Case of the Week: Switch


Case History

Switch, an 11-year-old, M/N DSH cat presented for lethargy and decrease in appetite. Completed thoracic and abdominal radiographs and found mass in thoracic cavity. Performed CT scan yesterday and found aggressive pulmonary lesion invading the liver and esophagus with possible metastasis to the mediastinum and kidney.

Scopio Practice Tip

In cats, the liver may be inadvertently aspirated when attempting to aspirate masses, fluid, or structures in the thorax, which is complicated in this case by the imaging findings that include liver involvement. Fortunately, if a case has been signed off, more slides can be attached for no charge and currently, there is no cut off time for adding slides. When slides are added, the case does not need to be uploaded again. The user is prompted to choose either the original pathologist, or the first available pathologist, to review the new slides. Ideally, the original pathologist completes the case, but if they are not available, it will automatically upload to the entire network after 25 minutes.

Webcam images with user chosen scan area denoted by thin green line.
  • Expected nucleated cellularity within blue oval.
  • Note that scan area is within glue and coverslip boundary, which improves resolution and decreases scan time.

Cytologic Features

Interpretation: Hepatocytes, mild to moderate hepatocellular vacuolization.

Take home points:
  • This sample is likely not diagnostic for the lesion described, but this is a known issue with the location, and new sample can be obtained and added to the case.
  • Vacuolar change is often described in hepatocytes and in the above, there are discrete vacuoles consistent with lipid, with lipid also seen surrounding the cells.
  • Technically, the type of vacuolar change cannot be confirmed on cytology, but the pattern and appearance does readily correlate with the following descriptions, allowing an interpretation.
  1. Indistinct hepatocellular vacuolation: glycogen (“steroid hepatopathy”), hydropic change, less commonly induction of SER (drug or toxin related).
  2. Distinct hepatocellular vacuolation: lipid.
  3. Feline hepatic lipidosis: distinct vacuoles, lipid distended hepatocytes, vacuoles may scallop the nuclear edges, large amounts of lipid in the background, evidence of cholestasis (bile casts).

Clinical follow up: Pending and will be shared next week.

Case of the Week patient information has been altered for client confidentiality.

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