American Society for Veterinary Clinical Pathology
2013 Case Review Histories
Case 1
Submitter
University
Harold Tvedten
Swedish University of the Agricultural Sciences (SLU)
Specimen: History, laboratory data, Advia 2120 graphics, photomicrographs of first blood smear.
Signalment:
The SLU UDS laboratory received an EDTA blood sample by mail on May 21 from a 1 year old border collie that
had pale mucous membranes. It had a diagnosis of urinary tract infection and had 1 + blood in its urine. The
same tube of blood was analyzed twice with an Advia 2120.
We received a second EDTA blood sample June 7.
Table 1
Test (May 21)
Patient
Reference Values
Hematocrit
30 %
39-59
WBC first analysis
7.66 x 109/L
6-17
WBC second analysis
21.74 x 109/L
6-17
Neutrophils first
1.6 x 109/L
3-11.5
Neutrophils second
1.6 x 109/L
3-11.5
Lymphocytes first
5.0 x 109/L
1-4.8
Lymphocytes second
19.3 x 109/L
1-4.8
Reticulocytes first
406 x 109/L
11-111
Reticulocytes second
286 x 109/L
11-111
NRBC/100 WBC
340
0
Test
May 21
June 7
Hematocrit
30.5 %
33
Table 2
WBC Perox
7.6 x 109/L
8.58
WBC Baso
21.74 x 109/L
13.64
Neutrophils
1.6 x 109/L
3.6
Lymphocytes Baso
19.3 x 109/L
9.13
NRBC/100WBC
340
147
Reticulocytes
406 x 109/L
31
Figure 1 Blood Smear Morphology May 21 (Giemsa stain, original magnification was about 500X)
Figure 2 Blood Smear Morphology May 21 (Giemsa stain, original magnification was about 1000X)
Figure 3 Advia Graphics May 21
Figure 4 Advia Graphics June 7, 2013
Questions
1. What caused the variations in cell counts?
2. Was the morphology of the erythrocytes diagnostic?
3. What additional tests should be performed?
4. What is the most likely tentative diagnosis?
Case 2
SUBMITTER
Seung Yoo
CONTRIBUTERS
Julia Ryseff
Christine Olver
COMPANY OR UNIVERSITY
Colorado State University, Department of
Microbiology, Immunology and Pathology
SPECIMEN: Cytospin preparation of thoracic fluid
SIGNALMENT: 15 year old Missouri Fox Trotter gelding
HISTORY AND CLINICAL FINDINGS: The patient was initially evaluated by the referring veterinarian
after the owner detected ventral swelling along the patient’s pectoral muscles in addition to
hyperthermia along the right side of the neck (ear to shoulder), however systemic body temperature
was determined to be within normal limits. Soon after, the patient developed hyperhydrosis of the right
side of the neck, right eye ptosis and muscle fasiculations along the right shoulder. Upon presentation
to Colorado State University, the above clinical signs were appreciated in addition to right-sided
laryngeal hemiplegia and atrophy of the right pectoral and suprascapular muscles.
LABORATORY DATA: A CBC revealed a mild leukopenia characterized by a neutropenia (2.7 [3.07.0 K/μL]) and lymphopenia (1.1 [1.5-4.0 K/μL]), and a mild normocytic, hypochromatic anemia (Hct
28.0% [31-47%], MCHC 35.0 [36.0-39.0 g/dL]). A serum biochemistry panel revealed a hypocalcemia
(11.0 [11.5-14.0 mg/dL]), hypomagnesia (1.5 [1.6-2.2 mg/dL]), hypoalbuminemia (2.5 [2.9-3.7 gm/dL]),
decreased GGT (9 [10-25 IU/L]) and decreased bicarbonate (25.6 [26-33 meq/L]). Urinalysis revealed
a USG of 1.041, pH 8.5 and numerous calcium carbonate crystals.
QUESTIONS:
What is your interpretation and differential diagnosis of the cytologic preparation?
Is there a correlation between the possible differentials and the patient’s clinical signs?
CASE 3
SUBMITTER
Sally Henderson
CONTRIBUTERS
Nicholas Jew1, Julie Byron1, Jon Dyce1, Armando
Irizarry2, Mary Jo Burkhard1
COMPANY OR UNIVERSITY
1
The Ohio State University, College of Veterinary
Medicine, Department of Veterinary Biosciences
2
Lilly Research Laboratories - Toxicology and Drug
Disposition, A Division of Eli Lilly and Company
SPECIMEN: Peripheral blood smear and photomicrographs of splenic FNA (both Wright-Giemsa
stain)
SIGNALMENT: 8 month old female intact Afghan hound
HISTORY AND CLINICAL FINDINGS: The dog was presented to The Ohio State University
Veterinary Medical Center (OSU-CVM) Orthopedic Surgery Service for evaluation of slipped hocks.
The owner also reported that the dog had been chronically underweight, inappetant, and lethargic.
The dog had been imported from a breeder in Germany, and was one of three surviving dogs from a
litter of five. Previous history included a coccidial infection upon arrival in the United States that was
treated with Albon 5% oral solution for ten days and a veterinary consultation that found that the dog’s
limbs were underdeveloped for her age. Assays to assess growth hormone levels, thyroid function,
and bile acids were all within reference intervals. Samples sent to the Gastrointestinal Laboratory,
Texas A&M University Veterinary Medicine and Biomedical Sciences revealed low normal cobalamin
and trypsin-like immunoreactivity (TLI), while folate and pancreatic lipase were within reference
intervals. Viokase treatment was initiated but discontinued when the dog developed diarrhea. The dog
also received 500mg metronidazole orally once daily and vitamin B12 injections every other week. At
the time of presentation, the dog was not currently experiencing any gastrointestinal signs.
Additionally, the owner reported that a male littermate of this dog had similar but more severe clinical
signs and episodes of seizures and was being examined at the Auburn University Veterinary
Teaching Hospital.
On physical exam the dog was bright, alert, and responsive with a body condition score of 1.5-2 out of
5. Abnormalities on physical exam included retained deciduous canines (504 and 604), mild
pododermatitis, dull mentation, laxity of the talocrural joint (right worse than left), laxity of the
metacarpophalangeal and carpometacarpal joints, generalized decreased muscle mass, and an
enlarged popliteal lymph node.
LABORATORY DATA: Prior CBC and biochemistry profile by rDVM were reportedly within reference
intervals but were not available for evaluation. Repeat CBC, biochemistry profile, fasted
TLI/cobalamin/folate and aspiration of the popliteal lymph node were declined.
Urinalysis (9-19-12):
Source
Cystocentesis
Urine color
Yellow
Appearance
Clear
Spec. gravity
1.051
pH
6.0
Protein
Trace
Glucose
Negative
Acetone
Negative
Bilirubin
Negative
Blood
Negative
Casts
None seen
Leukocytes
Occasional
Epithelial squam. cells
None seen
Epithelial trans. cells
Occasional
Erythrocytes
Occasional
Crystals
None seen
Bacteria
None seen
Ammonia:
21 Umol/L
0-29.9
ADDITIONAL DIAGNOSTIC TESTS:
Abdominal ultrasound: The spleen contained numerous, small, round, moderately well demarcated
hypoechoic nodules less than 5mm in diameter.
FNA of a splenic nodule:
Figure 1: The sample was markedly cellular with several aggregates of normal splenic stroma. Two dense
aggregates of a heterogeneous lymphoid population were seen, consistent with aspiration of a lymphoid follicle.
CBC requested: All values were within normal reference limits.
Blood smear. Slides
provided (Figure 2):
Cervical spinal radiographs: Dorsal tipping of the cranial aspect of the C6 vertebral body. The
vertebral canal is narrowed at the cranial aspect of C6. Interpretation: Mild dorsal
subluxation/instability of the C6 vertebral body with focal vertebral canal narrowing.
