Nov 012017
 

Liver imprint from a horse

 

Case information

An 11-month-old Thoroughbred filly presented to the Cornell University Hospital for Animals with a 10 day history of persistent lethargy, intermittent fever, diarrhea and hypodipsia. There was no response to antibiotics and fluids administered by the referring veterinarian.

On physical examination, the filly was quiet, alert and responsive, but in poor condition with a distended “pot-bellied” abdomen and dehydration. Mucous membranes of the oral and vaginal mucosa were hyperemic and the capillary refill time was 3 seconds. There were decreased borborygmi on abdominal auscultation. The filly had high heart and respiratory rates, with increased bronchovesicular sounds, and was afebrile.

Ultrasonographic examination of the thorax and abdomen revealed mild pleural roughening and a markedly enlarged liver that was comprised of several large or multiple coalescing masses, with intraluminal material in portal and splenic veins (suspected thrombosis). A 21 x 25 cm complex mass with a liquid center was noted in the cranial part of the abdomen. Thoracic radiographs did not reveal any abnormalities. Point-of-care testing revealed a packed cell volume of 64% and total protein by refractometer of 8.4 g/dL.

The filly was administered a bolus of 15 liters of intravenous fluids and then was treated with antibiotics and intravenous fluids overnight. The next day, blood was sampled for hematologic and biochemical testing (Tables 1 and 2) and a screening coagulation panel. Coagulation testing revealed a prolonged prothrombin time (27 seconds, reference interval 16-20 seconds) with a normal activated partial thromboplastin time (59 seconds, reference interval 45-66 seconds) and hyperfibrinogenemia (1131 mg/dL, reference interval 175-445 mg/dL). Bile acid testing revealed a high normal concentration (11 μmol/L, reference interval 0-11 μmol/L).

Table 1: Pertinent hematologic results
Test Result Units Reference interval
Hematocrit 51 % 31-47
MCV 33 fL 38-50
White blood cells 7.6 thou/μL 5.5-11.4
Neutrophils 4.6 thou/μL 2.7-6.6
Platelets 437 thou/μL 98-246
MPV 7.6 fL 5.8-11.5
Total protein by refractometer 8.9 g/dL 5.2-7.8

 

Table 2: Pertinent biochemical results
Test Result Units Reference interval
Sodium 129 mEq/L 134-141
Chloride 94 mEq/L 95-106
Bicarbonate 22 mEq/L 24-31
Anion gap 18 mEq/L 8-19
Albumin 2.1 g/dL 2.8-3.8
Globulin 5.7 g/dL 2.4-4.4
A/G 0.37   0.8-1.4
Glucose 52 mg/dL 75-117
AST 485 U/L 212-426
SDH 6 U/L 2-11
GGT 128 U/L 8-33
Total bilirubin 4.0 mg/dL 0.8-2.2
Direct bilirubin 0.5 mg/dL 0.1-0.3
Indirect bilirubin 3.5 mg/dL 0.5-2.1
CK 112 U/L 93-348
Iron 67 μg/dL 105-277
Transferrin saturation 21 % 26-62

 

The hepatic mass was biopsied under ultrasonographic guidance and scrapings were made from the submitted tissue, smeared onto slides and stained with modified Wright’s stain. Examine the representative images of the smears, then answer the questions below:

  1. Do most of the cells in the aspirate have features typical of mature hepatocytes?
  2. What is your cytologic diagnosis, incorporating all observed cytologic findings?
  3. Does this diagnosis provide pathophysiologic mechanisms that would explain some of the hematologic and biochemical findings?

Fig1_Nov2017

Figure 1: Scraping from a liver mass (10x)

Fig2_Nov2017

Figure 2: Scraping from a liver mass (50x).

Fig3_Nov2017

Figure 3: Scraping from a liver mass (50x)

Fig4_Nov2017

Figure 4: Scraping of a liver mass (50x)

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