the scientific journal of the veterinary faculty university - Slovenian ...
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112 T. Plavec, N. Tozon, T. Kotnikmildly enlarged (5 cm diameter). No o<strong>the</strong>r abnormalitieswere observed. The biopsy <strong>of</strong> <strong>the</strong> skin was alsoperformed.Histopathology <strong>of</strong> <strong>the</strong> right inguinal mass revealed<strong>the</strong> presence <strong>of</strong> seminoma and Sertoli celltumour in <strong>the</strong> right testis. The left testis was not examined.Lymphoma was present in <strong>the</strong> spleen andgastric lymph node. Subchronic dermatitis with amixed cell (predominantly eosinophils) populationwas present in <strong>the</strong> skin biopsies. Immunohistochemistryexamination <strong>of</strong> splenic and gastric lymphnode biopsies with CD3 and CD79 antibodies (DAKOREALTM, EnVision Detection System) confirmed aB cell lymphoma.Postoperatively a bloody-purulent urine was noticed.Dipstick and urine sediment analyses confirmeda diagnosis <strong>of</strong> purulent cystitis. Culture andsensitivity were not performed. Amoxicillin with clavulanicacid (Synulox, Pfizer) 20 mg/kg PO q12h for14 days was prescribed.The dog was rechecked one month later, seemedhealthy, gained two kilograms <strong>of</strong> body weight andits hair-coat showed signs <strong>of</strong> improvement. The palpableperipheral lymph nodes were unchanged andCBC was unremarkable (mild anaemia, haematocrit0.36 l/l). A month later, <strong>the</strong> dog had mild mandibularand praescapular lymphadenopathy. CBC was normal,with <strong>the</strong> exception <strong>of</strong> a mild anaemia (haematocrit0.34 l/l). The owners were <strong>of</strong>fered a multidrugchemo<strong>the</strong>rapy, but declined and were thus advisedto start corticosteroid treatment - methylprednisolone(Medrol, Pfizer; 2 mg/kg/day PO until relaps). Anadditional month later, three months after <strong>the</strong> operation,Lord’s hair looked normal again (Figure 5,6). A month later, after two months <strong>of</strong> methylprednisolonetreatment, <strong>the</strong> dog deteriorated, was depressedand anorexic and was euthanized at <strong>the</strong>owner’s request by <strong>the</strong> referring veterinarian.DiscussionThis is an unusual case with 3 different neoplasiasoccurring concurrently in a single dog. Multipletumours occurring in <strong>the</strong> brains (15, 16) or in <strong>the</strong>mammary tissue (17) were reported, but authors arenot aware <strong>of</strong> any report about concurrent multipletumour occurrence in different tissues.Preoperatively seen mild nonregenerative anaemiawith <strong>the</strong> haematocrit <strong>of</strong> 0.32 l/l and thrombocytopaeniacould have developed secondarily tolymphoma (18,19), but haematocrit <strong>of</strong> 0.35 l/l wasalso seen 3 months earlier, when lymphoma was notdiagnosed yet. Such a long course <strong>of</strong> <strong>the</strong> disease isunusual for lymphoma (18).In addition to symmetrical truncal alopecia o<strong>the</strong>rmale patients, but not <strong>the</strong> present case, may alsopresent o<strong>the</strong>r signs <strong>of</strong> feminization (8). The subsequentimprovement <strong>of</strong> <strong>the</strong> skin after surgery in contrast to<strong>the</strong> partial response to previous <strong>the</strong>rapy supports <strong>the</strong>assumption that <strong>the</strong>se changes were secondary tohyperoestrogenism due to Sertoli cell tumour. Plasmaoestradiol concentrations in male dogs should be lessthan 15 pg/ml. In dogs with Sertoli cell tumours, eostradiolconcentrations are usually 10 to 150 pg/ml, aswas in <strong>the</strong> present case (87,9 pg/ml) (9).Sertoli cell tumours metastasize in 2-14% <strong>of</strong>cases; seminomas do so even less frequently. Mostcommonly <strong>the</strong>y metastasize to <strong>the</strong> sublumbar(3), inguinal and iliac lymph nodes, lungs, liver,spleen, kidneys, pancreas (9), subcutis, brain andeyes (20). The above mentioned lymph nodes werenot enlarged in our case, as observed upon <strong>the</strong>exploratory laparotomy. However, gastric and mesentericlymphadenopathy was observed. While<strong>the</strong> gastric lymph node presented lymphoma andhad no evidence <strong>of</strong> a testicular cancer metastasis,<strong>the</strong> mesenteric lymph nodes were not examined histologically.Although we cannot rule out that <strong>the</strong>ywere enlarged due to metastasis <strong>of</strong> <strong>the</strong> testiculartumours, it is more likely that lymphoma was <strong>the</strong>cause. A postoperative serum oestrogen could haveaided in determination <strong>of</strong> Sertoli cell tumour metastasis.Retrospectively, considering <strong>the</strong> chronic diarrhoea,unresponsive to antibiotics, but responsive tocyclosporine, <strong>the</strong> mesenteric and gastric lymphadenopathy,and diagnosis <strong>of</strong> lymphoma in <strong>the</strong> latteras well as in <strong>the</strong> spleen, we believe this was a case <strong>of</strong>alimentary lymphoma. It is presumed that <strong>the</strong>y aremost likely B-cell in origin (18), but newer studiesare conflicting (21). However, it could be also a stageIVa <strong>of</strong> <strong>the</strong> multicentric form (18), which is perhapsmore likely regarding subsequent development <strong>of</strong>generalised lymphadenopathy.The chronic diarrhoea, mentioned in <strong>the</strong> history,could develop due to o<strong>the</strong>r causes such as lymphocytic-plasmaciticenteritis (LPE) or giardiasis, as<strong>the</strong> dog was positive for <strong>the</strong> latter. Giardiasis seemsto be a less likely cause for <strong>the</strong> diarrhoea as <strong>the</strong>dog failed to respond to a prolonged metronidazoleand spiramycin treatment, and did respond to cyclosporine(22, 23). It has been suggested, that LPEmay be a prelymphomatous change in <strong>the</strong> gastrointestinaltract (18). Cyclosporine treatment has beenreported to induce lymphoma or o<strong>the</strong>r tumours oc-