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.

Carcinoma hepatocelular metastático em Amazona aestiva / Metastatic hepatocellular carcinoma in Amazona aestiva

Background: Hepatocellular carcinoma is a primary malignant tumor of the liver tissue and its occurrence in birds is considered rare. The tumor can occur as a single mass leading to hepatomegaly, or as multiple nodules in the liver. In animals of the genus Amazona, only 1 case of metastatic hepatocellular carcinoma has been reported in the United States, therefore, little is known about its epidemiology and clinicopathological aspects in these species. In this context, the aim of this work was to describe a case of metastatic hepatocellular carcinoma in an Amazona aestiva. Case: A blue-fronted amazon parrot (Amazona aestiva) was referred to necropsy after being found dead in its enclosure. On examination, it presented cachectic body score. Examination of the coelomic cavity, revealed a serous translucent fluid and adhesions between the liver and peritoneum.A red mass restricted to the right hepatic lobe and raised to the capsular surface, interspersed with whitish and dark red multifocal areas was observed. When cut, this mass was soft, protruding, multilobulated, whitish and with a friable reddish center. Additionally, on the dorsal surface of the left lung lobe, there was a rounded, well defined, whitish, and soft nodule. Microscopically, partial replacement of the hepatic parenchyma was observed by neoplastic proliferation of cuboidal epithelial cells, organized in mantle and supported by a scarce fibrovascular stroma. Cells have large, eosinophilic, well-delimited cytoplasm, with a central, oval nucleus, loose chromatin, and evident nucleolus. Moderate pleomorphism was characterized by anisocytosis, anisokaryosis, and aberrant nuclei. In the lung, a focally extensive mass with a pattern similar to that seen in the liver was observed. In the kidney, multifocal neoplastic emboli were noted. Liver immunohistochemistry was performed. Positive and negative controls were used to validate the reaction; however, there was no immunolabelling for the evaluated antibodies. Discussion: The histopathological characteristics observed in this study favored the diagnosis of hepatocellular carcinoma (HCC) with metastasis to kidney and lung. Primary liver tumors are rare in wild birds. In ducks, experimental studies have pointed aflatoxins and the duck hepatitis B virus as oncogenic agents, however, in birds of the genus Amazona, there are no studies that evaluate predisposing factors to the development of liver carcinoma. Macroscopically, hepatocellular carcinoma may present in massive, nodular or diffuse forms. In birds, the right lobe is the largest, which may suggest that this lobe is more prone to the development of HCC, as seen in the present case. The solid form, similar to that observed in this report, seems to be more commonly observed, as seen in the wild bird reports consulted. Metastases most often spread hematogenous, and in the present report there was metastasis to kidneys and lungs, which is a common feature for this neoplasm. In the present case, there was no labeling by any of the antibodies, perhaps because of their aggressiveness, associated with autolytic factors that prevent the labeling of antibodies, in addition to the specificity in the antibodyantigen relationship. This tumor must be differentiated from other liver tumors such as cholangiocarcinoma, and also the well-differentiated hepatocellular adenoma, in addition to non-neoplastic conditions. HCC should be considered as a differential diagnosis for Amazona aestiva found dead in the enclosure without previous clinical signs. This neoplasm is rare in Amazon parrots and reports should be encouraged in order to contribute to the understanding of the epidemiological and clinicopathological aspects of the tumor.

Adenocarcinoma de saco anal com metástase vertebro-medular em um Cocker Spaniel / Anal sac adenocarcinoma with vertebromedullary metastasis in a Cocker Spaniel

Background: Several neoplasms can affect the perianal region, being the hepatic adenoma and the anal sac adenocarcinoma (ASAC), which is considered the most frequent. The ASAC is a malignant neoplasm originating from the secretory epithelium of the perianal apocrine glands and is rarely seen in veterinary medicine. The ASAC occurs mainly in adult to elderly canines with high metastasis rates. Patients may be asymptomatic or manifest discomfort and behavioral changes. In the presence of metastasis, the most frequent clinical signs are inappetence, coughing, dyspnea, and colorectal obstruction. Given this scenario, this paper aims to describe the clinical presentation, diagnostic examination, and necropsy findings of a Cocker Spaniel with ASAC and metastasis in the vertebral body, spinal cord, and cauda equina. Case: A 8-year-old neutered male Cocker Spaniel (12 kg of body mass) with a clinical history of non-ambulatory paraparesis was evaluated. The patient also presented tenesmus, difficulty to defecate, and the presence of nodules in the anal sac area. On the neurological examination, asymmetrical changes compatible with injury between L4-S3 were found. A complete blood count, serum biochemistry, and imaging exams such as plain radiography, abdominal ultrasonography (US), and magnetic resonance imaging (MRI) were requested. Blood count revealed anemia and neutrophilic leukocytosis and hypercalcemia. The liver showed increased echogenicity and thickened pancreas in the abdominal US scan. A slightly heterogeneous, vascularized mass with irregular borders was identified in the topographic region of the sublumbar lymph nodes; MRI images demonstrated an expansile formation in the ventral region of the lumbosacral spine, corresponding to the sublumbar lymph nodes and interruption of the cerebrospinal fluid at L5, suggestive of compression of the spinal cord and cauda equina. A presumptive diagnosis of perianal neoplasm with metastasis was made based on the complementary exams. The dog was referred to necropsy, which revealed a 4 cm tumor in the perianal region that invaded the pelvic canal. Multifocal nodules were present on the lung surface, liver, and kidneys, suggesting metastasis. On the cross-section of the spine, one could note the presence of the tumor in the vertebral bodies, spinal cord, and cauda equina from L5 to S3. Even with histopathological evaluation of the tumor, only the immunohistochemical analysis allowed us to confirm the anal sac adenocarcinoma. Discussion: Adenomas and carcinomas are perianal gland neoplasms common in adult and elderly male dogs; the Cocker Spaniel breed is among the most affected. The clinical signs presented by the patient, such as tenesmus and difficulty in adopting the posture of defecation, are common, although neurological changes are rare. As for metastasis, carcinomas of the perianal region present high chances of metastasis to organs including the liver, kidneys, and lungs, both lymphatically and hematogenously, but few studies have related these factors to neurological alterations due to metastasis. We concluded that metastases from carcinomas to the spine must be considered a possible differential diagnosis in cases of patients presenting clinical signs that are compatible with spinal cord compression and a history of previous neoplasm.

