JPC SYSTEMIC PATHOLOGY
DIGESTIVE SYSTEM
September 2018
D-M16

Signalment:  9-year-old male Cavalier King Charles spaniel 

HISTORY (JPC #3103040):  This animal had a history of diarrhea. The ileocecal junction appeared thickened on ultrasound.  Thickened segments were surgically resected.

HISTOPATHOLOGIC DESCRIPTION:  Small intestine:  Villi are multifocally expanded by dilated lacteals, the lamina propria and submucosa are edematous, and lymphatics are dilated transmurally. Multifocally, ectactic lacteals and lymphatics contain a variable amount of flocculent, pale eosinophilic proteinaceous fluid and fibrin admixed with few erythrocytes and degenerate neutrophils.  Within the submucosa, tunica muscularis, serosa and mesentery lymphatics exhibit a continuum of changes from simple dilation to formation of lipogranulomas, up to 2mm in diameter, which are characterized by partial to complete obstruction of the lumen and replacement  by amorphous amphophilic to pale eosinophilic lipid rich material which often contains cholesterol clefts, and/or basophilic granular material, surrounded by high numbers of lipid-laden macrophages, fewer lymphocytes, plasma cells and foreign-body type multinucleated giant cells which are further surrounded by a variably thick band of fibrosis.  In severely affected lymphatics endothelial cells are either shrunken with hypereosinophilic cytoplasm and pyknotic nuclei (necrosis), or lost.  Multifocally, there is hemorrhage, edema and fibrin admixed with these inflammatory cells.  Moderate numbers of lymphocytes and plasma cells infiltrate the mucosa, submucosa, tunica muscularis, serosa and mesentery.

MORPHOLOGIC DIAGNOSIS:  Small intestine:  Lymphangiectasia, chronic, diffuse, marked, with lipogranulomatous lymphangitis, Cavalier King Charles spaniel, canine.

GENERAL DISCUSSION: 

PATHOGENESIS: 

TYPICAL CLINICAL FINDINGS:

TYPICAL GROSS FINDINGS: 

TYPICAL LIGHT MICROSCOPIC FINDINGS:  Multifocal to diffuse lesions

ADDITIONAL DIAGNOSTIC TESTS: 

DIFFERENTIAL DIAGNOSIS:

For chronic diarrhea associated with panhypoproteinemia:

General causes of hypoproteinemia:

COMPARATIVE PATHOLOGY: 

REFERENCES:

  1. Gelberg HB. Alimentary system and the peritoneum, omentum, mesentery, and peritoneal cavity. In: Zachary JF, ed. Pathologic Basis of Veterinary Disease. 6th ed. St. Louis, MO: Elsevier; 2017:333, 336, 406.
  2. Hall EJ, Day MJ. Diseases of the small intestine. In: Ettinger SJ, Feldman EC, Côté E eds. Textbook of Veterinary Internal Medicine. 8th ed. St. Louis, MO: Elsevier; 2017:1535; 1558-1559.
  3. Miller LM, Gal A. Cardiovascular system and lymphatic vessels. In: Zachary JF, ed. Pathologic Basis of Veterinary Disease. 6th ed. St. Louis, MO: Elsevier; 2017:586-587, 615.
  4. Simmerson SM, Armstrong PJ, Wunschmann A, Jessen CR, Crews LJ, Washabau RJ. Clinical features, intestinal histopathology, and outcome in protein-losing enteropathy in Yorkshire terrier dogs. J Vet Intern Med. 2014;28(2):331-337.
  5. Tarpley HL, Bounous DI. Digestive system. In: Latimer KS, ed. Duncan & Prasse’s Veterinary Laboratory Medicine Clinical Pathology. 5th ed. Ames, IA: John Wiley & Sons, Inc.; 2011:242-243.
  6. Watson VE, Hobday MM, Durham AC. Focal intestinal lipogranulomatous lymphangitis in 6 dogs (2008-2011). J Vet Intern Med. 2014;28(1):48-51.
  7. Uzal FA, Plattner BA, Hostetter JM. Alimentary system. In: Maxie MG, ed. Jubb, Kennedy and Palmer’s Pathology of Domestic Animals. Vol 2. 6th ed. St. Louis, MO: Elsevier; 2016:90-91.


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