Thoracolumbar spinal radiographs: Left 13th rib is shortened and blunted with an appearance similar
to a lumbar transverse process and was interpreted as a transitional T13 vertebra. Midthoracic
lordosis. Bulge in the cardiac silhouette at the 1 to 2 o’clock region seen on ventrodorsal projection,
likely representing an enlarged main pulmonary artery.
Cardiology consultation: Trace mitral regurgitation. The left ventricular ejection fraction, as estimated
by the minor shortening fraction, was mildly reduced. Two dimensional methods for evaluating LV
ejection fraction (shortening area, single plane long axis ejection fraction) also suggested low-normal
global systolic function. The aortic valve was equivocally thickened. Trace tricuspid regurgitation and
trace pulmonic insufficiency.
Ophthalmology consultation: No ocular or neuro-ophthalmic abnormalities noted. Positive direct and
consensual pupillary light responses in both eyes, intraocular pressures of 13mmHg OU, and
Schirmer Tear Test values of 21mm OD and 24mm OS.
QUESTIONS:
What is your primary ‘big picture’ differential for the granules?
What is the most likely subcategory of differential diagnoses?
What further testing steps would you take to further your differential diagnosis?
CASE 4
SUBMITTER
Charlotte Hollinger
CONTRIBUTERS
Mike Scott
Jon Patterson
Matti Kiupel
Thomas Mullaney
Hal Schott
Pathobiology and Diagnostic
Investigation; Diagnostic Center for
Population and Animal Health, Michigan
State University
COMPANY OR UNIVERSITY
SPECIMEN: Impression smear of intracranial mass
SIGNALMENT: 23-year-old gray quarter horse gelding
HISTORY AND CLINICAL FINDINGS: This horse was presented for necropsy examination
approximately three hours after euthanasia. The horse had a six-month history of “chewing funny” and
a six-week history of progressive dysphagia characterized by dropping feed. He was also reported to
have unusually deep head submersion when drinking water, an intermittently altered whinny, and
weight loss.
The horse had been examined at the MSU Veterinary Teaching Hospital approximately three weeks
before euthanasia, at which time the only noted abnormality on general physical examination was a
“tucked up” abdominal contour signifying diminished intestinal filling. Careful oral and neurologic
examinations revealed no significant abnormalities with the exception of possible tongue weakness.
Although suggestive of hypoglossal (cranial nerve XII) neuropathy, the dysfunction appeared minor
because the tongue could be retracted into the mouth. The horse also appeared to have subtle hind
limb weakness, and although mild brainstem/spinal cord disease was considered, the change was
attributed to orthopedic lameness of the right hind limb that could be exacerbated by hock/stifle
flexion.
Skull radiographs revealed no abnormalities. Endoscopy revealed intermittent dorsal displacement of
the soft palate with epiglottic entrapment and mild osseous proliferation of the stylohyoid bones
(temporohyoid osteoarthropathy); swallowing appeared normal. Fluoroscopic examination of bariumcontaining feed ingestion revealed prolonged movement of food from the front to the back of the
mouth, but swallowing and propulsion of food down the esophagus appeared normal.
While in the hospital, the horse received 16 L of fluid via nasogastric tube to correct mild dehydration.
It was discharged with oral dexamethasone for inflammation, and with trimethoprim / sulfadiazine for
potential infectious disease. Over the next three weeks, clinical signs remained fairly stable until
approximately 48 hours prior to euthanasia, when the horse deteriorated with progressive hind-end
weakness.
LABORATORY DATA:
PCV = 40%, plasma TP = 7.8 g/dL
ADDITIONAL DIAGNOSTIC TESTS:
On necropsy examination, the most significant finding was:
QUESTIONS:
1. Based on gross examination, what are differential diagnoses for the large (5.5 × 2.6 × 2.0 cm),
well-demarcated, greenish-gray, gritty mass along the caudoventral cranium that markedly
compresses but does not invade the brainstem?
2. What are differentials after examination of the impression smear?
3. What additional tests would you recommend to assess these differentials?
CASE 5
SUBMITTER
Paola Cazzini and Sheryl Coutermarsh-Ott
CONTRIBUTERS
Laila Proença, Stephen Divers, Uriel Blas-Machado, Bridget Garner
COMPANY OR UNIVERSITY
University of Georgia
SPECIMEN: Bone marrow histologic section
SIGNALMENT: 3-year-old African pigmy hedgehog
HISTORY AND CLINICAL FINDINGS: History of anorexia, weakness, weight loss, behavioral
change, ataxia, and cervical and abdominal masses. Skin mites were observed.
LABORATORY DATA:
Table 1
CBC
Hct
Hgb
Rbc
MCV
MCHC
Ptl
MPV
WBC
Seg
Band
Lymph
Mono
Eos
Baso
Others
nRBC
3/8 Pretreatment
36.7
13.7
4.3
85.3
37.3
137
11.6
85.4
(30%) 25.6
(9%) 7.7
(3%) 2.6
(0%) 0
(9%) 7.7
(3%) 2.562
(46%) 39.284
2
3/12 Post-treatment
Reference interval*
Units
31.9
11.1
3.67
87
34.9
142
10
2.0
(11%) 0.220
(0%) 0
(32%) 0.6
(6%) 0.1
(17%) 0.3
(2%) 0.04
(32%) 0.6
3
36 +/- 7 (22-64)
12 +/- 2.8 (7-21.1)
6 +/- 2 (3-16)
67 +/- 9 (41-94)
34 +/- 5 (17-48)
226 +/- 108 (60-347)
n/a
11 +/- 6 (3-43)
5.1 +/- 5.2 (0.6-37.4)
n/a
4 +/- 2.2 (0.9-13.1)
0.3 +/- 0.3 (0-1.6)
1.2 +/- 0.9 (0-5.1)
0.4 +/- 0.3 (0-1.5)
0
n/a
%
g/dl
x106/µl
fl
g/dl
x103/µl
fl
x103/µl
x103/µl
x103/µl
x103/µl
x103/µl
x103/µl
x103/µl
x103/µl
/100 WBC
* Reference intervals are from “Exotic animal formulary”, by Carpenter J.W., Elsevier 4 th ed. 2012
ADDITIONAL DIAGNOSTIC TESTS: The clinical status of the animal continued to deteriorate with
worsening of depression, anorexia and lethargy. The hedgehog died the day after the second CBC
was performed and necropsy was performed. Histologic sections of bone marrow collected post
mortem are included in your slide box.
QUESTIONS:
1. What are the possible differentials and what features would you use to reach a definitive
diagnosis?
2. What stains would you use to confirm the cell(s) of origin?
CASE 6
SUBMITTER
Kristin Loria
CONTRIBUTERS
Koranda Wallace, Kyla Beguesse, Reema Patel,
Roberta Di Terlizzi, Madhu Sirivelu
University of Pennsylvania, College of Veterinary
Medicine, Department of Pathobiology
COMPANY OR UNIVERSITY
SPECIMEN: Impression of liver, Wright-Giemsa stain
SIGNALMENT: Lagamorph, 2 month old, male, Domestic rabbit
HISTORY AND CLINICAL FINDINGS: A two month old, male domestic rabbit, developed severe
bilateral vestibular signs and loss of balance in the morning and died enroute to Ryan Veterinary
Hospital at the University of Pennsylvania. Upon presentation, the patient had no subcutaneous
adipose tissue or body fat. The subcutaneous tissue and muscle were tacky. There was severe
atrophy of all muscles.
The patient had been obtained from a pet store two weeks prior. Until the development of vestibular
signs, the patient had appeared normal with apparently normal eating and drinking. There was
another healthy rabbit of the same age present in the house upon the acquisition of the patient.
