Cutaneous Mast Cell Tumor in a Bitch

Background: The diagnostic of neoplasia in dogs has risen significantly in the last years and this fact is mostly attributed to the longer life expectancy of these animals, which contributes to a greater chance of exposure to carcinogenic agents. In between the diverse tumors that could compromise skin, the mastocytoma is the third most commonly diagnosed neoplasia. It is characterized by being a form of neoplasia with round cells, these being the mast cells. The objective of the present study consisted in relating a case of cutaneous mastocytoma in a 7-year-old bitch mixed-breed treated at the Veterinary Medical Teaching Hospital of the University of Uberaba (UNIUBE) - Uberaba, MG, Brazil.Case: The bitch initially presented a localized nodule external to the right ear pinna with cytology test suggesting a mastocytoma. The nodule was surgically removed and, posteriorly, an histopatholgy was not requested. After 5 months since the emergence of the nodule and a month after its surgical resection, the tutor noticed the presence of a new growth in the ipsilateral cervical region to the previous nodule. At this moment, the responsible veterinarian decided to refer the animal to an oncologist. During the appointment with the oncologist, alterations such as hyporexia and anemia were related, and the presence of a nodule in the right cervical region measuring 4.5 to 4 cm of diameter was verified. Material for cytologic evaluation of the neoplasia was collected and again the result suggested a mastocytoma. The new tumor was also surgically removed but was then referred to histopathological evaluation for diagnostic confirmation, grading and evaluation of surgical margins. The tumor was classified as an infiltrative subcutaneous mastocytoma presenting, additionally, compromised surgical margins. After its excision, the association with a chemotherapy treatment using a protocol of Vimblastina 2 mg/m², i.v. in unique dosage per section, associated with Predinisona 1 mg/kg, v.o, SID was indicated. Each section was realized with an interval of 7 days in between. Only 2 chemotherapy sessions took place. Because of the worsening of the clinical condition associated with a very weakened animal the veterinarian opted for the euthanasia of the animal.Discussion: The diagnostic of mastocytoma must be realized through the association of cytology and histopathology, in case histopathological evaluation is needed to confirm the obtained cytology result, to grade the tumor and to evaluate the compromising of surgical margins. In this sense, it was observed that the bitch was submitted only to cytology diagnostic when it presented the nodule in the ear pavilion. Yet, at the second approach realized by the oncologist, it was possible to realize adequate diagnose methods. However, the animal was not submitted to clinical staging of the mastocytoma due to the non-authorization of the exam by the tutor. Such measure is very important, as it reflects directly in the treatment and prognostic of the animal. Thus, image exams such as abdominal ultrasonography and chest X-ray should have been realized, as well as cytological and histopathological evaluation of the regional lymph nodes, in order to search for metastasis points in these places. As the data suggests, the importance of clinical staging of animals affected by this neoplasia and the importance of cytological evaluation associated with histopathology for a correct diagnosis, prognosis and mastocytoma treatment is noted. It is emphasized that many times veterinarians face impediment related to requesting all necessary exams coming from tutors, which compromises treatment success.Keywords: canine, mast cell, cytology, histopathology, neoplasia, tumor, chemotherapy. Título: Mastocitoma Cutâneo em uma cadela Descritores: canino, mastócito, citologia, histopatologia, neoplasia, tumor, quimioterapia

