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174 EQUINE VETERINARY EDUCATION

Equine uet. Educ. (1999)11 (4)174-178

Satellite Article
Weight loss in the horse: a focus on abdominal neoplasia
LESLIEM. EAST,CATHERINE
J. SAVAGE
AND JOSIEL.TRAUB-DARGATZ
Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State
University, 300 West Drake, Fort Collins, Colorado 80523, USA.

Introduction Further diagnostic aids


Discerning the cause of weight loss in a horse can vary from Baseline data should be collected (i.e. biochemical profile,
straightforward to a highly complex evaluation of the haematology and urine analysis). The biochemical profile
patient. It is best to approach the diagnostic challenge of may target specific organ involvement and, therefore, aid
weight loss by addressing 3 main categories: inadequate localisation of the tumour. It may also indicate the
intake of calorieshtilisation, increased metabolic presence of a paraneoplastic syndrome (hormonal,
requirements and organ dysfunction (Traub-Dargatz et al. neurological, haematological and other clinical and
1992). Within these 3 main categories, there are a number biochemical disturbances associated with malignant
of specific disease processes and management factors that neoplasms). The more common of the paraneoplastic
may contribute to the problem of weight loss. If the horse syndromes involve the release of parathyroid hormone
has an adequate ration, a regular anthelmintic schedule, related peptide (PTHrP) and less commonly
routine dental care and minimal environmental stressors, erythropoietin. Excess PTHrP causes increased calcium
the veterinarian should focus on infectious, toxic, traumatic resorption from the bone resulting in clinical
and neoplastic causes for the weight loss. Figure 1 is an hypercalcaemia. This can lead to dystrophic calcification
overview of the more common causes for weight loss in the heart, blood vessels, and kidneys. Parathyroid-like
as well as a guide to available diagnostic aids for the substances have been identified in horses with gastric
veterinarian in determining the specific cause. squamous cell carcinomas and lymphosarcomas (Mair et
The primary focus of this weight loss review is on al. 1990; Marr 1994). Excessive erythropoietin production
methods of diagnosis of equine abdominal has been speculated to have caused polycythaemia in a
neoplasia. (Traub et al. 1983; Marr 1994). There are filly with a hepatocellular carcinoma (Roby et al. 1990).
numerous different neoplastic processes that can affect the Haematology provides more nonspecific evidence of an
equine abdomen relative to the tissue type affected, blood underlying neoplastic condition such as an anaemia due to
supply, and lymphatic drainage. Figure 2 summarises chronic disease or haemorrhage. Leucocytosis or
the different types of neoplasia that can occur in each hyperfibrinogenaemia may indicate a source of chronic
section of the gastrointestinal tract, peritoneum and major inflammation associated with a neoplasm (Traub et al.
abdominal organs. 1983). Other tests that may be of benefit for identifjmg
certain tumour types are outlined in Figure 1.
Methods Once the veterinarian has decided to focus on the
abdomen, a transrectal palpation should be performed to
Initial approach identify abnormal masses, thickened bowel walls,
When investigating the cause of equine weight loss, the irregular peritoneal surface (carcinomatosis) or enlarged
clinician should begin by obtaining a thorough history, lymph nodes (Traub et al. 1983). If an abnormality is
evaluation of the horse’s environment, and physical found, ancillary diagnostic aids such as abdominal
examination. Important physical examination findings ultrasonography, abdominal radiography, gastroscopy
that may suggest abdominal disease include: abnormalities (3 m endoscope), and nuclear scintigraphy may help define
in abdominal size, posture, borborygmi and faecal the nature of the mass.
consistency. If abdominal effision or an abdominal mass is If a gastroscope is not available, gastric lavage and
present, the abdomen may be pendulous whereas if the evaluation for neoplastic cells may be helpful, especially
patient is inappetent or has abdominal pain, the abdomen if malodour is noted during nasogastric intubation
may be tucked up or splinted. Borborygmi are often (Traub et al. 1983).
variable. The faecal consistency can range from well Ultrasonography may be used both transrectally
formed with mucous (increased transit time) to cow pie (5 MHz) and transabdominally (2.5-3.5 MHz) to visualise
(malabsorption or decreased transit time). All peripheral a mass and permit a transcutaneous biopsy of a mass.
lymph nodes should be evaluated for any enlargement; These ancillary aids may identify abnormal abdominal
however, this is an uncommon manifestation of abdominal structures or tissues even if no palpable abnormalities are
neoplasia. The appendicular and axial skeleton should be found on transrectal examination. Few veterinary clinics
evaluated for any signs of bony metastasis. are equipped to perform abdominal radiographs;
Leslie M. East et al. 175