Oxidative stress in female dogs with mammary neoplasms

ABSTRACT: The result of the reaction of free radicals with biomolecules is the formation of substances with the potential of inducing oxidative damage, a condition known as oxidative stress. There are voluminous literature data reporting the association, both as a cause and as a consequence, between different diseases and oxidative stress. In this study, 144 female dogs with mammary neoplasia were analyzed. The animals were submitted to clinical evaluation for disease staging, hematological evaluation, serum biochemistry (renal and hepatic function tests), and dosage of the oxidative damage biomarker, malondialdehyde (MDA), at the time of its approach and 30 days after treatment. A control group of 100 healthy animals was also submitted to determination of serum MDA levels. The mean age of the animals affected by mammary neoplasms was 9.88±2.95 (4 to 14) years, while in healthy animals it was 2.31±1.90 years (1 to 6). Of the 144 animals, 113 (78.9%) had malignant neoplasms, and 15, 21, 46, 17 and 14 animals were in clinical stage I, II, III, IV and V respectively and the carcinoma in a mixed tumor was the most frequent histological pattern in this group (26%). Thirty-one animals were diagnosed with benign neoplasms and mammary adenoma was the most frequent histological pattern in 15 animals (51.61%). Hematological changes in the preoperative period were observed in 44 (38.9%) and 12 (38.7%) animals with malignant and benign neoplasias, respectively, and there was a positive correlation between anemia and higher levels of MDA (P=0.0008) for animals with malignant tumors. Regarding serum biochemical parameters, the most frequent alterations in animals with malignant neoplasms were elevated ALT levels in 12 animals (10.6%), creatinine in 10 animals (8.84%) and urea in eight animals (7.07%). Females with benign neoplasms presented less occurrence of changes in these parameters. In the group of healthy animals (control), the mean serum MDA values were 12.08±4.18, whereas in the pre-treatment group, mean MDA was 24.80±5.74 for bitches with benign neoplasms and 32.27±10.24 for bitches with malignant tumors. A significant increase (P 0.001) in MDA levels was observed in animals with malignant mammary neoplasms when compared to healthy animals and with benign tumors. In addition, a significant reduction (P 0.001) was observed 30 days after treatment in MDA levels (27.37±7.86) in animals with malignant tumors. In conclusion, our results indicate an association between MDA seric levels and mammary neoplasms in dogs. The results suggest that this factor can be used as a biomarker of oxidative stress with a potential impact in the prognostic of mammary tumors, since significantly higher levels of MDA were detected especially in dogs carrying malignant tumors and presenting anemia.

RESUMO: O resultado da reação de radicais livres com biomoléculas é a formação de substâncias que podem ser utilizadas como marcadores de dano oxidativo, condição mais conhecida como estresse oxidativo. Evidências científicas comprovam a relação, quer como causa, quer como consequência, entre muitas doenças e o estresse oxidativo. Neste estudo, 144 cadelas portadoras de neoplasia de mama, foram submetidas à avaliação clínica para estadiamento da doença, avaliação hematológica, testes de função renal e hepática e dosagem do biomarcador de dano oxidativo, malondialdeído (MDA), no momento de sua abordagem e 30 dias após realização de tratamento. Um grupo controle de 100 cadelas saudáveis foi submetido também à determinação dos níveis séricos de MDA. A idade média dos animais acometidos por neoplasias mamárias foi de 9,88±2,95 (4 a 14) anos, enquanto que nos animais saudáveis foi de 2,31±1,90 anos (1 a 6). Dos 144 animais, 113 (78, 9%) apresentavam neoplasias malignas, sendo que 15, 21, 46, 17 e 14 animais encontravam-se em estadiamento clínico I, II, III, IV e V respectivamente, e o carcinoma em tumor misto foi o padrão histológico mais frequente neste grupo (26%). Trinta e um animais tiveram diagnóstico de neoplasias benignas, sendo que 7 estavam no estádio I, 16 no estádio II e 8 no estádio III e o adenoma mamário foi o padrão histológico mais frequente em 15 animais (51,61%). Alterações hematológicas no período pré-operatório foram observadas em 44 (38,9%) e 12 (38,7%) animais portadores de neoplasias malignas e benignas, respectivamente, sendo que houve correlação positiva entre anemia e níveis mais elevados de MDA (P=0,0008), para os animais com tumores malignos. Em relação aos parâmetros bioquímicos séricos, as alterações mais frequentes nos animais com neoplasias malignas foram a elevação dos níveis de ALT em 12 animais (10,6%), de creatinina em 10 animais (8,84%) e de ureia em oito animais (7,07%) Cadelas portadoras de neoplasias benignas apresentaram menor ocorrência de alterações nesses parâmetros. No grupo controle, a média dos valores séricos de MDA foi 12,08±4,18, enquanto que no grupo pré-tratamento, a média de MDA foi de 24,80±5,74 para as cadelas com neoplasia benigna e 32,27±10,24 para as neoplasias malignas. Verificou-se aumento significativo do valor sérico de MDA em cadelas portadoras de neoplasias malignas em comparação com os animais hígidos ou com neoplasias benignas (P 0,001). Ainda, 30 dias após o tratamento observou-se uma diminuição significativa (P 0,001) no valor médio de MDA (27,37±7,86) nos animais com neoplasias malignas. Em conclusão, os resultados deste estudo evidenciam uma associação entre níveis séricos aumentados de MDA e presença de neoplasias mamárias em cadelas. Os resultados sugerem que este fator pode ser utilizado como biomarcador de estresse oxidativo em cães, com provável impacto no prognóstico dos tumores mamários, uma vez que níveis significativamente mais altos de MDA foram detectados especialmente nas cadelas portadoras de tumores malignos e apresentando anemia.

Oxidative stress in female dogs with mammary neoplasms / Estresse oxidativo em cadelas com neoplasia mamária

The result of the reaction of free radicals with biomolecules is the formation of substances with the potential of inducing oxidative damage, a condition known as oxidative stress. There are voluminous literature data reporting the association, both as a cause and as a consequence, between different diseases and oxidative stress. In this study, 144 female dogs with mammary neoplasia were analyzed. The animals were submitted to clinical evaluation for disease staging, hematological evaluation, serum biochemistry (renal and hepatic function tests), and dosage of the oxidative damage biomarker, malondialdehyde (MDA), at the time of its approach and 30 days after treatment. A control group of 100 healthy animals was also submitted to determination of serum MDA levels. The mean age of the animals affected by mammary neoplasms was 9.88±2.95 (4 to 14) years, while in healthy animals it was 2.31±1.90 years (1 to 6). Of the 144 animals, 113 (78.9%) had malignant neoplasms, and 15, 21, 46, 17 and 14 animals were in clinical stage I, II, III, IV and V respectively and the carcinoma in a mixed tumor was the most frequent histological pattern in this group (26%). Thirty-one animals were diagnosed with benign neoplasms and mammary adenoma was the most frequent histological pattern in 15 animals (51.61%). Hematological changes in the preoperative period were observed in 44 (38.9%) and 12 (38.7%) animals with malignant and benign neoplasias, respectively, and there was a positive correlation between anemia and higher levels of MDA (P=0.0008) for animals with malignant tumors. Regarding serum biochemical parameters, the most frequent alterations in animals with malignant neoplasms were elevated ALT levels in 12 animals (10.6%), creatinine in 10 animals (8.84%) and urea in eight animals (7.07%). Females with benign neoplasms presented less occurrence of changes in these parameters. In the group of healthy animals (control), the mean serum MDA values were 12.08±4.18, whereas in the pre-treatment group, mean MDA was 24.80±5.74 for bitches with benign neoplasms and 32.27±10.24 for bitches with malignant tumors. A significant increase (P<0.001) in MDA levels was observed in animals with malignant mammary neoplasms when compared to healthy animals and with benign tumors. In addition, a significant reduction (P<0.001) was observed 30 days after treatment in MDA levels (27.37±7.86) in animals with malignant tumors. In conclusion, our results indicate an association between MDA seric levels and mammary neoplasms in dogs. The results suggest that this factor can be used as a biomarker of oxidative stress with a potential impact in the prognostic of mammary tumors, since significantly higher levels of MDA were detected especially in dogs carrying malignant tumors and presenting anemia.(AU)

