export_final exam anat path sa cases Flashcards
a. Describe the abnormalities and give a diagnosis.
There are multiple portosystemic shunts, from the portal vessels to a branch of the caudal vena cava
b. What is the pathogenesis of this condition, and how would you investigate it further?
Congenital portosystemic shunts are usually single and may be extrahepatic or intrahepatic (patent ductus venosus). In this case, the presence of multiple extrahepatic shunts suggests that portal hypertension caused by liver disease is the cause, and investigation of the liver (gross inspection, histopathology, serum biochemistry) would be useful
This photo is of the abdomen and hindlimbs of a 4-year-old cat. a. Describe the abnormalities and give a diagnosis.
The caudal aorta and iliac arteries contain a thrombus, which is red-purple and fills the lumen.
what clinical signs expect with saddle trhombus?
acute onset hindlimb paralysis, paresis, pain cool limbs and ft, absence of femoral pulses, hindlimb cyanosis
pathogenesis of saddle thrombus
cats- usually secondary to HCM: abN intracardiac blood flow causes thrombus formation in the left atrium that breaks off adn ebmolizes to the aortoilac bifurcation- causing obstruction and hind limb ischemia.
dogs- less common; causes = endocarditis, prothrombotic states (eg. Cushings, nephrotic syndrome)
describe lesion- 2yo dog
lungs have generlized pattern of reddining, with multifocal raised, white 1-5mm diameter nodules, TNCT
2 diff for multifocal nodules in dog lungs:
- blasto
2. metastatic neoplasia
how differentiate btwn blasto and neoplasia?
cytology: examine impression smear of lesion- if see budding yeasts then blasto
Kidney from a neonatal puppy that was found dead.
a. Describe the lesions.
b. List 2 or 3 differential diagnoses.
- multiple 1-3mm diameter foci of hemorrhage throughout kidney
- RO: canine herpes virus, septicemia +/- DIC
how confirm dx of herpes virus?
histopath- intranuclear inclusion bodies
-virus isolation and IHC alse can be useful
Heart and lungs from Dobe- lethargy, cough, ascites- describe gross lesions and dx:
dilation and thinning of both ventrical walls
Dx: DCM
what histo lesions are expected in heart adn other organs with DCM:
- myocardial fibrosis and fatty replacement of cardiac myofibers
OR
- multifocal mycocardial necrosis dt ischemia
+ hemosiderin-laden macs in pulm alveoli= CHF
+/- periacinar hepatic necrosis if severe enough to cause right heart failure
what see in liver on histo with RHF
periacinar necrosis
what confirms CHF on histo?
hemosiderin-laden macrophages in pulmonary alveoli
Brain from a 2-year-old cat with progressive neurologic disease, including fever, depression, ataxia, and seizures.
a. Describe the lesions. b. morph dx
a. multifocal raised nodules in meninges
b. multifocal granulomatous meningitis - feline infectious perotinitis (corona virus)
The opened chest cavity from a 1-year-old cat with an acute onset of fever and respiratory distress. The liver is at the left, and the neck is at the right.
a. Describe the lesions, and give a morphologic diagnosis.
the pleural cavity contains abundant green-brown cloudy material but lungs look normal (altho difficult to see)
morph dx: supp pleuritis
most likely cause of supp pleuritis in cats
- usually from penetrating injury (bite wound from another cat)
- other Ro’s: ruptured lung abscess or penetrating esophageal FB
why would supp pleuritis smell so bad
presence of anaerobes
Heart from an 8-year-old Jack Russell terrier with a 6 month history of progressive left heart failure and coughing.
a. Describe the abnormalities.
- left atrium is markedly enlarged
- left AV valve is disorted by smooth-surfaced, 103mm diameter, pink-white nodules
–the lumen of left ventrical is dilated
morph dx
left atrioventricular endocardiosis with left atrial and ventricular dilatation
pathogenesis of endocardiosis:
- chronic, degen process- no specific cause
- atrial dilatation is evidence that the valve is both stucturally and functionally incompetend
- the left ventricular dilatation (eccentric hypertrophy) represents a volume overload, dt valvular incompetence
what is common to see with an incomp valve
fibrosis of the atrium= jet lesion
how confirm heart failure with left heart?
gross evidence of pulm edema; histo lesions of hemosiderin-laden macs in the alveoli dt chronic passive congestion
(not ascites or periacinar hepatic necrosis b/c left side)
why do dogs die suddenly with endocardiosis
rupture of chordae, tendinae- weakening of chordae resulting from same degen process
-leads to dev rapid, progressive left HF and pulm edema
The base of the cranial vault (with the brain removed; rostral at the top, and the foramen magnum at the bottom) and the ventral surface of the brain. These photos are of an 8-year-old Dalmatian dog with a 1 month history of progressive ataxia, head tilt to the right, and depression.
a. Describe the lesions.
