Hemophagocytic Histiocytic Sarcoma in Dog

Background: Histiocytic sarcoma can present in a localized or disseminated form, being a malignant neoplasm derived from interstitial dendritic cells. Another form of the disease is called hemophagocytic histiocystic sarcoma (HHS), which originates from macrophages located in the splenic red pulp and bone marrow. HHS is a rare neoplasm with unknown etiology and rapid development. It mainly affects middle-aged to elderly animals. It primarily affects the spleen and bone marrow, with occurence of metastases in other organs. Some canine breeds are considered more predisposed to this neoplasia, among them the Rottweiler. The aim of this study was to report a case of HHS in a Rottweiler dog.Case: An 8-year-old Rottweiler suffering from hyporexia and progressive weight loss for a month was attended at the Veterinary Hospital of State University of Maringá. On physical examination, he only presented mild discomfort on abdominal palpation. Blood count was performed, which revealed mild thrombocytopenia (145,000/µL, reference value for the species 150,000-500,000/µL). The Polymerase Chain Reaction (PCR) exam was requested for babesiosis and ehrlichiosis, due to a history of ectoparasites. The animal was released with the prescription of Doxycycline at a dose of 10 mg/kg orally for 28 days. After 5 days, the condition worsened and the animal returned with emesis, apathy and hyporexia, being hospitalized. Abdominal ultrasound, blood count, urinalysis, serum urea and creatinine tests were requested. Among the hematological changes, thrombocytopenia (116,000/µL) and the appearing of regenerative anemia and atypical round cells with ample and slightly basophilic cytoplasm in the smear, similar to histiocytes, stood out. On ultrasound examination, splenomegaly was observed with hypoechogenic areas. Ultrasound-guided fine-needle aspiration cytology (FNAC) of the spleen was performed, which revealed the presence of abundant cellularity consisting of round cells arranged individually and in small groups, with variable nucleus / cytoplasm ratio, slightly basophilic cytoplasm and, sometimes, vacuolized. Eccentric nucleus with chromatin ranging from loose to dense, with evident and often multiple nucleus. In addition, a large number of multinucleated giant cells, mitosis figures (sometimes atypical) and intense anisocytosis and anisocariosis were observed. Furthermore, it was possible to observe erythrophagocytic activity, alterations compatible with histiocytic sarcoma (HS). After 10 days of the first visit, the animal died. At necropsy, samples from altered areas of the spleen, lungs and lymph nodes were collected and sent for histopathological and immunohistochemical examination, in which the diagnosis of hemophagic histiocytic sarcoma was confirmed, in addition to lungs and lymph node metastasis.Discussion: The prognosis of HHS is the worst among histiocytic disorders, as it is associated with coagulopathies and severe anemia due to erythrophagocytic activity, as occurred in the case presented, with a maximum survival time between one to two months. The described animal died ten days after showing the first clinical signs. The immunohistochemistry technique using HLA-DR, CD18, CD163, and CD11d markers was essential to confirm the cell line. Positivity for CD11d marker was found, which allowed to classify the neoplasm as hemophagocytic HS. This report exposes the importance of cytological examination for screening and histopathological and immunohistochemical tests to confirm the diagnosis of this extremely aggressive neoplasm

Atypical Transmissible Venereal Tumor in Dogs

Background: The Transmissible Venereal Tumor (TVT), classified as a round cell tumor, is considered one of the oldest existing tumors. It affects dogs all over the world and has a contagious characteristic. Despite the good response to clinical treatment in most cases, it can sometimes have non-classical presentations and even different behavior. Thus, the present study aims to report 3 cases of atypical TVT treated at the Veterinary Medical Teaching Hospital of the State University of Maringá (UEM) in Umuarama, Paraná, aiming to describe the epidemiology and clinical-pathological aspects, focusing on the diagnostic method used, the treatment of choice and the clinical follow-up of each case.Cases: Case records of 3 intact male mongrel dogs with atypical Transmissible Venereal Tumor (case 1: intranasal; case 2: intra-abdominal and case 3: cutaneous with lymph node metastasis) were reviewed regarding history, clinical signs, duration of clinical signs, examination findings, results and findings of complementary exams (hematological, biochemical, radiographic, ultrasonographic and cytological), treatment, follow-up and final result. Case 1: had an ulcerated mass in the nasal plane causing significant airway obstruction and respiratory difficulty. Case 2: had a lesion in a typical location (penile mucosa in the glans area) but with a large intra-abdominal mass in the lumbar paravertebral region, causing compression of important structures. Case 3: on the other hand, had cutaneous TVT with several ulcerated plaque lesions all over the skin, in addition to popliteal lymph node enlargement due to metastasis later confirmed by microscopy. All dogs reported were mixed breed, intact males with free access to the street. Despite the fact that each patient had their own anatomical tumor characteristics, they were all diagnosed through cytological examination and all classified as lymphocytic TVT. The standard treatment for this neoplasm was instituted; the chosen chemotherapy was vincristine sulfate at a dose of 0.75 mg/m2 intravenously every 7 days for 5-7 weeks. In addition, all 3 animals needed supportive treatment due to anorexia, bacterial contamination secondary to injuries, dehydration and pain.Discussion: Usually, TVT is not considered malignant, not causing metastasis, however it is now known that its behavior has changed a lot and more and more cases of metastatic or highly infiltrative TVT have been reported. The 3 cases presented in this report had epidemiological characteristics as mentioned in the literature, but the location, macroscopic and radiographic characteristics are uncommon for this neoplasm, that is, with an atypical tumor presentation. This demonstrates the importance of a good clinical evaluation and, especially, of the cytological exam, which was essential for the definitive diagnosis for the three cases presented. It is speculated that more “aggressive” cases of TVT may be correlated with the plasmacytic cytological type, however none of the patients described here had this cytological presentation. Thus, the clinician must be aware of the risk factors associated with this neoplasia, because even in non-classical presentations, the lymphocytic cell morphological characteristic was present and the patients responded well to the classic treatment, not requiring a change in chemotherapy protocols, however a special attention must be paid to the particularities involved in each presentation of the same tumor in different patients. Keywords: TVT, canine, neoplasm, metastasis, cytology

