Veterinary Medicine - March 2008 - (Page 148)

A challenging case PEER-REVIEWED 5. The surgically removed mass and adjacent pancreatic tissue from the caudal pole of the right lobe of the pancreas (the hemostat tip is adjacent to the mass). 6. Cytologic examination of a scraping from the pancreatic mass revealed a monomorphic population of neoplastic mononuclear cells in small cohesive groups with many cell-free nuclei typical of an endocrine neoplasm (modiﬁed Wright’s stain, 500X). vascular invasion was identi ed. A mild, multifocal lymphohistiocytic in ammatory in ltrate within the tumor was also identi ed. Small groups of atrophic exocrine pancreatic glandular epithelial cells were trapped within the neoplastic mass. The histologic examination results were consistent with a pancreatic islet cell tumor. The dog’s prognosis was poor because of the local invasion. and many of the cells had a single, small prominent nucleolus. The mononuclear cells also had moderate amounts of light-blue to gray, indistinct cytoplasm; mild anisocytosis, anisokaryosis, and a variation in the nuclear:cytoplasmic ratios were present. A few small cohesive clusters of exocrine pancreatic glandular epithelial cells and low to moderate numbers of cytologically normal small lymphocytes were also identi ed. The scrapings were cytologically consistent with an endocrine neoplasm. IMMUNOHISTOCHEMICAL ANALYSIS The results of an immunohistochemical analysis performed at The University of Minnesota showed that the neoplastic cells were immunoreactive for insulin, glucagon, and islet amyloid polypeptide. No neoplastic cells stained positively for pancreatic polypeptide, somatostatin, or gastrin. These ndings indicated that the pancreatic islet cell tumor was best characterized as a glucagonoma of alpha pancreatic islet cell origin. HISTOLOGIC EXAMINATION The histologic examination revealed that the section of pancreatic tissue consisted of a single, approximately 0.6-cm diameter, nonencapsulated, poorly delineated neoplastic mass that had in ltrated the adjacent normal exocrine pancreatic glandular tissue (Figure 7). The nodule was composed of round to polygonal neoplastic cells with lightly basophilic granular cytoplasm and round to slightly oval vesicular nuclei with a single prominent nucleolus (Figure 8). Mild anisocytosis, anisokaryosis, and a variation in the nuclear:cytoplasmic ratios were present. Mitotic gures were not seen, and no obvious FOLLOW-UP Three weeks after the surgery, the dog’s clinical condition improved. The skin lesions resolved, and the dog’s appetite and attitude returned to normal. However, seven months after the surgery, the dog returned to Purdue for reevaluation because of anemia, anorexia, and vomiting. Because of the owner’s nancial constraints 148 March 2008 VETERINARY MEDICINE http://www.stokespharmacy.com http://www.stokespharmacy.com

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Veterinary Medicine - March 2008 Contents Toxicology Brief Idea Exchange A Challenging Case An Update on Diagnosing and Treating Primary Lung Tumors CE Form Product Preview Advertiser Index Marketplace/Classifieds Mind Over Miller

Veterinary Medicine - March 2008

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