PATIENT: Marley barlow
HISTORY: MCT’s, mildly elevated AP, abnoramlities on abdominal ultrasound: renal cyst and gallbladder sediment
The appearance of the liver would be most consistent with benign hyperplasia or secondary / reactive hepatopathy, although guided biopsy results are pending, to exclude the presence of metastatic disease. PT and APTT times were within normal limits. The gallbladder sediment is suspended on agitation and is therefore not considered significant; this is a normal incidental finding in animals particularly when fasted. Renal cysts are again often an incidental finding, and this one is in a high risk location at the renal hilus, immediately adjacent to renal artery, vein and ureter, and at a depth of 5cm; the risk to benefit ratio for sampling this benign lesion is considered to make this unsuitable for sampling. Hepatic biopsy results will be posted under the ‘guided sample’ tab in a weeks time.
LIVER: Abnormal: patchy, multifocal hypoechoic lesions throughout parenhcyma <1cm diameter. normal size, regular margins.
BILIARY TRACT: Normal moderate quantity of biliary sediment, suspended on agitation. thin-walled, no cholestasis.
LEFT KIDNEY: Abnormal: normal size, regular margins, mild diffuse cortical hyperechogenicity and some speckling, good cm definition. Solitary 2cm diameter thin-walled renal cyst at renal hilus, immediately adjacent to renal artery, vein and ureter
RIGHT KIDNEY: Normal: as above, no cystic lesions
LEFT ADRENAL: Normal 5mm
RIGHT ADRENAL: Normal 5mm
URINARY BLADDER: Normal
ILIOSACRAL LYMPH NODES: Normal
VISCERAL LYMPH NODES: Normal
SMALL INTESTINES: Normal
LARGE INTESTINES: Normal
GENITAL TRACT: Prostate small and hyperechoic
Results indicate the presence of benign nodular hyperplasia, with no metastatic disease in the liver.
Mast cell tumours of skin, multifocal hypoechoic liver lesion, ? benign
hyperplasia, reactive hepatopathy, metastatic disease.
Liver. Six tru-cut biopsies measuring up to 10 x 1 x 1 mm. Embedded whole.
Liver (6 sections). There are recognisable portal triads and central veins in
the sections, but the architecture appears to be distorted in some areas by
nodular aggregates containing plates of hepatocytes up to two cell layers
thick. Many of the hepatocytes are mildly to moderately swollen with a
reticular pattern to the cytoplasm (hydropic change / cloudy swelling). The
hepatocytes are diffusely well differentiated. The triads contain recognisable
hepatic arterioles, portal veins and bile ducts. Low numbers of lymphocytes and
plasma cells are present around a few portal triads and central veins, and
there are also scattered small foci of myeloid haematopoiesis.
Nodular hyperplasia, multifocal, with cloudy swelling, moderate, liver.
There is evidence of benign nodular hyperplasia in these biopsies, and this
could explain the imaging findings. Cloudy swelling is also present, and this
could be a consequence of hyperplasia in this case as hepatocytes with the
nodular foci frequently are swollen and vacuolated. Cloudy swelling may also be
a non-specific reactive lesion to changes elsewhere in the body. There is no
evidence of either primary hepatic neoplasia or metastatic disease. There is no
evidence to suggest significant hepatic inflammation.
Sean Haugland BVSc MRCVS FRCPath