Megaureter gigante por ectopia ureteral intramural em cão

Background: The urinary tract is composed by kidneys, urinary bladder and urethra. The kidneys produce urine that achieve urinary bladder by ureters. These have the origin in the renal pelvis, run through the retroperitoneum, end up at the dorsolateral superficies of the urinary bladder, and empty at the trigone. Ureters abnormalities are the rarest congenital defects in the canine urinary tract and ureteroceles are cystic dilatations of the distal segment of the ureter that could be associated to partial or complete urinary obstructions and could lead to megaureter and hydronephrosis. So, the aim of the present study was to describe a case of megaureter by intramural ureteral ectopia in a bitch. Case: A 1-year-old-and-8-month bitch Akita, weighing 18 kg, was referred to the Uniube Veterinary Hospital with vaginal secretion, prostration, hypodipsia, hyporexia and pyrexia related by the tutor. On physical examination, an increase in vulva volume and a vaginal discharge were observed. Nevertheless, others physical exams, blood count and biochemical tests were considered to be within normal parameters. Urinalysis showed cloudy aspect, proteinuria, occult blood, erythrocytes, pyuria, leucocytes, and discreet presence of bacteria. Abdominal ultrasonography revealed a megaureter with right uterocele and excretory urography showed absence of glomerular filtration by right kidney. The patient was submitted to surgery for right kidney and ureter exeresis. Histopathology evaluation showed intense dilation of the ureter and severe multifocal renal fibrosis. The surgery was well succeeded, and the patient recovered completely.  Discussion: Once megaureter are associated with congenital abnormalities like ectopic ureter and ureterocele, it is usually diagnosed in young patients with medium age of 10 months, which is below the age of the patient in this case report. Additionally, in the patient here reported, the unilateral alteration could explain the absence of kidney fail symptoms. In more than 90% of the cases, the ureteral ectopia was associated with multiple anomalies in the urinary tract, as was observed in this patient, that presented besides ectopic ureter, ureterocele, megaureter and renal dystrophy. All these morphological alterations made impossible the complete urine elimination, which predispose to urinary tract infection, that was observed in this report. According to literature, urinary tract anomalies are associated with infection in 64 to 85% and 50% of the cases also present hydronephrosis and hydroureter. It was also described that ureteral ectopia is diagnosed by visualization of hydroureter in abdominal ultrasonography. The findings present in this report differs a little, once the right kidney was atrophic possibly by malformation or even so by a chronic renal lesion due to the difficulty in urine flow. The excretory urography showed no filtration in the right kidney, indicating non-functionality that was confirmed by histopathology, in which was observed small glomerulus and large amount of connective tissue deposition. In cases of unilateral megaureter with ipsilateral kidney commitment, there is indication of nephroureterectomy, that was performed in the patient of the present report. As far as we know, this is the first report of megaureter, ureterocele and ectopia ureteral together in the same patient. In conclusion, the procedure was secure, efficient and promote a better quality of life for the patient and prevent the recurrence of urinary tract infections. Keywords: Urinary system, malformation, nephroureterectomy, surgery, cystitis. Título: Megaureter gigante por ectopia ureteral intramural em cadela. Descritores: Sistema urinário, malformação, nefroureterectomia, cirurgia, cistite. ystitis.O sistema urinário é composto por rins, ureteres, bexiga e uretra. Os rins produzem a urina que chegará à bexiga por meio dos ureteres. Estes têm origem na pelve renal, correm pelo retroperitônio e desembocam na superfície dorsolateral caudal da bexiga e se esvaziam no trígono. Alterações nos ureteres são os defeitos congênitos mais raros do sistema urogenital de cães. Ureteroceles são dilatações císticas do segmento distal do ureter e podem estar associadas a obstruções urinárias parciais ou completas e podem levar ao megaureter e a hidronefrose. O presente estudo tem o objetivo de descrever um caso de megaureter por ectopia ureteral intramural em uma cadela. Caso: Uma cadela Akita, csecreção vaginal, prostração, hipodipsia, hiporexia e pirexia. Ao realizar o exame físico observou-se aumento de volume vulvar, corrimento vaginal. Os parâmetros do exame físico estavam normais. Não foram observadas alterações no hemograma e nem nos exames bioquímicos. Diversas alterações foram observadas na urinalise como aspecto turvo, proteinúria, sangue oculto, eritrócitos, piuria, leucócitos e presença discreta de bactérias. A ultrassonografia abdominal mostrou um megaureter com ureterocele direitos e a urografia excretora mostrou ausência de filtração glomerular no rim direito. O paciente foi submetido cirurgia para exérese do rim ureter direitos. A avaliação histopatológica do rim e ureter direitos mostrou dilatação intensa de ureter e fibrose renal multifocal intensa.O procedimento cirúrgico foi bem-sucedido e o animal se recuperou bem. Discussão: Por estar associado a alterações congênitas como ureter ectópico e ureterocele, o megaureter é diagnosticado em pacientes jovens com idade média de 10 meses, idade inferior ao paciente do presente relato. Adicionalmente, no animal aqui relatado, a alteração unilateral pode explicar  a falta de sinais de falha renal. Mais de 90% dos casos, a ectopia ureteral está associada a múltiplas anomalias do trato urinário, assim como o observado no paciente deste relato, que além do ureter ectópico, apresentava ureterocele, megaureter e atrofia renal. Com todas essas alterações morfológicas que impossibilitavam a eliminação completa da urina, observa-se, como consequência, a predisposição a infecções do trato urinário, o que de fato foi observado. A literatura aponta que anomalias do trato urinário estão associadas com infecção em 64 a 85% dos casos, ainda citaram que cerca de 50% dos casos apresentam hidronefrose e hidroureter.  Foi também descrito que ureteres ectópicos são diagnosticados em decorrência do hidroureter visibilizado na ultrassonografia abdominal. Os achados neste relato diferem um pouco do que foi descrito, visto que o rim direito estava atrofiado, possivelmente em decorrência de uma má formação ou até mesmo de uma lesão renal crônica causada pela dificuldade de escoamento da urina no lado direito, como citado anteriormente. A urografia excretora realizada no paciente do presente relatou evidenciou que não havia filtração no rim direito, indicando afuncionalidade, o que foi confirmado pela avaliação histopatológica, em que foi possível observar glomérulos diminutos e grande quantidade de deposição de tecido conjuntivo fibroso. Em casos de megaureter unilateral com presença de comprometimento grave do rim ipsilateral, há indicação de nefroureterectomia, como foi realizado no paciente deste relato. Até onde se sabe, esse é o primeiro relato de megaureter, ureterocele e ectopia ureteral em um mesmo paciente. Em conclusão, o procedimento executado foi seguro e se mostrou eficiente no tratamento do defeito anatômico congênito, promovendo assim uma melhor qualidade de vida para o paciente e prevenção de recorrência de infecções do trato urinário. Descritores: Sistema urinário; malformação; nefroureterectomia; cirurgia; cistite