LABORATORY DATA: None
ADDITIONAL DIAGNOSTIC TESTS: Necropsy with histopathology
QUESTIONS:
1. What differentials would you consider for an etiologic diagnosis?
2. What distinguishing characteristics help make your diagnosis?
3. What additional tests could be performed for a more definitive diagnosis?
CASE 7
SUBMITTER
CONTRIBUTORS
Meredeth McEntire, DVM1
Johanna Rigas, DVM, DACVP (Clinical Pathology) 2, Kevin Choy,
DVM1, Linda Lang, DVM1, Lindsay Fry, DVM1
COMPANY OR UNIVERSITY
1
Washington State University Veterinary Clinical Sciences
Animal, Dairy, and Veterinary Sciences
Utah State University
2
SPECIMEN: Impression smears of a right-sided cervical mass
SIGNALMENT: Nine year old male neutered domestic short haired cat
HISTORY AND CLINICAL FINDINGS: Prior to presentation the patient was evaluated for a
change in his tone of vocalization and was diagnosed with right-sided laryngeal paralysis via
endoscopic examination. No specific therapy was instituted. Nine months later the owner
identified a palpable right sided cervical mass prompting the current presentation. On
physical examination the patient had a round, firm, non-painful, moveable mass on his right
ventral neck that measured 1.8 cm x 2.2 cm x 1.4 cm. Otherwise, no other physical
abnormalities were noted.
LABORATORY DATA:
CBC & Urinalysis: No significant findings
Chemistry: The chemistry was unremarkable expect for hyperglycemia of 171 mg/dl (RI: 70140 mg/dl) attributed to a glucocorticoid-mediated stress response.
ADDITIONAL DIAGNOSTIC TESTING:
Total T4 (µg/dl)
Total T3 (ng/dl)
fT4 by ED (pmol/L)
2.4
42.4
16
1.8-4.5
75-200
10-50
Imaging
Ultrasound of the ventral neck revealed a well-circumscribed, smoothly marginated,
moderately to highly vascular mass in the right cervical tissues in the region of the right
thyroid gland (medial to the carotid artery). Regional lymph nodes appeared normal. A right
cervical mass of suspected thyroid origin was diagnosed.
Three-view thoracic radiographs were unremarkable.
QUESTIONS:
•
•
•
What is the significance of the pigmented material?
Within which type(s) of tumors are mast cells classically observed?
What are the potential molecular stimuli for the presence of mast cells?
CASE 8
SUBMITTER
Sarah S. K. Beatty
CONTRIBUTERS
Mark D. Dunbar
Heather L. Wamsley
Jeffrey R. Abbott
Hirotaka Kondo
Wendy W. Mandese
University of Florida College of Veterinary Medicine
COMPANY OR UNIVERSITY
SPECIMENS:
Direct preparation of abdominal effusion, Wright-Giemsa stain
Tissue imprint from enlarged mesenteric lymph node, Wright-Giemsa stain
SIGNALMENT: 5-year-old feral, castrated male, Domestic Shorthair cat
HISTORY AND CLINICAL FINDINGS: The patient was referred to the University of Florida Veterinary
Hospital (UFVH) for evaluation of dental disease, weight loss, and hyporexia. ANTECH Diagnostics
performed complete blood count and serum biochemistry prior to referral. FeLV/FIV ELISA was
negative.
On presentation to UFVH, physical examination under general anesthesia disclosed thickened
intestinal segments, moderate gingivitis, and body condition score of 3/9. Abdominal ultrasound
revealed a moderate amount of echogenic fluid throughout the peritoneal cavity. Associated with the
descending colon, a possible mass or severe thickening was observed with loss of wall layering. The
duodenum, jejunum, and ileum were also thickened with altered layering. Several mesenteric, gastric,
and colonic lymph nodes were enlarged. Multicentric neoplasia, including lymphoma, was the primary
differential diagnosis based upon diagnostic imaging. Abdominocentesis and ultrasound-guided fineneedle aspirates of the colonic mass and mesenteric lymph nodes were performed and submitted for
evaluation by the University of Florida Veterinary Diagnostic Laboratories Clinical Pathology Service.
LABORATORY DATA:
CBC (abnormal values only), prior to referral 4/15/2013 ANTECH Diagnostics
Analyte
Patient
Ref Interval
RBC (x106/µL)
5.58
L
5.92-9.93
Hematocrit (%)
28.6
L
29-48
WBC (x103/µL)
28.6
H
3.5-16.0
Seg Neutrophils (x103/µL)
19.73 H
2.5-8.5
Eosinophils (x103/µL)
4.29
H
0-1.0
Basophils (x103/µL)
0.29
H
0-0.15
Peritoneal fluid, 4/17/13
Cell counts were performed using an
Advia 120.
Parameter
Patient
Appearance (Color, transparency)
Red, opaque
Specific gravity
1.014
Refractometric total protein g/dL
<2.0
PCV %
1
Total nucleated cell count/μL
53,040
RBC/μL
410,000
Direct preparations were made for case
submission.
Pre-operative recheck on IV fluid
CBC & Serum Biochemistry (abnormal values only), 5/6/2013
Analyte
Patient
Ref Interval
Analyte
Patient
Ref Interval
RBC (x106/µL)
6.11 L
7.4-10.4
Total Protein (g/dL)
5.7
L
6.3-8.4
Hematocrit (%) (CALC)
31.5 L
34.0-51.0
Albumin (g/dL)
1.8
L
2.3-3.5
PCV (%) (SPUN)
30
34.0-51.0
Calcium (mg/dL)
6.0
L
8.7-10.7
WBC (x103/µL)
41.91 H
5.4-15.4
iCalcium (mmol/L)
1.19
1.12-1.32
Seg Neutrophils (x103/µL)
16.0 H
2.3-9.8
Sodium (mEq/L)
142 L
148-156
Eosinophils (x103/µL)
20.0 H
0-1.8
Potassium (mEq/L)
5.2
H
3.9-5.1
Basophils (x103/µL)
0.42 H
0-0.2
TCO2 (mEq/L)
21
H
14-19
Anion Gap
15.2 L
20-30
L
ADDITIONAL DIAGNOSTIC TESTS: Multiple firm, full thickness, colonic mural masses involving the
full length of the colon were observed during exploratory laparotomy. Enlarged mesenteric lymph
node samples were collected for tissue imprint cytology and histopathology. The lymph node imprint
cytology recapitulated the previous FNA results. Samples were not obtained from the gastrointestinal
tract given the diffuse pathology and patient morbidity concerns.
QUESTIONS:
1. What are considerations for this patient’s circulating eosinophilia?
2. What are differential diagnoses for the peritoneal fluid analysis and cytology?
3. What are considerations for the lymph node imprint cytology?
CASE 9
SUBMITTER
Mary Leissinger
CONTRIBUTERS
Diana McGovern, Stephen Gaunt
COMPANY OR UNIVERSITY
Louisiana State University
SPECIMEN: Thoracocentesis fluid, Direct smear, Wright-Giemsa stain
SIGNALMENT: “Honey”, a 14 year old female spayed Labrador Retriever
HISTORY AND CLINICAL FINDINGS:
Honey presented to the LSU VTH&C emergency service
in December of 2012 for lethargy and coughing of one-week duration. Her owner described the
cough as non-productive and stated that Honey was eating and drinking but appeared lethargic.
Pertinent medical history included an arytenoid lateralization performed in March 2010 for laryngeal
paralysis and an episode of aspiration pneumonia which occurred approximately one year prior to the
current visit and resolved with medical management. Honey was up to date on monthly heartworm
prevention and vaccinations and received monthly Adequan injections for arthritis.
