What s your diagnosis? Signlament: 11 y MC Maltese Mix. Presenting complaint: Pollakiuria with hematuria.

Transcription

1 What s yur diagnsis? Signlament: 11 y MC Maltese Mix Presenting cmplaint: Pllakiuria with hematuria. Histry: Zippy presented with a 4 day histry f pllakiuria. Straining t urinate had nt been nted, hwever pink tinged urine had been seen by the wner. On presentatin he had been drinking excessive amunts f water, had a gd appetite, but seemed nauseus. PE Findings: Zippy was bright, alert, and respnsive. Heart rate was 168 beats per minute. He was panting and his temperature was nrmal. Ptential enlargement f prstate was nted n rectal exam. All ther physical exam findings were within nrmal limits. Diagnstic Plan: - Cmplete bld cunt: Mild elevatin f red bld cells, platelets, and prtein. Attributed t dehydratin. - Serum Chemistry: Elevated prteins and elevated liver enzymes (ALT- 336U/L, ALP- 4701U/L) - Urinalysis via catheterizatin: red bld cells were present alng with sme epithelial cells. - Urine culture: n grwth - Abdminal radigraphs Figure 1: VD abdmen

2 Figure 2: Right lateral abdmen Radigraphic findings Mildly enlarged liver with runded margins Mderately gas distended stmach Feces and gas distended cln Enlarged prstate fr neutered male Multiple mineral pacities in caudal abdmen- suspect urinary bladder r prstate Radigraphic impressins Hepatmegaly with causes including infiltrative disease (inflammatin, infectin, r neplasia), ndular hyperplasia, r a metablic/endcrine disease. Prstatmegaly pssibly due t neplasia. Mineralizatin differentials including neplasia r cystic calculi. Suggest cmpressin study and perineal views t determine mineralizatin rgan f rigin, and rule ut calculi within the urethra.

3 Figure 3: Right lateral perineal Figure 4: Right lateral cmpressin Radigraphic findings N mineralized material in urethra. Multiple mineral pacities in the urinary bladder- cmpressin study was used t displace cln away frm urinary bladder. Cntents f bladder were then visualized separate frm clnic material.

4 Radigraphic impressins Mineralized material in bladder with differentials f neplasia r cystic calculi. Abdminal ultrasund recmmended Abdminal Ultrasund Figures 5 & 6 Urinary bladder with bladder mass

5 Ultrasund findings In the drsal central bdy and neck f the urinary bladder there is a sft tissue, irregularly marginated mass with linear mineral pacities. Ultrasund impressins Mineral pacity mass in bladder, mst likely differential is neplasia. - Urine catheterizatin fr cytlgy- Epithelial cell prliferatin. Higher number than nrmal, hwever there was n apparent signs f malignancy t lead t a cytlgical diagnsis f transitinal cell carcinma. Ptential differentials include transitinal cell carcinma, based n appearance, and unlikely a benign plyp r hyperplasia. - CADET SM BRAF Mutatin Test- DNA islated frm a urine sample detected the BRAF gene. 19% f the cpies f the BRAF gene were detected as mutant. Diagnsis- Transitinal cell carcinma lcalized t the bladder. Discussin- Transitinal cell carcinma is the mst cmmn neplasia f the bladder. It develps frm the transitinal epithelial cells that line the bladder and in dgs can invade deep int the bladder walls even invlving muscle layers. As it is difficult t remve bladder masses surgically, it is mst ften treated medically. There have been studies that shw the nn-steridal drug Pirxicam has an effect n transitinal cell carcinmas. It has been shwn t have an effect f decreasing tumr size r decreasing the chance f cntinued grwth f the tumr. Chemtherapy is als utilized in the treatment f transitinal cell carcinma. Mitxantrne is a chemtherapy agent whse mechanism f actin is thrugh Tpismerase II inhibitin and is indicated fr the treatment f transitinal cell carcinma. 85% f canine transitinal cell carcinma cases have a gene mutatin f the BRAF gene. The CADET SM BRAF gene assay prvides a highly sensitive methd t detect the presence f the BRAF gene mutatin in urine samples f dgs. The gene is nt detected in healthy dgs r dgs with cancers ther than transitinal cell carcinma. Case Fllw Up- Patient will be started n pirxicam and mitxantrne. The CADETSM BRAF Assay fr Diagnsis & Mnitring f Canine TCC/UC. Sentinel Bimedical, Sentinel, Knapp, Debrah W. Canine Bladder Cancer. Purdue Cmparative Onclgy Prgram, d=1&h=mv5gdonj49l-d3afvilob_jwsdoqh JCdjqKPVJzGqg&v=1&r= Mhammed SI, Deepika D, Abraham S, Snyder PW, Waters DJ, Lu M, Wu L, Zheng R, Stewart J, Knapp DW. Cyclxygenase inhibitrs in urinary bladder cancer: in vitr and in viv effects. Ml Cancer Ther 2006; 5: