Veterinary Medicine - March 2008 - (Page 150)

A challenging case PEER-REVIEWED 7. Histologic examination of tissue from the resected pancreatic mass revealed a discrete population of pale uniform neoplastic cells adjacent to normal exocrine pancreatic glandular tissue (upper left and entrapped within the neoplasm) (hematoxylin-eosin stain, 100X). 8. Histologic examination of tissue from the resected pancreatic mass revealed round to polygonal neoplastic cells with lightly basophilic granular cytoplasm and round to slightly oval vesicular nuclei with single prominent nucleoli, consistent with a pancreatic islet cell tumor (hematoxylin-eosin stain, 400X). and the dog’s poor clinical condition, the owner elected euthanasia. A blood sample was obtained before euthanasia, and the dog’s plasma glucagon concentration was 216 ng/L. Necropsy results showed no gross evidence of glucagonoma metastases or other primary neoplasia. A histologic examination of tissues from necropsy (pancreas, liver, kidney, spleen, adrenal glands, gastrointestinal tract, heart, lung, bone marrow) revealed splenic extramedullary hematopoiesis, mild and multifocal hepatocellular vacuolar degeneration, and cholestasis. The gross necropsy results and histologic ndings did not provide an explanation for the clinical signs or elevated glucagon concentration. DISCUSSION Islet cell tumors, uncommon neoplasms of neuroendocrine cells within the pancreas, are classi ed as insulinomas, glucagonomas, gastrinomas, or somatostatinomas, depending on the predominant hormone secreted by the neoplasm.2 About 200 cases in people have been reported.2-4 A few cases of glucagonomas in dogs have been reported, but the cytologic and histologic examination results have not been reported together.5-11 About 50% of the islet cell tumors in people are immunohistochemically reactive for multiple hormones. These tumors can secrete any of the hormones known to be present in the pancreatic islets, including insulin, glucagon, somatostatin, pancreatic polypeptide, and gastrin, either singly or in any combination.12 However, a single cell type and pancreatic hormone generally predominate and usually result in the corresponding metabolic syndrome.12 This ability to produce multiple hormones is also found in canine islet cell tumors.6,12,13 In people, glucagonomas are neoplasms of alpha cells that result in a paraneoplastic disease characterized by necrolytic migratory erythema, diabetes mellitus, weight loss, anemia, glossitis, stomatitis, thromboembolism, and gastrointestinal and neuropsychiatric disturbances. These clinical ndings along with hyperglucagonemia and a pancreatic islet cell tumor establish the diagnosis. Superﬁcial necrolytic dermatitis The hallmark clinical nding in people with a glucagonoma is necrolytic migratory erythema. The skin lesions have a predilection for the perioral region, perineum, lower abdomen, thighs, buttocks, and distal extremities. In all the reported cases of 150 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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