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WSC 20-21 Conf 6 Illustrated Results Joint Pathology CenterJoint Pathology Center Veterinary PathologyVeterinary Services Pathology Services WEDNESDAY SLIDE CONFERENCE 2020-2021 WEDNESDAY SLIDE CONFERENCE 2019-2020 Conference 6 C o n f e r e n c e 16 29 January 2020 30 September 2020 Dr. Ingeborg Langohr, DVM, PhD, DACVP Professor Department of Pathobiological Sciences Louisiana State University School of Veterinary Medicine Joint Pathology Center Baton Rouge, LA Silver Spring, Maryland CASE I: CASE S1809996 1: N16 (JPC-032 4135077(4084301).-00 ) Microscopic2.2x1.5x2 Description: cm firm mass The originatinginterstitium from the dura within themater section (meningioma). is diffusely infiltrated by Signalment:Signalment: A 3-month 13- old,yrs male,of age, mixed spayed- female,moderate to large numbers of predominantly breed pigGolden (Sus scrofa Retriever,) Canis lupus familiaris, caninemononuclear. Laboratory cells along results: with edema. There is abundantCytology: type II pneumocyteIt was reported hyperplasia that ante -mortem History: This pig had no previous signs of History: lining alveolarcytology septae of blood and manysmears of from the this animal were illness, andIt waswas reportedfound dead. that the patient had decreased consistent with lymphoid leukemia. appetite and lethargy for the past 1-2 weeks andalveolar spacesSpecial have staining: central Under areas polarized of light, Congo Gross Pathologyhad diarrhea: Approximately for ~1 day. She70% had of a history ofnecrotic macrophagesRed special admixedstain withrevealed other apple-green the lungs,seizures primarily for thein the past cranial ~3 years; regions her last of seizure wasmononuclear birefringence cells and of fewer material neutrophils. effacing glomeruli and the lobes,1 were month patchy ago. darkThe red,patient and hadfirm a generalizedOccasionally cardiac there vessel is free. nuclear basophilic comparedlymphadenopathy to the more normal (lymphoma). areas of lung.Patient was on phenobarbital, was obese and was 5-7% Microscopic description: Laboratorydehydrated. results: Porcine reproductive The microscopic findings for the submitted and respiratory syndrome (PRRS) PCR was tissues are: positive fromGross splenic Pathology: tissue, and PRRS IHC was stronglyRelevant immunoreactive gross patholog withinic findingsthe included: Kidneys: Glomeruli are diffusely and globally cytoplasmMultiple of macrophages (n=10) well in the-demarcated, affected unattached, obscured and expanded by amorphous lung tissue.soft, Porcine white, influenzalipid-like massesvirus PCR, (lipomas) ranging homogenous pale eosinophilic to amphophilic from 4-20 cm in diameter, were present in the material (amyloid). Bowman's capsules are porcine circovirus – 2 IHC, and subcutis. There was generalized enlargement of variably thickened and there is marked synechia Mycoplasmaperipheral hyopneumoniae lymph nodes IHC ~4 were times all larger than negative. norSmallmal. numbers The left caudal of E. lungcoli lobewere had a 1 cm focal isolated fromfirm, thedark cranioventral red area of lung depression. with The right aerobic culture.ventricular free wall was 3 mm and the left was 7 Lung, pig (HE, 6X). There is diffuse consolidation of mm (right:left ratio of 1:2.3). The right and leftthe lung. At low magnification, airway are filled with kidney contained innumerable miliary white fociexudate and the pleura and interlobular connective throughout the cortical parenchyma. A 3mm cysttissue are mildly expanded. was present on the cortical surface of the right kidney. The parietal lobe of the left cerebral Kidney, heart, dog. One section of kidney and heart are hemisphere was depressed by an approximately submitted for examination. (HE, 5X) 1 Kidney, dog. Glomeruli are diffusely and globally expanded by amyloid, and there is a marked loss of tubules within the intervening parenchyma. Moderate numbers of the lymphocytes and plasma cells are present within the interstitium. (HE, 100X) formation. The interstitium is diffusely infiltrated Meninges: Meningioma with small to moderate amounts of lymphocytes Brain: Meningioma-associated cerebrocortical and plasma cells. compression with locally extensive astrocytosis, oligodendrogliosis, neuronal satellitosis and Heart: Arteries and arterioles throughout the periglial edema myocardium frequently have transmural Lymph node and Spleen: Metastasis of lymphoid thickening of the vessel wall by amorphous pale leukemia amphophilic material (amyloid). Affected vessels Lung: Focal bronchioloalveolar carcinoma, well- often have recanalization characterized by differentiated multiple small caliber spaces. There is marked endocardial fibrosis and few scattered multifocal Contributor’s comment: areas of mild to moderate interstitial fibrosis; The animal in this case