Hazal ÖZTÜRK (1), Evrim EGEDEN (2), Özlem CALP EGEDEN (2), M. Metin BARLAN (3), Funda YILDIRIM (1), Aydın GÜREL (1)
1. Istanbul University, Faculty of Veterinary Medicine, Department of Pathology, Avcilar, Istanbul
2. Ada Veterinary Polyclinic Sülün Street No: 14 1. Levent 34330 Besiktas, Istanbul
3. Gayrettepe Florence Nightingale Hospital, Gayrettepe, Istanbul
Introduction
Breast tumors are the third most common neoplasia in cats and constitute the 17% of tumors seen in cats. %80 of cat breast tumors are malignant. Tumors with malignant prognoses mostly tend to spread to lymph nodes and lungs. We aim to present a case of cat breast tumor with a metastasis to lungs, mediastinal lymph node, intercostal muscles and diaphragm.
Material and Method
Findings
Histopathology
In the breast tissue sections, there were sporadic mucinous sights and inside there were epithelial neoplastic cells mostly in tubular forms as groups without a distinct capsule and with sporadic mucinous secretion in the cytoplasms. Epithelial neoplastic cells were observed to have malignity criteria such as advanced cellular atypia, anisocytosis, hyperchromasia, multiple nucleoli as well as large necrotic areas and inflammation characterized by neutrophile infiltrations. According to these findings, the diagnosis was mucinous adenocarcinoma (Image 1).
Image 1. Mucinous Adenocarcinoma. A. Sporadic mucinous secretion areas, neoplastic epithelial cells characterized by tubular forms. B. Tumor necrosis with neoplastic areas. C. Tubular forms consisting of mucinous secretion areas. D. Neoplastic epithelial cells and many mitotic figures showing anisocytosis, anisokaryosis and hyperchromasia.
Cytology
Anisocytosis, many solitary and in groups, atypical, neoplastic cells with multiple nucleoli and hyperchromatic nuclei were observed in the examination of the pleural effusion (Image 2).
Image 2. A, B. Many solitary atypical epithelial neoplastic cells showing anisokaryosis and anisocytosis, atypical epithelial neoplastic cells with multiple nucleoli and hyperchromatic nuclei.
Xray and CT
Xray imaging showed pleural effusion in the patient’s thorax and hazy infiltration along with homogenous density (Image 3. A.). Compressed segmental atelectalic areas and bilateral pleural effusion were observed in the lungs (Image 3).
Image 3. A. Xray. Pleural effusion in the chest cavity. B. Compressed segmental atelectalic areas and bilateral pleural effusion in the lungs.
Postmortem Macroscopical and Histopathological Examination
Lungs generally look collapsed; there are pleural thickening and pleura based opacity. Grey-white, well circumscribed, hard foci with miliary distribution of 0,2 cm size in diameter in the lungs, pleura, intercostal muscles and diaphragm. Necropsy showed growth in mediastinal lymph nodes and grey-white masses approximately 0,5-1 cm in diameter. Metastasis foci similar to the one in the breast tissue tubular in form and consisting of epithelial neoplastic cells in the lungs, mediastinal lymph nodes, intercostal muscles and pleura were observed. Pleura showed advanced mononuclear and neutrophile leukocyte inflammation cells and increased pleuritis characterized by fibrous collagen tissue (Image 4).
Image 4. A. Alveoral areas in the lungs, extensive metastatic carcinoma areas in tubular form. B. Mediastinal lymph node, extensive metastatic carcinoma areas in tubular form, lymphoid foci. C. Diaphragm, inflamed cells in the muscle, increased fibrous collagen tissue and metastatic carcinoma foci in tubular form. S. Lung-pleura, mononuclear and neutrophile leukocyte inflammatory cell infiltrations, pleuritis characterized by increased fibrous tissue.
Discussion and Results
Breast tumor was diagnosed with musinous carcinoma with histopathological examination and cytopathological examination of pleural effusion revealed metastasis to the chest cavity after one and a half year. Malignant neoplasia of the thorax area can show clinical symptoms of pleural effusion. Malignant pleural effusions can be successfully diagnosed with cytological examination. In human medicine in these types of neoplasia, pleuradesis technique with bleomycin is frequently used for palliative care. Patient did not suffer from any side effects after the procedure and spent a better remission period except for mild appetite loss until she had acute respiratory stress. This case showed that cytopathology is a valuable diagnostic tool in metastases of breast tumors in cats which have a high metastasis rate and the treatment procedure of which is complicated and difficult.
