A Case of Primary Papillary Disseminated Adenocarcinoma of Canine Lung

Vet Res Commun (2010) 34 (Suppl 1):S111–S115
DOI 10.1007/s11259-010-9378-1
EXTENDED ABSTRACT
A case of primary papillary disseminated

adenocarcinoma of canine lung
Maria Beatrice Conti & M. C. Marchesi & G. Angeli &

E. Lepri & C. Marinetti & F. Rueca
Published online: 12 May 2010

# Springer Science+Business Media B.V. 2010
Abstract Primary lung tumors are rare in dogs, whereas pulmonary metastatic neoplastic
involvement is common. We describe a case of a 12-year-old male, mixed-breed dog with a
3-month history of coughing and dyspnea. The investigating protocol, which also includes
transcutaneous pulmonary biopsy, allowed a diagnosis of lung adenocarcinoma that
necroscopic findings confirmed as a primary neoplasia. The tumor exhibited a nodular-
disseminated growth, mimicking the metastatic involvement of the lung, instead of the
single-mass appearance that has been observed by other authors. The present report
indicates that, although the incidence of canine primary lung neoplasms is markedly low,
this condition must be considered in the differential diagnosis of lung diseases that cause
coughing and dyspnea in older dogs.
Keywords Dog . Lung tumors . Adenocarcinoma . Diagnosis
Abbreviations
BAL Broncho-alveolar lavage
AlP alkaline phosphatase
ALT alanine transferase
γ-GT γ-glutamyltransferase
Introduction
In dogs, primary lung tumors are rare (1.2%) (Ogilvie et al. 1989; Sato et al. 2005), whereas
metastatic involvement of this organ occurs frequently (Castellano et al. 2006). As reported
in the literature (Jennier and Sorenmo 2004; Marconato 2005), primary tumors are more
M. B. Conti (*) : M. C. Marchesi : G. Angeli : C. Marinetti : F. Rueca

Department of Clinical Sciences, University of Perugia, Perugia, Italy
e-mail: mariabeatrice.conti@unipg.it
E. Lepri
Department of Biopathological Science and Hygiene of Food and Animal Production,
University of Perugia, Perugia, Italy
S112 Vet Res Commun (2010) 34 (Suppl 1):S111–S115
often described in geriatric dogs (9.3–10.9 years), especially in boxers, labrador retrievers,
springer spaniels, golden retrievers, and Irish Setters. The latter tumors normally appear as a
single mass in the right diaphragmatic lobe, as this region is larger on the right than on the
left (Jennier and Sorenmo 2004). Specifically, adenocarcinoma is usually located in
peripheral lung tissue and rarely disseminates into multiple small nodules (Jennier and
Sorenmo 2004; Marconato 2005; Moulton 1990). For these reasons, we describe a case of
primary papillary adenocarcinoma of the lung, which was characterized by disseminated
development, emphasizing the necessity to take into consideration this neoplasia in the
differential diagnosis of patients with clinical signs of chronic pulmonary pathology even
when single masses are absent upon thoracic radiographic examination.
Materials and methods
This study was conducted on a 12-year-old, male, mixed-breed dog that weighed 22 kg, and
was referred to the Veterinary Teaching Hospital of the University of Perugia due to a
3-month history of coughing and dyspnoea. Moreover the subject partially, but only
transiently, recovered when antibiotics and corticosteroids were administered. The dog was
physically examined, and additional testing was performed, including venous blood draws
for hemocytometric analysis and a complete biochemistry profile; arterial blood draw for
the measurement of blood gases; thoracic X-rays; bronchoscopy associated with broncho-
alveolar lavage (BAL) and biopsy of the bronchial mucosa; thoracic ultrasound, and lung
transcutaneous biopsy accordingly to Griffin’s protocol (Griffin 2004). BAL was used to
perform bacteriological, mycological, and cytological evaluations, whereas biopsy samples
underwent histopathological examination. Furthermore, we correlated the data with those of
anatomohistopathology.
Results
Upon clinical examination, the animal appeared depressed and presented tachypnea (40/min),
both inspiratory and expiratory distress, and a heart rate of 110 beats per min. A dry cough
was easily induced by palpation/traction of the trachea, presenting a strong vesicular lung
murmur that spread bilaterally. Blood analyses showed an increased alkaline phosphatase
(AlP), alanine transferase (ALT), and γ-glutamyltransferase (γ-GT) activities of 275 U/L,
45 U/L, and 14 U/L, respectively. Blood gas analysis confirmed the presence of acidosis from
total respiratory failure (pH 7.32, pO2 62 mm Hg, pCO2 58 mm Hg, and HCO3− 16 mEq/L).
Latero-lateral and dorso-ventral X-rays of the thorax showed a nodular-interstitial and
bronchial pattern that involved both lungs (Fig. 1). The performed bronchoscopy showed
evidence of a chronic exudative broncopathy, as well as the presence of disseminated
miliariform nodules on the mucosal surface (Fig. 2). Bacteriological and mycological
exams were both negative, and cytological specimens were compatible with chronic
inflammation, containing numerous macrophages at various stages of activation. Histolog-
ical evaluation of pulmonary biopsy samples allowed a diagnosis of adenocarcinoma, but
did not distinguish its origin as either primary or metastatic. A gross anatomopathological
examination showed an increase in the volumes of both lungs; whitish nodules of 1–3 mm
in diameter that were disseminated into the parenchyma and confluent, appearing as a
spread netlike texture in section (Fig. 3); an increase in tracheo-bronchial lymph node
volume; and hepatomegaly with an increase in lobular texture. Histopathological specimens
Vet Res Commun (2010) 34 (Suppl 1):S111–S115 S113
Fig. 1 Latero-lateral view. Nodular-interstitial and bronchial pattern is shown
revealed the formation of tubules and papillae delineated by cubic cells with a basal
nucleus; evidence of 1–2 nucleoli and scarce apical basophilic cytoplasm, growing in a
multifocal manner and of infiltrating nature not delimited; a marked anisokaryosis and
anisocytosis; an elevated mitotic index (15–20/10 hpf); intra-alveolar and intravascular
multifocal emboli, more frequently found in peribronchial lymphatic vessels and lymph
nodes, and widely infiltrated by neoplastic tissue; and hepatic centrolobular diffuse
degeneration, due to a state of hypoxemia. Immunohistochemistry with anti-thyroid
transcription factor-1 antibodies, positive in disseminated cells, allowed the classification of
this neoplasia as primitive pulmonary papillary adenocarcinoma (Bettini et al. 2009).
Fig. 2 Disseminated nodular lesions on the mucosal surface

