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Bladder tumor in dogs

Bladder tumor in dogs


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Bladder tumor in dogs {#Sec1}

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Bladder tumors are one of the most common tumors in dogs [[@CR1], [@CR2]]. Although urothelial carcinoma is the most common histologic subtype, the morphologic spectrum of neoplasia includes not only benign tumors but also malignant forms, with metastatic disease eventually developing [[@CR1], [@CR3]].

Several theories have been proposed regarding the etiology and progression of neoplasia, including dietary, infectious, inflammatory, immunologic, and environmental factors [[@CR3]]. Although most tumors in dogs arise in the bladder, they can also occur in other parts of the urinary tract [[@CR1]].

Because of the low incidence and prevalence of cancer in cats, there is a limited amount of published information regarding this disease. However, several studies have indicated that carcinoma of the feline urinary bladder is the most common urinary tract tumor, occurring at a higher incidence in female cats than in male cats [[@CR4]]. In contrast to urothelial carcinoma in dogs, urothelial carcinoma in cats occurs most often in the trigone, urethra, or distal ureter, with fewer cases involving the bladder [[@CR4]--[@CR6]].

The most common histologic subtypes of urothelial tumors in cats include solid or papillary forms and more recently, neoplasms with histologic variants such as glandular or apocrine differentiation, cytoplasmic mucin, and a small cell/anaplastic form [[@CR7]--[@CR9]]. The morphologic features and histopathologic grades of urothelial tumors in cats correlate well with their clinical behavior, and tumors that involve the trigone or urethra are more likely to recur [[@CR4], [@CR6]]. Cats with urothelial carcinoma frequently present with clinical signs secondary to urinary tract obstruction, including vomiting and polyuria/polydipsia, urinary tract infection, or urinary tract stasis.

In this report, we describe the histologic and immunohistochemical features of an invasive urothelial carcinoma in a cat with polyuria. A review of the histologic features, diagnostic criteria, and immunohistochemical markers is included.

Case report {#Sec2}

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A 7-year-old male neutered domestic shorthr cat was evaluated for a 2-week history of intermittent, severe polyuria and polydipsia. The cat had become markedly polyuric over the course of 2 ,days, and its owners had noted that the cat had a small body mass. Upon examination, there was an exophthalmos and moderate subcutaneous edema, and the left eye could not be visualized. The remnder of the physical examination was normal, including normal mucous membranes, capillary refill time, temperature, heart rate, respiratory rate, abdominal palpation, and neurologic status.

Laboratory evaluation revealed a serum urea nitrogen concentration of 31 ,mg/dL (reference range, 8 to 24 ,mg/dL), serum creatinine concentration of 0.5 ,mg/dL (reference range, 0.3 to 0.6 ,mg/dL), a blood pH of 7.45 (reference range, 7.35 to 7.45), an arterial carbon dioxide tension (pCO~2~) of 22 ,mmHg (reference range, 22 to 40 ,mmHg), and an arterial oxygen tension (pO~2~) of 83 ,mmHg (reference range, 75 to 150 ,mmHg). The complete blood count, serum biochemistry, and urinalysis results were within the reference ranges. The feline urine was grossly turbid. An abdominal ultrasound revealed a poorly visualized left kidney (e.g., nonvisualization of the left kidney and urinary tract) with marked, noncrescentic, perirenal and retroperitoneal edema, the bladder wall was thickened. Computed tomography of the abdomen revealed severe perirenal, retroperitoneal, and ureteral edema with a dilated cranial portion of the left urinary bladder. Severe ventral subcutaneous edema was also noted, and the presence of an effusion was suggested. The edema was likely a result of chronic water and salt depletion and a secondary result of the urinary obstruction.

Treatment {#jvim13657-sec-0004}

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Upon presentation, the cat was given IV fluids (0.9% NaCl[5](#jvim13657-note-1005){ref-type="fn"} ) and a constant rate infusion (CRI) of intravenous (IV) piroxicam[6](#jvim13657-note-1006){ref-type="fn"} at 1.5 ,mg/kg q12h. The IV fluid rate was manually increased in 1 ,mL/h increments as the owner reported the cat appeared visibly comfortable, and this was followed by a manual reduction in the fluid rate by 1 ,mL/h once the animal became visibly uncomfortable. At no time did the patient require administration of additional fluid or vasoactive drugs to mntn adequate perfusion. The total volume administered was 3.5 ,L. The IV piroxicam was continued at 1.5 ,mg/kg q12h for 4 ,days.

Treatment also involved manual assisted cage cleaning (i.e., scooping bedding from the cage and scrubbing the cage floor) and offering free access to an unencumbered litter box or paper shredding bin (see Fig ,[1](#jvim13657-fig-0001){ref-type="fig"}). Over the course of the next week, the patient's feces resolved and the urine changed from pink to translucent with a specific gravity of 1.008. She was not observed to be licking the perineum for several days. There was no recurrence of her signs at 1 ,month of follow‐up.

![Image of the litter box the cat was permitted to use during the course of the 1‐week hospitalization.](JVIM-30-721-g001){#jvim13657-fig-0001}

Discussion {#jvim13657-sec-0005}

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To our knowledge, this is the first reported case of bladder wall rupture secondary to urethral obstruction. Although it is a rare case, bladder wall rupture secondary to urethral obstruction has been documented in dogs, with reported causes including trauma and urolithiasis.[2](#jvim13657-bib-0002){ref-type="ref"}, [3](#jvim13657-bib-0003){ref-type="ref"} Urethral obstruction has also been associated with urethral erosion, although we could not find any reported cases of urethral erosion associated with bladder rupture.

In human medicine, spontaneous bladder wall rupture is an extremely rare phenomenon.[4](#jvim13657-bib-0004){ref-type="ref"} The literature review was limited by the fact that although the cause of spontaneous bladder rupture is unknown, the incidence of spontaneous bladder rupture appears to be decreasing.[5](#jvim13657-bib-0005){ref-type="ref"} In one study of patients with urinary tract rupture, 2 of the 3 cases of spontaneous rupture occurred



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