Síndrome da Hiperestesia Felina – Relato de Caso

Feline Hyperesthesia Syndrome (FHS) is a clinical condition, characterized by involuntary muscle contractions and changes in behavior. It is a rare syndrome, often of unknown origin, and the most common associated causes are skin related disorders, such as bacterial, fungal dermatitis, allergics and immune-mediated diseases. Causes related to the central nervous system and behavioral disorders are also reported. The clinical signs are varied, the diagnosis is often complex and the treatment varies according to the underlying cause. The purpose of this case report is to describe a case of FHS of possible dermatological etiology. A three-year-old Siamese male feline was treated for feline lower urinary tract disease throughout the duration of nine days. Associated, the animal also presented erythematous areas and hypotrichosis all over the face, especially around the eyes, nose and auricular pavilions, along with painful hypersensitivity to the touch and skin fasciculations in the lumbar and coccygeal region and pelvic limbs. An histopathological exam of the skin lesions was performed, where a chronic, superficial perivascular dermatitis was seen to be proliferative. Based on physical examination findings and additional tests, the animal was diagnosed with feline hyperesthesia syndrome secondary to dermatopathy.A Síndrome da Hiperestesia Felina (FHS) é uma condição clínica, caracterizada por contrações musculares involuntárias e mudanças de comportamento. É uma síndrome rara, muitas vezes de origem desconhecida, sendo que as causas mais comuns associadas são doenças relacionadas à pele, tais como dermatites bacterianas, fúngicas, alérgicas e doenças imunomediadas. Causas relacionadas ao sistema nervoso central e distúrbios comportamentais também são relatadas. Os sinais clínicos são variados, o diagnóstico muitas vezes é complexo e o tratamento varia de acordo com a causa de base.  O objetivo deste relato de caso é descrever um caso de FHS de possível origem dermatológica. Um felino, macho, de três anos, da raça Siamês, foi atendido apresentando doença do trato urinário inferior felino há nove dias. Associado, o animal possuía áreas eritematosas e de hipotricose por toda a face, principalmente ao redor dos olhos, nariz e pavilhões auriculares, juntamente com hipersensibilidade dolorosa ao toque e fasciculações cutâneas na região lombar, coccígea e membros pélvicos. Foi realizado exame histopatológico das lesões de pele, onde foi visualizada dermatite superficial perivascular crônica proliferativa. Com base nos achados de exame físico e nos exames complementares, o animal foi diagnosticado com síndrome da hiperestesia felina secundária à dermatopatia

