358 Brief Communications and Case Reports Vet Pathol 43:3, 2006

Vet Pathol 43:358–362 (2006)

Gastric Adenocarcinoma and Chronic Gastritis in Two Related Persian Cats

M. M. DENNIS, N. BENNETT AND E. J. EHRHART

Abstract. Two 12.5-year-old castrated male Persian cats from the same household, whose dams were
littermates, presented simultaneously with gastric adenocarcinoma associated with proliferative and
fibrosing gastritis. Intralesional adult Ollulanus tricuspis nematodes and rare surface-associated spiral-
shaped bacteria were identified in one cat. No etiologic agents were identified in tissues from the second
cat; however, gastric mucosa was examined following anthelmintic treatment. Clinical signs in each cat
had commenced 2 months apart and included vomiting, hematemesis, intermittent melena, and weight
loss. This is the first report of gastric adenocarcinoma occurring in housemate cats or cats of common
descent. Carcinogenesis may have been influenced by shared undetermined genetic and environmental
factors, possibly including Ollulanus tricuspis, spiral-shaped bacteria, or other etiologies for chronic
gastritis that remain unidentified.

Key words: Adenocarcinoma; cats; gastritis; Helicobacter; nematodes; neoplasia; Ollulanus tricuspis;
parasite.

Gastric adenocarcinoma is exceedingly uncommon in
cats. No predisposing factors have been identified in cats
that might be associated with gastric mucosal trans-
formation and tumorigenesis. This manuscript reports
the simultaneous occurrence of gastric adenocarcinoma
in two related cats from the same household and
discusses some potential contributory factors.
Two 12.5-year-old, castrated male Persian cats were
presented to Colorado State University Veterinary
Teaching Hospital (CSU-VTH), on the same day.
Clinical signs had emerged 2 months apart and included
vomiting, hematemesis, intermittent melena, hyporexia,
and weight loss of 4–6 months duration. The cats were
of common maternal lineage because they were born
from queens that were littermates, although the sires
were unrelated. The cats were raised strictly indoors
within the same household. They had been the only cats
in the household from the time they were young adults.
There was no known exposure to cats outside of the
household. Neither cat had been administered anthel-
mintic medication as an adult.
Cat No. 1 was referred to CSU-VTH with a diagnosis
of mild, chronic, multifocal, superficial lymphoplasma-
cytic gastritis based on endoscopic biopsies taken
3 months prior. The referring veterinarian described
the gross appearance of the fundic mucosa as irregular.
The cat had been treated with sucralfate, cimetidine,
cefazolin, enrofloxacin, chlorpheniramine, prednisone,
metronidazole, and amoxicillin, with no response.
Upon presentation to CSU-VTH, cat No. 1 was in
good body condition and no abnormalities were
detected by physical examination. No significant ab-
normalities were identified with a complete blood count,
serum biochemistry panel, or urinalysis. Endoscopy
identified coarsely nodular fundic mucosa and three 2-
to 4-cm-diameter polypoid masses located in the fundic
and cardiac gastric mucosa. Scant spiral-shaped bacteria
were identified in an impression smear made from the
cut surface of one fundic mass; however, a urea slant
bacterial culture grew no urease-producing bacteria. The
cat was treated with metronidazole, amoxicillin liquid
drops, and famotidine for 2 weeks and sucralfate
suspension for 5 days.
Endoscopic biopsies revealed severe, diffuse, fibros-
ing, and proliferative gastritis with intralesional nema-
tode parasites and rare surface-associated spiral-shaped
bacteria (Fig. 1). The mucosa was markedly thickened
with elongated, tortuous to ectatic gastric pits lined by
hyperplastic mucous neck cells. The lamina propria
contained abundant fibrous connective tissue that
replaced and separated gastric pits. Lymphocytes,
plasmacytes, and few follicular lymphoid aggregates,
neutrophils, and globule leukocytes were distributed
throughout the lamina propria. Profiles of nematodes
were most often located within superficial dilated gastric
pits. Nematodes averaged 30 mm in diameter and had
thin, ridged cuticles, tricuspid tails, and poorly discern-
able platymyarian-meromyarian musculature. The ne-
matodes were identified as Ollulanus tricuspis based on
their morphologic characteristics and location in the
stomach. Rare spiral-shaped bacteria that stained with
cresyl echt violet (CEV) were associated with the surface
of luminal epithelial cells. Both cats were treated with
fenbendazole.