-
z=5
ILcaloric intake/utilisation

Management Disease
I

II I I I

Poor quality feed Lameness Liver: Albumin, glucose, BUN, GGT, SDH, ALP,
Oral trauma Increased exercise Lactation Trauma AST, bile acids, clotting profile, ultrasonography
Mineral imbalance Organ failure
Vitamin imbalance Dental attrition Temperature Breeding stallion and biopsy (culture and histology)
Oesophageal disease Windchill Sepsis
Inadequate ration Infection
Overcrowding Stomach disease Breeding history Kidney: CBC; serum creat., BUN, Na, K, C1,
Inflammatory bowel di Neoplasia HCO,, Ca; urinalysis; fractional excretions;
Poor dental care Rectal examination
Neoplasia Chronic pain enzymuria; ultrasonography; cystoscopy; clotting
Parasitic infection Ultrasonography
Feeding on ground Neurological disease Exercise regime Milk production profile; biopsy (culture and histology)
Toxin exposure Housingkhelter Breeding book
I Spleen: CBC; ultrasonography; aspirate (culture
1 and cytology)
I History or physical evidence of trauma
Feed inspection
Ration analysis
I Blood Ehemistry (See organ dysfuntion)
CBC
I Adrenals: CBC; serum glucose; serundurine;
catecholamines
Separation of horses Lameness evaluation External, thoracic and abdominal evaluation for Pancreas: Serun GGT,Ca, insulin; amylase and
Oral examination Oral examination evidence of neoplasia or infection lipase on abdominal fluid and serum
Faecal flotation Endoscopylgastroscopy II
Faecal sand Neurological evaluation, Heart: Ausculation; echocardiography;
sedimentation EMG, CSF CBC, fibrinogen, blood chemistry, protein RID
Rectal examination electrocardiography; blood gas
Abdominal Feedlwater analysis
radiographs CBC, fibrinogen, serum Abdominocentesis (cytology and culture)
Gastroscopy (+I-biopsy or lavage) Pituitary: CBC; serum glucose; endogenous
chemistry ACTH, low-dose dexamethasone suppression
Zylose absorption Tracheal lavage (cytology and culture)
Rectal examination Thoracocentesis
AbdominaVthoracic ultrasonography Further evaluation of these organs for evidence
Abdominocentesis of neoplasia or infection
Abdomindthoracic radiography
External, thoracic and Exploratory surgeryllaparoscopy/thoracoscopy
Biopsy (+I- coagulation profile)
abdominal evaluation for
evidence of neoplasia I I Nuclear scintigraphy (699m)

Fig 1: Causes of weight loss in the horse and available diagmetic aide.

/iGiGZG, Ruled
\ o \,led out /Ruled out

I Inappropriate management Neurological disease

Neoplasia of other systems

Abdominal neoplasia

Squamous cell

Lymphosarcoma Leiomyosarcoma
Adenocarcinoma Lipomatosis Haemangiosarcoma
Leiomyosarcoma
Leiomyoma
Strangulating lipoma
Space occupying lipoma

Fig 2: Causes of weight lone in the horse (East and Savage 1998) with a focus on abdominal moplmia.
176 Weight loss in the horse

Fig 5: A large nodular renal adenocarcinoma, 31 x 16 x


16 cm,after right-sided surgical nephrectomy.

Fig 3: A large, 20 x 10 x 3 cm productive, necrotic squamus abdominocentesis with cytology, needle aspirate,
cell carcinoma involving the squamus portion of the biospy, laparoscopy and exploratory laparotomy.
stomach W a c e n t to the margo plicatus at necropsy. Any extensive work-up of weight loss should
include an abdominocentesis in an effort to identify
any abnormalities or neoplastic cells in the abdominal
fluid. If neoplastic cells are not seen in the abdominal
fluid, there may be a n increased total protein
concentration (>25 gA) and white blood cell count
(>5 x lO9fl) in the abdominal fluid. These abdominal fluid
changes may occur when a neoplastic mass invades other
tissues and outgrows its blood supply, i.e. tumour necrosis.
A fine needle aspirate or biopsy of a mass with
cytologyhistology of t h e sample may provide
invaluable information.
Laparoscopy and laparotomy may be required if less
invasive techniques have not elucidated the cause of weight
loss or if a treatment attempt is to be made (Darbareiner et
al. 1996). These 2 modalities may be the only means of
obtaining a definitive diagnosis when a mass lesion is not
Fig 4: A spherical hypoechoic lymphosarcoma m a s s lenwn accessible for transcutaneous biopsy, if multiple organ
in the splenic parenchyma visualised with involvement in suspected or if abdominal fluid analysis is
ultrasonography (3 MHx). inconclusive. Laparoscopy and laparotomy allow diagnostic
biopsies to be performed and permit optimal visualisation
however, radiographs sometimes permit visualisation of of abdominal structures. The following is a review of 3
large soft tissue masses or calcified tumour beds. equine cases with abdominal neoplasia.
Similarly, metastatic lesions to the lungs from t h e
abdomen may be detected on thoracic radiographs. Case reviews
Nuclear scintigraphic evaluation of the
equine abdomen with Tc-99m HMPAO Squamous cell carcinoma
(hexamethylpropyleneamine oxime) and HDP A 9-year-old Quarter Horse gelding was admitted for mild
(hydroxymethylene diphosphonate) has not been colic and inappetence of 3 days duration that had been
commonly applied, but has been used by one author (East unresponsive to oral fluids and flunixin meglumine
et al. 1998) to diagnose metastatic colonic administration. The horse had a history of progressive
adenocarcinoma to bone. weight loss over the past month that had stabilised with
Other useful diagnostic techniques in patients an augmented feeding regime. There was a regular
suspected to have abdominal neoplasia include anthelmintic and dental programme.
Leslie M. East et al. 177

