Background: The lung-digit syndrome is a rare syndrome characterized by the presence of a primary pulmonar neoplasia manifesting metastasis to the digit, occurring exclusively in felines. The diagnosis is based on the clinical signs, associated with radiographic and histopathological exams. There are no therapeutic protocols well-established, and surgical excision is considered controversial due to high recurrence and metastasis rates. The prognosis is considered poor, with low survival rates. The aim of this paper is to report a case of lung-digit syndrome attended in Rio de Janeiro.Case: A 12-year-old female cat, no defined race, was attend with the complaint of weight loss and injury in the right thoracic limb, already having histopathological diagnosis of squamous differentiation adenocarcinoma through biopsy. Physical examination showed no other clinical signs at first, including no signs of respiratory disease. Laboratory and imaging exams were performed, and the radiographic examination showed alterations in the pulmonary parenchyma showing a nodular area of increased radiographic density. Followed up by the manifestation of breathing noise at rest, as the first respiratory signs. The association of the clinical evaluation, medical history, and histopathological report from the limb lesion, lead to the suspicion diagnostic of lung-digit syndrome. The owners decide for the palliative treatment with chemotherapy, using carboplatin and prednisolone. Only the first session was performed, with the animal being euthanized due to clinical worsening 48 days after the initial manifestation of clinical signs. The diagnosis was confirmed by post mortem exams, and the pulmonary nodule were diagnosed as adenocarcinoma with squamous differentiation in concordance with the limb lesion diagnosis.Discussion: The lung-digit syndrome is still poorly studied in the veterinary medicine, with few reports published. Epidemiological data shows major incidence in elderly cats, with no racial or sexual predisposition, occurring in a 12-year-old cat in the present case. There are few theorys to explain the etiopathogenesis of the syndrome, however, none have been fully comproved. The clinical symptomatology varies from asymptomatic animals to those manifesting nonspecific systemic signs and respiratory signs. In this case the animal initially manifested only the presence of the digit injury and weight loss, with respiratory signs manifesting later. The digital lesion local signs usually include swelling, ulceration, purulent discharge, nail loss, and pain, occurring more frequently in the thoracic limbs, involving weight-bearing digits, as in the present report that occurred in the right thoracic limb, with involvement of the first and third digits. Radiographic findings may help in the diagnosis suspicion, having the confirmation by histopathological examination. The most frequent histological types involved in the syndrome are the adenocarcinoma, bronchoalveolar carcinoma, squamous cell carcinoma and adenosquamous carcinoma. The squamous-differentiated adenocarcinoma or adenosquamous carcinoma, as described in the histopathological report in the present case, is the least frequent. The treatment protocol is not well-established with no proven effective treatment. Surgical excision is not recomended as a palliative method, and the chemotherapy and radiotherapy sucess rates are still unknown. The prognosis is considered extremely unfavorable and early diagnosis represents the best attempt to control the disease.
Background: Peripheral neuroblast neoplasms are considered as a group of tumors derived from primitive cells of the neural crest that are progenitors of the sympathetic ganglia and adrenal medulla. Reports of neuroblastoma in dogs are scarce in English literature, and there are no reports from Brazil due to its rare occurrence or missed diagnosis, because modern techniques are often not accessible in Brazil. The aim of the present study was reported a case of metastatic peripheral neuroblastoma in a 10-month-old bitch of Canadian Shepherd breed, attended at the Small Animal Veterinary Hospital of the Federal Rural University of Rio de Janeiro (HVPA-UFRRJ).Case: A 10-month-old female dog, Canadian Shepherd breed, presenting prostration, inappetence, emesis, progressive weight loss, and difficulties in the locomotion of the pelvic limbs was brought to the Small Animal Veterinary Hospital of the Federal Rural University of Rio de Janeiro (HVPA / UFRRJ) for treatment. Palpation of the abdominal cavity revealed a mass of approximately 14.0 cm diameter in the thoracolumbar region. After the second visit to HVPA/ UFRRJ, there was worsening of the clinical condition and onset of pain and dyspnea; hence, euthanasia was performed. The dog was referred for necropsy; the examination revealed a mass measuring 40.0 × 35.0 cm in the abdominal cavity that caused displacement of the intestines and compressed the liver against the diaphragm, as well as another mass that traversed the diaphragm through the esophageal hiatus and surrounded the esophagus, aorta, and caudal vena cava. The right adrenal gland was compressed and adhered to the mass, and the left adrenal gland was not visualized. Specimens of various organs were collected, fixed in 10% buffered formalin, and processed according to routine histological technique. Immunohistochemical examination performed on mass specimens revealed positivity for the anti-CD56, anti-synaptophysin, anti-GFAP, and anti-NSE markers and negativity for the anti-chromogranin and anti-Olig2 markers. Based on pathology and immunohistochemistry findings, a diagnosis of poorly differentiated peripheral neuroblastoma was made; in addition, presence of emboli of neoplastic cells in the hepatic sinusoids and branches of the portal vein and metastasis in the spleen, lymph nodes, lung, and meninges were confirmed.Discussion: Positive results for neural markers associated with negative results for those of other small round cell tumors was considered to indicate the presence of neuroblast tumors; glioblastoma and oligodendroglioma were ruled out based on the absence of anti-Olig2 labeling, and, especially, the possibility of occurrence of pheochromocytoma was excluded based on the absence of anti-chromogranin. During necropsy, the location of the mass at the retroperitoneal space near the thoracolumbar junction, craniomedially in relation to the left kidney, was confirmed, which is compatible with the location of the adrenal gland. Metastasis in the dura mater was determined to be present based on necropsy findings alone, and neoplastic invasion through the esophageal hiatus of the diaphragm of a large part of the thoracic cavity was observed, which, to the best of our knowledge, have not been described in reports of veterinary medicine. The high rate of tumor growth and compression and invasion of adjacent tissues and organs may be considered as potential factors for unfavorable prognosis of peripheral neuroblastoma.
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