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Background: Despite being rare in domestic animals, pancreatic adenocarcinoma is the most common malignant tumor of the feline pancreas. Due non-specificity of clinical signs in cats and the late diagnosis of the neoplasm, it is necessary to understand this disease better, to contribute for the knowledge of its early recognition and treatment. Thus, this study aims to report a case of metastatic pancreatic ductal adenocarcinoma in a cat, focusing on the main clinical aspects, diagnosis, and prognosis of this disease, in addition to the description of the presentation of peritoneal carcinomatosis. Case: A 14-year-old male neutered mixed breed cat, was referred to the Feline Medicine Service (MedFel) of the Hospital de Clínicas Veterinárias (HCV) - Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, with a history of hyporexia, constipation and increased abdominal volume for 3 days, besides mild difficulty in locomotion and progressive weight loss in the last 6 months. On the physical examination, the patient was alert, with a body condition score of 6/9; muscle condition score 1/4 and moderate dehydration of 7%. Popliteal lymph nodes were enlarged, and abdominal distension was evident. Around 200 mL of a slightly cloudy, straw-yellow liquid were drained from the abdominal cavity. After draining the fluid, a new abdominal palpation was performed, and there were fecal retention and a palpable mass in the right hypogastric region. The result of the cytological analysis of the fluid was consistent with a protein-rich transudate, suggesting neoplastic effusion of epithelial origin. Hematological and biochemical changes included leukocytosis due to neutrophilia, monocytosis, lymphopenia, thrombocytosis and azotemia. On abdominal ultrasound, the patient had free fluid in the abdominal cavity, and the gallbladder had discreet of biliary sludge. The intestines showed some corrugated segments with other segments lacking definition of its layers, and without peristaltic movements, suggesting intestinal neoplasia. Pancreas and adrenals were not visualized. On the chest X-ray, moderate opacification of lung fields with a diffuse interstitial pattern was observed, suggesting lung metastasis. The patient presented an acute worsening of the clinical condition and the owner requested euthanasia. The patient was referred for necropsy and based on the macroscopic and microscopic changes, the post-mortem diagnosis was metastatic pancreatic ductal adenocarcinoma with peritoneal carcinomatosis. Discussion: The clinical presentation of cats with exocrine pancreatic neoplasia is nonspecific, as clinical signs are common to several diseases, such as anorexia, vomiting, abdominal pain, weight loss with normal appetite, jaundice, depression, and lethargy. Complementary blood tests also do not provide data that could lead to the suspicion of pancreatic neoplastic disease. In the present case, the diagnosis of metastatic pancreatic ductal adenocarcinoma with peritoneal carcinomatosis was only possible post mortem. The pancreas is a difficult organ to assess adequately using most diagnostic imaging methods, so histopathology is still the method of choice for differentiating pancreatic tissue comorbidities. Therefore, exploratory laparotomy should be instituted to provide tissue samples from the pancreas and its metastases for histopathological diagnosis, whenever ultrasound or other imaging methods indicate suspicious abdominal changes. The literature reports that less than 10% of affected cats treated with complete surgical removal of the mass and chemotherapy alone will survive more than a year, and the average time for untreated cats is only 6 days. The prognosis of this disease is bad and most cats are euthanized, due to rapid clinical worsening. Therefore, diagnosis is essential to determine an adequate prognosis in advanced cases and to support therapeutic decisions or euthanasia.

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Resumen La hipercalcemia maligna mediada por péptido relacionado con hormona paratiroidea (PR-PTH) es una manifestación poco común en tumores neuroendocrinos. Presentamos dos pacientes con tumores neuroendocrinos de páncreas con metástasis a hígado pero sin compromiso óseo en quienes se evidenció hipercalcemia maligna asociada a elevación de PR-PTH, con PTH suprimida. En ambos casos se logró normalizar temporalmente la calcemia con el uso de análogos de somatostatina, pero durante la evolución se requirió adición de bisfosfonatos en uno de ellos. Con la discusión de estos casos, la revisión de la literatura y de los casos similares publicados esperamos contribuir al mejor conocimiento de esta enfermedad.

Abstract Parathyroid hormone-related peptide-mediated hypercalcaemia (PTH-rp) is rare in patients with neuroendocrine tumours. The clinical cases are thus presented on two patients with pancreatic neuroendocrine tumours with liver metastases, but without bone involvement and with hypercalcaemia associated with elevated PTH-rp and with PTH suppressed. In both cases, it was possible to temporarily bring the calcium levels back to normal with the use of somatostatin analogues, but during the course of the disease, the addition of bisphosphonates was required in one of them. With the discussion of these cases and the review of the literature and similar published cases, it is hoped to contribute to provide better knowledge of this disease.

