Ch. 97: Pancreas Flashcards
Ryan JSAP 2021
Clinical findings, neurological manifestations and survival of dogs with insulinoma: 116 cases (2009-2020)
MC presenting clinical signs?
How many neurologically affected?
Overall survival sx? MM? significance?
Variables assoc with px & hazard ratios?
MC presenting CS: weakness (60%), epileptic seizures (34%) and changes in consciousness or behaviour (28%)
32/116 (28%) had abnormal neurological examination: MC obtundation (28%), decreased withdrawal reflexes (22%), absent menace response (19%)
Overall survival for dogs undergoing surgery (20 months) was significantly longer than in medically treated (8 months)
Independent factors reducing risk of death:
- Surgical treatment -HR 0.34 - 3 times less likely to die compared to medically treated
- Absence of metastasis - HR 1.72
Coss JSAP 2021
The appearance of canine insulinoma on dual phase computed tomographic angiography
Sx location matched CT location in # cases?
Predom CT findings?
CT accuracy overall?
Location at surgery matched that described on the CT images in 17 of 19 cases (89%)
Findings - hyperattenuation of insulinomas in the arterial phase is a predominant feature, (hypoattenuation or isoattenuation are much less common)
CT angiography is accurate in prediction of lesion location before surgery in most
Gaitan-Cobo JAVMA 2021
Use of stereotactic body radiation therapy for treatment of a pancreatic tumor in a cat
Partial response to SBRT
Wolfe JSAP 2022
Perioperative outcomes in dogs and cats undergoing pancreatic surgery: 81 cases (2008-2019)
MC procedures in D/C?
Most common dx in D/C?
Overall mortality? D/C?
Most common pancreatic procedure:
Dogs → partial pancreatectomy 63% (36/57)
Cats → pancreatic biopsy 63% (15/24)
Most common histologic dx:
Dogs → Pancreatic islet cell carcinoma 51% (29/57)
Cats → Pancreatitis 42% (10/24)
Overall mortality rate 14% (11/81)
Dogs → 11% (6/57)
Cats → 21% (5/24)
Walczak JSAP 2022
Fluorine-18 fluorodeoxyglucose positron emission tomography-computed tomography for staging of canine insulinoma: 3 cases (2019-2020)
Conclusion?
Unpredictable tumoural avidity limits the value of 18 F-fluorodeoxyglucose positron emission tomography-CT for staging canine insulinomas
Myers-Nodes JSAP 2022
Combined surgical and medical management of a cat with gastrinoma
Conclusion? (Case report, meh)
Long-term survival was achieved w/ surgical + medical approach using omeprazole & toceranib
Collgros JAVMA 2023
Blood glucose monitoring during surgery in dogs to assess completeness of surgical resection of insulinoma: 11 cases
Change in BG?
Mean DFI?
MST?
Associations with outcome?
What other tx helped in 3 cases?
Positive increase in blood glucose was detected in all cases, with a mean rise of 6.35 ± 4.5 mmol/L
Mean DFI 382 days
MST 762 days
Tumor stage was not associated with outcome
3 cases underwent a second surgery (metastasectomy) & achieved further prolongation of disease-free survival
** Veytsman VSURG 2023 **
BOO YAH STAN THE MAN - this will Fo Sho be on test
Retrospective study of 20 cats surgically treated for insulinoma
On presentation - # cats with hypoGly? Neuro? Inappropriate insulin?
Sx excision resulted in what BG response in #?
Survival to dc?
Median time to death?
Median OST?
Prognostic factors?
1, 2, 3, year survival rates?
20/20 were hypoglycemic, 18/20 with neurologic signs, 12/13 with inappropriate insulin levels on presentation
Excision of insulinomas resulted in immediate euglycemia or hyperglycemia in 18 cats (90%)
18/20 cats survived to hospital discharge (90%)
The median time to death or last postoperative follow up was 664 days (range: 2-1205 days)
Prognostic factors:
age at presentation (for DFI); time to postop euglycemia (for disease-related death (DRD)); preop and postop serum blood glucose concentrations; metastasis at time of surgery (DFI and DRD), & histopathologic tumor invasion (for overall ST)
Median OST for all cats was 863 days.
1-, 2- and 3-year survival rates: 75%, 51%, 10%
Conclusion: Excision of insulinoma resulted in euglycemia or hyperglycemia in most cats. Negative prognostic factors included young age, low serum glucose concentrations, metastasis at time of surgery, tumor invasion, and shorter time to euglycemia.