At the time of hospitalisation, the horse showed mildly 2 hypoechoic spherical lesions (2 x 2 cm) (Fig 4). Three
obtunded mentation, but no signs of colic. The remainder ultrasonographically-guided needle biopsies were
of the physical and transrectal examination was performed. Cytology revealed neoplastic appearing
unremarkable. Upon nasogastric intubation, a foetid lymphoblasts consistent with lymphosarcoma. The
odour was evident, but no reflux was present. owners opted for euthanasia.
Baseline data included haematology, serum Necropsy revealed multiple adhesions of the
biochemistry and abdominal fluid analysis. Haematology diffusely enlarged spleen to the body wall, left kidney,
revealed a mature neutrophilia; and biochemistry a mild and stomach. The liver had multiple small pale, 2 mm,
hyperglycaemia (6.44 mmoM: reference range 4.05-6.27 nodules and was adhered to the diaphragm. Regional
mmoM) and hypoalbuminemia (23 g/l: reference range lymph nodes were diffusely enlarged. No other gross
27-36 g/l). The abdominal fluid had a mildly elevated total abnormalities were found. The histological diagnosis was
white blood cell count (5.5 x lO9A: reference range 4 . 0 x primary splenic lymphosarcoma with lymphatic and
lO9A) and total protein concentration (37 g/l: reference hepatic metastasis.
range 4 5 g/l). The distribution of cells was normal.
The horse was given supportive medical care with i.v. Renal adenocarcinomu
fluids for 12 h and required no further analgesics. The
horse ate small amounts of grass hay when offered. Given A 16-year-old Quarter Horse mare was admitted for
the recent history of weight loss, colic, and inappetence evaluation of a right sided abdominal mass that had been
combined with the abnormal gastric odour and abdominal treated as an abscess for one month with trimethoprim-
fluid, a gastroscopic evaluation was performed to evaluate sulphamethoxazole (30 mg/kg bwt, per 0s q. 12 h) with no
the horse for the presence of gastric ulcers or neoplasia. A improvement. The horse had a one year history of weight
large proliferative ulcerated mass was found in the loss, intermittent inappetence and polydipsia.
squamous portion of the stomach. The owners declined The only abnormalities on physical examination were
surgical intervention and elected for euthanasia given the weight loss and mild tachycardia (52 beatdmin). Baseline
likelihood of gastric neoplasia. At necropsy, a large 20 x 10 laboratory data included a haemogram, serum
x 3 cm productive, necrotic mass was found in the biochemical profile, and urine analysis. Haematology
squamous stomach adjacent to the margo plicatus (Fig 3) revealed a mild neutrophilic leucocytosis, biochemistry
There were fibrous adhesions of the stomach to the liver was normal and hyposthenuria was the only abnormality
and the diaphragm. Histology revealed acantholytic on urine analysis.
stratified squamous epithelial cells with keratin pearls Transrectal palpation, ultrasonography, and
consistent with gastric squamous cell carcinoma. There transcutaneous biopsy were performed to further evaluate
were no metastatic lesions found. the mass. Transrectal palpation revealed a right-sided
abdominal mass that measured approximately 30 x 15 x
Lymphosarcoma 15 cm, but the entire mass could not be palpated.
Ultrasonography revealed a large hyperechoic mass
A 6-year-old Arabian mare was admitted for weight loss extending from the sublumbar musculature to the ventral
despite an excellent anthelmintic, dental care and abdomen on the right side. The mass appeared to originate
aggressive feeding programme. Physical examination was from the cranioventral aspect of the right kidney. No
normal except for the mare’s poor body condition and the ultrasonographic abnormalities were noted on
presence of an intermittent expiratory grunt. Extensive
ultrasonography of the left kidney or remainder of the
thoracic auscultation and rebreathing revealed no
abdomen. The owners elected not to have a biopsy taken of
adventitious lung sounds. Transrectal examination
the left kidney. Ultrasound-guided biopsies of the right-
revealed a diffusely enlarged spleen that was adherent to
sided mass revealed it to be a renal adenocarcinoma.
the body wall.
The owners elected for surgical removal. No
Haematology was normal other than a mild anaemia
abnormalities were noted on preoperative thoracic
(PCV = 29%: reference range 32-52%) and a mild
radiographs, e.g. no metastatic lesions visualised. The
hyperfibrinogenaemia (0.5 g/l: reference range 0.1-0.4 gA).
horse successfully underwent right-sided nephrectomy of
The only biochemical abnormalities were a low albumin
(21 g/l: reference range 2 7 3 6 gA) and an elevated globulin the renal adenocarcinoma (Fig 5) and follow-up a t 12
(44 gll: reference range 2&35 g/l) concentration. months revealed that the horse was clinically normal.
Further diagnostics were focused on evaluation of the
abdomen after a n abnormally enlarged spleen was Discussion
identified on transrectal palpation. An abdominocentesis
was performed. Although cytology of the abdominal fluid The diagnosis of abdominal neoplasia in the horse can be
was normal, there was a n elevated total protein extremely difficult given the vague clinical signs and
(38 gA: reference range <25 gA). Transabdominal minimal clinicopathologicalabnormalities that accompany
ultrasonography was performed. The spleen was the only this disease. The most common abnormalities
abnormal structure visualised from the 13th to 17th include: anaemia, hyperfibrinogenaemia, hypo-
intercostal space on the left side. Ultrasonography albuminaemia, leucocytosis and hyperglobulinaemia.
revealed that the spleen was diffusely enlarged with Many of these -clinicopathological abnormalities were
178 Weight loss in the horse