O resultado da reação de radicais livres com biomoléculas é a formação de substâncias que podem ser utilizadas como marcadores de dano oxidativo, condição mais conhecida como estresse oxidativo. Evidências científicas comprovam a relação, quer como causa, quer como consequência, entre muitas doenças e o estresse oxidativo. Neste estudo, 144 cadelas portadoras de neoplasia de mama, foram submetidas à avaliação clínica para estadiamento da doença, avaliação hematológica, testes de função renal e hepática e dosagem do biomarcador de dano oxidativo, malondialdeído (MDA), no momento de sua abordagem e 30 dias após realização de tratamento. Um grupo controle de 100 cadelas saudáveis foi submetido também à determinação dos níveis séricos de MDA. A idade média dos animais acometidos por neoplasias mamárias foi de 9,88±2,95 (4 a 14) anos, enquanto que nos animais saudáveis foi de 2,31±1,90 anos (1 a 6). Dos 144 animais, 113 (78, 9%) apresentavam neoplasias malignas, sendo que 15, 21, 46, 17 e 14 animais encontravam-se em estadiamento clínico I, II, III, IV e V respectivamente, e o carcinoma em tumor misto foi o padrão histológico mais frequente neste grupo (26%). Trinta e um animais tiveram diagnóstico de neoplasias benignas, sendo que 7 estavam no estádio I, 16 no estádio II e 8 no estádio III e o adenoma mamário foi o padrão histológico mais frequente em 15 animais (51,61%). Alterações hematológicas no período pré-operatório foram observadas em 44 (38,9%) e 12 (38,7%) animais portadores de neoplasias malignas e benignas, respectivamente, sendo que houve correlação positiva entre anemia e níveis mais elevados de MDA (P=0,0008), para os animais com tumores malignos. Em relação aos parâmetros bioquímicos séricos, as alterações mais frequentes nos animais com neoplasias malignas foram a elevação dos níveis de ALT em 12 animais (10,6%), de creatinina em 10 animais (8,84%) e de ureia em oito animais (7,07%) Cadelas portadoras de neoplasias benignas apresentaram menor ocorrência de alterações nesses parâmetros. No grupo controle, a média dos valores séricos de MDA foi 12,08±4,18, enquanto que no grupo pré-tratamento, a média de MDA foi de 24,80±5,74 para as cadelas com neoplasia benigna e 32,27±10,24 para as neoplasias malignas. Verificou-se aumento significativo do valor sérico de MDA em cadelas portadoras de neoplasias malignas em comparação com os animais hígidos ou com neoplasias benignas (P<0,001). Ainda, 30 dias após o tratamento observou-se uma diminuição significativa (P<0,001) no valor médio de MDA (27,37±7,86) nos animais com neoplasias malignas. Em conclusão, os resultados deste estudo evidenciam uma associação entre níveis séricos aumentados de MDA e presença de neoplasias mamárias em cadelas. Os resultados sugerem que este fator pode ser utilizado como biomarcador de estresse oxidativo em cães, com provável impacto no prognóstico dos tumores mamários, uma vez que níveis significativamente mais altos de MDA foram detectados especialmente nas cadelas portadoras de tumores malignos e apresentando anemia.(AU)

Oxidative stress in female dogs with mammary neoplasms / Estresse oxidativo em cadelas com neoplasia mamária

The result of the reaction of free radicals with biomolecules is the formation of substances with the potential of inducing oxidative damage, a condition known as oxidative stress. There are voluminous literature data reporting the association, both as a cause and as a consequence, between different diseases and oxidative stress. In this study, 144 female dogs with mammary neoplasia were analyzed. The animals were submitted to clinical evaluation for disease staging, hematological evaluation, serum biochemistry (renal and hepatic function tests), and dosage of the oxidative damage biomarker, malondialdehyde (MDA), at the time of its approach and 30 days after treatment. A control group of 100 healthy animals was also submitted to determination of serum MDA levels. The mean age of the animals affected by mammary neoplasms was 9.88±2.95 (4 to 14) years, while in healthy animals it was 2.31±1.90 years (1 to 6). Of the 144 animals, 113 (78.9%) had malignant neoplasms, and 15, 21, 46, 17 and 14 animals were in clinical stage I, II, III, IV and V respectively and the carcinoma in a mixed tumor was the most frequent histological pattern in this group (26%). Thirty-one animals were diagnosed with benign neoplasms and mammary adenoma was the most frequent histological pattern in 15 animals (51.61%). Hematological changes in the preoperative period were observed in 44 (38.9%) and 12 (38.7%) animals with malignant and benign neoplasias, respectively, and there was a positive correlation between anemia and higher levels of MDA (P=0.0008) for animals with malignant tumors. Regarding serum biochemical parameters, the most frequent alterations in animals with malignant neoplasms were elevated ALT levels in 12 animals (10.6%), creatinine in 10 animals (8.84%) and urea in eight animals (7.07%). Females with benign neoplasms presented less occurrence of changes in these parameters. In the group of healthy animals (control), the mean serum MDA values were 12.08±4.18, whereas in the pre-treatment group, mean MDA was 24.80±5.74 for bitches with benign neoplasms and 32.27±10.24 for bitches with malignant tumors. A significant increase (P<0.001) in MDA levels was observed in animals with malignant mammary neoplasms when compared to healthy animals and with benign tumors. In addition, a significant reduction (P<0.001) was observed 30 days after treatment in MDA levels (27.37±7.86) in animals with malignant tumors. In conclusion, our results indicate an association between MDA seric levels and mammary neoplasms in dogs. The results suggest that this factor can be used as a biomarker of oxidative stress with a potential impact in the prognostic of mammary tumors, since significantly higher levels of MDA were detected especially in dogs carrying malignant tumors and presenting anemia.(AU)

