Page 1480 - Cote clinical veterinary advisor dogs and cats 4th

754 Paraneoplastic Syndromes

Recommended Monitoring PEARLS & CONSIDERATIONS • Oral lesions in cats should be noted at the
• If benign neglect is chosen, clinicians should Comments time of exam, especially under the tongue.
VetBooks.ir exudation, and proliferation of growths; if Once thought to be a nuisance and often treated Client Education
monitor lesions for ulceration, purulent
noted, additional intervention is appropriate.
Not a zoonotic disease
by benign neglect with spontaneous regression,
• Clinicians should monitor for abnormal
persistence (e.g., development into a large persistent lesions should be addressed sooner SUGGESTED READING
to minimize the potential risk of malignant
or ulcerated mass), which could warrant transformation to SCC. Hnilica KA: Small animal dermatology—a color atlas
biopsy because of the potential for malig- and therapeutic guide, ed 4, Philadelphia, 2017,
nant transformation of affected cells to Prevention Elsevier, pp 175-177.
SCC. Owners should separate dogs with oral papil- AUTHORS: Karen Moriello, DVM, DACVD; Britt Levy,
lomatosis from other susceptible individuals. VMD
PROGNOSIS & OUTCOME EDITOR: Manon Paradis, DMV, MVSc, DACVD
Technician Tips
• Prognosis usually good • Thorough cleaning of exam tables and instru-
• Spontaneous regression is likely, with ments used to treat dogs with papillomas;
subsequent lifelong immunity. use dilute bleach 1 : 10

Paraneoplastic Syndromes

BASIC INFORMATION squamous cell carcinoma, mammary ASSOCIATED DISORDERS
adenocarcinoma, thyroid carcinoma, bron- • Chronic hypercalcemia can cause renal injury
Definition choalveolar carcinoma, multiple myeloma, by tubular mineralization and ischemic
Pathologic changes in structure or function that and others. damage.
develop secondary to and distant from a primary • Cachexia: multiple tumor types • Hyperglobulinemia/hyperviscosity syndrome
neoplasm. Certain paraneoplastic syndromes • Hypoglycemia: beta-cell tumor (insulinoma), can cause coagulopathy and hypertension,
(PNSs) occur frequently, whereas others are gastrointestinal leiomyosarcoma, hepatocel- resulting in retinal detachment, seizures,
rare. PNSs most commonly arise secondary lular carcinoma most common; others renal infarction, cerebral/pulmonary
to hormonal or cytokine factors produced by sporadically thromboembolism, and congestive heart
the tumor. In some instances, PNSs are more • Gastroduodenal ulceration: MCT, pancreatic failure.
harmful than the physical tumor. gastrinoma (Zollinger-Ellison syndrome) • Hypoglycemia usually causes depression,
• Erythrocytosis: renal tumors, nasal fibrosar- ataxia, and seizures.
Epidemiology coma, lymphoma, others • Gastroduodenal ulceration from excessive
SPECIES, AGE, SEX • Disseminated intravascular coagulopathy: histamine-induced gastric hydrochloric
Dogs and cats; generally no sex predisposition, hemangiosarcoma (HSA), acute leukemia, acid (HCl) production results in melena,
with few exceptions (e.g., feline acromegaly lymphoma hematemesis, and anemia.
associated with pituitary adenomas occurs more • Hyperviscosity syndrome: multiple myeloma, • Pancytopenia predisposes to opportunistic
commonly in males) lymphoma, leukemia, primary polycythemia infections and spontaneous hemorrhage.
• Hyperadrenocorticism: pituitary adenoma, • Myasthenia gravis–induced megaesophagus
GENETICS, BREED PREDISPOSITION adrenocortical adenoma/carcinoma predisposes to aspiration pneumonia.
• PNSs are rarely directly induced by genetic • Cardiac arrhythmias/altered blood pressure: • Hypertrophic osteopathy causes fever,
factors, with occasional exceptions. One pheochromocytoma, HSA lameness.
exception is nodular dermatofibrosis associ- • Anemia: HSA, lymphoma, leukemia, mul- • Hyperadrenocorticism predisposes to throm-
ated with an autosomal dominant heritable tiple myeloma, estrogen-producing tumors boembolism, hypertension, glomerulosclerosis.
mutation of the Birt-Hogg-Dubé syndrome (Sertoli cell), other chronic neoplasia • Acromegaly commonly causes insulin resis-
gene (FLCN) in German shepherds. Affected • Thrombocytopenia: lymphoma, leukemia, tance, upper airway obstruction, hypertrophic
dogs commonly develop bilateral renal cysts multiple myeloma, HSA cardiomyopathy, and renal failure.
or cystadenocarcinomas. Female dogs may • Leukocytosis: lung tumor, renal transitional Clinical Presentation
develop uterine leiomyoma. cell carcinoma (TCC), lymphoma, thymoma
• Certain purebreds are predisposed to indi- • Peripheral neuropathy: many tumors HISTORY, CHIEF COMPLAINT
vidual cancers, resulting in relatively higher • Alopecia: pancreatic carcinoma, hepatocel- • Hypercalcemia: most common clinical signs
incidence of PNS (e.g., boxers have higher lular carcinoma, lymphoma include polyuria and polydipsia (PU/PD).
incidence of T-cell lymphoma; boxers, pugs, • Hypertrophic osteopathy: lung tumor Others are lethargy, inappetence, vomiting
and Labrador retrievers have higher incidence (primary or metastatic), Sertoli cell tumor, from uremia (p. 491).
of mast cell tumors [MCTs]). renal TCC, nephroblastoma, adrenocortical • Cachexia: loss of lean body mass, often
carcinoma, Spirocerca lupi–induced esopha- despite normal appetite
RISK FACTORS geal sarcoma • Hyperviscosity syndrome: signs depend on
Individual PNSs associated with specific tumors: • Myasthenia gravis: thymoma, osteosarcoma organ system(s) affected: seizures, blindness,
• Hypercalcemia: T-cell lymphoma, anal sac • Acromegaly: pituitary adenoma (cats), syncope, dyspnea (p. 509)
apocrine gland adenocarcinoma, parathyroid mammary adenocarcinoma (dogs) • Hypoglycemia: depression, ataxia, seizures
adenoma most common; also reported • Superficial necrolytic dermatitis (hepatocu- • Gastroduodenal ulceration: anorexia, melena,
sporadically with malignant melanoma, taneous syndrome): glucagonoma hematemesis (p. 380)

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