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Bone Marrow Impression Diagnosis of Metastatic Neuroendocrine Neoplasia in a Lame Dog

This case study presents a 2-year-old castrated male Golden Retriever exhibiting chronic weight loss and progressive left thoracic leg lameness. Physical examinations revealed significant lameness, muscle atrophy, a solid scapular mass, enlarged liver, and abdominal distension. Imaging confirmed bone lysis and soft tissue masses. Cytopathology and histopathology identified metastatic neuroendocrine neoplasia and malignant pheochromocytoma with multiple metastases. The case underscores the importance of accurate diagnosis and treatment approaches for unusual tumors in canines.

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Bone Marrow Impression Diagnosis of Metastatic Neuroendocrine Neoplasia in a Lame Dog

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  1. Case # 85154:Bone marrow impression from a lame dog Presenter: Katie Boes Authors: Laurie O’Rourke, Geoffrey Saunders, Natalie Durrett Crawford, Nic Lambrechts, Jonathan Miller, Kurt Zimmerman Presented at SEVPAC 2008 – Permission granted for use on SEVPAC website only

  2. Signalment & History • Signalment • 2-year-old • Castrated male • Golden Retriever • History • Chronic weight loss • Progressive left thoracic leg lameness Presented at SEVPAC 2008 – Permission granted for use on SEVPAC website only

  3. 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 Presented at SEVPAC 2008 – Permission granted for use on SEVPAC website only

  4. 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 the
distal acoustic shadowing Presented at SEVPAC 2008 – Permission granted for use on SEVPAC website only

  5. Imaging: Metastasis Check • Abdominal ultrasound • Several soft tissue masses • Thoracic radiographs • Enlarged heart • Unremarkable lung fields Presented at SEVPAC 2008 – Permission granted for use on SEVPAC website only

  6. Gross Findings Presented at SEVPAC 2008 – Permission granted for use on SEVPAC website only

  7. 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 Presented at SEVPAC 2008 – Permission granted for use on SEVPAC website only

  8. Left scapular bone marrow impression, Modified Wright’s Presented at SEVPAC 2008 – Permission granted for use on SEVPAC website only

  9. Left scapular bone marrow impression, Modified Wright’s Presented at SEVPAC 2008 – Permission granted for use on SEVPAC website only

  10. Perirenal mass, H&E Presented at SEVPAC 2008 – Permission granted for use on SEVPAC website only

  11. Presented at SEVPAC 2008 – Permission granted for use on SEVPAC website only Perirenal mass, H&E

  12. Perirenal mass, H&E Presented at SEVPAC 2008 – Permission granted for use on SEVPAC website only

  13. Special Stains & Immunohistochemistry Presented at SEVPAC 2008 – Permission granted for use on SEVPAC website only

  14. 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 Presented at SEVPAC 2008 – Permission granted for use on SEVPAC website only

  15. 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 Presented at SEVPAC 2008 – Permission granted for use on SEVPAC website only

  16. 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 Presented at SEVPAC 2008 – Permission granted for use on SEVPAC website only

  17. 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 Presented at SEVPAC 2008 – Permission granted for use on SEVPAC website only

  18. 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 Presented at SEVPAC 2008 – Permission granted for use on SEVPAC website only

  19. 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 Presented at SEVPAC 2008 – Permission granted for use on SEVPAC website only

  20. 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 Presented at SEVPAC 2008 – Permission granted for use on SEVPAC website only

  21. Acknowledgements • VMRCVM’s Department of Biomedical Sciences • Dr. Eric Schultze, Eli Lilly & Co. • Dr. Christopher Ober, VMRCVM Presented at SEVPAC 2008 – Permission granted for use on SEVPAC website only

  22. References • 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. • Bouayad H, Feeney DA, Caywood DD, Hayden DW. Pheochromocytoma in dogs: 13 cases (1980-1985). J Am Vet Med Assoc. 1987;191:1610-1615. • 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. • Gilson SD, Withrow SJ, Wheeler SL, Twedt DC. Pheochromocytoma in 50 dogs. J Vet Intern Med. 1994;8:228-232. • Raskin RE, Meyer DJ. Atlas of Canine and Feline Cytology. Philadelphia, PA: W. B. Saunders; 2001: 31-32. Presented at SEVPAC 2008 – Permission granted for use on SEVPAC website only

  23. Questions? Presented at SEVPAC 2008 – Permission granted for use on SEVPAC website only

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