From:
Bruce Williams, DVM
Date: 2001-11-20 23:07:00 UTC
Subject: Re: Noobie biopsy results - need help interpreting.
--- In Ferret-Health-list@y..., "Lisa Shortley" <fer8queen@h...>
wrote:
We received the
> pathology report back and while rather lengthy, I'm still at a loss.
> Can someone please help interpret this or give me some sort of idea
> about what possibilities remain?
>
> But I'm starting to feel like perhaps there could be a trend here,
> perhaps? Is there a chance that this could have been treatable?
What
> about contagious?
>
> Here is the biopsy:
> Microscopic Description:
> The specimen consists of necropsy sections of stomach, liver, and
lymph
> node. The gallbladder is not identified and the wet tissue will be
> resectioned. The tissues are from a neutered male, 5 year old
ferret
> with a history of jaundice and a high bilirubin with normal liver
> values.
>
> The stomach has intense inflammation in the lamina propria which
extends
> into the submucosa and muscularis. Areas of ulceration are present
> which have neutrophilic infiltrates. Diffuse severe infiltrates of
> lymphocytes and plasma cells are present throughout the lamina
propria
> and are admixed with a few neutrophils. Well developed lymphoid
nodules
> are present along the muscularis mucosae and in the submucosa.
Many of
> these nodules have germinal centers. Inflammation extends to the
> serosal surface and represents neutrophils, histiocytes,
lymphocytes,
> and plasma cells.
>
> The liver has mild to moderat periportal inflammation representing
> lymphocytes, plasma cells, and neutrophils. Occasional bile ducts
have
> neutrophilic infiltrates. Bile ducts are mildly hyperplastic and
some
> ducts are dilated. Moderate cholestasis is present withint he
ducts.
> Mild telangiectasia is also noted.
>
> The architecture of the lymph node appears to be intact but the
slide
> has marked sectioning artifact which affects interpretation. A few
> germinal centers are recognized and show normal peripheral
maturation.
> Mild hemorrhage is present in the sinuses.
>
> Pathological Diagnosis:
> 1. Multifocal ulcerative gastritis, stomach
> 2. Severe lymphoplasmacytic gastritis, stomach
> 3. Moderate chronic active serositis, stomach
> 4. Mild to moderate chronic active cholangiohepatitis, liver
> 5. Moderate intraductular cholestasis with mild bilaiary
> hyperplasia and patchy biliary ectasia, liver.
> 6. Mild telangiectasia, liver
> 7. Reactive lymph node.
> 8. Mild to moderate chronic active cholangiohepatitis with
nodular
> lymphoid hyperplasia and hemorrhage, gallbladder.
>
> Comment:
> Gastric morphology is consistent with Helicobacter infection
although no
> organisms are seen. The presence of multiple ulcers has also been
> associated with Helicobacter infection. Inflammation extends into
the
> muscularis and is present on the serosal surface of the stomach
> suggesting the possibility of a perforated ulcer which is not
present in
> the examined sections.
>
> No evidence of biliary neoplasia is seen in the liver. Changes are
> consistent with a biliary obstructive and inflammatory process
possibly
> secondary to the gastric inflammation. Helicobacter infection in
mice
> is a documented cause of chronic cholangiohepatitis. The presence
of
> neutrophils could indicate bacterial infection. The lymph node
appears
> to be reactive but deeper sectioning is in progress for better
> morphology and the result will be noted in a supplemental report.
The
> result of wet tissue resectining for the gallbladder will also be
noted
> in a supplemental report.
>
> Supplemental Report:
> The gallbladder contains a mild to moderate inflammatory infiltrate
in
> the submucosa. Neutrophils, histiocytes, lymphocytes, and plasma
cells
> are identified. One lymphoid nodule is present within the
submucosa and
> moderate hemorrhage is noted in the lumen. No microorganisms are
seen.
> Deeper sectioning of the lymph node confirms the diagnosis of a
reactive
> node.
Dear Lisa:
First off, This doesn't ring of anything that could pose a threat of
contagion in your household. The evaluation of the Helicobacter
rings true, and it sounds like a relatively advanced case,
complicated by gastric ulcers. The changes in the liver are the
result of chronic inflammation in the gut - it would have been nice
to have seen a piece of intestine in this case. This degree of liver
inflammation is somewhat unusual - I think that bacterial infection
via the gastric ulcers has certainly contributed to it, and there may
also be an intestinal component that we simply won't ever know about.
The lymph node is reacting to all of these changes.
So it looks like we have a terrible case of Helicobacter, coupled
with chronic ulcer disease, and some systemic spread of bacterial
infection from the gut, likely using the ulcers as a portal. There
may be more in other organs that were not sampled, which may account
for his rapid demise, but we can only talk about the organs which
were submitted for examination.
However, there is no evidence that this is an outbreak of any kind.
With kindest regards,
Bruce Williams, DVM