On physical examination Honey was quiet, alert, and responsive with a temperature of 101.8 F and
heart rate of 90 BPM with strong femoral pulses. Honey was panting with increased respiratory effort
and harsh lung sounds were present in both right and left lung fields with no crackles or wheezes
auscultated. Honey was unable to stand for long periods and was also noted to have delayed
proprioception to her hind limbs. Multiple soft subcutaneous masses over her ventral abdomen and
thorax as well as multiple raised pink masses around her left eye and muzzle were noted.
LABORATORY DATA: Results of a complete blood count and plasma chemistry panel were
unremarkable. Pleural fluid obtained via thoracocentesis was red and cloudy and upon centrifugation
appeared straw colored and clear. The fluid had a nucleated cell concentration of 26,800/uL,
erythrocyte concentration of 920,000/uL, and protein concentration of 3.3 g/dL.
ADDITIONAL DIAGNOSTIC TESTS:
Three view thoracic radiographs: A soft tissue opacity was present in the cranial left hemi-thorax
consistent with either consolidation of the cranial portion of the left cranial lung lobe and/or a cranial
mediastinal mass. Moderate to severe pleural effusion was also present.
Thoracic and abdominal ultrasound: A heterogeneous hypoechoic irregularly marginated mass
measuring 8-9cm was present in the cranial mediastinum and did not appear to move with lung
inflation. Mild to moderate amounts of pleural effusion with suspended hyperechoic foci was present
bilaterally. Abdominal ultrasound was unremarkable.
QUESTIONS:
1. What are your cytologic differential diagnoses for this effusion?
2. What additional tests could be performed from the submitted sample to narrow these
differentials?
CASE 10
SUBMITTER
Sakurako Neo1
CONTRIBUTERS
Takayuki Mineshige2
Hideki Kayanuma3
Masaharu Hisasue1
Ryo Tsuchiya1
Kinji Shirota2
Veterinary School, Azabu University:
Laboratory of Internal Medicine 21
Laboratory of Pathology2
Laboratory of Veterinary Radiology3
COMPANY OR UNIVERSITY
SPECIMEN:


Photomicrographs of a Wright-Giemsa-stained impression smear from a surgically
resected liver biopsy
Hematoxylin and eosin (H&E) stained, 10% formalin fixed liver
SIGNALMENT:
3-year-old spayed female domestic short hair cat
HISTORY AND CLINICAL FINDINGS:
The cat was referred to the Veterinary Teaching Hospital (VTH) at Azabu University for evaluation of a
1-month history of anorexia, lethargy, intermittent vomiting, and previously diagnosed anemia,
increased liver enzymes, azotemia, probable hemoabdomen, and a mass on the right lateral liver
lobe. Before coming to our hospital, she received a blood transfusion and antibiotics. At presentation,
the only abnormal physical finding was severe stomatitis.
LABORATORY DATA:
Test
Patient
Unit
Reference
Interval
Test
Patient
Unit
Reference
Interval
WBC
13,200
/uL
5,500 – 19,500
Total protein
8.6
g/dL
5.4-7.8
Neutrophils
9,890
/uL
2,500-12,500
Albumin
4.3
g/dL
2.5-3.9
Lymphocyte
1,810
/uL
1,500-7,000
ALT
227
IU/L
19-90
Monocyte
370
/uL
0-850
ALP
118
IU/L
26-150
Eosinophil
1,130
/uL
0-1,500
GGT
2.0
IU/L
1-7
Basophil
0
/uL
0-0
Cholesterol
184
mg/dL
71-234
RBC
6.47
×106/uL
5.5-10
Triglyceride
69
mg/dL
8-71
PCV
23.6
%
24-45
Total Bilirubin
0.83
mg/dL
0.0-0.3
Hgb
7.7
g/dL
8-14
Creatinine
2.2
mg/dL
0.8-1.8
MCV
36.5
fL
40-55
Urea
27.7
mg/dL
15.0-37.0
MCH
11.9
pg
13-17
Calcium
10.5
mg/dL
8.0-11.0
MCHC
32.6
g/dL
30-36
Phosphorous
4.6
mg/dL
2.2-6.5
PLT
557
×103/uL
300-800
Glucose
97
mg/dL
64-152
Reticulocyte
92,521
/uL
>70,000
Sodium
156.3
mmol/L
145-159
Potassium
3.71
mmol/L
3.0-4.8
Chloride
114.8
mmol/L
111-125
Fe
105.1
ug/dL
79-101
UIBC
354.4
ug/dL
210-380
SAA
<2.5
mg/dL
<2.5
＊SAA concentrations were determined using a human turbidimetric immunoassay (SAATIA)
(Eiken Chemical Co., Tokyo, Japan)
URINALYSIS



Specific gravity: 1.017
Proteinuria: 2+(39.4mg/dL)
UP/UC ratio : 0.24
Microscopic findings:


RBC: 5-9/HPF
Many epithelial cells
ADDITIONAL DIAGNOSTIC TESTS:
SNAP® FeLV/FIV Combo test (IDEXX): Negative for both FeLV Ag and FIV Ab.
Radiographs: Enlarged liver with rounded margins
Abdominal ultrasound: Few hyperechoic foci measuring approximately 2×2㎝ were noted focally
within a lobe. One focus was surrounded by a hypoechoic region.
CT scan:



Liver: Lateral to central border from the right lateral lobe to the caudal lobe was irregular.
Spleen: localized nodule was present
Kidney: Right and left kidney capsular margins are mildly irregular
QUESTIONS:
1. What are the main differentials for the cytologic image and histologic section?
2. What special stain(s) could be used to confirm the major differential diagnosis?
3. What is present in the monocytoid cells?
CASE 11
SUBMITTER
Caroline Cluzel
CONTRIBUTERS
Carolyn Gara-Boivin, Romain Javard, Swan Speechi, Ahamat
Aboulmali Abdelkerim
Faculty of Veterinary Medicine, University of Montreal (Qc,
Canada)
COMPANY OR UNIVERSITY
SPECIMEN: Peripheral blood smear
SIGNALMENT: 7 year-old spayed female Greyhound dog
HISTORY AND CLINICAL FINDINGS: Roxy was referred for a history of chronic diarrhea, left
thoracic limb lameness and severe neck pain, which were unresponsive to usual treatments. Roxy
was adopted 4 years earlier from a rescue center (Vermont, USA). Acute diarrhea, thoracic limb
lameness and neck discomfort was noticed by the owner 5 months prior to presentation. At this time,
fecal examination was positive for Campylobacter and Giardia spp. and was treated with
fenbendazole, metronidazole and erythromycin. However, the diarrhea persisted. Initial treatments
with analgesics (tramadol, gabapentin) were insufficient for her discomfort. Corticosteroids
(prednisone) were added, which resolved most of the clinical signs. She was stable for 2 months,
however still showed intermittent diarrhea despite the symptomatic treatments. One week before
presenting to CHUV-UM, her lameness worsened and she developed a neurologic deficit in the left
thoracic limb. At this point, the owner increased the prednisone dose, and she became lethargic and
anorexic, with persistent diarrhea and increasing pain in the neck and left forelimb.
Initial examination revealed poor body condition (body score 2/9), hyperthermia (40.9°C [104.4°F]),
tachycardia (180 bpm), congested mucous membranes and rapid capillary refill time (CRT <1 sec).
The patient was very lethargic but ambulatory, and had severe neck pain and a complete
proprioceptive deficit of the left thoracic limb. Generalized discomfort with severe hepatomegaly was
noticed on abdominal palpation.
