Conference 17 11 February 2009
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The Armed Forces Institute of Pathology Department of Veterinary Pathology Conference Coordinator: Todd M. Bell, DVM WEDNESDAY SLIDE CONFERENCE 2008-2009 Conference 17 11 February 2009 Conference Moderator: Dr. Fabio Del Piero, DVM, DACVP material as well as clusters of erythrocytes (Fig. 1-1). The CASE I – S0 10582 (AFIP 3113965) neoplastic cells have indistinct cell borders, large amount of eosinophilic cytoplasm, one oval to elongated nucleus with rounded poles and finely granular heterochromatin Signalment: 20-year-old, gelding, Arabian horse and 1-2 small basophilic nucleoli. The cells have moderate (Equus caballus) anisokaryosis with rare mitotic figures per HPF (40X). There are scattered hemosiderin laden macrophages History: A cecal mass was submitted for within the mass. There are multifocal areas of chronic histopathology. hemorrhages with aggregations of siderophages present in the capsule. Gross Pathology: The submitted tissue was an approximately 4x5x4 cm round, firm, nodular, dark gray, Immunohistochemistry was performed. The submitted well encapsulated mass with intact surface mucosa. On mass was strongly positive for vimentin and c-kit and cut section the mass was distinct from the mucosa, white- slightly positive for NSE. It did not stain with desmin, tan and multilobulated. smooth muscle actin and S100. Unfortunately, no history was submitted with this mass to know the reason for Laboratory Results: None removal. Histopathologic Description: The mass is a well Contributor’s Morphologic Diagnosis: Cecum: demarcated, encapsulated, multilobulated, expansile Gastrointestinal stromal tumor with peripheral hemorrhage mass located from deep tunica muscularis to the serosa and siderophages compressing the adjacent tissues and muscle layers. The mass is composed of multiple large lobules separated Contributor’s Comment: Equine gastrointestinal by a thick dense fibrous connective tissue. The mass is stromal tumors are unique, benign mesenchymal tumors made of a large number of spindle shaped cells arranged often found in the cecum of horses. They are detected in interconnected and branching trabeculae separated by at surgery, meat inspection or necropsy and may occur sinuses filled with large amount of basophilic mucinous in stomach, small intestine and most commonly in the *Sponsored by the American Veterinary Medical Association, the American College of Veterinary Pathologists, and the C. L. Davis Foundation. WSC 2008-2009 Conference 17 1-1. Large intestine, horse. Gastrointestinal stromal tumor. Neoplastic cells are separated by myxomatous matrix with scattered hemorrhage and few hemosiderin- laden macrophages. (HE 400X) cecum (as in this case) and colon.1 These tumors are medicine, and thus criteria for malignancy have not yet different from leiomyomas although they have common been solidified. In humans, larger size and greater mitotic features. Grossly, these tumors are distinct and form activity point to malignancy and a poor prognosis, but exophytic multinodular masses on the serosal surface or future studies will be needed to determine their behavior transmurally. Histologically, they are usually composed in domestic animals.1 of interlacing fascicles with multiple sinuses filled with mucinous materials stained by alcian blue. There are often Contributing Institution: CAHFS – UC Davis; hemorrhagic and may have myxomatous islands within www.cahfs.ucdavis.edu their parenchyma.3 Immunohistochemically, they are positive for c-kit protein (CD117), vimentin and neuron References: specific enolase and mildly for smooth muscle actin.4 1. Brown C., Baker D.C, Barker I: Alimentary system. In: Jubb, Kennedy and Palmer’s Pathology of Domestic AFIP Diagnosis: Cecum: Gastrointestinal stromal Animals. 5th ed., pp. 127-128. Mosby Saunders, tumor, myxoid Philadelphia, PA, 2007 2. Cooper BJ, Valentine BA: Tumors of muscle. In: Conference Comment: Gastrointestinal stromal Tumors in Domestic Animals. ed Meuten DJ, 4th ed, pp. tumors (GISTs) have been reported in numerous domestic 328-333, Iowa State Press, Ames, Iowa, 2002 species and are thought to arise from the interstitial cells 3. Del Piero F, Summers BA, Credille KM, Cummings of Cajal, the precursors to the pacemaker cells in the JF, Mandelli G: Gastrointestinal stromal tumors in intestinal wall.2 Histologically, these tumors closely Equidae. Vet Pathol 33:611, 1996 resemble leiomyosarcomas, and immunohistochemistry 4. Hafner S. Harman G. King T: Gastrointestinal stromal is needed to differentiate them. GISTs are normally tumors of equine cecum. Vet Pathol 38:242-246, 2001 composed of spindle cells arranged in interlacing fascicles or in a whirling pattern. Another less common pattern is the myxoid pattern characterized