Despite immediate clinical improvement following
fenbendazole treatment, clinical signs recommenced and
worsened, and cat No. 1 returned 2 weeks later to CSU-
VTH for an exploratory laparotomy. Gastric adenocar-
cinoma was identified in surgical biopsies taken from
a dark brown, 1-cm-diameter polypoid mass that
protruded from the fundic mucosa (Fig. 2). Dilated
gastric pits were segmentally lined by neoplastic
cuboidal to polygonal epithelial cells that piled multiple
cell layers thick. There was segmental loss of the
glandular basement membrane. The cells had distinct
cell margins; plump, deep basophilic cytoplasm; and
Vet Pathol 43:3, 2006 Brief Communications and Case Reports
Fig. 1. Stomach, endoscopic biopsy; cat No. 1. The
mucosa contains dilated gastric pits that are separated
by abundant connective tissue and are lined by
hyperplastic mucous neck cells. Profiles of nematodes
are within multiple glands. Asterisk denotes the
characteristic tricuspid tail. Inset emphasizes distinctive
longitudinal cuticular ridges (arrows). HE. Bar 5
100 mm. Inset bar 5 10 mm.
Fig. 2. Stomach, surgical biopsy; cat No. 1.
Asterisks denote tubuloacinar structures comprised of
359
large, ovoid, basilar, hypochromatic nuclei with large
and multiple nucleoli. Neoplastic cells had high nucle-
ar : cytoplasmic ratio and marked anisokaryosis, and
averaged two mitoses per five high powered fields. A few
of these cells had a ‘‘signet ring’’ appearance, charac-
terized by large cytoplasmic vacuoles that peripherally
displaced and compressed nuclei. Tubuloacinar struc-
tures and nests of similar neoplastic epithelium invaded
the deep lamina propria, submucosa, and muscularis
and were within vessels. Noncancerous areas had
fibrosing and proliferative gastritis as previously de-
scribed. Rare surface-associated spiral-shaped bacteria,
which stained with CEV, were within gastric pits.
Intralesional nematodes were not identified in the
sections examined. In addition, parasites were not
identified with examination of gastric juice (2.5 ml) that
was aspirated at surgery and concentrated using the
Baermann technique.
Cat No. 1 was euthanatized twelve days after surgery.
At necropsy, omentum was adhered to the serosal
surface of a 3-cm-long 3 1.5-cm-thick, oblong, white,
firm mural mass that regionally expanded the wall of the
cranial aspect of the gastric fundus. The mucosa
overlying the mass was thickened and lacked rugal
folds. The remaining mucosa, except in the pyloric area,
was diffusely thickened and coarsely nodular. Histologic
evaluation of the stomach confirmed gastric adenocar-
cinoma and chronic proliferative and fibrosing gastritis.
Intralesional nematodes were not observed, although
spiral-shaped bacteria were. Metastasis was identified in
the liver and the kidney.
Cat No. 2 had developed similar clinical signs
2 months before cat No. 1, but was referred to CSU at
the same time as cat No. 1 with a diagnosis of moderate,
chronic, regional, ulcerative and pleocellular gastritis
with moderate epithelial dysplasia, based on endoscopic
biopsies taken 5 months prior. The referring veterinar-
ian described the gross appearance of the fundic mucosa
as irregular. The cat had been treated with famotidine,
sucralfate, and prednisone with limited response.
On presentation to CSU, cat No. 2 had lost
approximately 2.5 kg of body weight, despite being fed
six to seven meals of pureed, canned cat food per day.
Physical examination revealed a palpable mass in the
right cranial abdomen. Abdominal ultrasonography
revealed diffuse thickening of the stomach wall
(20 mm) with heterogenous echogenicity and loss of
r
neoplastic epithelium that invade the submucosa. The
overlying mucosa is affected with mucous neck cell
hyperplasia, lymphoplasmacytic inflammation, and fi-
brosis. HE; Bar 5 250 mm.
Fig. 3. Stomach, mucosal surface; cat No. 2. The
glandular mucosa is diffusely thickened and coarsely
nodular. Regionally, nodules coalesce to form polypoid
projections that overlay a transmural mass (arrows)
with a central area of necrosis (asterisk). Bar 5 1 cm.
360 Brief Communications and Case Reports
gastric layer distinction. A 3-cm 3 1.5-cm mass
extended from the gastric wall into the lumen of the
stomach. There were also several heteroechoic, ill-
defined nodules throughout the hepatic parenchyma.