LABORATORY DATA:
Table 1: Hematology a and coagulation b results
Parameter
HCT
HGB
RBC
MCV
MCHC
Platelets
WBC
Neutrophils
Lymphocytes
Monocytes
Eosinophils
Day 1
0.48
161
6.62
72.51
335.42
63*
6.79
5.95
0.26
0.46
0.10
Day 2 **
0.36
129
5.29
71.20
342
53*
4.20
3.52
0.06
0.47
0.11
Units
L/L
g/L
X 10 12/L
fl
g/L
X 10 9/L
X 10 9/L
X 10 9/L
X 10 9/L
X 10 9/L
X 10 9/L
Reference intervals
(0.37-0.57)
(129-184)
(5.70-8.80)
(58.80-71.20)
(310.00-362.00)
(143-400)
(5.2-13.9)
(3.90-8.00)
(1.30-4.40)
(0.20-1.10)
(0-0.60)
PT
PTT
17
139
s
s
(9-12)
(59-87)
RBC morphology appears normal
* No clotting, no platelet clumping
** Icterus 1+
a. Advia 120
b. SCA 2000
Table 2: Biochemistry results a
Parameter
Day 1*
Units
Reference
intervals
Parameter
Day 1*
Units
Reference
intervals
Glucose
Cholesterol
Total
bilirubin
ALT
ALP
GGT
Total
protein
Albumin
Globulin
A/G
6.3
5.90
mmol/L
mmol/L
(3.3-6.8)
(2.85-7.76)
6.52
103.00
mmol/L
µmol/L
(2.09-7.91)
(58.00- 127.00)
0.85
mmol/L
(0.75-1.70)
(4.00-62.00)
(6.00-80.00)
(0-10.00)
Urea
Creatinine
Inorganic
phosphorus
Calcium
Potassium
Sodium
15.70
µmol/L
(0-8.60)
860
1412
19.00
u/L
u/L
u/L
2.02
3.59
141.80
mmol/L
mmol/L
mmol/L
(2.38-3.00)
(3.82-5.34)
(143.00-154.00)
48.00
g/L
(56.60-74.80)
Chloride
111.50
mmol/L
(108.00-117.00)
19.90
28.10
0.71
g/L
g/L
(29.10-39.70)
(23.50-39.10)
(0.78-1.46)
Bicarbonates
Anion gap
18.20
15.69
mmol/L
mmol/L
(17.00-25.00)
(12.00-24.00)
*Hemolysis 1+; Mild icterus
a. Beckman Dxc 600
Table 3: Urinalysis (obtained via urethral catheter)
Physical examination
Chemical examination
Microscopic examination
Turbidity
Color
pH
USG
Proteins
Ketones
Glucose
Bilirubin
Blood
Leucocytes
Transitional cells
Lipids
Granular casts
Mixed casts
Bilirubin crystals
Amorphous crystals
Ammonium urate
3+
Brown
6.0
>1.060
5.0 g/L
Absent
2.8 mmol/L
3+
250
1-4 /field (400x)
1-3 /field (400x)
1+
0-3 /field (400x)
0-2 /field (400x)
1-2+
1+
2-3+
ADDITIONAL DIAGNOSTIC TESTS:
Abdominal ultrasound: Severe hepatomegaly with diffuse, hyperechoic, fine-textured parenchyma.
In the lumen of the urinary bladder, at least two round-shape floating structures (1.3 cm, hyperechoic
well-defined capsule, hypoechoic centre and surrounded by multiple hyperechoic speckles). Suspicion
of granulomatous duodenitis associated with diffuse colitis.
QUESTIONS:
1- Can you identify the significant finding on the blood smear?
2- How do you interpret the clinicopathological changes?
3- What is the most likely hypothesis to explain the occurrence of this infection?
4- Is there a zoonotic risk?
CASE 12
SUBMITTER
Austin Viall
CONTRIBUTERS
Elena Gorman and Susan Tornquist
COMPANY OR UNIVERSITY
Oregon State University
SPECIMEN: Blood smear (Wright-Giemsa stain)
SIGNALMENT: Twelve year-old, female-spayed, West Highland White Terrier
HISTORY AND CLINICAL FINDINGS:
The patient was presented to the Oregon State University Veterinary Teaching Hospital for investigation of
vomiting. Six months prior, the dog was diagnosed with cutaneous T-cell lymphoma and was receiving
prednisone and a tyrosine kinase inhibitor (masitinib) for chemotherapy. Three months after her lymphoma
diagnosis, she began having intermittent episodes of urinary incontinence. A week prior to presentation, a
urinalysis performed by her primary care veterinarian was unremarkable. The dog was prescribed empirical
antibiotic therapy for a possible occult urinary tract infection. She subsequently became lethargic and
developed severe vomiting, which prompted referral. The main physical examination abnormality was the
presence of numerous skin nodules
LABORATORY DATA:
Table A. Select Complete Blood Count Parameters
PARAMETER
RESULT
REFERENCE INTERVAL
WBC count
HCT
MCV
MCHC
Platelet count
Total solids
12,612
20%
75.3
29.9
68,000
10.9
6,000 - 17,000/µL
37 - 55%
60 - 77 fL
32-36 g/dL
200,000 - 500,000/µL
6.0 - 7.5 g/dL
Table B. Select Serum Biochemistry Parameters
PARAMETER
RESULT
REFERENCE INTERVAL
Total protein
9.2
5.1 - 7.8 g/dL
Albumin
2.0
2.5 - 4.0 g/dL
Globulins
7.2
2.1 - 4.5 g/dL
Cholesterol
69
112 - 328 g/dL
ALT
231
5 - 65 U/L
SPEC cPLI
823
≤ 200 ug/L
ADDITIONAL DIGANOSTIC TESTS:
Abdominal Ultrasonogram: The right pancreatic limb was mildly thickened and hypoechoic, with enhanced
peripancreatic fat echogenicity suggesting acute pancreatitis. Moderate hepatomegaly with increased
parenchymal heterogeneity and periportal lymphadenomegaly were observed. In context of the prior
lymphoma diagnosis, these later findings were concerning for visceral involvement.
QUESTIONS:
1) What disease processes may result in the atypical nucleated cells in circulation?
2) What cytologic markers may help determine the cellular identity of the population of atypical nucleated
cells?
CASE 13
SUBMITTER
Erin N. Burton, DVM
CONTRIBUTERS
Natalie Hoepp, DVM
Angela Royal, DVM, MS, Dipl. ACVP Samuel
Hocker, DVM
Gayle Johnson, DVM, PhD, Dipl. ACVP
Department if Veterinary Pathobiology
University of Missouri
College of Veterinary Medicine
COMPANY OR UNIVERSITY
SPECIMEN: Imprints, mass on the hard palate
SIGNALMENT: A 12 year old, male neutered, Boston terrier dog
HISTORY AND CLINICAL FINDINGS:
A 12 year old, male neutered Boston terrier dog presented to the referring veterinarian for acute leftsided facial swelling and mild mucopurulent nasal discharge. Therapy with prednisone and
amoxicillin/clavulanic acid was initiated with minimal response. On recheck exam approximately 3
weeks later, nasal discharge and facial swelling persisted and rightward deviation of the nasal planum
was noted. Over the next several weeks, the left sided facial swelling became progressively more
painful and exophthalmos developed in the left eye. The patient was then referred to the University of
Missouri Veterinary Medical Teaching Hospital (MU-VMTH) for further evaluation.
On presentation to the MU-VMTH, the patient was quiet, alert and responsive with normal vital signs.
Left sided facial swelling and lateral deviation of the muzzle was noted on physical examination. The
left supraorbital region was edematous and painful. The left eye was exophthalmic, did not retropulse
and had a moderate amount of mucopurulent discharge from the medial canthus. Similar discharge
was also observed from the ipsilateral nostril. There was decreased airflow observed from both
nostrils. On oral examination, the palatal tissue appeared normal; however there was a large, welldemarcated mass on the left side of the hard palate. Fine needle aspirates of the mass were
submitted for evaluation.
LABORATORY DATA: No additional tests were performed due to financial constraints.