by epithelioid cells arranged in trabeculae or sheets within a myxoid matrix.1 These tumors are a recently recognized entity in veterinary WSC 2008-2009 Conference 17 (Type 2 pneumocyte hyperplasia), and alveolar lumens contain a mixture of sloughed epithelial cells, intact and CASE II – 23279-08 (AFIP 3103695) degenerate neutrophils, large foamy macrophages, and few multinucleated giant cells. Rare macrophages contain Signalment: 10-year-old female equine Thoroughbred large, brightly eosinophilic, round, intranuclear inclusion (Equus caballus) bodies that peripheralize nuclear chromatin and are occasionally surrounded by a clear halo (Fig. 2-2). History: The mare had signs of equine protozoal myeloencephalitis (EPM) then developed pneumonia. Contributor’s Morphologic Diagnosis: Severe The mare responded to EPM therapy but had continuing multifocal nodular fibrosing interstitial pneumonia with weight loss and cachexia despite a variety of treatments for intranuclear inclusion bodies, Equus caballus; Equine pneumonia. The mare was euthanized due to continued multinodular pulmonary fibrosis loss of body condition. Etiology: Equine Herpesvirus-5 (EHV-5) Gross Pathology: Significant changes were restricted to the lungs. Bilaterally, lung lobes were diffusely firm and Contributor’s Comment: Equine multinodular failed to collapse when the thoracic cavity was opened. pulmonary fibrosis (EMPF) is a distinct entity in the Throughout the pulmonary parenchyma were multifocal category of equine chronic pulmonary disease. It is to coalescing firm, light pink, irregularly round nodules differentiated from other fibrosing inflammatory diseases, that varied in size from 1cm to large confluent masses. such as recurrent airway obstruction (RAO) or chronic The nodules were separated by normal appearing tissue. pneumonia, by the nodular pattern of fibrosis. This When sectioned, the masses had a firm fibrous texture and disease may have been previously reported under the bulged slightly on cut surface. names “idiopathic interstitial pneumonia with fibrosis” or “idiopathic pulmonary fibrosis.” Laboratory Results: None EMPF is most common in middle-aged horses. Horses Histopathologic Description: Sections of lung are with this disease present with non-specific signs of characterized by multifocal areas of pulmonary fibrosis respiratory disease including cough, fever, weight and inflammation bordered by more normal appearing loss, tachypnea, increased respiratory effort, and nasal lung tissue. Alveolar septa are moderately to severely discharge. Treatment with antibiotics may result in short- expanded by well organized mature collagen (Fig. term improvement, but symptoms recur after treatment 2-1). Alveoli are often lined by plump cuboidal cells is discontinued. Pulmonary nodules can be visualized 2-1. Lung, horse. Equine multinodular pulmonary fibrosis. 2-1. Lung, horse. Equine multinodular pulmonary fibrosis. Abundant septal fibrosis, moderate type II pneumocyte Abundant septal fibrosis, moderate type II pneumocyte hyperplasia, numerous lymphocytes, histiocytes, and hyperplasia, numerous lymphocytes, histiocytes, and neutrophils, with scattered multinucleated giant cells. (HE neutrophils, with scattered multinucleated giant cells. (HE 400X) 400X) WSC 2008-2009 Conference 17 with ultrasonography and/or radiography. Rule outs study by Bell identified EHV-5 in 64% of young racehorse include neoplasia, fungal pneumonia, and granulomatous nasal swabs, while a study performed by Wang identified pneumonia, which may also result in a nodular pattern. the virus in 48% of 5-9 month old Thoroughbred foals. Treatment of choice includes long-term (at least 6 weeks) administration of corticosteroids. Prognosis for the disease Intranuclear inclusion bodies are not a common feature in is considered fair to poor. Many horses are euthanized due gammaherpes infections but may be observed in California to continued respiratory complications and poor athletic sea lions infected with genital carcinoma caused by performance. gammaherpes virus. Murine herpesvirus-68 is a gamma herpesvirus associated with experimental fibrotic lung Lung tissue from this horse was positive via polymerase disease in mice. chain reaction (PCR) for EHV-5. EHV-5 is a DNA gammaherpes virus that has only recently been associated AFIP Diagnosis: Lung: Fibrosis, interstitial, nodular, with this disease entity. The pathogenesis of EHV-5 in this multifocal, severe with neutrophilic and histiocytic disease has not been fully elucidated but may contribute to alveolitis, type II pneumocyte hyperplasia and rare a “pro-fibrotic” lung environment via a Th-2 lymphocyte intrahistiocytic eosinophilic intranuclear inclusions inflammatory response. PCR can be performed on bronchoalveolar lavage samples or lung tissue. Unlike Conference