Chyloabdomen in a cat with pancreatic carcinoma

Véran, Emilie; Gallay-Lepoutre, Julie; Gory, Guillaume; Guillaumot, Pierre; Duboy, Julie

http://www.openveterinaryjournal.com E. Véran et al. Open Veterinary Journal, (2018) , Vol. 8(4): 452-457 ________________________________________________________________________________________________________ http://www.openveterinaryjournal.com E. Véran et al. Open Veterinary Journal, (2018) , Vol. 8(4): 452- 457 ________________________________________________________________________________________________________ 454 As no definitive diagnosis had been made, and given the mesenteric lesion of undetermined origin, an exploratory laparotomy was performed. Diazepam (Valium® Roche 10mg/2mL, Roche, Boulogne-Billancourt, France), 0.3 mg/kg body weight (BW), IV, was given as premedication. Anesthesia was induced using alfaxalone titrated to effect (Alfaxan® 10mg/mL, Dechra Veterinary Products SAS, Montigny-le-Bretonneux, France), 3 mg/kg BW, IV. Oro-tracheal intubation was readily performed with a 3-mm cuffed tube. Anesthesia was maintained with isoflurane (Vetflurane® 1000mg/g, Virbac, Carros, France) vaporized in oxygen. Analgesia was provided by morphine (Morphine Lavoisier 10mg/mL, C.D.M. Lavoisier, Paris, France), 0.2 mg/kg BW, IV, q2h. A midline laparotomy was performed. A large amount of chylous effusion was removed. The mesentery was folded upon itself by necrotic adhesions. Those were released and biopsies of the abnormal mesentery close to the pancreas and of mesenteric and pancreaticoduodenal lymph nodes were obtained. No other abnormalities were seen on thorough examination of abdominal cavity. Abdomen wall was closed routinely. The cat recovered well from the anesthesia. She was discharged 2 days after surgery with amoxicillin/clavulanic acid, 20 mg/kg BW, PO, q12h for 5 days (Késium® 62.5mg, Ceva Santé Animale, Libourne, France), rutin, 62.5 mg/kg BW, PO, q8h, and a low-fat diet (Royal Canin gastro-intestinal low fat, Royal Canin SAS, Aimargues, France). Biopsies revealed exocrine pancreatic tissue infiltrated by solid sheets of large polygonal cells with oval nuclei, prominent nucleoli and coarse chromatin (Fig. 3) . Anisokaryosis was moderate and mitotic rate was low. Mesenteric fat tissue showed necrotic areas surrounded by vacuolated macrophages (Fig. 4) . Lymph node biopsies were free from metastatic lesions. Pancreatic carcinoma with mesenteric necrotic and granulomatous remodeling was diagnosed. Standard chemotherapy and targeted therapy (tyrosine kinase inhibitor) were declined. The cat was palliatively maintained under rutin and low-fat diet (Royal Canin gastro-intestinal low fat, Royal Canin SAS, Aimargues, France). Three days after discharge, the cat was presented to the referring veterinarian for inappetence and depression. Non-steroidal anti-inflammatory drugs (Metacam® 0,5 mg/ml Suspension orale pour chats, Boehringer Ingelheim France Division Santé Animale, Reims, France) were prescribed for a few days and the cat improved. On telephonic follow-up, three weeks after discharge, the patient was in good general condition. No relapse of the abdominal effusion was reported. However, one month after surgery, the cat was presented to her regular veterinarian for decreased appetite. 200 mL of abdominal effusion were removed. Despite administration of prednisolone (Dermipred® 5mg, Ceva Santé Animale, Libourne, France), maropitant (Cérénia® 16mg, Zoetis, Paris, France), and mirtazapine (Norset® 15mg, MSD France, Courbevoie, France), the cat's condition worsened with rapid recurrence of effusion. She was euthanized 52