Cytology from ultrasound-guided percutaneous fine-
needle aspirates of gastric and hepatic masses was
consistent with carcinoma. Four days after discharge,
the cat was administered fenbendazole, as described
above, based on the endoscopic biopsy results of cat
No. 1 that had demonstrated Ollulanus tricuspis.
Cat No. 2 was euthanatized 3 weeks later. At
necropsy, examination of the stomach revealed a firm,
white, invasive, transmural mass that spanned the
caudal surface of the body of the gastric fundus and
regionally extended into the greater and lesser omentum,
spleen, and left limb of the pancreas. The gastric mucosa
overlying the mass was thickened up to four times
normal with a central area of necrosis (Fig. 3). Except in
the area of the pylorus, the remaining mucosa was
diffusely thickened and nodular. Hepatic and pulmo-
nary nodules consistent with metastases were present.
Histologic evaluation identified gastric adenocarcinoma,
similar to that described for cat No. 1, and confirmed
hepatic and pulmonary metastasis. There was severe,
diffuse, chronic proliferative and fibrosing gastritis,
strikingly similar to that of cat No. 1. Nematode
parasites were not seen in sections examined. Spiral-
shaped bacteria were not identified with hematoxylin
and eosin, Warthin-Starry silver, or CEV stains.
Gastric adenocarcinoma occurring simultaneously
in two cats of the same age and from the same
household has not been reported. The unlikelihood of
such an event suggests a common environmental,
genetic, or infectious influence, or a combination of
these factors. Gastrointestinal adenocarcinoma is the
most common nonhematopoietic gastrointestinal tumor
found in the cat.24 However, gastric adenocarcinoma
represents only 1% of all feline gastrointestinal adeno-
carcinomas,24 with only eight reported cases.1–3,17,24
Therefore, it is surprising to detect two cats from the
same household with this disease. Two retrospective
studies have reported a male predilection for gastroin-
testinal adenocarcinoma.3,18 Although approximately
two-thirds of feline gastrointestinal adenocarcinoma is
reported in Siamese cats, a heritable pattern has not
been recognized.18,24 A familial predisposition for
gastric adenocarcinoma has recently been identified in
Chow Chow dogs (E. McNeil, personal communica-
tion). Because these cats shared maternal lineage, the
possible influence of genetic factors on carcinogenesis
should be considered.
Ollulanus tricuspis is a viviparous trichostrongyle
nematode of the feline stomach with a characteristic
life cycle that is capable of completion within a single
host. Cats usually become infected through ingestion of
vomitus that contains any life stage of Ollulanus.11
Long-haired cats may transmit these parasites more
efficiently because of their propensity for hairball-
associated vomiting related to frequent grooming.8
Antemortem diagnosis of the infection requires micro-
Vet Pathol 43:3, 2006
scopic examination of the vomitus, stomach contents, or
gastric mucosa, because eggs and larvae are not typically
passed in the feces.11 In one study, evaluation of three
histologic sections identified organisms in only half of
infected cats;9 therefore, histology is not a sensitive
diagnostic approach.
The pathogenicity of O. tricuspis is poorly un-
derstood. O. tricuspis has been considered clinically
insignificant by some authors.9,19 Clinical signs may be
intermittent and include chronic vomiting, anorexia, or
weight loss.8,11 The gastric mucosa may appear grossly
normal, or may have erosions, excess mucus, or
a nodular appearance.7,10,19 There may be increased
follicular lymphoid aggregates, globule leukocytes, and
reactive fibrosis throughout the lamina propria.9,11
Dilated gastric pits or glandular atrophy may accom-
pany these lesions. Adult O. tricuspis nematodes are
usually localized to the mucus coating the luminal
surface, or to the lumina of dilated gastric pits.
Although epithelial hyperplasia has not been a consistent
finding, trichostrongylids infecting other species, in-
cluding Ostertagia ostertagia in cattle, Ostertagia
circumsincta in small ruminants, Trichostrongylus
axei in horses, and Nochtia nochti in Asian macaques,
have been associated with proliferative gastric or
abomasal lesions.20,22 Trichostrongylid gastritis in
most species is typically characterized by similar mucous
neck cell hyperplasia and by mild lymphocytic in-
flammation.