Cutaneous Mast Cell Tumor in a Bitch

Background: The diagnostic of neoplasia in dogs has risen significantly in the last years and this fact is mostly attributed to the longer life expectancy of these animals, which contributes to a greater chance of exposure to carcinogenic agents. In between the diverse tumors that could compromise skin, the mastocytoma is the third most commonly diagnosed neoplasia. It is characterized by being a form of neoplasia with round cells, these being the mast cells. The objective of the present study consisted in relating a case of cutaneous mastocytoma in a 7-year-old bitch mixed-breed treated at the Veterinary Medical Teaching Hospital of the University of Uberaba (UNIUBE) - Uberaba, MG, Brazil.Case: The bitch initially presented a localized nodule external to the right ear pinna with cytology test suggesting a mastocytoma. The nodule was surgically removed and, posteriorly, an histopatholgy was not requested. After 5 months since the emergence of the nodule and a month after its surgical resection, the tutor noticed the presence of a new growth in the ipsilateral cervical region to the previous nodule. At this moment, the responsible veterinarian decided to refer the animal to an oncologist. During the appointment with the oncologist, alterations such as hyporexia and anemia were related, and the presence of a nodule in the right cervical region measuring 4.5 to 4 cm of diameter was verified. Material for cytologic evaluation of the neoplasia was collected and again the result suggested a mastocytoma. The new tumor was also surgically removed but was then referred to histopathological evaluation for diagnostic confirmation, grading and evaluation of surgical margins. The tumor was classified as an infiltrative subcutaneous mastocytoma presenting, additionally, compromised surgical margins. After its excision, the association with a chemotherapy treatment using a protocol of Vimblastina 2 mg/m², i.v. in unique dosage per section, associated with Predinisona 1 mg/kg, v.o, SID was indicated. Each section was realized with an interval of 7 days in between. Only 2 chemotherapy sessions took place. Because of the worsening of the clinical condition associated with a very weakened animal the veterinarian opted for the euthanasia of the animal.Discussion: The diagnostic of mastocytoma must be realized through the association of cytology and histopathology, in case histopathological evaluation is needed to confirm the obtained cytology result, to grade the tumor and to evaluate the compromising of surgical margins. In this sense, it was observed that the bitch was submitted only to cytology diagnostic when it presented the nodule in the ear pavilion. Yet, at the second approach realized by the oncologist, it was possible to realize adequate diagnose methods. However, the animal was not submitted to clinical staging of the mastocytoma due to the non-authorization of the exam by the tutor. Such measure is very important, as it reflects directly in the treatment and prognostic of the animal. Thus, image exams such as abdominal ultrasonography and chest X-ray should have been realized, as well as cytological and histopathological evaluation of the regional lymph nodes, in order to search for metastasis points in these places. As the data suggests, the importance of clinical staging of animals affected by this neoplasia and the importance of cytological evaluation associated with histopathology for a correct diagnosis, prognosis and mastocytoma treatment is noted. It is emphasized that many times veterinarians face impediment related to requesting all necessary exams coming from tutors, which compromises treatment success.Keywords: canine, mast cell, cytology, histopathology, neoplasia, tumor, chemotherapy. Título: Mastocitoma Cutâneo em uma cadela Descritores: canino, mastócito, citologia, histopatologia, neoplasia, tumor, quimioterapia

