transitional cell carcinoma in a dog sarra borne lord vete 3313: radiology and clinical imaging
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Transitional Cell Carcinoma in a Dog
Sarra Borne Lord
VETE 3313: Radiology and Clinical Imaging
Harriet – History and Signalment
10 year old
Spayed female
Scottish terrier
History of hematuria, without bacteruria
Repeated treatment with antibiotics to no avail
Generally good health otherwise, good appetite
Current on vaccinations
Physical Exam
Weight: 16 pounds
BCS: 3/5
Rectal temp 101.2 F
Heart Rate: 120 bpm
Respiratory rate: 24 bpm
Normal thoracic auscultation
No discomfort on abdominal palpation
Normal rectal palpation
Diagnostics – Laboratory Findings
CBC
UrinalysisSpG: 1.017, pH: 8.5
Negative for protein, glucose, ketones and bilirubin
Blood: 3+, WBC/hpf: 0-2, RBC/hpf: >100
No casts, bacteria, crystals or mucus on sediment
Biochemistry Panel GLU (glucose) 97 60-125 mg/dL
BUN (blood urea
nitrogen)
16 7-27 mg/dL
CREA (creatinine) 0.9 0.4-1.8 mg/dL
PHOS (phosphorus) 4.3 2.1-6.3 mg/dL
ALKP (alkaline
phosphatase)
191 10-150 U/L
ALT(alanine
aminotransferase)
42 5-107 U/L
K (potassium) 5.1 4.0-5.6 mmol/L
Na (sodium) 147 141-156 mmol/L
Cl (chloride) 109 105-115 mmol/L
CHOL (cholesterol) 217 112-328 mg/dL
RBC (red blood
cells
6.59 5.50-8.50
M/uL
HCT (hematocrit) 42.5 37-55 %
HGB (hemoglobin) 15.3 12-18 g/dL
WBC (white blood
cell)
8.23 5.7-16.3 K/uL
Neutrophils 5.76 3-11K/uL
PLT (platelet) 441 175-500 K/ul
Diagnostic Imaging – Retrograde Cystography
NEGATIVE CONTRAST CYSTOGRAPHY
Bladder was catheterized, the urine drained, and 60 ml carbon dioxide is instilled into the bladder until slightly turgid.
Negative contrast cystography showed a potential mass effect in the trigone area.
Carbon dioxide is removed from bladder in preparation for a positive contrast cystogram.
This procedure generally safe but can cause air embolization. Carbon dioxide or nitrous oxide can be used if available and they negate this risk.
Photo courtesy Veterinary Imaging Associates, 2015
Diagnostic Imaging – Retrograde Cystography
POSITIVE CONTRAST CYSTOGRAPHY
Diluted positive contrast media (Renografin-60 60 ml total diluted 50:50 with sterile water) isinstilled into the bladder.
Mass effect still visible but not clearly defined.
Positive contrast allows visualization of filling defects and can be used to examine the urethra for defects.
Photo courtesy Veterinary Imaging Associates, 2015
Diagnostic Imaging – Retrograde Cystography
DOUBLE CONTRAST CYSTOGRAPHY
Contrast media removed from the bladder and air re-instilled.
These radiographs are a double contrast study
Any remaining positive contrast media that adheres to bladder wall is usually because of a lesion.
This helps to define the margins of a mass effect.Photo courtesy Veterinary Imaging Associates, 2015
Diagnostic Imaging - Ultrasound
BLADDER ULTRASONOGRAPHY
Increases visibility of the margins of the mass.
Useful for scanning remainder of abdominal organs for any additional suspicious areas or metatheses.
Harriet’s liver, spleen, kidneys, and intestines were normal.
Some of her mesenteric lymph nodes were mildly enlarged.
)
Photo courtesy Veterinary Imaging Associates, 2015
Diagnostic Imaging - Cystoscopy
Diagnosis of transitional cell carcinoma requires obtaining a sample of the mass.
An aspirate of the tumor should be avoided due to the potential of tumor seeding at the site of the puncture.
Surgical biopsy can be done but is very invasive.
Cytologic evaluation can be done by rubbing the tip of a urinary catheter against the mass to extract cells.
Cystoscopy is a better option but requires referral. Transitional cell carcinoma with white fimbriation (Finnish,
n.d.)
Photo courtesy the Finnish Veterinary Association, n.d.
Transitional Cell Carcinoma
Cancer of the urinary tract can affect any of the structures (bladder, kidneys, ureters, urethra)
The most common cancer of the dog urinary bladder is transitional cell carcinoma (TCC)
It is a malignant cancer that arises from the transitional epithelial cells that line the bladder.
Scottish terriers have an 18-20% higher risk of TCC than other breeds (Knapp, 2013)
Cytology smear transitional cell carcinoma (Scurrell, 2012)
Therapeutic Recommendations
Surgical excision
Not possible if the cancer is situated in the neck or trigone area
Radiation therapy.
Can lead to harmful complications
Medical management
Piroxicam
Chemotherapy
Mitoxantrone
Vinblastine
Metronomic chemotherapy
Chemotherapy with medical management
References
Caswell, M. (2011, June). Transitional cell carcinoma of the urinary bladder in a 14-year-old dog. The
Canadian Veterinary Journal, 52, 673-675. Retrieved from
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3095172/
Contrast studies of small animals. (2015). Retrieved from http://www.online-vets.com/contrast_4.html
Glickman, L. T., Raghavan, M., Knapp, D. W., Bonney, P. L., & Dawson, M. H. (2004). Herbicide exposure
and the risk of transitional cell carcinoma of the urinary bladder in Scottish Terriers. Journal of the
American Veterinary Medical Association, 224, 1290-1297.
Knapp, D. W. (2013). Canine bladder cancer. Retrieved from
https://www.vet.purdue.edu/pcop/files/docs/CanineUrinaryBladderCancer.pdf
Scurell, E. (2012). Transitional cell carcinoma (TCC) in a dog. Retrieved from
http://www.cytopath.co.uk/caseofmonthMarch2012.html
The Finnish Veterinary Association. (n.d.). Kuvat figures. Retrieved from http://www.sell.fi/index.php?id=513
Thrall, D. E. (2013). Textbook of veterinary diagnostic radiology (6th ed.). : Saunders.
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