Today's Veterinary Practice

JAN-FEB 2018

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89 JANUARY/FEBRUARY 2018 ‚óŹ TVPJOURNAL.COM CLINICAL INSIGHTS A pseudo-layered pattern has been described in some canine gastric epithelial neoplasia, such as carcinoma. 17 In that study, pseudo-layering was characterized by transmural thickening with altered wall layering, as well as a poorly echogenic lining along the innermost and/or outermost portions of the gastric wall, separated by a more echogenic central region. 17 Leiomyosarcomas produce focal masses, often involving the gastric antrum, and thickening of the muscular layer of the gastric wall. 19 These neoplasms are usually small, rounded masses that protrude into the gastric lumen at the level of the cardia. The luminal surface of these lesions is usually smooth, due to their origin in the muscularis layer. Lymphoma is the most common gastric neoplasm in the cat. It appears as a focal mass, multiple masses, or diffuse infiltrative neoplasia, characterized by thickening and/or loss of normal layered appearance to the wall ( FIGURE 11 ). 20-22 Features of malignant histiocytosis include a single, well circumscribed, hypoechoic mass with well-defined borders and an abnormal loss of wall layering in the dog. 23 Benign Gastric Neoplasms Adenomas can occur in dogs and cat and can appear flat or polypoid. 18 Gastric leiomyomas are the second most common neoplasm in the stomach of a dog. They form single or multiple, sessile, round polyps protruding into the lumen. 24 The most common locations include the gastric cardia or gastroesophageal junction. 25 Leiomyomas cannot be differentiated from leiomyosarcomas using ultrasonography alone; cytology or histopathology are required for definitive diagnosis. Other Causes of Gastric Wall Masses or Abnormal Wall Layering Chronic hypertrophic gastritis can cause severe gastric wall thickening without a loss of wall layering, or a thickened, hypoechoic layer can be seen surrounding the pyloric lumen (interpreted as a thickened muscularis layer, histologically). 9 In particular, the rugal folds of the mucosal layer become severely thickened and project into the lumen. 26,27 Eosinophilic sclerosing fibroplasia occurs in cats. Ultrasonographically, they are focal mass lesions or mural thickening at the pyloric antrum with a loss of wall layering ( FIGURE 12 ). 28,29 Pythiosis is a chronic, pyogranulomatous infection caused by the water mold Pythium insidiosum. This can cause focal thickening of the gastric wall, with partial or complete obliteration of the wall layers ( FIGURE 13 ). 30,31 FIGURE 11. Longitudinal axis view of the stomach of a cat diagnosed with gastrointestinal lymphoma via cytology (A). Note the loss of wall layering and the severely thickened and hypoechoic gastric wall ( calipers ). Blood flow through this hypoechoic mass is confirmed using color Doppler (B). A B FIGURE 12. Longitudinal axis view of a segment of jejunum of a cat diagnosed with eosinophilic sclerosing fibroplasia via cytology. Note the abnormally thickened, hypoechoic muscularis layer, causing overall thickening of this segment ( calipers ). This disease is difficult to distinguish between other inflammatory and neoplastic diseases but can be confirmed using cytologic or histopathologic methods.

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