Feline gastrointestinal eosinophilic sclerosing fibroplasia

Question 1

What is feline gastrointestinal eosinophilic sclerosing fibroplasia

Answer 1

FGESF refers to a clinical and pathological entity of unknown cause or association defined by the presence of eosinophilic mass(es), largely confined to the gastrointestinal tract and associated lymph nodes, most commonly near the pylorus or ileocolic junction

Question 2

What is the prognosis for FGESF

Answer 2

The prognosis for affected cats is considered guarded

Question 3

What is the median age for FGESF

Answer 3

7 years

Question 4

What are the most frequent historical and physical findings

Answer 4

Historical findings:
- weight loss
- hyporexia
- chronic vomiting and/or diarrhea of at least 3 months’ duration

Physical findings:
- a firm, irregular, fixed abdominal mass in the cranial and/or mid-abdomen

Question 5

Is there a breed predisposition

Answer 5

Longhaired cats and specifically the Ragdoll breed may be overrepresented

Question 6

Which physical aspect of the mass is a easy mean to make a difference with other common intra-abdominal masses

Answer 6

The tissue is hard and often “gritty” on advancing the needle or scalpel blade due to abundant trabeculae of mature organised collagen
- this is a useful and inexpensive point of differentiation from other common intra-abdominal masses of cats, such as large cell lymphoma, mast cell neoplasia and non-scirrhous adenocarcinoma

Question 7

What is the suspected cause for FGESF

Answer 7

It has been hypothesised that affected cats suffer from immunological dysregulation triggered by one or more factors
- the trigger might be dietary (food allergy or intolerance), dysbiosis or other predisposing factors (e.g., ingestion of ectoparasites, endoparasites, excessive ingested hair or plant material)

Question 8

What is the most consistent hematological abnormality

Answer 8

eosinophilia

Hyperglobulinemia is the most common biochemical abnormality

Question 9

What would be a strong clue for FGESF

Answer 9

FGESF should be considered in cats with peripheral eosinophilia and an abdominal mass, as cats with neoplasia tend to have a stress-induced eosinopenia
- paraneoplastic eosinophilia can also be seen with intra-abdominal lymphoma

Question 10

What are the ultrasonnographic changes in FGESF

Answer 10

US changes are non-specific, consisting of solitary masses with mural thickening and loss of layering in the stomach, duodenum, jejunum or colon

Question 11

What is the best treatment plan

Answer 11

Surgical debulking should be done first if there is partial or complete gastrointestinal obstruction

Glucocorticoids are the main useful drugs as they interfere with cytokines and other factors promoting survival of eosinophils

Antibiotics are recommended given the high percentage of lesions where bacteria have been visualised
- a combination of amoxicillin clavulanate plus metronidazole would appear to be a good empirical choice
- marbofloxacine plus metronidazole is also possible

Addition of chlorambucil or lomustine could enhance efficacy