pancreatic neoplasia

Question 1

what are the characteristics of pancreatic adenoma?

Answer 1

• Benign, singular - may be incidental finding
• Can obstruct pancreatic duct and cause exocrine pancreatic insufficiency

Question 2

what are the characteristics of pancreatiic adenocarcinoma?

Answer 2

• More common than adenoma, but still infrequent
• Usually originate from duct system but can arise from acinar tissue
• Tumour necrosis can cause pancreatic inflammation
• Can spread to neighbouring or distant organs

Question 3

what does insulinoma cause in SA, what species are they common in?
what treatment can be used?

Answer 3

• Hypoglycaemia with normal or elevated blood insulin
  ◦ Can present as emergency
• Steroids may be useful in treatment (insulin antagonism)
• Common in ferrets

Question 4

what are the clinical signs of pancreatic neoplasia?
what about in cats?

Answer 4

• May be similar to chronic pancreatitis – vomiting, anorexia, diarrhoea, weight loss (+/- jaundice if bile duct obstruction)
  ◦ Insulinoma: Signs of hypoglycaemia – weakness, tremor, tachycardia…seizure, collapse
• May have signs associated with metastatic lesions, e.g. lameness, dyspnoea, bone pain
• Cats – paraneoplastic alopecia (‘shiny skin disease’ – alopecia of ventrum, limbs and face)

Question 5

what laboratory abnormalites can be seen with pancreaitc neoplasia?

Answer 5

Insulinoma: Hypoglycaemia
Some dogs have very high serum lipase
Hypercalcaemia can occur

Question 6

what can be seen on imaging with pancreatic neoplasia?

Answer 6

Radiography:
* Decreased contrast cranial abdomen
* May see mass
* Spleen may be caudally displaced

Ultrasound:
* Soft tissue mass in region of pancreas
* If peritoneal effusion present, sample it for cytology
* Fine needle aspiration (FNA) of mass can be attempted but may not exfoliate readily – only successful in 25% of cases

Question 7

what is the treatment/prognosis for:
adenomas?
adenocarcinomas?
insulinomas?

Answer 7

Adenomas (benign) – only treat if cause clinical signs
◦ If find during ex-lap – partial pancreatectomy to establish diagnosis

Adenocarcinomas – prognosis grave
◦ Metastatic disease often present by time of diagnosis (liver, abdominal and thoracic lymph nodes,mesentery, intestines,lungs)
◦ If no gross metastatic lesions, surgical resection can be attempted but clear margins rarely achieved
◦ Little success with chemotherapy and radiation therapy

Insulinoma
◦ Surgical removal if possible, or palliative medication (prednisolone, diazoxide)
◦ Ferrets may survive for months to years on medical palliation but dose often needs to be titrated upwards over time