O resultado da reação de radicais livres com biomoléculas é a formação de substâncias que podem ser utilizadas como marcadores de dano oxidativo, condição mais conhecida como estresse oxidativo. Evidências científicas comprovam a relação, quer como causa, quer como consequência, entre muitas doenças e o estresse oxidativo. Neste estudo, 144 cadelas portadoras de neoplasia de mama, foram submetidas à avaliação clínica para estadiamento da doença, avaliação hematológica, testes de função renal e hepática e dosagem do biomarcador de dano oxidativo, malondialdeído (MDA), no momento de sua abordagem e 30 dias após realização de tratamento. Um grupo controle de 100 cadelas saudáveis foi submetido também à determinação dos níveis séricos de MDA. A idade média dos animais acometidos por neoplasias mamárias foi de 9,88±2,95 (4 a 14) anos, enquanto que nos animais saudáveis foi de 2,31±1,90 anos (1 a 6). Dos 144 animais, 113 (78, 9%) apresentavam neoplasias malignas, sendo que 15, 21, 46, 17 e 14 animais encontravam-se em estadiamento clínico I, II, III, IV e V respectivamente, e o carcinoma em tumor misto foi o padrão histológico mais frequente neste grupo (26%). Trinta e um animais tiveram diagnóstico de neoplasias benignas, sendo que 7 estavam no estádio I, 16 no estádio II e 8 no estádio III e o adenoma mamário foi o padrão histológico mais frequente em 15 animais (51,61%). Alterações hematológicas no período pré-operatório foram observadas em 44 (38,9%) e 12 (38,7%) animais portadores de neoplasias malignas e benignas, respectivamente, sendo que houve correlação positiva entre anemia e níveis mais elevados de MDA (P=0,0008), para os animais com tumores malignos. Em relação aos parâmetros bioquímicos séricos, as alterações mais frequentes nos animais com neoplasias malignas foram a elevação dos níveis de ALT em 12 animais (10,6%), de creatinina em 10 animais (8,84%) e de ureia em oito animais (7,07%) Cadelas portadoras de neoplasias benignas apresentaram menor ocorrência de alterações nesses parâmetros. No grupo controle, a média dos valores séricos de MDA foi 12,08±4,18, enquanto que no grupo pré-tratamento, a média de MDA foi de 24,80±5,74 para as cadelas com neoplasia benigna e 32,27±10,24 para as neoplasias malignas. Verificou-se aumento significativo do valor sérico de MDA em cadelas portadoras de neoplasias malignas em comparação com os animais hígidos ou com neoplasias benignas (P<0,001). Ainda, 30 dias após o tratamento observou-se uma diminuição significativa (P<0,001) no valor médio de MDA (27,37±7,86) nos animais com neoplasias malignas. Em conclusão, os resultados deste estudo evidenciam uma associação entre níveis séricos aumentados de MDA e presença de neoplasias mamárias em cadelas. Os resultados sugerem que este fator pode ser utilizado como biomarcador de estresse oxidativo em cães, com provável impacto no prognóstico dos tumores mamários, uma vez que níveis significativamente mais altos de MDA foram detectados especialmente nas cadelas portadoras de tumores malignos e apresentando anemia.(AU)

Primary hepatic neoplasms in cattle / Neoplasmas hepáticos primários de bovinos

Primary hepatic neoplasms are mostly detected in cattle as incidental findings in slaughterhouses or diagnosed at the necropsy, wherein it may be related to the cause of death. A proper characterization of primary hepatic neoplasms is essential to provide an accurate diagnosis, especially at the slaughter lines, in order to reduce erroneous condemnations. This work aimed to characterize the gross, histological, and immunohistochemical features of primary liver neoplasms detected in slaughtered cattle in Southern Brazil. Nineteen primary hepatic neoplasms were identified. Grossly, these lesions were classified according to their distribution, as focal, multifocal, or diffuse. Histologically, the shape and arrangement of the cells, as well as possible malignant features were evaluated. Immunohistochemistry (IHC) was also performed for biliary epithelium (anti-CK7) and hepatocytes (anti-Hep Par-1) markers. Hepatocellular carcinoma (84.2%) was the most frequently detected hepatic neoplasm, followed by cholangiocarcinoma (15.8%), and these were only identified in adult cows. Hepatocellular carcinomas occurred as solitary masses or multifocal nodules, which on the cut surface were often green. Cholangiocarcinomas occurred as multifocal nodules, occasionally showing an umbilicated appearance. Histologically, hepatocellular carcinomas had mostly trabecular and solid patterns, while cholangiocarcinomas presented mostly a solid arrangement. Upon IHC, all hepatocellular carcinomas were immunolabeled for anti-Hep Par-1, ranging from mild (25%), moderate (31.2%) to marked (43.7%), while immunolabeling for anti-CK7 was detected only in one case of cholangiocarcinoma.(AU)

Os neoplasmas hepáticos primários são detectados em bovinos principalmente como achados incidentais em matadouros ou diagnosticados na necropsia, quando podem estar relacionados à causa da morte. A caracterização adequada dos tumores hepáticos primários é essencial para obter diagnósticos precisos, especialmente nas linhas de abate, com o propósito de reduzir condenações errôneas. Este trabalho teve o objetivo de determinar as características macroscópicas, histológicas e imuno-histoquímicas dos neoplasmas primários do fígado de bovinos abatidos em um matadouro-frigorífico no Sul do Brasil. Dezenove neoplasias hepáticas primárias foram identificadas. Macroscopicamente, os tumores hepáticos foram classificados de acordo com sua distribuição, como focais, multifocais ou difusos. Histologicamente, a forma e o arranjo das células e possíveis características malignas foram avaliados. Também foi realizada imuno-histoquímica (IHQ) para marcadores de epitélio biliar (anti-CK7) e hepatócitos (anti-Hep Par-1). O carcinoma hepatocelular (84,2%) foi o neoplasma hepático mais frequentemente detectado, seguido pelo colangiocarcinoma (15,8%). Esses tumores foram identificados apenas em vacas adultas. Os carcinomas hepatocelulares eram vistos como massas solitárias ou nódulos multifocais que na superfície de corte geralmente eram esverdeados. Os colangiocarcinomas foram observados como nódulos multifocais, ocasionalmente com aspecto umbilicado. Histologicamente, os padrões mais observados nos carcinomas hepatocelulares foram trabeculares e sólidos, enquanto nos colangiocarcinomas o arranjo sólido foi o mais frequente. Na IHQ, todos os carcinomas hepatocelulares foram marcados por anti-Hep Par-1, com marcação que variou de leve (25%), moderada (31,2%) a acentuada (43,7%); imunomarcação para anti-CK7 foi detectada em apenas um caso de colangiocarcinoma.(AU)

