Pancreas: neoplasia

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Sections available in full article Introduction, Presenting signs, Acute presentation, Age predisposition, Special risks (e.g. anesthetic), Pathogenesis, Pathophysiology, Timecourse (incubation, duration), Diagnosis, Presenting problems, Client history, Clinical signs, Diagnostic investigation, Confirmation of diagnosis, Gross autopsy findings, Differential diagnosis, Treatment, Initial symptomatic treatment, Monitoring, Sequelae, Prognosis, Expected response to treatment, Reasons for treatment failure, Sources, Publications, Vetstream contributor(s),
Contributors Mr Andrew Gardiner BVM&S, Cert SAS, MSc, MRCVS

Introduction

  • Cause : neoplasia of exocrine or endocrine pancreas is rare:
    • Exocrine :
      • Adenocarcinoma.
      • Nodular hyperplasia.
      • Adenoma.
    • Endocrine :
      • Islet-cell neoplasms (rare in cats  Insulinoma  ).
  • Signs : pancreatitis  Pancreatitis  jaundice, hypoglycemia  Hypoglycemia  .
  • Diagnosis : laboratory tests, ultrasonography, exploratory laparotomy.
  • Treatment : surgical resection insulin-secreting tumors.
  • Medical treatment for pancreatitis may be needed additionally after surgery.
  • Prognosis ; poor; high incidence of metastasis from pancreatic neoplasms.
  • Euthanasia should be considered.

Diagnosis

Clinical signs

  • Jaundice.
  • Abdominal pain.
  • Palpable mass.
  • Pyrexia.
  • Alopecia (some cases of carcinoma).
  • Weight loss.
  • Ascites.

Diagnosis

Differential diagnosis

  • Other causes of jaundice eg cholangiohepatitis  Liver: cholangitis  , FIP  Feline infectious peritonitis  .
  • Other causes of alopecia eg hyperadrenocorticism  Hyperadrenocorticism  , feline symmetrical alopecia .
  • Diabetes mellitus  Diabetes mellitus  .
  • Other causes of hypoglycemia  Hypoglycemia  .

Sequelae

Prognosis

  • Very poor as likely to be malignant neoplasm of pancreas with metastasis by the time of exploratory surgery.

Expected response to treatment

  • Very variable from complete resolution of clinical signs if a benign tumor is completely resected through to steady deterioration in the animal as malignancy supervenes.

Reasons for treatment failure

  • Failure to resect all neoplastic tissue is likely.
  • Local or distant metastases may already be present.
  • Secondary sites may continue to secrete high levels of insulin (insulinoma).
  • Iatrogenic pancreatitis/peritonitis may cause the patient to deteriorate further.

Sources

Publications

Refereed papers

  • Bennett PF, Hahn KA, Toal RL & Legendre AM (2001)Ultrasonographic and cytopathological diagnosis of exocrine pancreatic carcinoma in the dog and cat.J Am Anim Hosp Assoc.37(5), 466-473.
  • Tasker Set alResolution of paraneoplastic alopecia following surgical removal of a pancreatic carcinoma in a cat.JSAP40(1), 16-19.
  • Brooks D G, Campbell K L, Dennis J Set al(1994).Pancreatic paraneoplastic alopecia in three cats.JAAHA30, 557.

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