB and IB as well as liver MDA level and NO level. In conclusion, Ech was found to possess hepatoprotective effect against intrahepatic cholestasis induced by hepatotoxin such as ANIT.(AU)

O presente estudo destinou-se a avaliar os efeitos protetores do Ech na colestase intra-hepática em ratos induzidos por uma única injeção (i.p.) de alfa-naftilisotiocianato (ANIT) (75 mg / kg de peso corporal). Os ratos foram pré-tratados oralmente durante 48 horas (uma dose / 24 horas) com cada (1, 5 e 10 mg / kg de peso corporal) e ácido ursodeoxicólico (UDCA) 80 mg / kg de peso corporal, em seguida, injetado com ANIT. ANIT atividades de soro marcadamente aumentadas de alanina amino transaminasa (ALT), aspartato de amino transaminases (AST) e fosfatase alcalina (ALP), que foi acompanhada por uma inflamação maciça de células epiteliais no ducto biliar às 24h após a injeção de ANIT. A ANIT também aumentou os níveis de proteína total (TP), bilirrubina total (TB), bilirrubina direta (DB), bilirrubina indireta (IB), no entanto, diminuem o teor de albumina (ALB). Além disso, a ANIT aumentou o nível de MDA hepático e NO e diminuiu o nível de GSH e a atividade de GST. O Ech exerceu efeitos hepatoprotectores e anticolestáticos como avaliado por uma diminuição significativa nas atividades de AST sérica, ALT e ALP e os níveis de TP, TB, DB e IB, bem como o nível de MDA no fígado e o nível de NO. Ech foi encontrado para possuir efeito protetor no fígado contra a colestase intra-hepática induzida por hepatotoxina, como a ANIT.(AU)

Colecistoduodenostomia para tratamento de obstrução biliar secundária a platinossomose felina / Cholecystoduodenostomy for treatment of biliary obstruction secondary to feline platinossomosis

Background: Platynosomum spp. it is a trematode that has a predilection for the liver and biliary tissues whose infection isacquired through the ingestion of metacercarian gecko viscera. Felines are the definitive hosts and clinical signs are variable.The diagnosis is through history, hematological and biochemical exams, ultrasound, bile cytology or histopathology. Thetreatment of choice is cholecystoduodenostomy. This paper aims to report the case of a cat who was treated at the UberabaVeterinary Hospital with chronic cholangitis secondary to platinosomosis, but there was a transfusion reaction and she died.Case: A 4-year-old, uncastrated SRD cat was treated at the Uberaba Veterinary Hospital complaining of severe episodesof vomiting three days ago, hyporexia and darkened urine. The general clinical examination showed moderate dehydration, jaundice and hepatomegaly. The animal was hospitalized for better investigation of its condition. Increased valuesof ALT, alkaline phosphatase and all bilirubins were observed. Ultrasound showed liver suggestive of liver disease andsteatosis, and gallbladder without alteration. During hospitalization, she remained jaundiced and hypoxic, and the esophageal tube was placed. The initial clinical suspicion was cholangiohepatitis. Liver biopsy and cholecystoduodenostomywere then suggested, with refusal by the tutor. The ultrasound was repeated and showed the same alterations described,besides cholangitis. Stool examination was negative for Platynosomum spp. and positive for Isospora spp. The patientwas treated with anthelmintic for three days and received supportive treatment for another week until the tutor authorizedcholecystoduodenostomy. During surgery, cholecystocentesis was performed and the parasite Platynosomum spp. in adultform. After four days, a new blood count was done and the animal was still anemic and the blood...

Colecistoduodenostomia para tratamento de obstrução biliar secundária a platinossomose felina / Cholecystoduodenostomy for treatment of biliary obstruction secondary to feline platinossomosis

Background: Platynosomum spp. it is a trematode that has a predilection for the liver and biliary tissues whose infection isacquired through the ingestion of metacercarian gecko viscera. Felines are the definitive hosts and clinical signs are variable.The diagnosis is through history, hematological and biochemical exams, ultrasound, bile cytology or histopathology. Thetreatment of choice is cholecystoduodenostomy. This paper aims to report the case of a cat who was treated at the UberabaVeterinary Hospital with chronic cholangitis secondary to platinosomosis, but there was a transfusion reaction and she died.Case: A 4-year-old, uncastrated SRD cat was treated at the Uberaba Veterinary Hospital complaining of severe episodesof vomiting three days ago, hyporexia and darkened urine. The general clinical examination showed moderate dehydration, jaundice and hepatomegaly. The animal was hospitalized for better investigation of its condition. Increased valuesof ALT, alkaline phosphatase and all bilirubins were observed. Ultrasound showed liver suggestive of liver disease andsteatosis, and gallbladder without alteration. During hospitalization, she remained jaundiced and hypoxic, and the esophageal tube was placed. The initial clinical suspicion was cholangiohepatitis. Liver biopsy and cholecystoduodenostomywere then suggested, with refusal by the tutor. The ultrasound was repeated and showed the same alterations described,besides cholangitis. Stool examination was negative for Platynosomum spp. and positive for Isospora spp. The patientwas treated with anthelmintic for three days and received supportive treatment for another week until the tutor authorizedcholecystoduodenostomy. During surgery, cholecystocentesis was performed and the parasite Platynosomum spp. in adultform. After four days, a new blood count was done and the animal was still anemic and the blood...(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)