Talbot JVIM 2022
Medical and surgical management of pancreatic fluid accumulations in dogs: a retrospective study of 15 cases
MC U/S finding?
MC Cyto finding? How many negative culture?
Sx discharge vs euth #?
MM outcomes?
U/S of dogs with suspected pancreatic abscessation - Hypoechoic 10/15
Cytology: predominantly neutrophilic inflammation
11/15 negative culture (9/11 had abx prior to sampling)
4/15 positive (E. coli, Staphylococcus pseudintermedius, or both)
Surgery: 7/15
4/7 discharged (57%), 3/7 euthanized (43%)
Medical Management: 8/15
7/8 discharged (88%), 1 died
3/7 (43% of survivors) then represented and had surgical intervention due to recrudescence of clinical signs and subsequently, all were discharged; remaining 4/7 did not require additional intervention
Luce JAVMA 2022
Gastrointestinal foreign body obstruction is not associated with abnormal point-of-care pancreas-specific lipase test results in dogs
Proportion of abnormal SNAP CPL in each group?
Conclusion?
Proportions of abnormal SNAP cPL test results: GIFBO 12% (3/25)
non-GIFBO 16% (4/25)
- with no significant difference.
SNAP cPL test results are mostly reliable but can still be abnormal in a small percentage of dogs with GIFBO and older dogs without GIFBO or signs of pancreatitis
Bruckner JAVMA 2019
Laparoscopic omentalization of a pancreatic cyst in a cat
Case report, meh
Left pancreatic limb – percutaneously drained & omentalized then partial cystectomy
survived , primary cyst resolved, more formed later
Polansky JAVMA 2018
Resolution of hyperinsulinemic hypoglycemia following partial pancreatectomy in a dog with nesidioblastosis
Case report, meh
Partial left pancreatectomy and hepatic / local LN biopsies done – islet cell hypertrophy & hyperplasia no neoplasia
FU exam 8 mo later, dog healthy and results of CBC / Chem including BG [x] normal
Saeki JVECC 2022
Assessment of changes in blood pancreatic lipase activities using FDC-v-LIP in dogs that underwent various surgical procedures
What was blood pancreatic lipase finding?
Blood pancreatic lipase activities significantly increased postoperatively compared to preoperative measurements
FDC-v-Lip showed a strong correlation with cPLI and was considered a useful marker for acute pancreatitis diagnosis with high sensitivity and specificity
(FUJI DRI-CHEM v-Lip-P b = FDC-v-Lip)
Petrelli JVIM 2023
Serum insulin concentration in dogs with insulinoma as a clinical marker for presence of metastasis at the time of diagnosis
SIC and mets?
SIC and survival?
Any associations?
Conclusion?
WHO Stages of Insulinoma:
Stage I: T1N0M0 (primary tumor w/o evidence of metastasis)
Stage II: T1N1M0 (primary tumor with locoregional lymph node metastasis)
Stage III: T1N0M1 or T1N1M1 (primary tumor with distant metastasis w/ or w/o locoregional lymph node metastasis)
Study:
59 dogs with diagnosis of insulinoma
Examine association b/w serum insulin concentration (SIC) and survival and clinical disease stage in dogs with insulinoma
Results:
Median SIC was 33 mIU/L (8-200) in Stage I dogs
Median SIC was 45 mIU/L (12-213) in Stage II/III dogs
No difference identified in proportion of dogs with increased SIC w/ or w/o metastasis
No association was identified b/w SIC and survival
No association was identified b/w dogs grouped by SIC (normal vs. high SIC) and survival either
Conclusion
SIC was not different b/w dogs w/ or w/o metastasis
SIC does not provide information regarding disease stage and is not associated with survival time in dogs w/ INS
Del Busto JVIM 2020
Incidence of postoperative complications and outcome of 48 dogs undergoing surgical management of insulinoma
PQ What affect did stage have on MST?
PQ What % had diabetes post-op?
- MST was 372 d (1-1680d) with dogs with stage I dz having longest survival time
Stage I dogs had MST of 652 d (2-1680d) whereas dogs with either stage II or III dz had MST of 320 d (range 1-1260d)
- Postoperative hyperglycemia was ID in 33% (16/48) of the dogs, of which 9 (19% of total population) developed persistent DM
No factors that could be used as predictors for development of DM were ID
Interestingly – only 42% dogs had insuling:glucose ratio > 30
Conclusions: stage of dz and postop hypoglycemia were associated with greater odds of relapse and decreased survival time; these could be used when discussing prognosis; in this study postop DM developed more commonly than previously reported, but no factors were ID that might be useful predictors