Primary hepatic neoplasms in cattle / Neoplasmas hepáticos primários de bovinos

Primary hepatic neoplasms are mostly detected in cattle as incidental findings in slaughterhouses or diagnosed at the necropsy, wherein it may be related to the cause of death. A proper characterization of primary hepatic neoplasms is essential to provide an accurate diagnosis, especially at the slaughter lines, in order to reduce erroneous condemnations. This work aimed to characterize the gross, histological, and immunohistochemical features of primary liver neoplasms detected in slaughtered cattle in Southern Brazil. Nineteen primary hepatic neoplasms were identified. Grossly, these lesions were classified according to their distribution, as focal, multifocal, or diffuse. Histologically, the shape and arrangement of the cells, as well as possible malignant features were evaluated. Immunohistochemistry (IHC) was also performed for biliary epithelium (anti-CK7) and hepatocytes (anti-Hep Par-1) markers. Hepatocellular carcinoma (84.2%) was the most frequently detected hepatic neoplasm, followed by cholangiocarcinoma (15.8%), and these were only identified in adult cows. Hepatocellular carcinomas occurred as solitary masses or multifocal nodules, which on the cut surface were often green. Cholangiocarcinomas occurred as multifocal nodules, occasionally showing an umbilicated appearance. Histologically, hepatocellular carcinomas had mostly trabecular and solid patterns, while cholangiocarcinomas presented mostly a solid arrangement. Upon IHC, all hepatocellular carcinomas were immunolabeled for anti-Hep Par-1, ranging from mild (25%), moderate (31.2%) to marked (43.7%), while immunolabeling for anti-CK7 was detected only in one case of cholangiocarcinoma.(AU)

Os neoplasmas hepáticos primários são detectados em bovinos principalmente como achados incidentais em matadouros ou diagnosticados na necropsia, quando podem estar relacionados à causa da morte. A caracterização adequada dos tumores hepáticos primários é essencial para obter diagnósticos precisos, especialmente nas linhas de abate, com o propósito de reduzir condenações errôneas. Este trabalho teve o objetivo de determinar as características macroscópicas, histológicas e imuno-histoquímicas dos neoplasmas primários do fígado de bovinos abatidos em um matadouro-frigorífico no Sul do Brasil. Dezenove neoplasias hepáticas primárias foram identificadas. Macroscopicamente, os tumores hepáticos foram classificados de acordo com sua distribuição, como focais, multifocais ou difusos. Histologicamente, a forma e o arranjo das células e possíveis características malignas foram avaliados. Também foi realizada imuno-histoquímica (IHQ) para marcadores de epitélio biliar (anti-CK7) e hepatócitos (anti-Hep Par-1). O carcinoma hepatocelular (84,2%) foi o neoplasma hepático mais frequentemente detectado, seguido pelo colangiocarcinoma (15,8%). Esses tumores foram identificados apenas em vacas adultas. Os carcinomas hepatocelulares eram vistos como massas solitárias ou nódulos multifocais que na superfície de corte geralmente eram esverdeados. Os colangiocarcinomas foram observados como nódulos multifocais, ocasionalmente com aspecto umbilicado. Histologicamente, os padrões mais observados nos carcinomas hepatocelulares foram trabeculares e sólidos, enquanto nos colangiocarcinomas o arranjo sólido foi o mais frequente. Na IHQ, todos os carcinomas hepatocelulares foram marcados por anti-Hep Par-1, com marcação que variou de leve (25%), moderada (31,2%) a acentuada (43,7%); imunomarcação para anti-CK7 foi detectada em apenas um caso de colangiocarcinoma.(AU)

Decision making process in simultaneous laparoscopic resection of colorectal cancer and liver metastases: review of literature

Purpose: The benefits of laparoscopic approaches to treat colorectal cancer (CRC) and colorectal liver metastases (CRLM) separately are well established. However, there is no consensus about the optimal timing to approach the primary tumor and CRLM, whether simultaneously or staged. The objective of this review with practical reports is to discuss technical aspects required for patient selection to perform simultaneous laparoscopic approaches for CRC and CRLM. Methods: Literature review of oncological factors associated with patient selection for surgical treatment of CRLM and the use of laparoscopy in those cases, and report of technical aspects for simultaneous CRC and CRLM approaches. Results: Simultaneous laparoscopic resection has been successful in many series of selected patients, although it seems to be safer to perform minor and major liver resection with non-extended colorectal resections, and to avoid two high-risk procedures at the same time. Conclusions: Simultaneous CRC and CRLM resections seem to be safe when patients are carefully selected, also considering the risk of recurrence concerning oncologic outcomes. The pre-planning of simultaneous resection is mandatory to plan trocar positioning, procedure sequencing, and patient position.(AU)

Hemangiossarcoma associado a quimiodectoma em cadela Pit Bull idosa / Hemangiosarcoma associated with chemodectoma in an old Pit Bull bitch

Background: The prevalence of neoplasms in domestic animals has been augmenting over the years. Hemangiosarcoma, which most frequently affects large breed dogs, is a neoplasm with high metastatic power and corresponds to 5% of malignant neoplasms. Chemodectoma, a neoplasm that can have malignant or benign behavior, is uncommon, corresponding to less than 8% of all cardiac tumors, and originates from cardiac chemoreceptor cells and involves mainly the aortic and carotid bodies. The aim of this study is to describe the case of an elderly Pit Bull dog with hepatic hemangiosarcoma and chemodectoma associated with four other different tumors: hemangioma, papilloma, mastocitoma and melanoma. Case: A 14-year-old female Pit Bull, castrated, was presented to Veterinary Clinic of the Federal University of Santa Catarina (UFSC), Curitibanos Campus, Brazil. The owner referred apathy, hyporexia, and increased abdominal volume for two weeks. Physical examination showed emaciation and abdominal effusion. Abdominocentesis was performed, three liters of serosanguineous fluid was drained and a sample was sent for analysis. Complementary tests were requested and showed mild hypoalbuminemia, normocytic normochromic anemia, and lymphopenia. The ultrasound examination revealed thickening of vessels and hepatomegaly, in addition to the presence of an oval structure containing hyperechogenic cavitations. Diagnostic exploratory laparotomy was indicated, but the owner refused. Drug therapy was prescribed in a palliative manner and, during the clinical follow-up period, two abdominocentesis procedures and one thoracentesis procedure were performed, both resulting in simple transudate. Finally, the patient developed severe apathy, edema in all limbs, and died at home. Necroscopic examination was done and revealed hemoperitoneum and hemothorax...

