From: Bruce Williams, DVM
Date: 2001-04-12 11:07:00 UTC
Subject: Re: islet cell carcinoma - histopathology report posted #2
--- In Ferret-Health-list@y..., "Lisa Shortley" <shortleylj@m...>
> We took his stitches out over the weekend and then Monday, he
> acting strange and was wobbly. I treated him as if it were an
> episode. I took him to the vet's Tues and after a 3 hour fast, his
> glucose was a 54. So he's back on pred again.
> Anyway, here it all is:
> > BIOPSY
> > Microscopic Description:
> > The specimen consists of a section of pancreas and a lymph node.
> > architecture of the pancreas has been disrupted by a neoplasm
> > composed of moderately homogeneous epithelial cells arranged in
> > partially separated by thin incomplete fibrovascular septa. The
> > cells are characterized by round to oval open nuclei, one
> > and scant to moderate eosinophilic slightly granular to
> > cytoplasm. The mitotic rate is 1-5 per high power field.
> > cells extend into the adjacent fat and exocrine pancreatic tissue.
> > The architecture of the lymph node has been partially effaced by
> > metastatic neoplastic epithelial cells identical to those seen in
> > pancreas. A thin rim of normal lympphoid tissue is present
> > the neoplastic infiltrates.
> > Pathological Diagnosis:
> > 1. Islet cell carcinoma, pancreas.
> > 2. Metastatic islet cell carcinoma, pancreatic lymph node.
> > Comment:
> > Median survival time of ferrets with pancreatic islet cell
> > is reported as 16 months (483 days) and 10.3-17.5 months in two
> > separate articles. median disease free interval (DFI) is
> > 8 months (240 days) and 10.6 months respectively. However, with
> > pressence of an islet cell carcinoma which has metastasized to a
> > lymph node, the median survival time may be significantly less.
> > Ref: JAVMA 209: 1737 and 1741-1745, 1996. Neoplastic cells
> > focally to the margins of the pancreatic biopsy. The lymph node
> > appears adequately excised.
> > SO, there it all is...I really look forward to hearing what you
> > think. It sounds as though, even though you both said it is
> > this is what has occured with my Sterling.
this is certainly rare, and I would be interested if you could send
me the name of the pathologist offline (and the case #) so I could
get a chance to look at the case. True metastasis of insulinomas is
certainly rare in ferrets, but baded on this report, I am tempted to
accept the diagnosis, because they made the point that the cells in
the lymph node resembeld those of the pancreatic tumor, and islet
cells are fairly characteristic in appearance.
The question I have is that if we removed the insulinoma, and
completely removed the lymph node, what is the prognosis?
Unfortunately, we so rarely see true islet cell carcinomas (a
carcinoma being a definitively malignant neoplasm - and any
definitive evidence of metastasis to another organ or lymph node
certainly fulfills the criteria) that it is difficult to give a
prognosis in this case.
At any rate, the fact that the glucose is still in the 50's is of
concern. Often when a tumor has the ability to metastasise, it can
go to multiple organs at once, so we may have a tumor in the liver or
spleen as well that will continue to liberate insulin.
If the diagnosis is truly appropriate, then the condition in this
ferret would mimic that seen in the dog, and unfortunately,
metastasis is generally quick and widespread.
With kindest regards,
Bruce Williams, DVM, DACVP
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