Concurrent renal adenocarcinoma and polycythemia in a dog

Abstract

Concurrent renal adenocarcinoma and polycythemia were diagnosed in a 19-month-old, female Rhodesian ridgeback. An unusually early presentation for this neoplasm, it is the second reported case of renal adenocarcinoma in a dog less than two years of age. Concurrent renal adenocarcinoma and polycythemia have been reported previously in four older dogs. In the dog of this report, clinical signs included brick-red mucous membranes, lethargy, a periodic systolic heart murmur, and engorged retinal vessels. A large retroperitoneal mass and pulmonary metastatic nodules were present at the time of diagnosis. Red blood cell count, packed cell volume, and hemoglobin concentration were greatly increased (12,940,000 red blood cells/microliter; 73.2%; and 26.6 g/dl, respectively). Histopathological diagnosis was renal adenocarcinoma. Polycythemia was the result of excessive erythropoietin production by the neoplasm.

Pathology in Practice

“…In the study by Bryan et al 4 on primary renal neoplasia in 82 dogs, the most common hematologic abnormalities were neutrophilia (22/63), anemia (21/64), and thrombocytopenia (6/68). In addition to leukocytosis, there are other paraneoplastic syndromes reported for dogs with renal carcinomas, including hypertrophic osteopathy, 8,9 hypoglycemia, 10 and polycythemia, 11 although these were not observed in the dog of the present report. The cause of the dog’s resolved thrombocytopenia remains uncertain, although we favor disseminated intravascular coagulation or a paraneoplastic process as the leading differential diagnosis.…”

Renal adenocarcinoma-associated erythrocytosis in a cat: Clinicopathological features and immunohistochemical results

“…The improvement in renal function (creatinine concentration and USG) after manual erythrocytapheresis and nephrectomy could support this statement. Variable degree of renal impairment or dysfunction with azotemia and different urinary findings (hematuria, proteinuria and reduced urine concentrating ability) have been previously described in cases of SIE associated with renal neoplasia (Gorse, 1988;Crow et al, 1995). These findings highlight the strong impact of erythrocytosis, even if mild or moderate, on kidney perfusion and function, as a consequence of abnormally increased RBC mass and hyperviscosity (Nitsche, 2004).…”

“…In particular, a link between renal neoplasia and SIE has been widely reported in humans and dogs (Hodges et al, 2007;Durno et al, 2011;Osumi et al, 2013;), but has only occasionally described in cats (Hasler and Giger, 1996;Henry et al, 1999;Yuki et al, 2005;Klainbart et al, 2008;Noh et al, 2013). Different types of renal tumors including carcinoma, lymphoma and fibrosarcoma have been related with SIE in dogs (Gorse, 1988;Crow et al, 1995;Durno et al, 2011), while an association with renal adenocarcinoma has been reported in feline patients (Yuki et al, 2005;Klainbart et al, 2008;Noh et al, 2013). This report describes a case of SIE in a cat affected by renal cell adenocarcinoma, the patient stabilization through manual erythrocytapheresis, and the EPOimmunostaining on the affected kidney.…”

Secondary polycythaemia associated with high plasma erythropoietin concentrations in a dog with a necrotising pyelonephritis

“…Two pathophysiological mechanisms have been proposed to explain increased EPO concentrations encountered in renal disorders. First, autonomous excretion of EPO or EPO‐like substances by renal tumours has been proven to cause erythrocytosis (Hammond and Winnick 1974, Peterson and Zanjani 1981, Nelson and others 1983, Crow and others 1995). Alternatively, compression of renal tissue by a mass is thought to result in impaired parenchymal blood flow and stimulation of EPO secretion within the remaining kidney tissue as a physiological response to local tissue hypoxia (Hammond and Winnick 1974).…”

“…Inappropriate secondary erythrocytosis is caused by elevated EPO concentrations in the absence of systemic hypoxia and is most commonly associated with neoplasia. Besides carcinomas, sarcomas and lymphomas of primary renal origin (Peterson and Zanjani 1981, Nelson and others 1983, Gorse 1988, Waters and Prueter 1988, Crow and others 1995, Hilscher and Eberle 2004), a variety of non‐renal neoplasms such as nasal fibrosarcoma (Couto and others 1989), caecal leiomyosarcoma (Sato and others 2002) and schwannoma (Yamauchi and others 2004) have reportedly been associated with inappropriate secondary erythrocytosis. In these cases of non‐renal neoplasias, ectopic EPO production within the tumour tissue was responsible for the erythrocytosis.…”