Pericardial malignant mesothelioma diagnosed in a dog by immunocytochemistry of the pericardial fluid: a case report

Our plain-English summary of Pericardial malignant mesothelioma diagnosed in a dog by immunocytochemistry of the pericardial fluid: a case report, by E.W. Choi (BMC Veterinary Research, 2023).

The study

• Author: E.W. Choi
• Journal: BMC Veterinary Research
• Published: 2023;19(1):89
• Type of article: Case report
• Cited by: 4 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Background: Pericardial effusions are one of the most common cardiac diseases in dogs. Common causes of haemorrhagic pericardial effusions include neoplasia, such as hemangiosarcoma, mesothelioma, chemodectoma, and ectopic thyroid tumours, and benign idiopathic pericardial effusion. Distinguishing among reactive mesothelial cells, malignant mesothelioma, and adenocarcinoma in body effusions is a diagnostic challenge. Therefore, the author aimed to discover whether the observed cells were reactive mesothelial, mesothelioma, or adenocarcinoma cells through immunocytochemistry using five markers (cytokeratin, vimentin, desmin, E-cadherin, and calretinin) in a canine patient.

Case Presentation: A 2.1 kg, spayed female, 10-year-old Yorkshire Terrier dog presented to a local hospital with dyspnoea and was evaluated for pericardial effusion. The presence of pericardial fluid was confirmed, and she was referred to our hospital for further evaluation. In cytological evaluation, cells shed individually or in clusters were observed, along with numerous non-degenerative neutrophils and macrophages. The cells showed binucleation, anisocytosis, anisokaryosis, abnormal nucleoli, abundant basophilic cytoplasm, high nuclear-cytoplasmic ratio, and coarse chromatin. Large atypical multinucleate cells were also observed. Erythrophagia was observed, indicating chronic haemorrhage. Immunocytochemistry using pericardial fluid was positive for cytokeratin, vimentin, desmin, E-cadherin, and calretinin. Therefore, malignant mesothelioma was diagnosed.

Conclusions: Immunocytochemistry is a very useful diagnostic technique because it can determine whether several fluorescent markers are simultaneously expressed in the same cell. Further, E-cadherin and calretinin can be used for the differential diagnosis of reactive mesothelial cells, malignant mesothelioma, and adenocarcinoma in dogs.

© 2023. The Author(s).

In plain English

This veterinary case report described one dog, a 2.1 kg, spayed female, 10-year-old Yorkshire Terrier, seen at a local hospital for breathing difficulty (dyspnoea). Fluid was found around the heart (pericardial effusion), and the dog was referred to Kangwon National University Veterinary Teaching Hospital in the Republic of Korea. There, 30 ml of the fluid was drawn under ultrasound guidance. Bacterial and fungal cultures were negative, and blood tests showed no abnormalities. Under the microscope the fluid contained abnormal cells, including large atypical cells with several nuclei. The author then stained the fluid with five markers (cytokeratin, vimentin, desmin, E-cadherin and calretinin), and all five were positive. On that basis, pericardial malignant mesothelioma was diagnosed from the fluid of the living dog. The article does not report a tissue biopsy or autopsy for this dog. The author concluded that E-cadherin and calretinin can be used to tell apart reactive mesothelial cells, malignant mesothelioma and adenocarcinoma in dogs, and stated that larger studies are needed. The article does not mention asbestos or any other exposure.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Case report (single veterinary patient)
• Who was studied: One dog: a 2.1 kg, spayed female, 10-year-old Yorkshire Terrier with dyspnoea, referred to Kangwon National University Veterinary Teaching Hospital, Republic of Korea
• Exposure: Not reported. The article does not discuss asbestos or any other exposure.
• Main results:
  • In this dog, bacterial and fungal cultures of the pericardial fluid were negative, and there were no abnormalities in the complete blood count or serum chemistry
  • Microscopic examination of this dog's pericardial fluid showed abnormal cells, including large atypical multinucleate cells, along with neutrophils and macrophages
  • Immunocytochemistry of this dog's pericardial fluid was positive for all five markers (cytokeratin, vimentin, desmin, E-cadherin and calretinin), and malignant mesothelioma was diagnosed
• The authors' conclusion: The author concluded that immunocytochemistry is a very useful diagnostic technique and that E-cadherin and calretinin can be used to distinguish reactive mesothelial cells, malignant mesothelioma and adenocarcinoma in dogs
• Limitations the authors state:
  • The author stated that further studies with larger sample sizes are needed before testing with only two markers (E-cadherin and calretinin) can be relied on
  • The author noted the test took two days to complete, was estimated to cost hundreds of dollars per marker, and was not known to be offered by commercial labs in the area

Topics

The National Library of Medicine indexes this study under subjects our site covers: Mesothelioma.

Medical terms in this study, explained in our Lexicon: Pericardial, Mesothelioma, Pericardial Effusion, Idiopathic, Reactive Mesothelial Hyperplasia, Adenocarcinoma, Desmin, Calretinin.

Related studies

• Cytological differential diagnosis among adenocarcinoma, epithelial mesothelioma, and reactive mesothelial cells in serous effusions by immunocytochemistry — X.Y. Su, G.D. Li, et al. (2011)
• Recurrence of Pericardial Mesothelioma Affecting the Myocardium After Pericardial Resection — M. Rodríguez, H.R. Mallidi, et al. (2018)
• Recurrent Tumor Suppressor Alterations in Primary Pericardial Mesothelioma — I.M. Schaefer, A. Mariño-Enríquez, et al. (2023)
• Primary pericardial mesothelioma: a case report of a patient treated with an immune checkpoint inhibitor as the second-line treatment — O. Arponen, V. Salo, et al. (2021)
• Primary pericardial mesothelioma complicated by pericardial calcification — J. Zhang, D. Liu, et al. (2023)
• Echocardiographic characteristics of primary malignant pericardial mesothelioma and outcomes analysis: a retrospective study — L. Kong, Z. Li, et al. (2018)

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