Isabelle's pathology report and ultrasound picture
By Elizabeth

Isabelle's ultrasound pictures of the adrenal glands:

Histology report following adrenal surgery:

HISTORY: Exploratory laparotomy. ? Adrenal tumour - sample enclosed. Splenectomy - 2 samples enclosed.

Adrenal Cortical Carcinoma and Extramedullary Haemopoiesis

Prognosis Very Guarded

TUMOUR: The sections reveal the typical appearance of an adrenal cortical carcinoma, composed of pleomorphic cell populations comprising large, polyhedral cells with abundant, eosinophilic, finely vacuolated cytoplasm; and smaller, more basophilic cells with relatively scant cytoplasm. These two basic cell types are present in variable proportions as mixed sheets, or as smaller nests or cords of a single cell type, surrounded and separated by a fairly generous amount of fibrous stroma. There is moderate nuclear pleomorphism, with occasional atypia, and a few mitotic figures can be found, but the mitotic index is not particularly high. There is evidence of infiltrative behaviour, with nests of neoplastic cells spreading into the adjoining mesenteric fat.

According to many sources, adrenal cortical tumours are the second most common neoplasms in ferrets, after islet cell tumours of the pancreas. As with islet cell tumours they are more frequently recorded in spayed females and castrated meales than entire animals. Adenomas are small and usually present as a discrete nodule within an otherwise unremarkable gland, while carcinomas are large, frequently completely effacing the normal architecture of the gland. Distant metastasis apparently occurs infrequently, so early surgical removal of the affected adrenal gland can be curative, even with carcinoma. I am concerned in this case, houwever, by the presence of clusters of neoplastic cells within the lumen of a vein adjacent to the tumour; although I cannot rule out the possibility that they are there artefactually (i.e. dragged there by the microtome blade), I suspect this is evidence of metastatic potential.

SPLEEN: The two sections examined are histologically similar. Microscopy reveals marked congestion and extramedullary haemopoiesis (EMH), but little else worthy of note. EMH is commonly seen in the spleen of the ferret and excessive EMH is a common cause of splenomegaly. The cause is uncertain; it may be compensatory for myeloid insufficiency, but in some cases no such deficiency can be demonstrated. There is no significant stimulation of germinal centres to suggest Aleutian Disease, nor are there any accumulations of obvioulsy atypical lymphocytes to suggest lymphoma.

Overall, given the appearance of the adrenal carcinoma, the prognosis is very guarded.