had multiple neoplastic associated cardiac myocytes are shrunken and processes. The neoplastic leukemic lymphoid fragmented (degeneration). There are also a few cells were effacing the lymph nodes, in multifocally extensive areas of myocardial loss pericapsular vessels associated with lymph nodes and replacement by adipose tissue and scattered and multifocally present in the spleen. This macrophages, lymphocytes and plasma cells. neoplasm is considered the primary cause of illness in this case. The meningioma and its Contributor’s morphologic diagnosis: compression against the parietal lobe of the brain Kidney: Severe diffuse global glomerular resulted in seizures. There was also a well- amyloidosis differentiated bronchioloalveolar carcinoma Heart: Submassive severe coronary arterial wall identified in one site in the lung. amyloidosis with recanalization Heart: Moderate multifocal interstitial Amyloidosis can be secondary to chronic myocardial fibrosis and fatty infiltration with inflammatory or neoplastic processes; myocardial degeneration. considering the multiple neoplasms in this case, Morphologic diagnoses for tissues not submitted: Heart, dog. The walls of myocardial arteries are multifocally expanded by amyloid which encroaches on the lumen. There is moderate fibroplasia of the adjacent arterial wall and periarteriolar fibrosis. There is loss of myofibers and replacement fibrosis in the adjacent myocardium. (HE, 97X) including lymphoid leukemia, it is likely that the associated with the amyloid light chain (AL amyloid deposition in the kidney, and possible form), is the most common form in humans, the myocardial vasculature as well, was while secondary amyloidosis, which is associated secondary to other disease processes going on. with the amyloid-associated (AA) form, is most The amyloid deposition in the vessels of the heart common in animals. may also be secondary to aging, as senile amyloid plaques have been reported in muscular arteries The AL form is immunoglobulin-derived and can of the myocardium, lungs, and spleen of old dogs. be deposited by B lymphocytes as well as plasma The cause of the myocardial lesions may be cells and result from immunocyte dyscrasias. The secondary to the vascular amyloidosis in the heart AA form of amyloidosis is derived from the and impaired oxygenation of the associated musculature. The term amyloid refers to a group of glycoproteins whose protein components represent β-pleated sheet patterns. In a healthy patient, the immune system is usually able to either repair (chaperones) or degrade (ubiquitin- proteosome pathway) these proteins. However, if the body is unable to perform such feats, one can end up with amyloidosis. These proteins deposit into organs and result in pressure atrophy of adjacent cells as they accumulate. Kidney, dog. Under polarized light, Congo Red Amyloidosis can be classified into systemic histochemical stain reveals apple-green birefringence of (amyloid deposits in multiple organs) and amyloid effacing glomeruli. (Congo Red, 10X) (Photo: localized (single organ) amyloidosis, and further Courtesy of Tuskegee University College of Veterinary categorized into primary and secondary Medicine) amyloidosis. Primary amyloidosis, which is The amyloid that was found in the cardiac vessels of this animal may be due to the systemic disease affecting this dog but may also be associated to aging. Cardiac amyloidosis has been reported in dogs ≥7 years and is somewhat comparable to the senile cardiac amyloidosis of humans, which is seen in those age 70 and greater. A prominent difference is that amyloid builds up in the atria and ventricles of the heart in humans, while studies show that it primarily only affects arterioles in dogs.2 Heart dog. A Masson’s trichrome demonstrates the mural Grossly, amyloidosis can be diagnosed by using fibroplasia surrounding amyloid plaques in affected Lugol's agent followed by diluted sulfuric acid. If arterioles. (Masson’s trichrome, 100X) the tissue becomes a purple to dark blue tinge, it is positive for amyloidosis. Microscopically, one precursor serum-amyloid associated (SAA) could use Congo Red stain as well as thioflavine- protein. This precursor is synthesized in the liver T. The stain itself is not taken up by the protein, and its production is increased in pro- but rather caught in the β-pleated sheet. Under inflammatory states such as chronic polarized light, the amyloid proteins emit an inflammation and neoplasia. With the lack of apple-green birefringence with the Congo Red. In proteolytic action on these proteins, amyloidosis the case of AA amyloidosis, the addition of can result. Humans have these same two forms, potassium permanganate results in the loss of the as well as the β-amyloid form (Aβ) which is Congo Red stain, enabling
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