ADDITIONAL DIGANOSTIC TESTS: No additional tests were performed due to financial constraints.
QUESTIONS:
1. What are your differential diagnoses based on the microscopic findings?
2. What other anatomic locations are common for this lesion?
CASE 14
SUBMITTER
Laureen Peters
CONTRIBUTERS
Balázs Szladovits, Norelene Harrington,
Kristine Jensen, Damer Blake, Kate English
The Royal Veterinary College
COMPANY OR UNIVERSITY
ADDRESS
PHONE NUMBER
Hawkshead Lane, North Mymms
Hatfield, Herts, AL9 7TA, UK
+441707666596
FAX NUMBER
+441707661464
E-MAIL ADDRESS
lpeters@rvc.ac.uk
SPECIMEN: Direct smear of bile (modified Wright’s stain)
SIGNALMENT: Ten month old female entire Basenji
HISTORY AND CLINICAL FINDINGS:
The patient presented to the Queen Mother Hospital for Animals (QMHA) with a two week history of
icterus, lethargy and intermittent episodes of vomiting, which partially responded to enrofloxacin. Prior
history revealed recurrent (monthly) episodes of diarrhea, with the last episode occurring three
months prior to presentation. The patient was fed a diet of raw beef and chicken wings. Physical
examination was unremarkable with the exception of mildly icteric mucus membranes. Orangecolored feces were also noted in the rectum. The body condition score was 3.5/9 at time of
presentation.
LABORATORY DATA:
CBC abnormalities:
-
Slight normocytic, normochromic anemia (PCV 36%; RI 37-55%. MCV 70.0 fL; RI
60.0-77.0 fL. MCHC 33.1 g/dL; RI 31.0-37.0 g/dL)
Mild mature neutrophilia (13.8x109/L; RI 3.0-11.5x109/L); morphology unremarkable
Serum chemistry abnormalities:
-
Slight hypoalbuminemia (27.8 g/L; RI 28.0-39.0 g/L)
Mildly decreased urea (2.5 mmol/L; RI 3.0-9.1 mmol/L)
Moderate to marked hyperbilirubinemia (29.4 μmol/L; RI 0-2.4 μmol/L)
Markedly increased ALT (1354 U/L; RI 13-88 U/L)
Markedly increased ALP (5278 U/L; RI 19-285 U/L)
Markedly increased fasting bile acids (238.0 μmol/L; RI 0.1-5.0 μmol/L)
Moderately decreased folate (4.2 μg/L; RI 7.1-14.4 μg/L)
Clotting: PT and APTT within reference intervals
Urinalysis:
-
Yellow, clear
SG 1.030
Dipstick assessment: bilirubin 2+, protein: trace
ADDITIONAL DIGANOSTIC TESTS:
Abdominal ultrasound examination revealed an enlarged mesenteric lymph node, while the liver,
pancreas and gall bladder appeared unremarkable. FNAs of the lymph node were non-diagnostic due
to low cellularity and poor cell preservation.
Laparoscopy was performed one week after initial presentation. The liver appeared subjectively
smaller than expected, but otherwise macroscopically normal, and the gall bladder was distended.
Wedge biopsies of the liver were taken and histopathological examination revealed portal vein
hypoplasia, arteriolar duplication, marked bile duct proliferation with mild portal fibrosis, mild
lymphoplasmacytic and neutrophilic portal hepatitis and vacuolar hepatopathy. An additional tissue
section stained with Rhodanine did not identify any copper, and bacterial culture of the tissue was
negative. Follow-up abdominal ultrasound one week later showed a dilated common bile duct.
Cholecystocentesis was performed and bile was submitted for cytology.
QUESTIONS:
1) What is your cytologic interpretation of the bile aspirate?
2) Do you think these findings are incidental or pathological?
3) What further tests would you recommend?
CASE 15
SUBMITTER
William R. Gow
CONTRIBUTORS
Adriana Nielson, Robert Foster, Dorothee Bienzle
COMPANY OR UNIVERSITY
Department of Pathobiology, Ontario Veterinary College,
University of Guelph, Ontario
SPECIMEN: Section of submandibular lymph node
SIGNALMENT: 18 year old Warmblood gelding
HISTORY: This horse is a pleasure horse, typically ridden 4-5 times per week with a history of
recurrent intermittent swelling/cellulitis and lameness on the left forelimb for duration of 1.5 years. The
horse has a one-month history of a heart murmur and mild nasal discharge from the left nostril,
noticed by the regular veterinarian. The horse was treated with trimethoprim-sulfamethoxazole
antibiotics for 3 weeks, whereby the nasal discharge resolved. One week prior to presentation to the
Ontario Veterinary College Health Sciences Centre, the horse presented to the regular veterinarian for
ventral edema, along with its previously noted heart murmur, and was then referred. Further historical
findings include three months of recurrent lethargy and exercise intolerance.
CLINICAL FINDINGS: Physical examination findings included: Swelling and contracture of the left
forelimb, decreased lung sounds on both sides of the thorax, decreased heart sounds on the right
side with a grade 3/6 left-sided apical diastolic heart murmur, mild jugular distension, ventral edema
and bilaterally enlarged and firm submandibular lymph nodes.
Upon further evaluation by thoracic ultrasonography, bilateral pleural effusion was noted.
Thoracocentesis was performed by placement of bilateral chest tubes and yielded 12 litres of
sanguinous fluid from the right side and one litre of sanguinous fluid from the left side.
A repeat thoracic ultrasound, following drainage of the pleural effusion, showed no residual pleural
effusion, no mediastinal mass, fibrin deposition surrounding the heart and moderate regurgitation at
the aortic valve.
LABORATORY DATA:
A complete blood count revealed a mild erythrocytosis (HCT of 0.52 L/L, reference interval 0.280.44L/L and Hb concentration of 183 g/L, reference interval 112-169 g/L) and a mild lymphopenia
(1.29 x 109/L, reference interval 1.3-4.7 x 109/L). On biochemistry there was a mild hyperproteinemia
(76 g/L, reference interval 58-75 g/L), mild hypoalbuminemia (25 g/L, reference interval 30-37 g/L),
moderate hyperglobulinemia (51 g/L, reference interval 46-41 g/L), moderately low A:G ratio (0.49,
reference interval 0.8-1.3), mild decreased AST (225 U/L, reference interval 259-595 U/L) and
moderately elevated concentration of serum amyloid A (40.6 mg/L, reference interval 0-19 mg/L).
Fibrinogen concentration was also moderately increased (4.9 g/L, reference interval 1.2-2.3 g/L). No
other abnormalities were detected.
To further characterise the hyperglobulinemia, a serum protein electrophoresis was also performed.
Image 8: Serum protein electrophoresis
Analysis of the pleural effusion from both sides revealed:
Clarity
Colour
Nucleated cell count
Refractometric protein concentration
Right
Cloudy
Red
11.65 x 109/L
37 g/L
Left
Cloudy
Red
13.88 x 109/L
36 g/L
Image 1: Cytocentrifuge preparation of right
side pleural effusion fluid (Wright’s stain,40X
objective)
Image 2:
Cytocentrifuge preparation of left side pleural
effusion fluid (Wright’s stain, 60X objective)
Cytologic description:
There was a hemorrhagic background. Leukocytes consisted of frequent round, medium to large
monotypic cells with prominent pale light blue cytoplasm and occasional small granular azurophilic
granules. Occasional cells had deeply basophilic cytoplasm. The cells had oval to irregular indented
nuclei with clumped nuclear chromatin and prominent chromocenters. There were occasional mitotic
figures noted. Rare non-degenerate neutrophils, mast cells and plasma cells were noted and
occasional macrophages with vacuolation and erythrophagia were seen. A 100 cell differential on the
left side fluid yielded: 80% large lymphocytes, 17% neutrophils, 2% macrophages and 1% plasma
cells. The 100 cell differential on the right side yielded: 79% large lymphocytes, 17% neutrophils, 3%
macrophages and 1% mast cells.