Helicobacter spp. have been associated with gastric
adenocarcinoma in humans, ferrets, and a Syrian
hamster.5,15 Gastric Helicobacter-like organisms
(GHLOs) were associated with gastric adenocarcinoma
in a cougar.25 Helicobacter spp. have also been
associated with gastric mucosal fibrosis and with
eosinophilic, lymphoplasmacytic, or lymphofollicular
gastritis in cats.4,6,21 The failure of a urea slant bacterial
culture prepared from the gastric mucosa of cat No. 1 to
detect urease-producing organisms may indicate that
organisms were present in numbers below detection
level or were not Helicobacter spp. Although GHLOs
may have contributed to gastritis and carcinogenesis in
cat No. 1, GHLOs are commonly found in normal,
healthy cats, and it is not unusual to incidentally observe
small numbers in normal feline gastric biopsies.16,21
Rare spiral-shaped bacteria were microscopically asso-
ciated with the gastric mucosa of cat No. 1; however,
prior antibiotic therapy may have reduced bacteria
numbers. In contrast, GHLOs are generally present in
large numbers when associated with gastric inflamma-
tion.12
In the two cases described herein, the characteristics
of the gastritis, although nonspecific, were consistent
with either gastric spirochetosis or ollulanosis. It is
common for multiple cats within the same household to
be simultaneously infected with Ollulanus tricuspis.9
Nematodes were not detected in cat No. 2. However,
histologic examination was performed after fenbenda-
zole therapy, which is considered highly efficacious.26 It
is possible that cat No. 2 was never infected with
Vet Pathol 43:3, 2006 Brief Communications and Case Reports
Ollulanus. However, the clinical history and histologic
changes, in the absence of spiral-shaped bacteria,
support infection in cat No. 2 as well. The involvement
of other unidentified etiologies cannot be definitively
excluded.
There have been no reports of gastric adenocarcino-
ma associated with O. tricuspis infection in the cat. The
relationship of these conditions remains uncertain, but
the possible association is compelling because other
helminths, such as Spirocerca lupi, Schistosoma sp., and
Taenia taeniaeformis larvae, are associated with malig-
nancy in various species.13,23 Noninfectious chronic
inflammatory lesions affecting the cat have a propensity
for malignant transformation, including vaccine-associ-
ated sarcoma and trauma-induced uveal sarcoma.14,27
Chronic gastritis, alone or in combination with other
environmental and genetic factors, may have facilitated
the development of gastric adenocarcinoma in these two
related cats.
Acknowledgements
The authors thank Drs. M. Fettman and N. Ehrhart
for critical review of this manuscript and Dr. C. Hibler
for assistance with parasite identification.
References
1 Brodey RS: Alimentary tract neoplasms in the cat:
a clinicopathologic survey of 46 cases. Am J Vet Res
27(116): 74–80, 1966
2 Cotchin E: Neoplasia. In: Diseases of the cat and
their management, ed. Wilkinson GT, 2nd ed., pp.
366–386. Blackwell Scientific, Boston, MA, 1983
3 Cribb AE.: Feline gastrointestinal adenocarcinoma:
a review and retrospective study. Can Vet J 29:
709–712, 1988
4 Fox JG, Batchelder M, Marini R, Van L, Handt L,
Li X, Shames B, Hayward A, Campbell J, Murphy
JL: Helicobacter pylori–induced gastritis in the
domestic cat. Infect Immun 63(7): 2674–2681, 1995
5 Fox JG, Dangler CA, Sager W, Borkowski R, Gliato
JM: Helicobacter mustelae–associated Gastric Ade-
nocarcinoma in ferrets (Mustela putorius furo). Vet
Pathol 34:225–229, 1997
6 Handt LK, Fox JG, Stalis IH, Rufo R, Lee G, Linn
J, Li X, Kleanthous H: Characterization of feline
Helicobacter pylori strains and associated gastritis in
a colony of domestic cats. J Clin Microbiol 33(9):
2280–2289, 1995
7 Hanichen T, Hasslinger MA: Chronic gastritis
caused by Ollulanus tricuspis (Leuckart 1865) in
a cat. Berl Munch Tierarztl Wochenschr 90(3):
59–62, 1977
8 Hargis AM, Haupt KH, Blanchard JL: Ollulanus
tricuspis found by fecal flotation in a cat with
diarrhea. J Am Vet Med Assoc 192:1122–1123, 1982
9 Hargis AM, Prieur DJ, Blanchard JL: Prevalence,
lesions, and differential diagnosis of Ollulanus
tricuspis infection in cats. Vet Pathol 20:71–79, 1983
361
10 Hargis AM, Prieur DJ, Blanchard JL, Trigo FJ:
Chronic fibrosing gastritis associated with Ollulanus
tricuspis in a cat. Vet Pathol 19:320–323, 1982
11 Hendrix CM: Identifying and controlling helminths
of the feline oesophagus, stomach, and liver. Vet
Med 473–476, 1995
12 Hermanns W, Kregel K, Breuer W, Lechner J:
Helicobacter-like organisms: histopathological ex-
amination of gastric biopsies from dogs and cats.