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Introducción: La neoplasia sólido papilar del páncreas (NSPP) descrita por Frantz en 1959 es una lesión rara, indolente, cuyo origen no ha sido dilucidado. La OMS lo establece como una neoplasia usualmente benigna, con un incremento en su frecuencia en los últimos años. Se presenta en mujeres jóvenes cuya edad promedio es 30 años. Raros casos son reportados en hombres. El presente estudio tiene como finalidad determinar el patrón al USE de la neoplasia solido papilar y correlacionarlos con los hallazgos citológicos de la punción aspiración por aguja fina. (PAAF). Métodos: Se evaluaron retrospectivamente 10 casos visualizados por USE y diagnosticados por PAAF como NSP durante Julio del 2006 a Junio del 2009. Resultados: 90% de los casos eran de género femenino, cuya edad promedio fue 35,2 años. El 90% fueron tumores únicos, con un tamaño tumoral predominante entre 4 a 6 cm en el 60%. No hubo preferencias en la localización. Al USE las lesiones eran de paredes gruesas, 90% ecomixtas, con áreas hiper e hipoecogénicas, macro, microquistes y áreas sólidas, el 10% mostró calcificaciones. En el 100% de los casos los extendidos citológicos presentaron, estructuras papilares con material metacromático en patrón de letras chinas, células con núcleos uniformes, cromatina finamente granular y hendiduras. Conclusión: La PAAF guiada por USE es un método eficaz para el diagnóstico de las NSPP.

Introduction: Solid papillary neoplasia of the pancreas (NSPP) described by Frantz in 1959 is a rare lesion, indolent, whose origin has not been elucidated. WHO establishes it as a neoplasm usually benign, with an increase in frequency in recent years. It occurs in young women whose average age is 30 years. Rare cases are reported in men. This study aims to determine the USE pattern of the solid papillary neoplasia and correlate them with the cytological findings of fine needle aspiration (PAAF). Methods: 10 cases were evaluated retrospectively visualized by USE and diagnosed by PAAF as NSP during July 2006 to June 2009. Results: 90% of the cases were female, whose average age was 35.2 years. 90% were single tumors with a predominant tumoral size between 4 to 6 cm in 60%. There was no preference in location. At USE the lesions were thick-walled, 90% mixed echogenic images with hyper and hypoechoic areas, macro, micro-cysts and solid areas, 10% showed calcifications. In 100% of the cases the cytological study presented papillary structures with metachromatic material in chinese characters pattern, cells with uniform nuclei, finely granular chromatin and crevices. Conclusion: PAAF guided by USE is an effective method for diagnosis of the NSPP.

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Objetivos: identificar os métodos de avaliação nutricional pré-operatória que possam diagnosticar a desnutrição em pacientes com neoplasia periampolar. Métodos: estudo prospectivo com 29 pacientes submetidos à cirurgia no Hospital de Clínicas de Porto Alegre. As avaliações foram realizadas no pré-operatório e incluíam dados antropométricos, bioquímicos e clínicos. Resultados: dos pacientes analisados 86% apresentaram perda de peso, destes 88% foram classificados com perda de peso grave, a média de perda de peso foi de 13,81%. A dobra cutânea tricipital mostrou desnutrição e perda de massa magra em 25 pacientes (86%), em relação à dobra cutânea subescapular 19 pacientes tiveram diminuição da massa magra e foram classificados como desnutridos. Em relação à circunferência muscular do braço e a circunferência do braço identificou-se 7 (24%) e 5 (17%) pacientes com desnutrição, respectivamente. Na avaliação bioquímica a concentração sérica de albumina, transferrina e contagem total de linfócitos indicou redução correspondente à desnutrição em 12 (41%), 20 (69%) e 18 pacientes (62%) respectivamente. Quinze deles (52%) tinham diagnóstico de diabetes mellitus. Conclusão: todos os pacientes apresentaram alguma variável nutricional alterada, mas o índice de massa corporal e a dosagem de albumina demonstraram alteração com menor frequencia enquanto que o percentual de perda de peso e a dobra cutânea tricipital mostraram a maior capacidade para detectar desnutrição.

Aim: to identify methods of preoperative nutritional assessment that can establish the diagnosis of malnutrition in patients with periampullary cancer. Methods: prospective study with 29 patients undergoing surgery in the Hospital de Clínicas de Porto Alegre. Assessments were performed during the preoperative period and included anthropometric, biochemical, and clinical data. Results: eighty-six percent of the patients showed weight loss, and 88% of these were classified as severe weight loss, while their mean weight loss was 13.81%. Triceps skinfold thickness revealed malnutrition and lean body mass decrease in 25 patients (86%); in relation to the subscapular skinfold thickness, 19 patients had lean body mass decrease and were classified as malnourished. In terms of arm muscle circumference and arm circumference, 7 (24%) and 5 (17%) patients had malnutrition, respectively. In the biochemical evaluation, serum albumin, transferrin and lymphocytes total count decreased suggesting malnutrition in 12 (41%), 20 (69%) e 18 (62%) patients, respectively. Fifteen patients (52%) had diabetes mellitus. Conclusion: all patients were found to have some degree of malnutrition. Body mass index and serum albumin level showed to be the least sensitive among the parameters used, whereas weight loss percentage and triceps skinfold thickness had the highest sensitivity for malnutrition in these patients.

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