Cytologic Interpretation/Diagnosis: Lymphocytic effusion, suspicious for lymphoma
Based on these findings, fine needle aspirates and incisional biopsies of the enlarged submandibular
lymph nodes were done.
Image 3: Fine needle aspiration of an
enlarged lymph node (Wright’s stain, 100X
objective)
Cytologic description:
The slides were highly cellular and of fair to good quality. There was a minimal degree of background
hemorrhage. There were frequent lysed cells with fragmented bare nuclei. There was a monotypic
population of large round lymphocytes (approximately 90%) with clear to light blue prominent
cytoplasm and frequent azurophilic granules. These cells had centrally placed oval nuclei with
clumped nuclear chromatin and rare single round nucleoli. Rare mitotic figures were noted.
Occasional to frequent plasma cells were seen.
Cytologic Interpretation/Diagnosis: Lymphoma and plasma cell hyperplasia
ADDITIONAL DIAGNOSTIC TESTS:
Bacterial culture of pleural effusion from both the right and left sides yielded neither aerobic nor
anaerobic bacterial growth.
Trans-rectal palpation and trans-abdominal ultrasonography did not detect further masses within the
abdominal cavity.
QUESTIONS:
What are the differential diagnoses?
What stains would be required to further characterize this lesion?
How could the gammopathy be explained?
What further tests would be helpful in confirming your suspicion?
CASE 16
SUBMITTERS
April White
CONTRIBUTERS
Christine Olver
COMPANY OR UNIVERSITY
Colorado State University, Department of Microbiology,
Immunology and Pathology
SPECIMEN: Impression smears of a right inguinal lymph node
SIGNALMENT: Eight year old, male castrated, mixed breed dog
HISTORY AND CLINICAL FINDINGS: The patient presented to CSU oncology services for evaluation of a
recurrent abdominal mass in the right inguinal region. Two years prior, the patient had an abdominal mass
removed from the right inguinal region. Upon physical examination, a large, firm, mass was palpated in the
right inguinal region and in the caudal abdomen. Rectal exam revealed enlarged sublumbar lymph nodes.
LABORATORY DATA: A CBC and serum biochemistry panel were unremarkable.
ADDITIONAL DIAGNOSTIC TESTS: Thoracic radiographs were within normal limits. Abdominal ultrasound
revealed severe enlargement of both medial iliac and hypogastric lymph nodes measuring up to 6 cm in
diameter. Additionally, there was a large, irregularly marginated, right sided, subcutaneous abdominal mass
that had multiple hypoechoic internal cavitations and was presumed to be the right inguinal lymph node. This
mass extended beyond the limits of the ultrasonographic screen and could not be measured. Fine needle
aspirates of the mass were obtained. Based on the cytological findings, the mass was surgically removed, and
submitted for histopathologic evaluation.
QUESTIONS:
1. What are the differentials for a firm, caudal abdominal mass?
2. What is your interpretation and differential diagnosis of the cytologic preparation?
3. What are some distinguishing features of these cells?
CASE 17
SUBMITTER
Sabrina Vobornik, DVM
CONTRIBUTERS
Gwen Levine, DVM, DACVP1
Jessica Hokamp, DVM, DACVP1
John Edwards, DVM, PhD, DACVP1
Kristen Eden, DVM1
Sharman Hoppes, DVM, DABVP (Avian)2
Texas A&M University
COMPANY OR UNIVERSITY
SPECIMEN: Impression smears from an ovarian mass
SIGNALMENT: 2-year-old, female, Wheaton chicken
HISTORY AND CLINICAL FINDINGS: The hen presented to Texas A&M Veterinary Medical
Teaching Hospital (VMTH) for evaluation with a 3-week history of progressive weight loss and
coelomic distension. Two months prior, the hen was diagnosed with clostridial enteritis that resolved
following treatment with metronidazole. Upon recognition of coelomic distention, the hen was treated
empirically by the owner for about a week with enrofloxacin and metronidazole with minimal
improvement. The hen presented to VMTH for evaluation; a fecal culture identified clostridial
overgrowth. In addition, based on coelomic palpation, egg yolk coelomitis was suspected, but the
owner did not wish to pursue further diagnostics at that time. The patient was treated with
metronidazole in conjunction with meloxicam and enrofloxacin. After 4 days without improvement, the
patient re-presented to VMTH for further evaluation. On physical examination, the hen was bright,
alert, and responsive. Heart sounds were strong and regular. The keel was prominent on palpation.
The coelom was hot to the touch and fluid-filled. It was noted that the animal had watery, yellow
feces.
LABORATORY DATA: None performed
ADDITIONAL DIAGNOSTIC TESTS: Abdominal ultrasound revealed several liver masses and a
small amount of coelomic fluid. The reproductive tract was reported as unremarkable. Analysis of
coelomic fluid revealed a histiocytic and lymphocytic exudate with evidence for previous hemorrhage.
The liver masses were not aspirated.
An exploratory coeliotomy revealed multifocal nodules over the digestive and genital tract.
QUESTIONS:
1. What is your cytologic diagnosis/interpretation of the ovarian mass?
2. Where did the mass most likely originate?
CASE 18
SUBMITTER
Sally Henderson
CONTRIBUTERS
M. J. Radin1, K. Tefft1, C. Weder1, M. L.
Wellman1
1
The Ohio State University, College of
Veterinary Medicine Department of
Veterinary Biosciences
COMPANY OR UNIVERSITY
SPECIMEN: Fluid from a cystic tubular structure in the caudal abdomen
SIGNALMENT: 1 year old male castrated French bulldog
HISTORY AND CLINICAL FINDINGS: The dog presented to the Ohio State University Veterinary
Medical Center (OSU-VMC) for evaluation of persistent urine dribbling from his prepuce and
intermittent urinary tract infections. The owners obtained the dog at 7-8 weeks of age from a local pet
store and he had already been castrated. He had persistently dribbled urine since purchase and
would frequently urinate small amounts throughout the house and in his cage. The dog had been
treated for two urinary tract infections by the rDVM and was currently on 68mg Baytril every 24 hours
for hematuria.
On physical exam, the dog was bright, alert, and responsive. Abnormalities included a well-developed
mammary chain bilaterally, a rudimentary structure resembling a vulva in the area of the scrotal sac,
and a caudally displaced prepuce with a hypoplastic penis that was unable to be extruded from the
prepuce. An os penis was palpated.
Figure 1
LABORATORY DATA:
CBC (3-13-13):
Analyte :
Patient
Plasma protein (g / dL)
6.3
HCT (%)
45
Hemoglobin (g / dL)
15.7
12
RBC (x10 / L)
5.8
MCV (fL)
78
MCHC (g / dL)
34.7
RDW (%)
12.9
9
Retic absolute (x10 / L)
57.4
9
Platelet count (x10 / L)
438
Macroplatelets
Occasional
Clumps
Moderate
9
Total leukocytes (x10 / L)
15.3
9
Segmented neutrophils (x10 / L)
12.4
9
Lymphocytes (x10 / L)
2.6
9
Monocytes (x10 / L)
0.3
WBC Morphology: Occasional reactive lymphocytes
Reference Interval
5.7 - 7.2
37 – 56
12.1 – 18.8
4.8 – 8.1
67 – 79
32.5 – 34.8
11.5 – 14.6
< 60
108 – 433
4.1 – 15.4
3.0 – 10.4
1.0 – 4.6
0 – 1.2
RBC Morphology: slight anisocytosis, rare polychromasia, slight poikilocytosis.