J Comp Pathol 112(3): 307–318, 1995
13 Johnson RC: Canine spirocercosis and associated
esophageal sarcoma. The Compendium on Continu-
ing Education for the Practicing Veterinarian. 14(5):
577–580, 1992
14 McEntee MC: Feline vaccine-associated sarcomas.
J Vet Intern Med 15(3): 176–182, 2001
15 Nambier PR, Kirchain S, Fox JG: Gastritis-associ-
ated adenocarcinoma and intestinal metaplasia in
a Syrian hamster naturally infected with Helicobac-
ter species. Vet Pathol 42(3): 386–390, 2005
16 Papasouliotis K, Barr FJ, Gruffydd-Jones TJ:
Occurrence of gastric Helicobacter-like organisms
in cats. Vet Rec 140(14): 369–370, 1997
17 Patnaik AK, Liu SK, Hurvitz AI, McClelland A:
Nonhematopoeitic neoplasms in cats. J Natl Cancer
Inst 54(4): 855–860, 1975
18 Patnaik AK, Liu SK, Johnson GF: Feline intestinal
adenocarcinoma: A clinicopathologic study of 22
cases. Vet Pathol 13:1–10, 1976
19 Reindel JF, Trapp AL, Armstrong PJ, Stickle RL:
Recurrent plasmacytic stomatitis-pharyngitis in a
cat with esophagitis, fibrosing gastritis, and gastric
nematodiasis. J Am Vet Med Assoc 190(1): 65–67,
1987
20 Scott I, Hodgkinson SM, Lawton DE, Khalaf DE,
Reynolds GW, Pomroy WE, Simpson HV: Infection
of sheep with adult and larval Ostertagia cicum-
cincta: gastric. Int J Parasitol 28(9): 1383–1392, 1998
21 Simpson KW, Strauss-Ayali D, Scanziani E, Strau-
binger RK, McDonough PL, Straubinger AF,
Chang Y-F, Domeneghini C, Arebi N, Calam J:
Helicobacter felis infection is associated with lym-
phoid follicular hyperplasia and mild gastritis but
normal gastric secretory function in cats. Infect
Immun 68(2): 779–790, 2000
22 Smetana HF, Orihel TC: Gastric papillomata in
Macaca speciosa induced by Nochtia nochti (Nema-
toda: Trichostrongyloidea). J Parasitol 55(2): 349–
351, 1969
23 Stephens LC, Gleiser CA, Jardine JH: Primary
pulmonary fibrosarcoma associated with Spirocerca
lupi infection in a dog with hypertrophic pulmonary
osteoarthropathy. J Am Vet Med Assoc 182(5):
496–498, 1983
24 Turk MAM, Gallina AM, Russell TS: Nonhemato-
poietic gastrointestinal neoplasia in cats: a retro-
spective study of 44 cases. Vet Pathol 18:614–620,
1981
25 Yamazaki Y, Aono I, Ohya T, Shibahara T, Kadota
K: Gastroduodenal adenocarcinomas and rectal
362 Brief Communications and Case Reports Vet Pathol 43:3, 2006

adenoma in a cougar (Felis concolor) infected with
Helicobacter-like organisms and spirochetes. J Vet
Med Sci 64(2): 149–153, 2002
26 Zakhryalov YN, Chekushkina TV: Trials of pre-
parations effective against Ollulanus in experimen-
tally infected kittens. Trudy Dal nevostochnogo
Zonal nogo Nauchno-Issledovatel skogo Veterinar-
nogo Instuta 11:24–26, 1980 [in Russian]
27 Zeiss CJ, Johnson EM, Dubielzig RR: Feline
intraocular tumors may arise from transformation
of lens epithelium. Vet Pathol 40(4): 355–362, 2003
Request reprints from Michelle Dennis, 308 Pathology
Bldg., 1619 Campus Delivery, Colorado State Uni-
versity, Fort Collins, CO 80523 (USA). E-mail:
Michelle.Dennis@colostate.edu.