Hemangiossarcoma associado a quimiodectoma em cadela Pit Bull idosa / Hemangiosarcoma associated with chemodectoma in an old Pit Bull bitch

Background: The prevalence of neoplasms in domestic animals has been augmenting over the years. Hemangiosarcoma, which most frequently affects large breed dogs, is a neoplasm with high metastatic power and corresponds to 5% of malignant neoplasms. Chemodectoma, a neoplasm that can have malignant or benign behavior, is uncommon, corresponding to less than 8% of all cardiac tumors, and originates from cardiac chemoreceptor cells and involves mainly the aortic and carotid bodies. The aim of this study is to describe the case of an elderly Pit Bull dog with hepatic hemangiosarcoma and chemodectoma associated with four other different tumors: hemangioma, papilloma, mastocitoma and melanoma. Case: A 14-year-old female Pit Bull, castrated, was presented to Veterinary Clinic of the Federal University of Santa Catarina (UFSC), Curitibanos Campus, Brazil. The owner referred apathy, hyporexia, and increased abdominal volume for two weeks. Physical examination showed emaciation and abdominal effusion. Abdominocentesis was performed, three liters of serosanguineous fluid was drained and a sample was sent for analysis. Complementary tests were requested and showed mild hypoalbuminemia, normocytic normochromic anemia, and lymphopenia. The ultrasound examination revealed thickening of vessels and hepatomegaly, in addition to the presence of an oval structure containing hyperechogenic cavitations. Diagnostic exploratory laparotomy was indicated, but the owner refused. Drug therapy was prescribed in a palliative manner and, during the clinical follow-up period, two abdominocentesis procedures and one thoracentesis procedure were performed, both resulting in simple transudate. Finally, the patient developed severe apathy, edema in all limbs, and died at home. Necroscopic examination was done and revealed hemoperitoneum and hemothorax...(AU)

Metastatic osteoblastic osteosarcoma in a captive scarlet macaw (Ara macao)

Osteosarcoma is a malignant primary tumor of the bone, which is considered rare in birds. This report describes an osteoblastic osteosarcoma in a scarlet macaw (Ara macao), which was apathetic with progressive weight loss, and had a tumor in the distal portion of the femur and proximal tibiotarsus with ulcerated pododermatitis in the contralateral limb. Euthanasia was elected due to poor diagnosis after radiographic and cytological examination. Histopathology and immunohistochemistry were performed and confirmed the diagnosis of an osteoblastic osteosarcoma with hepatic and pulmonary metastases.(AU)

Metastatic osteoblastic osteosarcoma in a captive scarlet macaw (Ara macao)

Osteosarcoma is a malignant primary tumor of the bone, which is considered rare in birds. This report describes an osteoblastic osteosarcoma in a scarlet macaw (Ara macao), which was apathetic with progressive weight loss, and had a tumor in the distal portion of the femur and proximal tibiotarsus with ulcerated pododermatitis in the contralateral limb. Euthanasia was elected due to poor diagnosis after radiographic and cytological examination. Histopathology and immunohistochemistry were performed and confirmed the diagnosis of an osteoblastic osteosarcoma with hepatic and pulmonary metastases.

Metástase hepática de tumor gastrointestinal estromal (gist) em cão: relato de caso / Hepatic metastasis of gastrointestinal stromal tumors (gist) in dog: case report

Os tumores mesenquimais originados a partir de células intersticiais de Cajal, denominados tumores gastrointestinais estromais (GIST) são raros em humanos e com incidência ainda desconhecida em cães. A diferenciação de GIST, leiomiossarcoma e leiomioma com base apenas em exames de imagem, morfológicos e colorações simples por meio da histologia é muitas vezes difícil, sendo indicada realização de imuno-histoquímica. Foi atendida uma cadela, sem padrão racial definido, oito anos, 17kg de peso corporal, com discreto aumento de volume abdominal, sendo evidenciada por ultrassom abdominal neoformação intra-abdominal em região mesogástrica, sem demais alterações clínicas. Durante celiotomia exploratória, identificou-se que a neoformação intestinal localizava-se em jejuno, optando pela realização de enterectomia, sendo posteriormente diagnosticada como leiomiossarcoma pela análise histopatológica. Preconizou-se a instituição de quimioterapia adjuvante com o uso de doxorrubicina (30 mg/m²), a cada 21 dias, totalizando seis sessões. Após dez meses do tratamento cirúrgico, a paciente foi submetida a novo estadiamento clínico, sendo visibilizado, mediante ultrassom abdominal neoformações sólidas em fígado. A partir de biópsia hepática guiada por ultrassom com agulha “tru-cut” e análise histológica e imuno-histoquímica, definiu-se que as neoformações hepáticas eram metástases de GIST, instituindo o tratamento com fosfato de toceranib (Palladia®). Desde o momento da enterectomia ao óbito da paciente, contabilizou-se 20,4 meses de sobrevida global.

Mesenchymal tumors originating from interstitial cells of Cajal, called stromal gastrointestinal tumors (GIST) are rare in humans and their incidence is still unknown in dogs. The differentiation of GIST, leiomyosarcoma and leiomyoma based only on imaging, morphological and simple staining through histology is often difficult, and immunohistochemistry is indicated. A female dog, mixed breed, eight years old, 17kg of body weight, with a slight increase in abdominal volume, and ultrasound evidence of an intra-abdominal neoformation in the mesogastric region, without other clinical changes was seen. During exploratory celiotomy, it was identified that the intestinal neoformation in jejunum, opting for enterectomy, being identified as leiomyosarcoma according to histopathological analysis. Adjuvant chemotherapy was instituted using doxorubicin (30mg / m²) every 21 days, totaling six sessions. The patient underwent a new clinical staging, 10 months after enterectomy, where were visualized, by abdominal ultrasound, neoformations in the liver. Based on ultrasound guided liver biopsy with “tru-cut” needle and histological and immunohistochemical analysis, the neoformation was defined as GIST liver metastasis, being instituted treatment with toceranib phosphate (Palladia®). From the time of enterectomy to the death of the patient, 20,4 months of overall survival were counted.

Metástase hepática de tumor gastrointestinal estromal (gist) em cão: relato de caso / Hepatic metastasis of gastrointestinal stromal tumors (gist) in dog: case report

Os tumores mesenquimais originados a partir de células intersticiais de Cajal, denominados tumores gastrointestinais estromais (GIST) são raros em humanos e com incidência ainda desconhecida em cães. A diferenciação de GIST, leiomiossarcoma e leiomioma com base apenas em exames de imagem, morfológicos e colorações simples por meio da histologia é muitas vezes difícil, sendo indicada realização de imuno-histoquímica. Foi atendida uma cadela, sem padrão racial definido, oito anos, 17kg de peso corporal, com discreto aumento de volume abdominal, sendo evidenciada por ultrassom abdominal neoformação intra-abdominal em região mesogástrica, sem demais alterações clínicas. Durante celiotomia exploratória, identificou-se que a neoformação intestinal localizava-se em jejuno, optando pela realização de enterectomia, sendo posteriormente diagnosticada como leiomiossarcoma pela análise histopatológica. Preconizou-se a instituição de quimioterapia adjuvante com o uso de doxorrubicina (30 mg/m²), a cada 21 dias, totalizando seis sessões. Após dez meses do tratamento cirúrgico, a paciente foi submetida a novo estadiamento clínico, sendo visibilizado, mediante ultrassom abdominal neoformações sólidas em fígado. A partir de biópsia hepática guiada por ultrassom com agulha “tru-cut” e análise histológica e imuno-histoquímica, definiu-se que as neoformações hepáticas eram metástases de GIST, instituindo o tratamento com fosfato de toceranib (Palladia®). Desde o momento da enterectomia ao óbito da paciente, contabilizou-se 20,4 meses de sobrevida global.(AU)