Urinalysis (3-11-13):
Source
Urine color
Appearance
Spec. gravity
pH
Protein
Glucose
Acetone
Bilirubin
Cystocentesis
Yellow
Clear
1.038
6.0
1+
Negative
Negative
Negative
Blood
Casts
Leukocytes
Squamous epithelial cells
Transitional epithelial Cells
Erythrocytes
Crystals
Bacteria
1+
None seen
8 – 20/HPF
3 - 6/HPF
0 -1/HPF
3 – 8/HPF
None seen
None seen
Urine culture (3-12-13): Beta-hemolytic Streptococcus canis, susceptible to penicillin.
ADDITIONAL DIAGNOSTIC TESTS:
Abdominal Ultrasound (3-12-13): There is a tubular structure between the urinary bladder and
colon. This structure bifurcates at the level of the urinary bladder neck and extends cranially as paired
tubular structures within the right and left abdomen. Termination of these paired tubular structures
within the mid abdomen is not well-defined. There is a lobular, cystic, echogenic mass ventral to the
colon and surrounding the proximal urethra. This mass appears contiguous with the prostate and
tubular structure without discrete or separable margins.
CT and Excretory Urogram (3-13-13): The os penis is
small and no testicular tissue is present. The contrast
media highlighted a tubular structure that was
caudodorsal to the bladder and ventral to the colon,
measuring 3.2cm (length) x 3.7cm (width) x 3.1 cm
(height). Cranially, two tubular structures diverge
laterally and terminate at the level of the superficial
inguinal rings. The ureters course normally into the
trigone region of the urinary bladder. The urethra exits
the bladder caudally, courses ventral to the large tubular
structure, and continues caudally into the pelvic urethra.
When pressure is applied to the urinary bladder,
contrast medium is extravasated into the tubular
structure (figure 2, arrow).
Figure 2
Fine needle aspirate of the wall of the cystic tubular structure (3-13-13)
Figure 3
Figure 4
Fluid from the cystic tubular structure (3-13-13). Slide provided in the set:
Figure 5
QUESTIONS:
What normal or abnormal structures may be found
between the bladder and colon?
CASE 19
SUBMITTER
Julie Hilligas1
CONTRIBUTERS
Gwendolyn J. Levine1
Tom G. Schwan2
Maria Esteve-Gassent1
Carly Duff 3
Jennifer Procuniar 3
Texas A&M University1,3
National Institute of Allergy and Infectious Diseases2
COMPANY OR UNIVERSITY
SPECIMEN: Peripheral blood smear
SIGNALMENT: 7 year-old, female spayed Dachshund
HISTORY AND CLINICAL FINDINGS: The patient presented to the Texas Veterinary Medical
Teaching Hospital (TVMTH) after a 3 day history of lethargy and abnormal behavior, including tailtucking and segregating from the other dog and people within the home. The dog is a predominately
indoor pet with occasional access to an open backyard in a rural area of Texas near a lake. Rabies
and bordetella vaccinations were up to date. Physical examination revealed bilateral mydriasis,
slowed pupillary light reflexes and an exaggerate response to a menace test. Rectal temperature was
elevated at 104.5 (F). The remainder of the physical exam was unremarkable.
LABORATORY DATA:
Complete Blood Count:
Test
PCV
Platelets
WBC
Neutrophils
Lymphocytes
Monocytes
Eosinophils
Result
38.7
47,000
8,300
6225
1494
415
166
Flag
L
Reference
31.0-56.0%
200,000-500,000/µl
6,000-17,000/µl
3,000-11,500/µl
1,000-4,800/µl
150-1,250/µl
100-1,250/µl
Abnormal Chemistry Panel Results:
Test
Cholesterol
Total Protein
Albumin
Result
119
5.6
2.2
Flag
L
L
L
Reference
120-248 mg/dl
5.7-7.8 g/dl
2.4-3.6 g/dl
ADDITIONAL DIAGNOSTIC TESTS: A urinalysis was performed and was unremarkable.
QUESTIONS:
1. What is/are the significant finding(s) on the blood smear?
2. Are the complete blood count findings unexpected?
3. What diagnostic tests could be performed to confirm the diagnosis?
CASE 20
SUBMITTER
Elizabeth J. O’Neil
CONTRIBUTERS
Elizabeth J. O’Neil,1 Shelley Burton1
Urs Giger2
Atlantic Veterinary College, University of
Prince Edward Island
School of Veterinary Medicine, University of
Pennsylvania
COMPANY OR UNIVERSITY
SPECIMEN: Wright-Giemsa stained blood smear
SIGNALMENT: Three-year-old neutered male domestic shorthaired cat named Marcellus
HISTORY AND CLINICAL FINDINGS: Marcellus presented with a 2 day history of vomiting and
inappetence. There was the suspicion that he had ingested a foreign body (anti-static dryer sheet) a
week earlier. On presentation, he was quiet, alert and responsive. Abnormal physical examination
findings included dehydration (estimated at 7%), blue-tinged mucous membranes and yellow teeth
(Figure 1). Marcellus had been acquired as a stray kitten at ~8 weeks of age; the teeth and mucous
membranes were discolored since that time.
Figure 1.
Oral mucous
membranes
and teeth
LABORATORY DATA: Serum biochemistry: Changes consisted of mild decreases in sodium (146
mmol/L, reference interval (RI) 149 - 156 mmol/L) and chloride (109 mmol/L, RI 112 - 133 mmol/L)
concentrations and mildly increased activities of ALT (109 U/L, RI 34 - 90 U/L), AST (52 U/L, RI 11 44 U/L), and CK (1094 U/L, RI 58 - 489 U/L).
Hematology:
Parameter (units)
Patient Data
Reference Interval
RBC (x1012/L)
HGB (g/L)
HCT (L/L)
MCV (fL)
MCH (pg)
MCHC (g/L)
7.5
98
0.29
39
13
340
6.4 - 11.5
89 - 156
0.28 - 0.44
35 - 52
12 - 17
310 - 381
Reticulocytes %
Reticulocytes (x109/L)
Platelets (x109/L)
0-1
0 - 85
WBC (x109/L)
nRBCs /100 WBC
2.3
171
Clumped, appear
adequate
18.1
0
Segmented neutrophils (x109/L)
Band neutrophils (x109/L)
Eosinophils (x109/L)
Basophils (x109/L)
Lymphocytes (x109/L)
Monocytes (x109/L)
Refractometric protein (g/L)
14.5
0
0.5
0.2
2.7
0.2
78
2.2 - 9.5
0.0 - 0.1
0.0 - 1.5
0.0 - 0.2
0.5 - 7.5
0.0 - 0.6
65 - 84
306 - 517
4.7 - 17.0
<1
ADDITIONAL DIAGNOSTIC TESTS: Imaging studies indicated a linear foreign body.
QUESTIONS:
1. What is a possible hematological cause for the physical examination finding of yellow teeth?
2. What additional diagnostic tests could be performed?
3. What is the main finding on the blood smear and what additional tests could be performed?
BONUS CASE 1
SUBMITTER
A Russell Moore DVM
CONTRIBUTERS
Anne Barger DVM, MS, DACVP, Erica
Hartmann DVM
University of Illinois
COMPANY OR UNIVERSITY
SPECIMEN: Rectal Smear
SIGNALMENT: 2 year old FS Old English Sheepdog named Lilly
HISTORY AND CLINICAL FINDINGS: Approximately one week history of coughing, anorexia,
lethargy, intermittent vomiting and one day history of hemoptysis. On physical examination Lilly had a
BCS 2/9, was febrile and tachypneic with enlarged prescapular and popliteal lymph nodes. A rectal
scraping was submitted.
LABORATORY DATA: CBC, Chem, UA were essentially WNL
QUESTIONS:
Question 1: What other sites should be evaluated in this patient?
Question 2: What tests could be performed to confirm this diagnosis?