present in the cases described. If there is specific organ Colorado and Drs L.J. Krauter and L.M. East for the
involvement, related biochemical parameters may be clinical case of splenic lymphosarcoma admitted to
abnormal (Fig 1).Some patients with lymphosarcoma Pilchuck Veterinary Hospital, Snohomish, Washington.
may have a low IgM on radioimmunoassay due to putative
suppressor T lymphocyte activity. (Furr et al. 1992) References
Common clinical signs associated with abdominal
neoplasia include intermittent fever, anorexia, weight Bounous, D.I. (1993) Diagnostic dilemma: Case presentation.
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(Traub et al. 1983). All of these signs in varying Chafin, M.K., Schmitz, D.G., Brumbaugh, G.W. and Hall, D.G.
combinations were present in the patients described. (1992) Ultrasonographic characteristics of splenic and hepatic
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(squamous cell carcinoma and lymphosarcoma) had East, L.M., Steyn, P.S., Dickinson, C.E. and Frank, A.A. (1998)
abnormalities of abdominal fluid, i.e. transudate and Occult osseous metastasis of a colonic adenocarcinoma
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revealed the gastric squamous cell carcinoma. horse. Vet. Rec. 126,99-101.
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splenic lymphosarcoma and pseudohyperparathyroidism.
abdominal neoplasia can be straightforward to complex.
Equine vet. J. 21, 221-226.
Many patients can be diagnosed in the field without
special equipment. The eventual definitive diagnosis or McKenzie, E.C., Mills, J.N. and Bolton, J.R. (1997) Gastric
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The authors would like to thank Drs T.S.Stashak, D. Traub, J.L., Bayly, W.M., Reed, S.M., Modransky, P.D. and
Frisbie and C.J. Savage for the clinical case of renal Rantanen, N.W. (1983) Intraabdominal neoplasia as a cause of
adenocarcinoma admitted to Colorado State University chronic weight loss in the horse. Comp. cont. Educ. pruct. Vet.
Veterinary Teaching Hospital, Fort Collins, Colorado; Drs 5, S526-534.
C.E. Dickinson and L.M. East for the clinical case of Traub-Dargatz, J.L., Fettman, M.J. and Dargatz, D. (1992)
squamous cell carcinoma admitted to Colorado State Identifying the cause of weight loss in horses. Vet. Med. 87,
University Veterinary Teaching Hospital, Fort Collins, 346-355.