Megaureter gigante por ectopia ureteral intramural em cão

Background: The urinary tract is composed by kidneys, urinary bladder and urethra. The kidneys produce urine that achieve urinary bladder by ureters. These have the origin in the renal pelvis, run through the retroperitoneum, end up at the dorsolateral superficies of the urinary bladder, and empty at the trigone. Ureters abnormalities are the rarest congenital defects in the canine urinary tract and ureteroceles are cystic dilatations of the distal segment of the ureter that could be associated to partial or complete urinary obstructions and could lead to megaureter and hydronephrosis. So, the aim of the present study was to describe a case of megaureter by intramural ureteral ectopia in a bitch. Case: A 1-year-old-and-8-month bitch Akita, weighing 18 kg, was referred to the Uniube Veterinary Hospital with vaginal secretion, prostration, hypodipsia, hyporexia and pyrexia related by the tutor. On physical examination, an increase in vulva volume and a vaginal discharge were observed. Nevertheless, others physical exams, blood count and biochemical tests were considered to be within normal parameters. Urinalysis showed cloudy aspect, proteinuria, occult blood, erythrocytes, pyuria, leucocytes, and discreet presence of bacteria. Abdominal ultrasonography revealed a megaureter with right uterocele and excretory urography showed absence of glomerular filtration by right kidney. The patient was submitted to surgery for right kidney and ureter exeresis. Histopathology evaluation showed intense dilation of the ureter and severe multifocal renal fibrosis. The surgery was well succeeded, and the patient recovered completely.  Discussion: Once megaureter are associated with congenital abnormalities like ectopic ureter and ureterocele, it is usually diagnosed in young patients with medium age of 10 months, which is below the age of the patient in this case report. Additionally, in the patient here reported, the unilateral alteration could explain the absence of kidney fail symptoms. In more than 90% of the cases, the ureteral ectopia was associated with multiple anomalies in the urinary tract, as was observed in this patient, that presented besides ectopic ureter, ureterocele, megaureter and renal dystrophy. All these morphological alterations made impossible the complete urine elimination, which predispose to urinary tract infection, that was observed in this report. According to literature, urinary tract anomalies are associated with infection in 64 to 85% and 50% of the cases also present hydronephrosis and hydroureter. It was also described that ureteral ectopia is diagnosed by visualization of hydroureter in abdominal ultrasonography. The findings present in this report differs a little, once the right kidney was atrophic possibly by malformation or even so by a chronic renal lesion due to the difficulty in urine flow. The excretory urography showed no filtration in the right kidney, indicating non-functionality that was confirmed by histopathology, in which was observed small glomerulus and large amount of connective tissue deposition. In cases of unilateral megaureter with ipsilateral kidney commitment, there is indication of nephroureterectomy, that was performed in the patient of the present report. As far as we know, this is the first report of megaureter, ureterocele and ectopia ureteral together in the same patient. In conclusion, the procedure was secure, efficient and promote a better quality of life for the patient and prevent the recurrence of urinary tract infections. Keywords: Urinary system, malformation, nephroureterectomy, surgery, cystitis. Título: Megaureter gigante por ectopia ureteral intramural em cadela. Descritores: Sistema urinário, malformação, nefroureterectomia, cirurgia, cistite. ystitis.O sistema urinário é composto por rins, ureteres, bexiga e uretra. Os rins produzem a urina que chegará à bexiga por meio dos ureteres. Estes têm origem na pelve renal, correm