Ruby's x-ray pictures

X-rays 27-12-2008.

X-rays showing pleural effusion (fluid filled chest). A lot of pictures but as usual I couldn't decide which one to use...


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Ruby's histopathlogy report

Diagnosis
Pancreatic Endocrine Tumour - “Insulinoma” and Cardiomyopathy

Prognosis
Not Applicable

Histopathology Report

Sections from necropsy samples of multiple tissues from a 6-year-old, neutered female Ferret, were examined microscopically.

LIVER: 2 samples received; 2 sections examined. These reveal marked congestion showing a strikingly zonal (perlacinar) distribution. There is also mild, patchy extramedullary haemopoiesis (EMH).

KIDNEY: 2 received; 1 section examined from each. Mild, broadly similar pathological changes are present in both kidneys. Occasional tubules are dilated with proteinaceous material, there is very mild, patchy interstitial fibrosis, sometimes accompanied by a mild to moderate lymphocytic infiltrate, and a few glomeruli have thickened basement membranes and increased cellularity, sometimes with adhesions to Bowman's capsule.

SPLEEN: 1 sample received; 1 section examined. The parenchyma is markedly expanded by a combination of congestion, EMH and mild hyperplasia of the white pulp. The serosal surface is highly irregular, with numerous small, villous projections covered by a single layer of mesothelial cells.

LUNG: 1 sample received; 1 section examined. This is congested and there is moderately increased cellularity of alveolar walls. There is possibly some patchy atelectasis, but this is difficult to assess with confidence as the lung was largely deflated at the time of fixation.

HEART: 1 received; 2 sections examined. Grossly the left ventricle appeared dilated. Microscopy reveals mild, patchy myocardial degeneration and early replacement fibrosis, consistent with a mild cardiomyopathy.

PYLORUS: 1 sample received; 1 section examined. Microscopy reveals moderate, predominantly lymphocytic inflammation of the pyloric mucosa, but no obvious case was found. No Helicobacter were seen.

LARGE INTESTINE: 2 samples received; 2 sections examined. There is slightly increased cellularity of the mucosa, accompanied by mild fibrosis, consistent with a very mild, chronic colitis.

PANCREAS: 3 samples received; 3 sections examined. Microscopy reveals a fairly generalized, patchy to diffuse, predominantly periductal, lymphocytic inflammation accompanied by mild interstitial oedema and fibrosis, but in one of the sections there is also a small Islet cell adenoma (Insulinoma).

LYMPH NODE: 4 samples received; 4 sections examined. These are enlarged chiefly as a result of medullary oedema and haemorrhage. The cortical follicles are only mildly active and, with one exception, the parafollicular regions are not appreciably hypercellular.

DIAGNOSIS: Insulinoma; Cardiomyopathy; Interstitial pneumonia; Hepatic congestion.

DISCUSSION: Histopathological examination has revealed a variety of mild pathological changes, many of which were probably of minimal clinical significance, such as the mild chronic nephritis, mild chronic colitis and gastritis, and increased EMH in the liver and spleen. Of greater significance is an insulinoma and there is also moderately severe pulmonary and hepatic congestion and lymph node oedema, all together suggestive of congestive heart failure (presumably a result of the cardiomyopathy), as well as interstitial pneumonia. Whether the cardiomyopathy was in some way associated with the insulinoma is uncertain, but both are fairly common in ferrets, so their concurrent presence may have been coincidental.