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Extensive small intestinal wall thickening in a catAna Rita Ramalho Furtado,1 Jordi Puig,2 Roberta Rasotto,2 Mauro Pivetta3
1Swayne and Partners,Newmarket, Suffolk, UK2Animal Health Trust,Newmarket, Suffolk, UK3NDSR, Bletchingley, UK
Correspondence toDr Ana Rita Ramalho Furtado,rita.ramalho.furtado@gmail.com
Received 17 December 2014Revised 6 January 2015Accepted 12 January 2015
To cite: Furtado ARR,Puig J, Rasotto R, et al. VetRec Case Rep Publishedonline: [please include DayMonth Year] doi:10.1136/vetreccr-2014-000166
DESCRIPTIONA two-year-old domestic shorthair cat presented forinvestigation of a six-month history of intermittentvomiting, weight loss, hyporexia and lethargy.Abdominal ultrasound was performed and revealedextensive small intestinal wall thickening (averagethickness measured 8 mm) with preserved layering.In particular, there was marked thickening of the
muscularis propria layer (variable thickness from4 to 5 mm) with normal mucosal and submucosallayers (Daniaux and others 2014), Overall, therewas normal intestinal peristaltic activity and no evi-dence of intestinal obstruction.The ultrasonographic changes were consistent
with intestinal smooth muscle hypertrophy such asseen with severe diffuse inflammatory infiltrativebowel disease or a diffuse neoplastic intestinaldisease such as lymphoma (Fig 1) (Zwingenbergerand others 2010 and Diana and others 2003).Full-thickness biopsies of duodenum, jejunum and
ileum were collected. Histopathology confirmed thethickening of the intestinal wall due to markedexpansion/thickening of the muscularis with mildfibrosis and inflammation in the mucosa. The tunicamuscularis was approximately five times (inner layerfour times, external layer one time) thicker than thesubmucosal layer (Fig 2). Immunohistochemistry forCD3 and CD79a demonstrated that the lymphoidpopulation infiltrating the intestinal mucosa was com-posed of an admixture of Tand B lymphocytes rulingout lymphoma.In this case, ultrasound was proven to be an essen-
tial means of diagnosis showing similar muscularischaracteristics as the ones seen on histopathology(Fig 2). However, full-thickness surgical biopsy fol-lowed by histopathology and immunohistochemistryare mandatory to reach a final diagnosis.
FIG 1: Linear probe transverse plane image through asegment of small intestine illustrating severe muscularisintestinal wall thickening
FIG 2: (a) Histopathology of the duodenum. The tunica muscularis (asterisk) appears approximately five timesthicker than the submucosa (dagger). H&E stain; bar=400 mm. (b) Linear probe longitudinal plane image of theduodenum, illustrating the same muscularis thickening as seen on (a)
Furtado ARR, et al. Vet Rec Case Rep 2015;3:e000166. doi:10.1136/vetreccr-2014-000166 1
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Contributors All the authors have given final approval of the submittedmanuscript for which all take public responsibility for the whole content. All theauthors qualify for authorship based on making one or more of the substantialcontributions to the intellectual content, conception and design, acquisition of dataand analysis and interpretation of data. Furthermore, ARRF has participated indrafting of the manuscript, while JP was responsible for critical revision of themanuscript for important internal medicine content, RR for the histopathologycontent and MP for the diagnostic imaging content.
Competing interests None.
Provenance and peer review Not commissioned; externally peer reviewed.
REFERENCESDANIAUX L. A., LAURENSON M. P., MARKS S. L., MOORE P. F., TAYLOR S. L., CHEN R. X.,ZWINGENBERGER A. L. (2014) Ultrasonographic thickening of the muscularis propria infeline small intestinal small cell T-cell lymphoma and inflammatory bowel disease. Journalof Feline Medicine and Surgery 16, 89–98.
DIANA A., PIETRA M., GUGLIELMINI C., BOARI A., BETTINI G., CIPONE M. (2003)Ultrasonographic and pathologic features of intestinal smooth muscle hypertrophy infour cats. Veterinary Radiology Ultrasound 44, 566–569.
ZWINGENBERGER A. L., MARKS S. L., BAKER T. W., MOORE P. F. (2010) Ultrasonographicevaluation of the muscularis propria in cats with diffuse small intestinal lymphoma orinflammatory bowel disease. Journal of Veterinary Internal Medicine 24, 289–292.
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2 Furtado ARR, et al. Vet Rec Case Rep 2015;3:e000166. doi:10.1136/vetreccr-2014-000166
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