- white, poorly demarcated mass extends from rightventrolateral surface of the brainstem, centered on pons
- adherent or non-adherent?
2 most likely ddx for mass: (how differentiate)
neoplasia and localized inflammation
- differentiate with cytology (segs with abscess, etc)
- or diff with histo for definitive dx
- culture is suspect bacterial inflammation
list brain tumors in dogs:
- meningioma
- astrocytoma and oligiodroglioma
- invading tumors (osteosarc, nasal adenocarc)
- tumors which met to brain (carcinomas, lymphoma)
What are the major causes of nasal disease in dogs? For which of these would a biopsy provide a definitive or highly suggestive diagnosis?
- Neoplasia (histo definitive)
- Aspergillus (histo dx)
- FB (histo non-specific- dx relies on scope or rads)
- Allergic rhinitis (histo evid of eos suggest allergic dz but eos can be seen in other dz eg. neoplasia)
- Bacterial rhinitis secondary to underlying causes)
What are the major causes of nasal disease in cats? For which of these would a biopsy provide a definitive or highly suggestive diagnosis?
- viral (herpes, calici)- histo non-specific unless inclusion bodies if very acute)
- nasopharyngeal polyps (yes, defin)
- bacterial (sequel to viral)
- neoplasia (lymph, carc)- yes defin
- crypto, fb, post-inflamm stenosis
- mycoplasma?
- chlamydophila
chlamydophila causes:
conjunctivitis and rhinitis
how decide what to bx in rhinitis?
rhinoscopy for focal lesions
-note bx of nasa mucoa in other areas of nasal cavity will not give dx!
High magnification view of a 1-cm-diameter cystic structure affecting the dorsal edge of the left lung (the aorta is visible in the photo, between the two lung lobes). Incision of the nodules revealed the brown-black structures shown in the 2nd photo.
a. What is the etiology?
Paragonimus kellicotti
what see on cytology with Paragonimus?
operculated pigmented eggs + inflamm reaction
Caudal abdomen from a dog. The first two images show the intestines, with the bladder at the lower left and the liver at the far right. In the third image, the intestine has been opened.
a. Describe the lesions.
petechial and ecchymotic hemorrhages in the mesentery adn serosal surface of the intestine and bladder
(on another view, the intestines are bloody)
most likely cause of melena, petechial and ecchymotic hemorrhage:
- Thrombocytopenia (most likely)
- Coag disorder
- DIC
- . Vasculitis
why prob not coag disorder if just see petechial hemorrhage in abd on intestines and bladder?
b/c would see hemoabdomen and hemarthrosis too
Lungs from an old dog.
a. Describe the lesions and differential diagnoses.
- neoplasia *
2. blasto
A microscopic image of an impression smear of one of the nodules is shown. What is the diagnosis–be as specific as possible!
neoplasia- carcinoma
where to carcinomas that met to lungs come from?
- tonsillar, thyroid
- biliary, pancreatic, intestinal
- mammary, ovarian
Liver from a dog.
a. Describe the lesions.
- liver is slightly smaller than normal
- abnormal tan-yellow-green, formed entirely by 2-10mm diameter nodules that protrude the capsular surface
list 5 causes or forms of liver dz
- chronic hep (beddlingtons, westies, cockers)
- PSS
- Acute hepatotoxicity:drugs, toxins
- Biliary obstruction- cholestasis, neoplasia, pancreatitis
- cholangiohep from ascending infection
- hepatic neoplasia
- hepatic nodular hyperplasia
- steroid hepatopathy
Ultrasound-guided liver biopsies are commonly used to investigate cases of liver disease in dogs. What are the limitations of these ultrasound-guided biopsies?
+US bx are tiny- most useful with diffuse dz = chronic hep, cholangiohep, acute necrosis
- hard to diff neoplasia and nodular hyperplasia with US
- focal lesions (eg. ealry neoplasia or inflamm) can be missed by bx
The histopathology report in this case describes “lymphoplasmacytic inflammation centred on portal tracts, fibrosis that extends from portal tract to portal tract and dissects the surrounding parenchyma, and nodular hyperplasia”, and gives a diagnosis of idiopathic lymphoplasmacytic portal hepatitis with fibrosis. How is this information useful to you?
