Chronic Respiratory Disease in a
Domestic Shorthair Cat
April 30th, 2014
Jamie Zhen
History
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12 year-old male castrated Domestic
Shorthair cat
Lethargy
Inappetence
Weight loss
Chronic coughing
o
one instance of hemoptysis
Unusual rDVM thoracic radiographs
History
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12 year-old male castrated Domestic
Shorthair cat
Lethargy
Inappetence
Weight loss
Chronic coughing
o
one instance of hemoptysis
Unusual rDVM thoracic radiographs
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6 other strictly indoor cats
FeLV/FIV negative
No changes in urination &
defecation
Physical Exam
Temperature: 103.3 F
Heart rate: 210 bpm
Respiratory rate: 30 bpm
No heart murmur
Harsh lung sounds bilaterally
Mild serous ocular & nasal discharge
Moderate dental tartar and halitosis
Right thyroid slip
No abnormalities on abdominal palpation
Problems & Differential Diagnoses
Inflammatory: pharyngitis, tracheitis
Upper airway
Neoplasia: mediastinal, laryngeal, tracheal
Inflammatory: bronchitis
Bacterial
CHRONIC COUGH
Viral
Infectious
Lower airway &
Parenchymal
Fungal: Coccidiomycosis, Histoplasmosis
Parasitic: Heartworm, Lungworm, Paragonimus
Protozoal: Toxoplasmosis
Pleural space
disease
Neoplasia
Vascular
Primary/metastatic
Pulmonary thromboembolism
Bronchial compression
Problems & Differential Diagnoses
Neoplasia: adenoma, carcinoma, metastatic
Thyroid slip
Hyperplasia
Hyperthermia
Elevated
temperature
Fever
Lethargy
Inappetence
Weight loss
Diagnostic Plan
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Complete blood count
Chemistry panel
Urinalysis
T4 Level
Imaging:
o Thoracic radiographs
o CT scan
Bloodwork Abnormalities
CBC
Result
Reference Range
Hematocrit
13% (Low)
31 - 48
MCV
64 fL (High)
40 - 52
MCHC
30 g/dL (Low)
32 - 35
Absolute Reticulocyte count
22.5 thou/uL (NORMAL)
8.5 - 60.7
WBC
432 thou/uL (High)
5.1 - 16.2
Segmented neutrophils
380 thou/uL (High)
2.3 - 11.6
Band neutrophils
38.9 thou/uL (High)
0 - 0.1
Monocytes
8.6 thou/uL (High)
0 - 0.7
Platelet count
52 thou/uL (Low)
195 - 624
2.8 mEq/L (Low)
3.8 - 5.7
CHEMISTRY
Potassium
Diagnostics
Complete blood count
Chemistry panel
Urinalysis
• severe macrocytic, hypochromic, minimally regenerative anemia
• severe inflammatory leukogram with left shift & toxic changes
• severe thrombocytopenia (platelet clumps were present)
• mild hypokalemia
• no significant clinical abnormalities
T4 Level
• 1.34 ug/dL (LOW), Reference range: 1.5 - 4
• Hyperthyroidism less likely
Imaging:
• Thoracic radiographs
• CT scan
Thoracic Radiographs
CT Scan
CRANIAL
CAUDAL
Differential Diagnoses
Inflammatory: pharyngitis, tracheitis
Upper airway
Neoplasia: mediastinal, laryngeal, tracheal
Inflammatory: bronchitis
Bacterial
CHRONIC
COUGH
Viral
Infectious
Lower airway &
Parenchymal
Fungal: Coccidiomycosis, Histoplasmosis
Parasitic: Heartworm, Lungworm, Paragonimus
Protozoal: Toxoplasmosis
Pleural space
disease
Neoplasia
Vascular
Primary/metastatic
Pulmonary thromboembolism
Bronchial compression
Further Diagnostics
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Tracheal wash
o Productive cough during procedure
o Collected contents
Tracheal Material Cytology
Criteria of Malignancy
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Mitotic figures
Multinucleation
Pleomorphism (variable shape)
Changes in nuclear to cytoplasmic ratio
Variable nucleolar size, shape or multiple
nucleoli
Anisocytosis (variable cell size)
Anisokaryosis (variable nuclear cell size)
Result:
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Carcinoma
Purulent inflammation
Necrosis
Prognosis
• Poor
• Euthanasia
• Educational necropsy
Histology
40x
20x
NORMAL LUNG
1. Terminal bronchiole
2. Respiratory bronchiole
6. Alveoli
7. Smooth muscle
Immunohistochemistry
20x
Cytokeratin 7 Stain:
epithelial cell marker
20x
Cytokeratin 19 Stain:
epithelial cell marker of bronchioles
Bronchogenic Adenocarcinoma
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Primary lung tumors rare in cats
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70-80% adenocarcinomas
