Persistant hyperglycaemia in young bearded dragon

RE: Persistant hyperglycaemia in young bearded dragon

Marie Kubiak — Thu, 04 Feb 2016 16:45:52 GMT

That is interesting, thank you for the follow up. Never seen hyperglycaemia in tandem with lymphoma in reptiles but perhaps this will add to the differentials to consider!

Marie

RE: Persistant hyperglycaemia in young bearded dragon

Gillian Mostyn — Tue, 02 Feb 2016 17:05:13 GMT

Thanks for that update- really interesting!

RE: Persistant hyperglycaemia in young bearded dragon

Ashley Sykes — Tue, 02 Feb 2016 14:18:14 GMT

Marie,

An update on this case. I re-scanned after a 5ml emeraid feed and still could not see any defined masses (our scanner is not the best regardless, and perhaps nore are my skills!).

After much discussion with the owner we opted for euthanasia given the potential ddx. The owner was happy for me to post-mortem, but did not want to know the results.

On post mortem the stomach lining was normal, no descrete masses, abdominal cavity entirely normal except for a dark discrete mass juse next to the ?pancreas. The two linked pictures below show the "mass", it is below the pancreas and stomach in the pictures:

http://i.imgur.com/WBmzJRz.jpg

http://i.imgur.com/Yxw13m6.jpg

(copy and past the URLs)

I removed this section and sent for histo (Idexx). The results are below:

DIAGNOSIS
Lymphoma/lymphoid leukaemia - please refer to comment

CLINICAL HISTORY
Floss presented with four weeks of inappetance. Persistent hyperglycaemia. Decided in euthanasia and post-mortem examination. Neuroendocrine neoplasia? Post-mortem unremarkable with this lesion next to pancreas.

HISTOLOGY
One specimen is submitted and one section is evaluated after processing.

Block A, one section, shows the presence of normal pancreatic tissue with a well demarcated lesion on the periphery (might be splenic tissue). It shows a solid proliferation of neoplastic round cells, most closely resembling neoplastic lymphocytes. They are intermediate in size containing a small to moderate amount of eosinophilic cytoplasm with indistinct cellular borders. There is moderate karyomegaly. Nuclei vary between small and round to medium-sized and oval, hyperchromatic with stippled chromatin and amphophilic nucleoli. Six mitotic figures are present per high power field/400x. A number of blood vessels on the periphery, as well as blood vessels associated with the pancreas, show similar neoplastic round cells in the lumen intermixed with red blood cells.

COMMENT
Histological evaluation is most consistent with the presence of neoplastic lymphocytes in a solid organ as well as within the lumen of blood vessels. This is most compatible with lymphoma progressing to leukaemia or leukaemia with solid mass formation. Reptiles do not have lymph nodes and the solid lesion might be present within splenic tissue, but no normal tissue is available to confirm this definitively. A neuroendocrine carcinoma is an important differential diagnosis, and these tumours may resemble lymphomas on histological level, but the presence of neoplastic round cells within the lumen of blood vessels is more consistent with lymphoma/leukaemia, which are also fairly common tumours seen in bearded dragons. Neoplasia is thus confirmed. The prognosis was grave and euthanasia was the best treatment option.

I thought you might like to see that! Amazingly interesting!

RE: Persistant hyperglycaemia in young bearded dragon

Ashley Sykes — Mon, 25 Jan 2016 14:09:27 GMT

Brilliant, thanks as always Marie. I am back in tomorrow so will scan it after a full feed and see what I can see - perhaps some cranial fluidy "blobs", v tiny, were not ovaries but masses? Need to re-scan and re-assess. Certainly no follicular stasis seen. I think it may well be euthanasia and post-mortem / histo depending on what the owner wants, or ex-lap poss euth. Will have a chat!

RE: Persistant hyperglycaemia in young bearded dragon

Marie Kubiak — Sun, 24 Jan 2016 07:04:34 GMT

I would certainly be concerned about a gastric neurendocrine carcinoma (somatostatinoma). She is a little younger than the typical age group of 1.5-3yrs but the ongoing hyperglycemia in the absence of other causes is suspicious.

I would repeat the ultrasound after giving a liquid feed and examine the gastric wall carefully looking for a small (2-3m) mass and checking the rest of the coelom, especially liver, for mets. I often see hepatic lipidosis alongside these so the liver may look abnormal to start with! Gastroscopy after a couple of days of clear liquid feeds is an alternative. They aren't always marked- one I saw a couple of years ago we couldn't image at all and it only showed up on histo.

Corpora lutea are unusual findings on ovarian scans in reptiles- could this be consolidated follicles from chronic failure of ovulation? I have rarely seen hyperglycaemia in beardies with follicular stasis where infection has developed but it isn't the norm.

Marie