Pathology of the Hematopoietic System. Case studies

Transcription

1 Pathology of the Hematopoietic System Case studies Shannon Martinson, September 2015

2 Signalment: 9 yr-old MC cat Case Study 1 History: Cat had been anorexic and developed bleeding in the eyes Physical Exam: Dehydration (skin tent) Blood present in the eyes (anterior chamber) Abdominal palpation revealed enlarged irregular kidneys Blood chemistry: Elevated urea and creatinine

3 Postmortem findings Case Study 1

4 Case Study 1 Postmortem findings Gross Description

5 Case Study 1 Postmortem findings Gross Description Marked enlargement of the kidneys Nodular/irregular capsular surface

6 Gross Description? Case Study 1

7 Case Study 1 Gross Description? On cut surface, there are multifocal to coalescing, 1-3 cm, white, round to irregular masses scattered throughout both of the kidneys; they efface the tissue and bulge on section

8 Differentials Case Study 1

9 Case Study 1 Differentials Malignant neoplasia (Lymphoma, Renal carcinoma.) Any other possibilities?

10 Case Study 1 Multifocal granulomatous nephritis due to FIP are easily be mistaken for renal lymphoma! Feline Infectious Peritonitis (Pyogranulomatous nephritis) Two main differentials for this lesion in cats: Lymphoma and FIP Need Histology! Renal lymphoma

11 Case Study 1 There is a nodule within the kidney that looks more blue than normal suggests an increase in the cellularity of the tissue

12 Case Study 1 Densely cellular sheet-like infiltrates efface the normal renal architecture leaving few remaining glomeruli

13 Case Study 1 These cells have distinct cell margins, scant eosinophilic cytoplasm, and round nuclei with stippled chromatin and prominent nucleoli. Mitoses are present.

14 Morphologic Diagnosis: Case Study 1

15 Case Study 1 Morphologic Diagnosis: Renal lymphoma Comments: Lymphoma is the most common renal tumor in the cat It may cause kidney deficiency/failure by destroying parenchyma or by obstructing urine outflow Involvement of the iris was bilateral in this case and accounts for hyphema (=blood in the anterior chamber). Given the age of the cat, do you think Feline leukemia virus is the likely underlying cause? What is the typical age of cats with FeLV-associated lymphoma? What forms of lymphoma are commonly seen in FeLV positive cats?

16 Signalment: 8 yr-old beagle History: Case Study 2 Neck pain for the past couple of weeks Paresis, followed by paralysis developed over the past few days Differentials: Trauma IVDD Neoplasia

17 Signalment: 8 yr-old beagle History: Case Study 2 Neck pain for the past couple of weeks Paresis, followed by paralysis developed over the past few days Differentials: Trauma IVDD Neoplasia Radiographs Other imaging (CT, MRI) Blood work Urinalysis courtesy of Dr L Pack, AVC

18 Case Study 2 courtesy of Dr L Pack, AVC

19 Case Study 2 Gross Description

20 Case Study 2 Gross Description On section, the soft pink gelatinous mass is present within the marrow cavity of the vertebral body with slight protrusion into the spinal canal.

21 Case Study 2 Gross Description On section, the soft pink gelatinous mass is present within the marrow cavity of the vertebral body with slight protrusion into the spinal canal. Marked increase in the cellularity of the bone marrow

22 Case Study 2 Gross Description On section, the soft pink gelatinous mass is present within the marrow cavity of the vertebral body with slight protrusion into the spinal canal. Sheets of neoplastic round cells with plasmacytoid features infiltrate the bone.

23 Morphologic Diagnosis: Case Study 2

24 Case Study 2 Morphologic Diagnosis: Myeloma, vertebral body Comments/Questions: Usually these masses are multiple occasionally they are focal as seen here. What are some useful diagnostic tests/findings that can be used to diagnose this disease clinically?

25 Case Study 2 courtesy of Dr A Matthews AVC Helpful diagnostic findings for diagnosing myeloma: Hypercalcemia: Increased osteoclastic activity within bone lesions Hypergammaglobulinemia: Clonal neoplastic plasma cells secrete immunoglobulins (fragments) of one class monoclonal gammopathy Bence-Jones proteinuria Immunoglobulin light chains pass through glomerulus into urine Radiographs showed punched out lesions in the vertebrae

26 Case study 3 Signalment: 7 year old MC Golden Retriever History: Anorexia and lethargy, several days PE: Lymphadenopathy noted. Marked enlargement of the spleen detected on abdominal palpation and ultrasound Differentials:

27 Case study 3 Signalment: 7 year old MC Golden Retriever History: Anorexia and lethargy, several days PE: Lymphadenopathy noted. Marked enlargement of the spleen detected on abdominal palpation and ultrasound Differentials: Splenic +/- LN Neoplasia Splenic Congestion Splenic EMH Hemolytic Disease Amyloidosis Sepsis Granulomatous splenitis/lymphadenitis

28 Case study 3 5 cm

29 Case study 3 Gross Description Is this a bloody or meaty spleen? 5 cm

30 Case study 3 Gross Description There is diffuse marked splenomegaly (10 15 x 35 cm) with rounding of the splenic margins. On section, the tissue is dry and bulging Is this a bloody or meaty spleen? Meaty the spleen bulges on cut section with no oozing of blood. 5 cm

31 Case study 3 Differentials:

32 Case study 3 Diffuse splenomegaly with a firm consistency = Meaty Spleens Septicemia Salmonella Hemolytic disease Differentials: Lymphoma Mast cell neoplasia Histiocytic sarcoma Granulomatous disease Histoplasmosis Amyloidosis

33 Diffuse splenomegaly with a firm consistency = Meaty Spleens Septicemia Salmonella Hemolytic disease Lymphoma Mast cell neoplasia Histiocytic sarcoma Case study 3 Granulomatous disease Histoplasmosis Amyloidosis How will you achieve a definitive diagnosis?

34 Case study 3 Cytology How will you achieve a definitive diagnosis?

35 Case study 3 Histology Sheets of neoplastic round cells Lymphoma How will you achieve a definitive diagnosis?