Case # 85154:Bone marrow impression from a lame dog

Presenter: Katie BoesAuthors: Laurie O’Rourke, Geoffrey Saunders, Natalie Durrett Crawford, Nic Lambrechts, Jonathan Miller, Kurt Zimmerman

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Signalment & History

Signalment– 2-year-old– Castrated male – Golden Retriever

History– Chronic weight loss– Progressive left thoracic leg lameness

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Physical Examination

BCS 3/9 Left front limb

– Grade 3/4 lameness– Muscle atrophy– Pain with shoulder flexion– Solid scapular mass

Enlarged liver Abdominal distension

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Imaging: Left Shoulder

Radiographs– Well-circumscribed area

of bony lysis at the scapular neck, surrounded by a soft tissue mass

Ultrasound– Cortical lysis

• Loss of echogenic interface

• Loss of thedistal acoustic shadowing

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Imaging: Metastasis Check

Abdominal ultrasound– Several soft tissue

masses

Thoracic radiographs– Enlarged heart– Unremarkable lung

fields

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Gross Findings

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Samples Collected

Cytopathology– Bone marrow impressions from the left

scapula Histopathology

– Perirenal mass, small intestine, liver, pancreas, spleen, kidney, lung

– Not the left scapular mass

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Left scapular bone marrow impression, Modified Wright’sPresented at SEVPAC 2008 – Permission granted for use on

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Left scapular bone marrow impression, Modified Wright’sPresented at SEVPAC 2008 – Permission granted for use on

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Perirenal mass, H&EPresented at SEVPAC 2008 – Permission granted for use on

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Perirenal mass, H&EPresented at SEVPAC 2008 – Permission granted for use on

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Perirenal mass, H&EPresented at SEVPAC 2008 – Permission granted for use on

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Special Stains & Immunohistochemistry

Stain ResultSignificance &

Cell Origin

Grimelius silver stain Strong (+) Chromaffin cell

Vimentin (-) Not mesenchymal

Cytokeratin AE1/3 (-) Not epithelial

Synaptophysin Strong (+) Neuroendocrine

Chromatogranin A Weak (+) Neuroendocrine

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Diagnosis

Cytopathologic opinion of bone marrow– Consistent with metastatic neuroendocrine

neoplasia Histopathologic diagnosis

– Perirenal mass: malignant pheochromocytoma with metastases to the liver, pancreas, spleen, kidney, lung, and scapula bone, canine

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Review: Neuroendocrine Cytologic Appearance Highly cellular Many free nuclei Cells exfoliate in loosely

attached sheets Round to polygonal

cells Indistinct cell borders

– Occasionally distinct Nuclei are round to

indented

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Comments

Histopathologic sections of the scapular mass were not taken, however…– Antemortem FNAs of the scapular mass

and several intraabdominal masses revealed similar neoplastic cells as described in the postmortem bone marrow impression smear

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Pheochromocytomas:Cell Origin & Signalment Type of paraganglioma tumor of the

chromaffin cells arising from the adrenal medulla

Uncommon tumor of older dogs– 0.1% to 0.01% of all tumors in dogs– Mean age of 11 yrs (range of 1-15 yrs)

No breed or sex predilection

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Pheochromocytomas:Presenting Complaints None (incidental finding)

– 48-57% Non-specific Excessive catecholamine production

– 23-43%– Signs associated with hypertension– Panting, dyspnea, coughing, weakness,

exercise intolerance

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Pheochromocytomas:Clinical Diagnosis Routine blood and urine analysis

– Variable and non-specific Measure catecholamines and their metabolites in

blood and urine– Low availability– High technical difficulty and expense– False negatives due to cyclical excretion

Catecholamine stimulation and suppression tests– Dangerous due to profound changes in blood pressure

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Pheochromocytomas:Treatment & Survival Surgery is the treatment of choice

– Mortality rates: 22-29%– Survival with complete removal: Up to 3.25 years

Survival– No correlation between prognosis and histologic

appearance in dogs– Neurologic disease, abdominal distension, and

weight loss associated with advanced tumor stages

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Acknowledgements

VMRCVM’s Department of Biomedical Sciences

Dr. Eric Schultze, Eli Lilly & Co. Dr. Christopher Ober, VMRCVM

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References

1. Barthez PY, Marks, SL, Woo J, Feldman EC, Matteucci M. Pheochromocytoma in dogs: 61 cases (1984-1995). J Vet Intern Med. 1997;11:272-278.

2. Bouayad H, Feeney DA, Caywood DD, Hayden DW. Pheochromocytoma in dogs: 13 cases (1980-1985). J Am Vet Med Assoc. 1987;191:1610-1615.

3. Capen CC. Tumors of the adrenal gland. In: Moulton JE, ed. Tumors in Domestic Animals. 3rd ed. Berkeley, CA: University of California Press; 1990:576-583.

4. Gilson SD, Withrow SJ, Wheeler SL, Twedt DC. Pheochromocytoma in 50 dogs. J Vet Intern Med. 1994;8:228-232.

5. Raskin RE, Meyer DJ. Atlas of Canine and Feline Cytology. Philadelphia, PA: W. B. Saunders; 2001: 31-32.

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Questions?

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