Hemophagocytic Histiocytic Sarcoma in Dog

Background: Histiocytic sarcoma can present in a localized or disseminated form, being a malignant neoplasm derived from interstitial dendritic cells. Another form of the disease is called hemophagocytic histiocystic sarcoma (HHS), which originates from macrophages located in the splenic red pulp and bone marrow. HHS is a rare neoplasm with unknown etiology and rapid development. It mainly affects middle-aged to elderly animals. It primarily affects the spleen and bone marrow, with occurence of metastases in other organs. Some canine breeds are considered more predisposed to this neoplasia, among them the Rottweiler. The aim of this study was to report a case of HHS in a Rottweiler dog.Case: An 8-year-old Rottweiler suffering from hyporexia and progressive weight loss for a month was attended at the Veterinary Hospital of State University of Maringá. On physical examination, he only presented mild discomfort on abdominal palpation. Blood count was performed, which revealed mild thrombocytopenia (145,000/µL, reference value for the species 150,000-500,000/µL). The Polymerase Chain Reaction (PCR) exam was requested for babesiosis and ehrlichiosis, due to a history of ectoparasites. The animal was released with the prescription of Doxycycline at a dose of 10 mg/kg orally for 28 days. After 5 days, the condition worsened and the animal returned with emesis, apathy and hyporexia, being hospitalized. Abdominal ultrasound, blood count, urinalysis, serum urea and creatinine tests were requested. Among the hematological changes, thrombocytopenia (116,000/µL) and the appearing of regenerative anemia and atypical round cells with ample and slightly basophilic cytoplasm in the smear, similar to histiocytes, stood out. On ultrasound examination, splenomegaly was observed with hypoechogenic areas. Ultrasound-guided fine-needle aspiration cytology (FNAC) of the spleen was performed, which revealed the presence of abundant cellularity consisting of round cells arranged individually and in small groups, with variable nucleus / cytoplasm ratio, slightly basophilic cytoplasm and, sometimes, vacuolized. Eccentric nucleus with chromatin ranging from loose to dense, with evident and often multiple nucleus. In addition, a large number of multinucleated giant cells, mitosis figures (sometimes atypical) and intense anisocytosis and anisocariosis were observed. Furthermore, it was possible to observe erythrophagocytic activity, alterations compatible with histiocytic sarcoma (HS). After 10 days of the first visit, the animal died. At necropsy, samples from altered areas of the spleen, lungs and lymph nodes were collected and sent for histopathological and immunohistochemical examination, in which the diagnosis of hemophagic histiocytic sarcoma was confirmed, in addition to lungs and lymph node metastasis.Discussion: The prognosis of HHS is the worst among histiocytic disorders, as it is associated with coagulopathies and severe anemia due to erythrophagocytic activity, as occurred in the case presented, with a maximum survival time between one to two months. The described animal died ten days after showing the first clinical signs. The immunohistochemistry technique using HLA-DR, CD18, CD163, and CD11d markers was essential to confirm the cell line. Positivity for CD11d marker was found, which allowed to classify the neoplasm as hemophagocytic HS. This report exposes the importance of cytological examination for screening and histopathological and immunohistochemical tests to confirm the diagnosis of this extremely aggressive neoplasm

Geoeconomic variations in epidemiology, ventilation management, and outcomes in invasively ventilated intensive care unit patients without acute respiratory distress syndrome: a pooled analysis of four observational studies

Background: Geoeconomic variations in epidemiology, the practice of ventilation, and outcome in invasively ventilated intensive care unit (ICU) patients without acute respiratory distress syndrome (ARDS) remain unexplored. In this analysis we aim to address these gaps using individual patient data of four large observational studies. Methods: In this pooled analysis we harmonised individual patient data from the ERICC, LUNG SAFE, PRoVENT, and PRoVENT-iMiC prospective observational studies, which were conducted from June, 2011, to December, 2018, in 534 ICUs in 54 countries. We used the 2016 World Bank classification to define two geoeconomic regions: middle-income countries (MICs) and high-income countries (HICs). ARDS was defined according to the Berlin criteria. Descriptive statistics were used to compare patients in MICs versus HICs. The primary outcome was the use of low tidal volume ventilation (LTVV) for the first 3 days of mechanical ventilation. Secondary outcomes were key ventilation parameters (tidal volume size, positive end-expiratory pressure, fraction of inspired oxygen, peak pressure, plateau pressure, driving pressure, and respiratory rate), patient characteristics, the risk for and actual development of acute respiratory distress syndrome after the first day of ventilation, duration of ventilation, ICU length of stay, and ICU mortality. Findings: Of the 7608 patients included in the original studies, this analysis included 3852 patients without ARDS, of whom 2345 were from MICs and 1507 were from HICs. Patients in MICs were younger, shorter and with a slightly lower body-mass index, more often had diabetes and active cancer, but less often chronic obstructive pulmonary disease and heart failure than patients from HICs. Sequential organ failure assessment scores were similar in MICs and HICs. Use of LTVV in MICs and HICs was comparable (42·4% vs 44·2%; absolute difference -1·69 [-9·58 to 6·11] p=0·67; data available in 3174 [82%] of 3852 patients). The median applied positive end expiratory pressure was lower in MICs than in HICs (5 [IQR 5-8] vs 6 [5-8] cm H2O; p=0·0011). ICU mortality was higher in MICs than in HICs (30·5% vs 19·9%; p=0·0004; adjusted effect 16·41% [95% CI 9·52-23·52]; p<0·0001) and was inversely associated with gross domestic product (adjusted odds ratio for a US$10 000 increase per capita 0·80 [95% CI 0·75-0·86]; p<0·0001). Interpretation: Despite similar disease severity and ventilation management, ICU mortality in patients without ARDS is higher in MICs than in HICs, with a strong association with country-level economic status