S114 Vet Res Commun (2010) 34 (Suppl 1):S111–S115
Fig. 3 Gross lung appearance (left) and lung section (right). Note the diffuse texture
Discussion
The case of a primary disseminated papillary adenocarcinoma, rarely described in the

literature (Jennier and Sorenmo 2004; Marconato 2005), led us to a critical review of its
adopted diagnostic protocol. The clinical signs were similar to those normally observed in
chronic bronchopneumopathies in dogs. With regard to the laboratory analysis results, the
increases in serum levels of AlP, γ-GT, and ALT are most likely related, in our opinion, to
liver damage, also evident in histopathology specimens, and secondary to chronic
hypoxemia. The latter condition is in agreement with the arterial blood gas values,
suggesting that the structural damage was in such an advanced stage that it causes total
respiratory failure even at rest. Among the instrumental investigations performed,
ultrasonography provided limited information because the most superficial layers of the
lungs were under continuous ventilation, preventing the penetration of ultrasound. Chest X-
rays instead allowed for a more focused diagnosis, because the images were compatible
with metastatic lung cancer, pulmonary mycosis, and those conditions characterized by
interstitial-nodular patterns (Burk and Feeney 2003). However, such images did not provide
sufficient guidance on the nature of the neoplasia because the disseminated nodular
appearance was not consistent with the finding of a single mass, which is a characteristic of
primary adenocarcinoma (Jennier and Sorenmo 2004; Marconato 2005). Moreover, even
though bronchoscopy and BAL did not allow the identification of the neoplasm, they
helped rule out infection. The finding of tumor cells in BAL aliquots is in fact quite rare,
and the absence of the latter should not be considered discriminatory because lavage
involves the bronchial tree and mucus will sometimes prevent the lavage fluid from
reaching the bronchioles (Cowell et al. 1989). Additionally, the visualization of tumor cells
in cytological specimens can be challenging because of the concomitant presence of
inflammatory cells that have a greater tendency to exfoliate and are therefore found in
higher concentrations in the retrieved fluid (Cowell et al. 1989; Jennier and Sorenmo 2004).
We would like to share some thoughts on transcutaneous biopsy sample procedures as it
turned out to be the only investigation that allowed us to make a clear diagnosis, even
without the recognition of primary lung disease. In our experience, the above-mentioned
technique should be used more frequently in the diagnoses of diseases that involve the
pulmonary parenchyma, even if the procedure can lead to severe complications, such as a
pneumothorax or hemothorax. While such incidents did not occur here, it is true that lung
biopsy guidance is often precluded in all cases where lung ultrasound is difficult. In light of
these discussions, the pathology described, although rare, should always be included in a
differential diagnosis of geriatric patients with chronic cough and dyspnoea. Additionally,
Vet Res Commun (2010) 34 (Suppl 1):S111–S115 S115
the radiographic findings of an interstitial-nodular pattern should not preclude the

possibility of primary adenocarcinoma.
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Vet Res Commun (2010) 34 (Suppl 1):S111–S115

A case of primary papillary disseminated

Maria Beatrice Conti & M. C. Marchesi & G. Angeli &

Published online: 12 May 2010

Keywords Dog . Lung tumors . Adenocarcinoma . Diagnosis

M. B. Conti (*) : M. C. Marchesi : G. Angeli : C. Marinetti : F. Rueca

Materials and methods

Fig. 1 Latero-lateral view. Nodular-interstitial and bronchial pattern is shown

Fig. 2 Disseminated nodular lesions on the mucosal surface

The case of a primary disseminated papillary adenocarcinoma, rarely described in the

the radiographic findings of an interstitial-nodular pattern should not preclude the

Bettini G, Marconato L, Morini M, Ferrari F (2009) Thyroid transcription factor-1 immunohistochemistry:

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