pelo retroperitônio e desembocam na superfície dorsolateral caudal da bexiga e se esvaziam no trígono. Alterações nos ureteres são os defeitos congênitos mais raros do sistema urogenital de cães. Ureteroceles são dilatações císticas do segmento distal do ureter e podem estar associadas a obstruções urinárias parciais ou completas e podem levar ao megaureter e a hidronefrose. O presente estudo tem o objetivo de descrever um caso de megaureter por ectopia ureteral intramural em uma cadela. Caso: Uma cadela Akita, csecreção vaginal, prostração, hipodipsia, hiporexia e pirexia. Ao realizar o exame físico observou-se aumento de volume vulvar, corrimento vaginal. Os parâmetros do exame físico estavam normais. Não foram observadas alterações no hemograma e nem nos exames bioquímicos. Diversas alterações foram observadas na urinalise como aspecto turvo, proteinúria, sangue oculto, eritrócitos, piuria, leucócitos e presença discreta de bactérias. A ultrassonografia abdominal mostrou um megaureter com ureterocele direitos e a urografia excretora mostrou ausência de filtração glomerular no rim direito. O paciente foi submetido cirurgia para exérese do rim ureter direitos. A avaliação histopatológica do rim e ureter direitos mostrou dilatação intensa de ureter e fibrose renal multifocal intensa.O procedimento cirúrgico foi bem-sucedido e o animal se recuperou bem. Discussão: Por estar associado a alterações congênitas como ureter ectópico e ureterocele, o megaureter é diagnosticado em pacientes jovens com idade média de 10 meses, idade inferior ao paciente do presente relato. Adicionalmente, no animal aqui relatado, a alteração unilateral pode explicar  a falta de sinais de falha renal. Mais de 90% dos casos, a ectopia ureteral está associada a múltiplas anomalias do trato urinário, assim como o observado no paciente deste relato, que além do ureter ectópico, apresentava ureterocele, megaureter e atrofia renal. Com todas essas alterações morfológicas que impossibilitavam a eliminação completa da urina, observa-se, como consequência, a predisposição a infecções do trato urinário, o que de fato foi observado. A literatura aponta que anomalias do trato urinário estão associadas com infecção em 64 a 85% dos casos, ainda citaram que cerca de 50% dos casos apresentam hidronefrose e hidroureter.  Foi também descrito que ureteres ectópicos são diagnosticados em decorrência do hidroureter visibilizado na ultrassonografia abdominal. Os achados neste relato diferem um pouco do que foi descrito, visto que o rim direito estava atrofiado, possivelmente em decorrência de uma má formação ou até mesmo de uma lesão renal crônica causada pela dificuldade de escoamento da urina no lado direito, como citado anteriormente. A urografia excretora realizada no paciente do presente relatou evidenciou que não havia filtração no rim direito, indicando afuncionalidade, o que foi confirmado pela avaliação histopatológica, em que foi possível observar glomérulos diminutos e grande quantidade de deposição de tecido conjuntivo fibroso. Em casos de megaureter unilateral com presença de comprometimento grave do rim ipsilateral, há indicação de nefroureterectomia, como foi realizado no paciente deste relato. Até onde se sabe, esse é o primeiro relato de megaureter, ureterocele e ectopia ureteral em um mesmo paciente. Em conclusão, o procedimento executado foi seguro e se mostrou eficiente no tratamento do defeito anatômico congênito, promovendo assim uma melhor qualidade de vida para o paciente e prevenção de recorrência de infecções do trato urinário. Descritores: Sistema urinário; malformação; nefroureterectomia; cirurgia; cistite

Epilepsy Magazine

Revista sobre Epilepsia, realizada pelos alunos do 2° ano de Enfermagem exercido na Unidade Curricular de Patologia coordenada pela Profa. Dra. Andréa Cristina de Moraes Malinverni e pelo Prof. Dr. Ricardo Artigiani Neto, tendo como tutores e colaboradores: Pad. Luciana Cristina Teixeira e Pad. Jaques FrancoNovaes de Carvalho