Page 1257 - Cote clinical veterinary advisor dogs and cats 4th

629.e2 Mass, Pancreatic

Mass, Pancreatic Client Education
Sheet
VetBooks.ir Differential Diagnosis
HISTORY, CHIEF COMPLAINT
BASIC INFORMATION
• Pancreatitis: vomiting, anorexia, lethargy, • Pancreatitis: inflammation, necrosis, abscess,
Definition diarrhea, abdominal pain pseudocyst, fibrosis
Mass visualized in the pancreas by ultrasonog- • Exocrine neoplasia: similar but may include • Exocrine neoplasm: adenocarcinoma
raphy or during exploratory celiotomy weight loss • Metastasis of another primary neoplasm to
• Secondary biliary obstruction: similar; some the pancreas: gastric or duodenal adenocar-
Epidemiology owners may also note icterus cinoma, leiomyosarcoma, lymphoma
SPECIES, AGE, SEX • Endocrine neoplasia
Dogs: ○ Insulinoma: weakness, lethargy, altered Initial Database
• Masses associated with pancreatitis: more neurologic state, seizures, collapse (p. 552) • CBC: possible inflammatory leukogram (e.g.,
common in older intact or spayed females ○ Gastrinoma (rare): vomiting, anorexia, with pancreatitis): left shift, toxic neutrophil
• Endocrine pancreatic neoplasia: more hematemesis, melena, pallor, lethargy, changes; anemia if gastrinoma results in
common in middle-aged to older dogs abdominal pain, evidence of shock if bleeding ulcer
Cats: perforated gastric ulcer with peritonitis • Serum biochemistry profile, urinalysis: reflect
• Exocrine pancreatic neoplasia: middle-aged underlying disorder
to older cats PHYSICAL EXAM FINDINGS ○ Elevated amylase, lipase ± bilirubin ± liver
• Mass may be palpable if secondary to enzyme concentrations: pancreatitis
RISK FACTORS pancreatitis; neoplastic masses are rarely ○ Hypoglycemia: insulinoma
• Pancreatitis palpable ○ Hyperbilirubinemia, bilirubinuria: second-
○ Hyperadrenocorticism, diabetes mellitus, • Otherwise, varies depending on cause of ary biliary obstruction
hyperlipidemia pancreatic mass ○ Hypoproteinemia, increased blood urea
• Pancreatic abscess ○ Pancreatitis, exocrine pancreatic neoplasia nitrogen (BUN): secondary to bleeding
○ Pancreatitis, pancreatic cyst, or pseudocyst ■ Abdominal pain, dehydration, icterus, ulcer
palpable abdominal mass, pyrexia • Survey abdominal radiographs
ASSOCIATED DISORDERS ■ Panniculitis associated with pancreatitis ○ Mass effect in region of pancreas: may
Dogs: (rare) displace duodenum laterally, pylorus crani-
• Pancreatitis-associated masses ○ Endocrine pancreatic neoplasia ally. Depending on size, mass may not be
○ Biliary obstruction secondary to the mass ■ Neurologic findings associated with appreciated on routine radiographs (e.g.,
• Exocrine pancreatic neoplasia hypoglycemia masses associated with endocrine neoplasia
○ Biliary obstruction ■ Necrolytic dermatitis associated with are typically very small).
○ Paraneoplastic alopecia or panniculitis some endocrine tumors (p. 754) ○ Possible increased radiopacity in area of
• Endocrine pancreatic mass ■ Alopecia of the ventral abdomen and pancreas (pancreatitis)
○ Insulinoma: hypoglycemia: weakness, hindlimbs with “shiny” appearance ○ Diffuse granular appearance to abdomen:
collapse, possibly seizures (cats) carcinomatosis
○ Gastrinoma: gastric ulceration, vomiting, • Survey thoracic radiographs: help rule
melena, anemia Etiology and Pathophysiology out metastatic disease if neoplasia is
Cats: • Pancreatitis (canine, feline) (pp. 740 and suspected
• Exocrine pancreatic neoplasia 742)
○ Biliary obstruction • Exocrine pancreatic neoplasia: cause Advanced or Confirmatory Testing
○ Paraneoplastic alopecia unknown • Abdominal ultrasound or computed tomo-
• Endocrine pancreatic mass • Secondary biliary obstruction: lack of bile graphic exam:
○ Gastrinoma (rare): gastric ulceration, secretion into the intestine results in a lack ○ Pancreas, morphology/echogenicity of
vomiting, melena, anemia, lethargy of digestion and absorption of fat and fat- mass
soluble vitamins, most importantly vitamin ■ Generalized inflammation of pancreas
Clinical Presentation K; possible development of significant and surrounding structures: pancreatitis
DISEASE FORMS/SUBTYPES coagulopathy (p. 118) ■ Fluid-filled mass: pancreatic abscess
Dogs: • Endocrine pancreatic neoplasia: occasion- (mixed echogenicity common),
• Associated with pancreatitis ally seen as part of the multiple endocrine cyst (contents generally anechoic),
○ Inflammatory/necrotic mass neoplasia 1 (MEN 1) syndrome due pseudocyst
○ Abscess to mutations in the MEN 1 gene in ■ Solid mass (head of pancreas): exocrine
○ Pseudocyst humans neoplasia
• Nodular hyperplasia ○ Inappropriate, excessive insulin secretion ■ Small, isolated, well-defined mass:
• Neoplasia (primary pancreatic): exocrine leads to persistent, profound hypoglycemia. insulinoma (hepatic metastases are com-
(adenocarcinoma) or endocrine (e.g., • Hyper/hypocoagulability can occur in dogs monly present at time of diagnosis but
insulinoma, rarely gastrinoma) with extrahepatic biliary obstruction. cannot be differentiated from nodular
• Metastatic or local extension of another hyperplasia by ultrasound)
primary neoplasm DIAGNOSIS ○ Evaluation of adjacent organs
• Icterus secondary to biliary obstruction ■ Extension of pancreatic disease into
Cats: Diagnostic Overview duodenum (inflammation, neoplasia)
• Associated with pancreatitis Presenting history and physical exam findings ■ Extension of duodenal disease into
• Exocrine neoplasia are often nonspecific, and the diagnosis is pancreas (neoplasia)
• Icterus secondary to biliary obstruction suggested by results from the initial database, ■ Evidence of metastatic disease (regional
• Endocrine neoplasia (i.e., insulinoma, particularly diagnostic imaging. lymph nodes, liver, carcinomatosis
gastrinoma): extremely rare [ascites usually is also present])
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