- idiopathic dz
- tx supportive vs eliminating cause
- fibrosis that extends into hepatic parenchyma is a poor prognostic indicator meaning the dz will be progressive
If there is nodular hyperplasia of hepatocytes, why is the liver failing to function normally?
fibrous tissue prevents blood from entering space of disse and encountering hepatocytes= “functional shunts” develop where portal blood by-passes the hyperplastic nodules and passes directly into the hepatic vein adn vena cava
What clinical signs do you expect in this dog?
Anorexia, lethargy, jaundice, ascites, hepatic encephalopathy, & coagulopathy
(this dog had hepatocutaneous syndrome)
What abnormalities in the serum biochemistry are expected with hepatitis with fibrosis?
Elevated serum levels of liver enzymes (ALT, ALP, GGT) indicate the presence of hepatocellular injury and portal hepatic disease
Opened chest from a 5-year-old cat.
a. Describe the abnormality, and give a morphologic diagnosis.
b. What clinical signs do you expect?
- pleural cavity contains clear fluid= hydrothorax
- signs: exercise intolerane, dyspnea, tachypnea, muffled heart or lung sounds
hydrothorax in cats dt
- right or left HF
- hypoproteinemia and lymph obstruction uncommon
Intestines from a 6-week-old puppy with an acute onset of bloody diarrhea.
The CITE test for parvovirus was negative.
a. What lesions are present?
a. intestine is dilated with gas, congested, ground glass apperance on the serosal surface (fibrin strand on serosal surface)
b. parvo (CPV-2)
does a negative CITE Ag test RO parvo?
no- thought Ab in intestine blocks Ag so the Ab in the test can’t bind
how confirm parvo?
histo and IHC
-virus isolation or FA good but virus cleared after 10-14days so may be negative if after this time
decribe lesion
oral mucosa is pale-white, pleural cavity filled with blood
3 most likely dx of hemothorax
- anticoag rodenticide (arfarin, brodifacom)
- fatal thymic hemorrhage in jouvenile dogs post-trauma with leash
- fractured ribs
- tumours
- lung torsion
- idiopathic hemorrhage
The spleen is diffusely enlarged
a. 4 most likely causes
- IMHA
- Lymphoma
- Barbituate exposure from euthanasia
- splenic or gastric torsion
IMHA = splenic enlargment- how know?
- meaty spleen b/c too many hematopoetic cells and macs are phagocytosing red cells
- clinically: anemia and jaundice
if large diffuse spleen b/c lymphoma- how know?
meaty spleen with neoplastic lymphoctyes
- hepatomegaly and enlarged LN present
- cyto examination will confirm dx
what makes think barbituate exposure with enlarged spleen?
spleen enlarged b/c of congestion= bloody if sectioned and then will collapse after 15mins
splenic or gastric torsion- why suspect?
spleen enlarged from congestion so bloody when cut
-will see torsion at necropsy
Heart from a 6-year-old cat with a progressive history of respiratory distress.
a. Describe the lesion.
white material on epicarial surface that doens’t protrude
dx of white material on epicardial surface of heart of cat?
precip of euthanasia solution*
Pancreas from a 6-year-old Cocker spaniel with an acute onset of abdominal pain. The duodenum is visible at the bottom of the photo.
a. Describe the lesions.
multifocal, 2-7mm diameter angular areas throughout pancreatic tissue
grossly- chalky texture; histo foci coag necrosis
dx?
acute pancreatitis
what would you expect on omentum with acute pancreatitis?
similar foci of fat necrosis as consequence of leakage of activated lipase from inflamed pancreatic tissue
Heart from a 6-month-old dog that died during anaesthesia. The left ventricle, aorta, aortic valve (AV), and coronary artery (CA) are indicated.
a. Describe the abnormality and give a diagnosis.
fibrous tissue band encircles the left AV outflow tract, about 1cm proximal to aortic valve
Dx: subaortic stenosis
what congenital dz most common in puppies
SAS
PDA
VSD
PS
AV valve dysplasia
What are the pathophysiologic consequences of the lesion in this case?
SAS- obstruction to outflow= P overload and CONcentric hypertrophy (without dilation)
-reduced perfusion of coronary artery= myocardial infarcts
-myocardial infarcts=
arrhythmias, syncope, sudden death
-occasionally left heart failure= pulmonary edema
Tissues from a parrot. The great vessels extending cranially from the heart are thickened and hard. The other photos are cross-sections of this artery.
Diagnosis?
atherosclerosis
