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Transitional Cell Carcinoma in a Dog Sarra Borne Lord VETE 3313: Radiology and Clinical Imaging Harriet – History and Signalment 10 year old Spayed female Scottish terrier History of hematuria, without bacteruria Repeated treatment with antibiotics to no avail Generally good health otherwise, good appetite Current on vaccinations Physical Exam Weight: 16 pounds BCS: 3/5 Rectal temp 101.2 F Heart Rate: 120 bpm Respiratory rate: 24 bpm Normal thoracic auscultation No discomfort on abdominal palpation Normal rectal palpation Diagnostics – Laboratory Findings CBC Biochemistry Panel RBC (red blood cells 6.59 5.50-8.50 M/uL HCT (hematocrit) 42.5 37-55 % HGB (hemoglobin) 15.3 12-18 g/dL WBC (white blood cell) 8.23 5.7-16.3 K/uL Neutrophils 5.76 3-11K/uL PLT (platelet) 441 175-500 K/ul Urinalysis GLU (glucose) 97 60-125 mg/dL BUN (blood urea nitrogen) 16 7-27 mg/dL CREA (creatinine) 0.9 0.4-1.8 mg/dL PHOS (phosphorus) 4.3 2.1-6.3 mg/dL ALKP (alkaline phosphatase) 191 10-150 U/L ALT(alanine 42 5-107 U/L aminotransferase) SpG: 1.017, pH: 8.5 K (potassium) 5.1 4.0-5.6 mmol/L Negative for protein, glucose, ketones and bilirubin Na (sodium) 147 141-156 mmol/L Blood: 3+, WBC/hpf: 0-2, RBC/hpf: >100 Cl (chloride) 109 105-115 mmol/L No casts, bacteria, crystals or mucus on sediment CHOL (cholesterol) 217 112-328 mg/dL Diagnostic Imaging – Retrograde Cystography NEGATIVE CONTRAST CYSTOGRAPHY Photo courtesy Veterinary Imaging Associates, 2015 Bladder was catheterized, the urine drained, and 60 ml carbon dioxide is instilled into the bladder until slightly turgid. Negative contrast cystography showed a potential mass effect in the trigone area. Carbon dioxide is removed from bladder in preparation for a positive contrast cystogram. This procedure generally safe but can cause air embolization. Carbon dioxide or nitrous oxide can be used if available and they negate this risk. Diagnostic Imaging – Retrograde Cystography POSITIVE CONTRAST CYSTOGRAPHY Photo courtesy Veterinary Imaging Associates, 2015 Diluted positive contrast media (Renografin-60 60 ml total diluted 50:50 with sterile water) isinstilled into the bladder. Mass effect still visible but not clearly defined. Positive contrast allows visualization of filling defects and can be used to examine the urethra for defects. Diagnostic Imaging – Retrograde Cystography DOUBLE CONTRAST CYSTOGRAPHY Photo courtesy Veterinary Imaging Associates, 2015 Contrast media removed from the bladder and air re-instilled. These radiographs are a double contrast study Any remaining positive contrast media that adheres to bladder wall is usually because of a lesion. This helps to define the margins of a mass effect. Diagnostic Imaging - Ultrasound ) BLADDER ULTRASONOGRAPHY Photo courtesy Veterinary Imaging Associates, 2015 Increases visibility of the margins of the mass. Useful for scanning remainder of abdominal organs for any additional suspicious areas or metatheses. Harriet’s liver, spleen, kidneys, and intestines were normal. Some of her mesenteric lymph nodes were mildly enlarged. Diagnostic Imaging - Cystoscopy Diagnosis of transitional cell carcinoma requires obtaining a sample of the mass. An aspirate of the tumor should be avoided due to the potential of tumor seeding at the site of the puncture. Surgical biopsy can be done but is very invasive. Cytologic evaluation can be done by rubbing the tip of a urinary catheter against the mass to extract cells. Cystoscopy is a better option but requires referral. Transitional cell carcinoma with white fimbriation (Finnish, n.d.) Photo courtesy the Finnish Veterinary Association, n.d. Transitional Cell Carcinoma Cancer of the urinary tract can affect any of the structures (bladder, kidneys, ureters, urethra) The most common cancer of the dog urinary bladder is transitional cell carcinoma (TCC) It is a malignant cancer that arises from the transitional epithelial cells that line the bladder. Scottish terriers have an 18-20% higher risk of TCC than other breeds (Knapp, 2013) Cytology smear transitional cell carcinoma (Scurrell, 2012) Therapeutic Recommendations Surgical excision Radiation therapy. Can lead to harmful complications Medical management Not possible if the cancer is situated in the neck or trigone area Piroxicam Chemotherapy Mitoxantrone Vinblastine Metronomic chemotherapy Chemotherapy with medical management References Caswell, M. (2011, June). Transitional cell carcinoma of the urinary bladder in a 14-year-old dog. The Canadian Veterinary Journal, 52, 673-675. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3095172/ Contrast studies of small animals. (2015). Retrieved from http://www.online-vets.com/contrast_4.html Glickman, L. T., Raghavan, M., Knapp, D. W., Bonney, P. L., & Dawson, M. H. (2004). Herbicide exposure and the risk of transitional cell carcinoma of the urinary bladder in Scottish Terriers. Journal of the American Veterinary Medical Association, 224, 1290-1297. Knapp, D. W. (2013). Canine bladder cancer. Retrieved from https://www.vet.purdue.edu/pcop/files/docs/CanineUrinaryBladderCancer.pdf Scurell, E. (2012). Transitional cell carcinoma (TCC) in a dog. Retrieved from http://www.cytopath.co.uk/caseofmonthMarch2012.html The Finnish Veterinary Association. (n.d.). Kuvat figures. Retrieved from http://www.sell.fi/index.php?id=513 Thrall, D. E. (2013). Textbook of veterinary diagnostic radiology (6th ed.). : Saunders.