Relationship between serum MMP-9 level and prognosis after radical resection for Hilar cholangiocarcinoma patients

Purpose: To analyze the preoperative serum matrix metalloproteinase-9 (MMP-9) levels and prognosis of patients with hilar cholangiocarcinoma (HC) undergoing radical resection. Methods: Preoperative serum MMP-9 levels in patients with HC undergoing radical resection were detected by enzyme-linked immunosorbent assay (ELISA). The ROC curve assay was used to analyze the preoperative serum MMP-9 level to determine the most valuable cut-off point. The relationship between MMP-9 and clinicopathological features of HC patients was analyzed. Kaplan-Meier method was used to analyze the prognostic factors, and COX regression model was used to analyze the independent risk factors affecting prognosis. Results: Preoperative serum MMP-9 levels were significantly elevated in the death patients compared with the survival patients. The most valuable cut-off point for preoperative serum MMP-9 for prognosis was 201.93 ng/mL. Preoperative serum MMP-9 was associated with Bismuth-Corlette classification) and lymph node metastasis. Kaplan-Meier analysis showed that MMP-9, Bismuth-Corlette classification, Lymph node metastasis, Portal vein invasion, Hepatic artery invasion, Liver invasion, Incised margin, and Preoperative biliary drainage were related to prognosis. Cox regression model confirmed that hepatic artery invasion, liver invasion, incised margin, and MMP-9 have the potential to independence predicate prognosis in HC patients. Conclusion: Preoperative serum MMP-9 has high predictive value for prognosis and is an independent influencing factor for the prognosis of patients with hilar cholangiocarcinoma.(AU)

Parasitological and histological aspects of Holochilus sciureus naturally infected by Schistosoma mansoni / Aspectos parasitológicos e histológicos de Holochilus sciureus naturalmente infectados por Schistosoma mansoni

Schistosomiasis is a neglected disease that affects millions of people around the world, being common in the state of Maranhão. A total of 225 rodents of the Holochilus sciureus species from the Western Lowland Maranhão were studied, of which 144 animals (64%) exhibited Schistosoma eggs in their feces samples. Macroscopic lesions characterized as well-defined whitish areas on the liver and spleen surfaces were observed. Histopathological examination revealed multifocal granulomas in the esophagus, liver, spleen, pancreas and duodenum, with structures compatible with Schistosoma mansoni eggs, as well as severe hepatic micro-vacuolar degeneration, multifocal and coalescent, with proliferation of random bile ducts and associated epithelial hyperplasia to areas of fibrosis. Adult forms of the parasite were observed in the blood vessels of the portal space. The lungs exhibited moderate and diffuse interstitial pneumonia with intralesional S. mansoni eggs. In the kidneys, hyaline cylinders were observed in the pelvis and diffuse hemorrhage. In conclusion, H. sciureus displays a pathological picture similar to human being. This rodent plays a role as sentinel in Baixada Maranhense.(AU)

A esquistossomose é uma doença negligenciada que afeta milhões de pessoas em todo o mundo, sendo comum no estado do Maranhão. Um total de 225 roedores da espécie Holochilus sciureus da Planície Ocidental do Maranhão foram estudados, dos quais 144 animais (64%) apresentaram ovos de Schistosoma em suas fezes. Lesões macroscópicas caracterizadas como áreas esbranquiçadas bem definidas nas superfícies do fígado e baço foram observadas. O exame histopatológico revelou granulomas multifocais no esôfago, fígado, baço, pâncreas e duodeno, com estruturas compatíveis com ovos de Schistosoma mansoni, degeneração micro-vacuolar hepática grave, multifocal e coalescente, com proliferação de ductos biliares aleatórios e hiperplasia epitelial associada a áreas de fibrose. Formas adultas do parasito foram observadas nos vasos sanguíneos do espaço portal. Os pulmões exibiram pneumonia intersticial moderada e difusa com ovos de S. mansoni intralesionais. Nos rins, foram observados cilindros hialinos na pelve e hemorragia difusa. Em conclusão, H. sciureus apresenta um quadro patológico semelhante ao ser humano. Este roedor desempenha um papel de sentinela na Baixada Maranhense.(AU)