Mesenchymal tumors originating from interstitial cells of Cajal, called stromal gastrointestinal tumors (GIST) are rare in humans and their incidence is still unknown in dogs. The differentiation of GIST, leiomyosarcoma and leiomyoma based only on imaging, morphological and simple staining through histology is often difficult, and immunohistochemistry is indicated. A female dog, mixed breed, eight years old, 17kg of body weight, with a slight increase in abdominal volume, and ultrasound evidence of an intra-abdominal neoformation in the mesogastric region, without other clinical changes was seen. During exploratory celiotomy, it was identified that the intestinal neoformation in jejunum, opting for enterectomy, being identified as leiomyosarcoma according to histopathological analysis. Adjuvant chemotherapy was instituted using doxorubicin (30mg / m²) every 21 days, totaling six sessions. The patient underwent a new clinical staging, 10 months after enterectomy, where were visualized, by abdominal ultrasound, neoformations in the liver. Based on ultrasound guided liver biopsy with “tru-cut” needle and histological and immunohistochemical analysis, the neoformation was defined as GIST liver metastasis, being instituted treatment with toceranib phosphate (Palladia®). From the time of enterectomy to the death of the patient, 20,4 months of overall survival were counted.(AU)

Primary gallbladder adenocarcinoma in a cat

Background: Biliary tumors have low incidence in cats and are more common in elderly animals. Hepatobiliary tumors have different classifications and their etiology is difficult to interpret. In most cases, the diagnosis is only possible in advanced stages, which clouds the precursor factors. The late diagnosis is explained by the absence or specificity of clinical manifestations and laboratory changes. The majority of hepatobiliary neoplasms in cats are incidental findings in surgeries or necropsies. This study aimed to report clinical, laboratory, pathological and immunohistochemical results in a feline case of gallbladder adenocarcinoma. Case: 4-year-old male castrated mix breed cat was admitted at a veterinary clinic with a history of polyuria / polydipsia, anorexia, apathy, jaundice and emesis for 60 days. The animal had been treated in another clinic with silymarin, famotidine and cyanocobalamin, and fed by esophageal tube based on the presumptive clinical diagnosis of cholangitis. The clinical examination revealed jaundice, abdominal pain, weight loss, enlargement of the liver and gallbladder and the presence of a structure in the epigastric region. Based on clinical signs, blood tests (complete blood count and liver enzymes), abdominal ultrasound and thoracic radiography were requested. In the exam results, eosinophilia, bilirubinemia and increased alkaline phosphatase, glutamic pyruvic transaminase and gamma glutamyl transferase were observed, in addition to the presence of icteric and hemolyzed serum. Ultrasound exam revealed thickened and dilated cystic and common ducts, large and thick gallbladder, bile with bile mud, hypoechogenic liver, thickening in the duodenal papilla and enlarged pancreatic and duodenal lymph nodes. There were no alterations in thoracic radiography. Based on the findings, the diagnosis of...

Primary gallbladder adenocarcinoma in a cat

Background: Biliary tumors have low incidence in cats and are more common in elderly animals. Hepatobiliary tumors have different classifications and their etiology is difficult to interpret. In most cases, the diagnosis is only possible in advanced stages, which clouds the precursor factors. The late diagnosis is explained by the absence or specificity of clinical manifestations and laboratory changes. The majority of hepatobiliary neoplasms in cats are incidental findings in surgeries or necropsies. This study aimed to report clinical, laboratory, pathological and immunohistochemical results in a feline case of gallbladder adenocarcinoma. Case: 4-year-old male castrated mix breed cat was admitted at a veterinary clinic with a history of polyuria / polydipsia, anorexia, apathy, jaundice and emesis for 60 days. The animal had been treated in another clinic with silymarin, famotidine and cyanocobalamin, and fed by esophageal tube based on the presumptive clinical diagnosis of cholangitis. The clinical examination revealed jaundice, abdominal pain, weight loss, enlargement of the liver and gallbladder and the presence of a structure in the epigastric region. Based on clinical signs, blood tests (complete blood count and liver enzymes), abdominal ultrasound and thoracic radiography were requested. In the exam results, eosinophilia, bilirubinemia and increased alkaline phosphatase, glutamic pyruvic transaminase and gamma glutamyl transferase were observed, in addition to the presence of icteric and hemolyzed serum. Ultrasound exam revealed thickened and dilated cystic and common ducts, large and thick gallbladder, bile with bile mud, hypoechogenic liver, thickening in the duodenal papilla and enlarged pancreatic and duodenal lymph nodes. There were no alterations in thoracic radiography. Based on the findings, the diagnosis of...(AU)

Differential diagnoses in 83 dogs with icterus / Diagnósticos diferenciais em 83 cães com icterícia

Icterus (jaundice) is a yellowish pigmentation resulting from the depositing of bilirubin in tissues due to its high plasmatic concentration. The pathogenesis of icterus includes metabolic changes or obstructed bilirubin excretion and it is classified as pre-hepatic, hepatic and post-hepatic. This study aimed to evaluate and classify different causes of icterus in dogs during post mortem examination. These dogs were examined from 2014 to 2017, using macroscopic and histologic exams as well as ancillary tests. Eighty-three dogs were examined macroscopically and microscopically. They were separated into groups of icterus types: 24 (28.9%) dogs had pre-hepatic icterus, 45 (54.2%) had hepatic, 13 (15.7%) pre-hepatic and hepatic and one (1.2%) had post-hepatic icterus. Many factors were identified as a cause of icterus, including infectious agents (51/83), neoplasms (13/83), hepatic degeneration (11/83), chronic hepatic diseases (6/83), and obstructive causes (1/87). Among the infectious causes, leptospirosis, ehrlichiosis and disorders suggestive of septicemia were diagnosed. Neoplasms associated with icterus were cholangiocarcinoma, hemangiosarcoma and lymphoma. Other causes of icterus included degenerative diseases, such as lipidosis and glycogen degeneration. Hepatic fibrosis (cirrhosis) as a chronic disease and cholelithiasis also produced icterus. PCR was performed to confirm leptospirosis and ehrlichiosis. Samples of total DNA were used to amplify a fragment of a gene from Leptospira interrogans and Ehrlichia canis. In some dogs, co-infection of these agents was detected. The classification and identification of icterus etiologies in dogs is very important due to the number of diseases with this alteration, where ante mortem diagnosis is not always easily performed when some of these conditions are present.(AU)

