From:
macdoodle99@yahoo.com
Date: 2001-04-23 17:20:00 UTC
Subject: Re: Follow up Mackenzie's insulinoma surgery
--- In Ferret-Health-list@y..., "Bruce Williams, DVM" <williams@e...>
wrote:
> > Okay, I thought this might come up, so when I consented for the
> > specimens to go to the pathologist I asked if I would be able to
> get
> > them back in case I wanted a second opinion, and I was told yes.
> So,
> > on Monday or tuesday I will call my vet and ask if I can get the
> > parafin blocks. Are there specific things I should ask for? Or
> just
> > parafin blocks?
>
> The paraffin blocks are what is needed, or a set of 10 recuts from
> each block, so that I can run a series of tests - insulin, keratin,
> and probably others.
> >
> > By the way, out of curiosity, if the mets are not islet cell
> > carcinoma and are another type of adenocarcinoma as you
suggested,
> > what else is in the differential diagnosis?
>
> Gastric, intestinal, even adrenal would probably be in the
> differential. However, many of the carcinomas which spread widely
in
> the abdomen, are too anaplastic (immature) to identify a definitive
> cell of origin until necropsy.
>
>
> With kindest regards,
>
> Bruce H. Williams, DVM, DACVP
> Join the Ferret Health List at
> http://groups.yahoo.com/group/Ferret-Health-list
Hi Dr. Williams,
I spoke to my vet today. She spoke to the pathologist. The
pathologist refused to give up her parafin blocks and was going to
charge me $10 per slide. However, when my vet told her I was
planning on sending them to you, the pathologist apparently was
willing to work with you to get whatever samples you want but only
directly through you. She apparently has been in contact with you
before and states that you know her email address. Her name is Dr.
Drury Reavill. If you don't have her email address, I will send you
her telephone number in a private email if you still wish to pursue
this.
FYI, if it might spare you the trouble of getting specimens, here is
the path report:
Microscopic:
Liver: In the examined sections of the liver, there is fragmentation
of the biopsy. Diffusely, the hepatocytes have a fine cytoplasmic
vacuolization. In one of the sections, there is an infiltrative
unencapsulated discrete neoplasm that is comprised of cords to small
nest of cuboidal cells. These cuboidal cells have indistinct
cytoplasmic borders, small to moderate amounts of a finely granular
amphophilic to basophilic cytoplasm, and an oval hyperchromic cell
nucleus. The cell nucleus has indistinct basophilic nucleoli.
These cords to nests are supported in fine fibrovascular stroma.
There is also variable dilation of the cords and nests with diffuse
congestion noted. The mitotic rate is low at 1-2 per high power
field. Within the neoplasm, there are cystic spaces also forming of
which contain abundant red blood cells. The neoplasm is infiltrating
into the surrounding hepatic parenchyma and completely effaces the
normal architecture.
Pancreas: There is a focal hyperplastic isles of langerhans noted in
the pancreastic section. Adjacent to this hyperplastic proliferation
of the islet cells, there is also a section with dilation of acinar
ducts. In this area of intralobular exocrine pancreatic ductal
dilation, there is also a reduction in the number of pancreatic
acinar structures.
Duodenal mass: In the examined section of biopsy of which there is
abundant adipose tissue most likely of the omentum, there are also
the fragments of a well-differentiated islet cell tumor. This islet
cell tumor is comprised of nests of cords of well-differentiated
islet cells supported on fine fibrovascular stroma, and the tumor is
surrounded by a thin fibrovascular stroma.
Diagnosis:
1) Liver: Metastatic islet cell carcinoma
2) Pancreas: Hyperplastic isles of langerhans
3) Omental mass: Metastatic islet cell tumor.
There is also a comment, which among other things, states that islet
cell tumors commonly recur and multiple may arise within the pancreas
and can metastasize as these have.
I have been doing some reading in a ferret magazine and some non-
medical ferret books about insulinoma and they don't distinguish
between insulinoma and islet cell carcinoma, which I have been
differentiating in terms of thinking that it's the carcinoma that is
malignant and can metastasize. In fact, after the surgery, I asked
my vet if he thought this was an islet cell carcinoma as opposed to
insulinoma and he didn't really differentiate between the two
either. If insulinomas are malignant and can metastasize, is it even
important to differentiate the between insulinoma and islet cell
carcinoma?
As an update, you were surprised that Mackenzie's blood sugar was
elevated despite not having excised the primary tumor. 4 days after
her surgery her blood sugar was down to 69.
Kristy