Pericardial effusion associated with metastatic disease from an unknown primary tumor in a dog

What can we learn from cancer of unknown primary in canine oncology?

Cancer of unknown primary (CUP) represents a heterogeneous group of metastatic tumors that lack an identifiable primary site despite an extensive diagnostic work-up. It is a well-recognized entity that is characterized by early dissemination, aggressive clinical course, unpredictable metastatic pattern, intrinsic treatment resistance, and a dismal prognosis. Despite the molecular diagnostic workup and personalized therapy, the expected improvements in the diagnosis and treatment of CUP have not been achieved. Comparative oncology has a promising role in the exchange of knowledge and practices between humans and canines. Therefore, we intended to review the literature reporting on CUP in dogs in order to identify some interesting parallels and unique results that could be transposed to in-human research.

Cardiac magnetic resonance in the differentiation of neoplastic and nonneoplastic pericardial effusion

BACKGROUND

Cardiac magnetic resonance (CMR) is the imaging modality of choice for cardiac tumors in people. Although neoplastic pericardial effusion (PE) carries a poor prognosis, benign idiopathic pericardial effusion does not. Definitive diagnosis is critical for surgical intervention, but currently available diagnostic techniques such as echocardiography and pericardial fluid cytology often are inconclusive.

HYPOTHESIS/OBJECTIVE

Describe CMR findings associated with PE and determine whether CMR aids in differentiation of benign and neoplastic causes of PE.

ANIMALS

Eight client-owned dogs with PE diagnosed by transthoracic echocardiography (TTE).

METHODS

CMR was performed with a 1.5 T, including dark blood, steady-state free procession cine, pre- and postcontrast T1-weighted imaging, and delayed inversion recovery prepped imaging.

RESULTS

CMR confirmed a cardiac mass and supported suspected tumor type in 4 dogs with suspected hemangiosarcoma. In 1 equivocal TTE case, CMR did not demonstrate a mass, but neoplasia was later diagnosed. In another equivocal case, CMR did not demonstrate a mass but showed findings consistent with a pericardiocentesis complication. In 1 dog without evidence of cardiac neoplasia, abdominal magnetic resonance imaging identified presumptive hepatic and splenic metastases. On reevaluation of the original CMR study, the 2 equivocal cases that were interpreted as tumor negative were reassessed as tumor positive.

CONCLUSIONS AND CLINICAL IMPORTANCE

CMR did not substantially improve diagnosis of cardiac tumors compared with TTE in these 8 cases, but it yielded useful descriptive information regarding extent, anatomic location, and potential tumor type and confirmed that CMR requires extensive additional training for tumor identification.

Metastatic Pericardial Tumors in a Dog With Equivocal Pericardial Cytological Findings

A metastatic tumor associated with pericardial effusion was diagnosed in a 6-year-old, female, mixed-breed dog. Echocardiography identified multiple echogenic masses adherent to both visceral and parietal pericardium, while results of pericardial fluid cytology were non-diagnostic. The distribution pattern of the masses is remarkable in that they protruded from both pericardial surfaces, rather than one, and demonstrated an oscillatory motion during the cardiac cycle. Pathological examination confirmed the diagnosis of multiple metastatic tumors of the pericardium, with the primary tumor being an anaplastic gastric adenocarcinoma.

Long-term survival of 23 dogs with pericardial effusions

Twenty-three dogs with pericardial effusions were identified from case records made between 1992 and 2000. Fourteen of the 23 were diagnosed with idiopathic pericardial effusions, and three of these were treated successfully by one pericardiocentesis. In the remaining 11 cases the pericardial effusion recurred; six cases were managed long-term by either two (three cases), three (two cases), or 11 repeated pericardiocenteses, and the remaining five were treated by pericardiectomy. The median survival time of the six dogs treated by repeated pericardiocentesis was five years and nine days.

Immunohistochemical characterisation of the lesions of canine idiopathic pericarditis

Pericardial tissue was obtained from 14 dogs with idiopathic pericarditis, and from three dogs with pericardial effusion associated with neoplastic disease, for histopathological assessment and characterisation of infiltrating leucocytes by immunohistochemistry. The major pathological change was extensive pericardial fibrosis which was generally accompanied by a mixed inflammatory response that was of greatest intensity at the cardiac surface of the tissue. Perivascular lymphoplasmacytic aggregates were present at the pleural surface and within the fibrosed pericardium. There were no features that clearly distinguished the samples from dogs with neoplastic disease from dogs with idiopathic pericarditis. The pericardial infiltrates were dominated by MAC 387+ monocyte-macrophages and plasma cells expressing immunoglobulin (Ig)A or IgG. CD3+ T lymphocytes and major histocompatibility complex (MHC) class II+ macrophages were less common, although the perivascular aggregates were mixtures of T and B lymphocytes and a proportion of fibroblasts expressed MHC class II. There was no vascular pathology or deposition of immunoglobulin or complement within vessel walls. These findings are consistent with an immune response dominated by humoral effector mechanisms (Th2 immunity) but do not clearly support a primary immune-mediated pathogenesis for idiopathic pericarditis.