Icterícia é a pigmentação amarelada decorrente da deposição de bilirrubina em tecidos devido à elevada concentração plasmática. A patogênese da icterícia inclui alterações no metabolismo ou na excreção de bilirrubina, sendo classificada em pré-hepática, hepática ou pós-hepática. O objetivo desse estudo foi identificar, avaliar e classificar as causas de icterícia em cães necropsiados de 2014 a 2017, associando as lesões macroscópicas, histológicas e exames complementares. Foram avaliados macro- e microscopicamente 83 cães com diferentes intensidades de icterícia. Os cães foram separados em grupos de acordo com o tipo de icterícia: 24 (28,9%) cães com icterícia pré-hepática, 45 (54,2%) cães com icterícia hepática, 13 (15,7%) com icterícia pré-hepática e hepática e um (1,2%) com icterícia pós-hepática. Foram identificadas várias etiologias associadas à icterícia, dentre elas pode-se destacar, agentes infecciosos (51/83), neoplasmas (13/83), processos degenerativos (11/83), crônicos (6/83) e obstrutivos (1/83). Dentre as causas infecciosas, destacam-se a leptospirose, a erliquiose e as lesões sugestivas de septicemia. Entre os neoplasmas associados com icterícia destacaram-se o colangiocarcinoma, hemangiossarcoma e linfoma. Outras causas de icterícia incluiriam os processos degenerativos como as degenerações gordurosa e glicogênica. Fibrose hepática (cirrose) e colelitíase foram também diagnosticados como causa de icterícia. A PCR foi utilizada para o diagnóstico confirmatório de leptospirose e erliquiose. Amostras de DNA total foram utilizadas para amplificar um fragmento dos genes de Leptospira interrogans e de Ehrlichia canis. Em alguns cães foi detectada co-infecção por estes agentes. A classificação e a identificação das causas de icterícia em cães são relevantes devido ao grande número de doenças que apresentam essa alteração, muitas vezes sem diagnóstico ante mortem.(AU)

Differential diagnoses in 83 dogs with icterus / Diagnósticos diferenciais em 83 cães com icterícia

Icterus (jaundice) is a yellowish pigmentation resulting from the depositing of bilirubin in tissues due to its high plasmatic concentration. The pathogenesis of icterus includes metabolic changes or obstructed bilirubin excretion and it is classified as pre-hepatic, hepatic and post-hepatic. This study aimed to evaluate and classify different causes of icterus in dogs during post mortem examination. These dogs were examined from 2014 to 2017, using macroscopic and histologic exams as well as ancillary tests. Eighty-three dogs were examined macroscopically and microscopically. They were separated into groups of icterus types: 24 (28.9%) dogs had pre-hepatic icterus, 45 (54.2%) had hepatic, 13 (15.7%) pre-hepatic and hepatic and one (1.2%) had post-hepatic icterus. Many factors were identified as a cause of icterus, including infectious agents (51/83), neoplasms (13/83), hepatic degeneration (11/83), chronic hepatic diseases (6/83), and obstructive causes (1/87). Among the infectious causes, leptospirosis, ehrlichiosis and disorders suggestive of septicemia were diagnosed. Neoplasms associated with icterus were cholangiocarcinoma, hemangiosarcoma and lymphoma. Other causes of icterus included degenerative diseases, such as lipidosis and glycogen degeneration. Hepatic fibrosis (cirrhosis) as a chronic disease and cholelithiasis also produced icterus. PCR was performed to confirm leptospirosis and ehrlichiosis. Samples of total DNA were used to amplify a fragment of a gene from Leptospira interrogans and Ehrlichia canis. In some dogs, co-infection of these agents was detected. The classification and identification of icterus etiologies in dogs is very important due to the number of diseases with this alteration, where ante mortem diagnosis is not always easily performed when some of these conditions are present.(AU)

Icterícia é a pigmentação amarelada decorrente da deposição de bilirrubina em tecidos devido à elevada concentração plasmática. A patogênese da icterícia inclui alterações no metabolismo ou na excreção de bilirrubina, sendo classificada em pré-hepática, hepática ou pós-hepática. O objetivo desse estudo foi identificar, avaliar e classificar as causas de icterícia em cães necropsiados de 2014 a 2017, associando as lesões macroscópicas, histológicas e exames complementares. Foram avaliados macro- e microscopicamente 83 cães com diferentes intensidades de icterícia. Os cães foram separados em grupos de acordo com o tipo de icterícia: 24 (28,9%) cães com icterícia pré-hepática, 45 (54,2%) cães com icterícia hepática, 13 (15,7%) com icterícia pré-hepática e hepática e um (1,2%) com icterícia pós-hepática. Foram identificadas várias etiologias associadas à icterícia, dentre elas pode-se destacar, agentes infecciosos (51/83), neoplasmas (13/83), processos degenerativos (11/83), crônicos (6/83) e obstrutivos (1/83). Dentre as causas infecciosas, destacam-se a leptospirose, a erliquiose e as lesões sugestivas de septicemia. Entre os neoplasmas associados com icterícia destacaram-se o colangiocarcinoma, hemangiossarcoma e linfoma. Outras causas de icterícia incluiriam os processos degenerativos como as degenerações gordurosa e glicogênica. Fibrose hepática (cirrose) e colelitíase foram também diagnosticados como causa de icterícia. A PCR foi utilizada para o diagnóstico confirmatório de leptospirose e erliquiose. Amostras de DNA total foram utilizadas para amplificar um fragmento dos genes de Leptospira interrogans e de Ehrlichia canis. Em alguns cães foi detectada co-infecção por estes agentes. A classificação e a identificação das causas de icterícia em cães são relevantes devido ao grande número de doenças que apresentam essa alteração, muitas vezes sem diagnóstico ante mortem.(AU)

Comparison of the prognostic value of platelet-based prognostic models in patients with malignant hepatic tumors after TACE therapy

Purpose: To investigate the prognostic value of 17 platelet-based prognostic scores in patients with malignant hepatic tumors after TACE therapy. Methods: In total, 92 patients were divided into death group and survival group according to long-term follow-up results. The AUC was calculated to determine the optimal cut-off values for predicting prognosis. To determine better prognostic models, platelet-based models were analyzed separately after being showed as binary according to cut-off values. Cumulative survival rates of malignant hepatic tumors were calculated using Kaplan-Meier curves and differences were analyzed by the log-rank test. Univariate and multivariate analyses were performed to identify platelet-based prognostic scores associated with overall survival. Results: Univariate analysis showed that APGA, APRI, FIB-4, FibroQ, GUCI, Kings score, Lok index, PAPAS, cirrhosis, number of tumors, vascular cancer embolus, AFP, ALP and APTT were significantly related to prognosis. A multivariate analysis showed that the APGA, number of tumors, ALP and APTT were independently associated with overall survival. Conclusion: This study showed that the APGA, a platelet-based prognostic score, was an independent marker of prognosis in patients with malignant hepatic tumors after TACE and was superior to the other platelet-based prognostic scores in terms of prognostic ability.(AU)