Cholangiocarcinoma and hepatic myelolipoma incarcerated in a peritoneopericardial diaphragmatic hernia with pulmonary metastasis and carcinomatosis in a cat

Abstract

Case summary A 14-year-old female neutered Persian-cross cat was presented with a 1 week history of anorexia and lethargy. On physical examination, marked tachypnoea and dyspnoea were evident. Radiographs of the thorax revealed a globoid-shaped cardiac silhouette with heterogeneous opacity consistent with a peritoneopericardial diaphragmatic hernia (PPDH), pulmonary nodules compatible with metastasis, seven sternal segments and a small liver in the cranial abdomen with loss of serosal detail. On echocardiography, there was no evidence of cardiac tamponade. Triple-phase CT angiography demonstrated a mixed soft tissue-, mineral- and fat-attenuated liver mass arising from the left hepatic lobes that showed a pronounced heterogeneous contrast-enhancement pattern within the pericardial sac, which was producing a marked mass effect on the adjacent structures. Additionally, there was an increase in attenuation of the mesenteric fat and peritoneal effusion. The pulmonary nodules were confirmed. Imaging findings were compatible with a malignant hepatic neoplasia incarcerated in a PPDH, lung metastasis and carcinomatosis. Owing to the poor prognosis, the cat was humanely euthanased. Histopathological diagnosis was cholangiocellular carcinoma and hepatic myelolipoma, pulmonary metastasis and carcinomatosis. Relevance and novel information Hepatic cholangiocarcinoma incarcerated in a PPDH with pulmonary metastasis and carcinomatosis has not been previously described. Suspicion of a hepatic neoplasia should be raised in cases of PPDH and pulmonary nodules.

Peritoneopericardial diaphragmatic hernia in a healthy adult feline (Felis catus domesticus): diagnosis to surgical treatment - Case repor

“…Hematological examinations in cats affected by PPDH may present subtle changes (Barge et al, 2019) or may not show changes (Banz & Gottfried, 2010;Liptak et al, 2002). Therefore, even in the presence of a blood cell count and serum chemistry profile within normal range or with subtle changes, as in this report, it is possible to have PPDH.…”

“…The cat did not show clinical signs associated with the presence of PPDH, such as changes in the gastrointestinal or cardiorespiratory system (Barge et al, 2019;Barrett & Kittrell, 1966;Liptak et al, 2002), being observed only in apathy, weight loss, and lack of appetite. As in this report, some animals can be diagnosed as middle-aged or older (MacPhail, 2014), may be asymptomatic, and Then, a small incision was made in the pericardium to remove its adhesion to the diaphragm.…”

Peritoneopericardial diaphragmatic hernia in a healthy adult feline (Felis catus domesticus): diagnosis to surgical treatment - Case repor

“…The cat did not show clinical signs associated with the presence of PPDH, such as changes in the gastrointestinal or cardiorespiratory system ( Barge et al, 2019 ; Barrett & Kittrell, 1966 ; Liptak et al, 2002 ), being observed only in apathy, weight loss, and lack of appetite. As in this report, some animals can be diagnosed as middle-aged or older ( MacPhail, 2014 ), may be asymptomatic, and may not even reveal pathological changes in herniated or thoracic organs ( Cunha et al, 2000 ; Hunt & Johnson, 2007 ).…”

Diagnostic imaging features of hepatic myelolipoma incarcerated in a peritoneopericardial diaphragmatic hernia in a cat

“…It has also been reported that herniation of the liver is associated with a poor prognosis in fetal congenital diaphragmatic hernia in human medicine, suggesting compression of the lung by the herniated liver, and increased size of defect in the diaphragm and disturbed regulation of liver growth [ 13 ]. Studies have also described malignant neoplasia with or without hepatic myelolipoma in old cats with PPDH [ 14 15 ]. Thus, the prolonged enclosure of the hepatic parenchyma in a PPDH without surgical treatment can increase the risk of transformation and malignant changes because of vascular and lymphatic congestion and chronic hypoxia of hepatic tissue [ 14 15 ].…”

“…Studies have also described malignant neoplasia with or without hepatic myelolipoma in old cats with PPDH [ 14 15 ]. Thus, the prolonged enclosure of the hepatic parenchyma in a PPDH without surgical treatment can increase the risk of transformation and malignant changes because of vascular and lymphatic congestion and chronic hypoxia of hepatic tissue [ 14 15 ]. The development of myelolipomas may be associated with the presence of foci of tumor necrosis in human medicine [ 16 ].…”