Signs
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Early: weight loss, lethargy, weakness, vomiting, pyrexia
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Late: dyspnea, tachypnea, coughing, hemoptysis
Diagnosis
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Routine laboratory data not diagnostic
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Case report Dole et al 2004:
Paraneoplastic leukocytosis in cat with primary lung tumor
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Radiographic appearance: solitary lung masses, pleural effusion (~33%)
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Definitive diagnosis often made at necropsy
Bronchogenic Adenocarcinoma
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Metastases
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Other areas of lungs, lymph nodes, long bones, liver, spleen, pancreas, adrenal glands
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Eyes, skeletal muscle
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Digits: feline lung-digit syndrome
Prognosis: POOR
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Hahn & McEntee (1998), n = 21 cats
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Moderately differentiated tumors:
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Median survival times with complete surgical resection ~700 days
Poorly differentiated tumors
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Median survival time 75 days
Maritato et al (2014), n = 20 cats
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Surgical resection of primary lung tumor
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Median survival time 11 days
Negative prognostic indicators
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clinical signs (dyspnea), pleural effusion, metastases, poorly differentiated tumors
Cost
• Diagnostics
o ~$1387
o CT scan subsidized
• Necropsy
o educational
References
1. Dole RS et al. Paraneoplastic leukocytosis with mature neutrophilia in a cat with pulmonary squamous cell carcinoma. Journal
of Feline Medicine and Surgery. (2004) 6(6):391-395
2. Kahn & McEntee. Prognosis factors for survival in cats after removal of a primary lung tumor: 21 cases (1979-1994). Veterinary
Surgery. (1998) 27:307-311
3. Langlais LM et al. Pulmonary adenocarcinoma with metastasis to skeletal muscle in a cat. Practitioners’ Corner. (2006)
47:1122-1123
4. Maritato et al. Outcome and prognostic indicators in 20 cats with surgically treated primary lung tumors. Journal of Feline
Medicine and Surgery. (2014) 16(4):1-6
5. Petterino C et al. Bronchogenic adenocarcinoma in a cat: an unusual case of metastasis to the skin. Veterinary Clinical
Pathology. (2005) 34(4):401-404
6. Rossi F et al. Unusual radiographic appearance of lung carcinoma in a cat. Journal of Small Animal Practice. (2003) 44:273-276
7. Schoen K et al. Hypercalcemia of malignancy in a cat with bronchogenic adenocarcinoma. J Am Anim Hosp Assoc. (2010)
46:265-267
Picture References:
1. http://themetapicture.com/chemistry-question/
2. http://kittentoob.com/cat-news/
3. http://www.purinaveterinarydiets.com/resources/files/cat_chart.pdf
4. http://www.shutterstock.com/pic-95776864/stock-photo-bad-breath-cat-cartoon.html
5. http://vecto.rs/designs/feline
6. http://aercmn.com/services/internal-medicine/treatment-cats-with-hyperthryroid-disease/
7. http://www.howtobeaheroine.com/2012/11/13/a-decision/house-its-not-lupus-its-never-lupus/
8. http://www.familyvet.com/Cats/Resp.html
9. http://mousebreath.com/2012/12/millionaires-prefer-dogs-to-cats/
10. https://www.atdove.org/Addon/ET-Wash/PrintArticle.pdf
11. http://www.freemake.com/blog/best-summer-memes-with-grumpy-cat/
12. http://cal.vet.upenn.edu/projects/histo/Labrespiratory.htm
Acknowledgements
Dr. Cheryl Balkman
Dr. Erica Behling-Kelly
Dr. John Lucy
Dr. Heather Daverio
Dr. Alana Rosenblatt
Class of 2014
All Staff in CUHA
Questions?
Further Diagnostics
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Bone marrow aspirate
o Granulocytic
hyperplasia
o Erythroid hyperplasia
Blood Smear