Saturday, November 8, 2014

141109. Lymphoma in a Miniature PInscher (2014) and Jack Ruseell (2011)

Saturday Nov 8, 2014

"I notice a large swelling below the right neck," the owner of this 9-year-old female unspayed Miniature Pinscher said.
"Actually, there is another one on the left neck," I examined the active dog that jogs with the owner.
"These are mandibular lymph nodes. The two popliteal lymph nodes behind the knees are much swollen too."


Advised:
TESTS to stage the cancer
1. Biopsy of lymph node
2. CBC (done)
3. serum chemistry profile
4. urinalysis
5. abdominal ultrasound (liver, spleen, intestinal lymph node, internal lymph nodes)
6. chest x-ray (lung, internal lymph nodes, intestinal tract)
7. bone marrow aspirate

Above tests are for STAGING OF LYMPOMA (to search for tumours in other locations)


 BLOOD TEST 2 BY TOA PAYOH VETS ON NOV 9, 2014
Haemoglobin 20  (12-18)
Red cell count 8.8 (5.5-8.5)

Total white cell count 25.3 (6-17)
Neutrophils 24.4% (60-70)    Absolute 6.17 (3-11.5)
Lymphocytes 74.5% (12-30)    Absolute 18.85 (1-4.8)
Monocytes 0.4% (3-10)    Absolute 0.1 (0.15-1.35)
Eosinophils 0.7% (2-10)    Absolute 0.18 (0.1-1.25)
Basophils 0 (rare)    Absolute 0 (rare)

liver and kidneys OK

BLOOD TEST NO. 2 ON NOV 11, 2014
Generalised lymphadenopathy including submandibular, prescap, inguinal and popliateal
Haemoglobin 19.2  (12-18)
Red cell count 8.77 (5.5-8.5)

Total white cell count 21.5 (6-17)
Neutrophils 21% (60-70)    Absolute 4.5 (3-11.5)
Lymphocytes 60% (12-30)    Absolute 12.9 (1-4.8)
Monocytes 18% (3-10)    Absolute 3.8 (0.15-1.35)
Eosinophils 1.2% (2-10)    Absolute 0.25 (0.1-1.25)
Basophils 0.2% (rare)    Absolute 0.05 (rare)

Peripheral blood smear -  shows normochromic normocytic erthroyctes. Mild leucocytosis, lymphocytosis, some reactive lymphocytes seen. Platelets adequate in number. Babesia -ve

FNA popliteal and prescap inconclusive.

Lymph Node excisional biopsy
Cytology (L and R prescap). Smear - mainly small to medium sized lymphocytes. Some lysed cells with no visible cytoplasmic boarder.
(L and R politeal). smears mainly small to medium sized lymphocytes. Some cells with a hand-mirror shape with cytoplasmic pseudopod.

Ultrasound of abdomen - possible liver infiltration. KIV FNA of liver.
X-ray chest - 3 views. No visible enlarged internal lymph node in chest
Urinalysis cystocentesis



pH 5.8 (5.5-8.5), SG 1.020 (1.015 - 1.045). Occasional RBC, WBC, epithelial cells, bacteria. Crystals variable.
creatinine, albumin, total protein tests


TENTATIVE DIAGNOSIS
Lymphoma

CAUSE - Unknown. Old age.


5 FORMS
1. External lymph nodes
2. Gastrointestinal tract
3. Mediastinal
4. Skin
5. Bone marrow

TREATMENT
Expensive. IV chemotherapy.
Remission. Recurrence. Most dogs after chemotherapy live for around one year if there is no recurrence.

REFERENCE:
http://www.vet.purdue.edu/pcop/canine-lymphoma-research.php


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LYMPHOMA IN A JACK RUSSELL IN 2011



Monday, March 28, 2011

378. Sunday Case. "My Jack Russell suddenly can't see"

I HOPE THIS REAL CASE WILL HELP THE 5TH YEAR VET STUDENT WITH THOUSANDS OF SUBJECTS TO REMEMBER AND BE EXAMINED BEFORE GRADUATION!

One look from my reception counter and I could see that this Jack Russell was suffering from Canine Lymphosarcoma. Some vets prefer to call it Canine Lymphoma. The two lumps of the size of ping-pong balls on the right and left lower jaws were too obvious to miss.

The owners were a young couple in their early 30s and an older woman and there was great emotions involved. The mum was distressed that the 8-year-old male Jack Russell walked into chairs and just could not see on this fine Sunday morning. Only the day before, the dog was zipping here and there when exercised outdoors. No accidents. No falls. No injuries. The dog just couldn't see! Why? What happened?

I decided to handle this case as the leading vet responsible for the outcome and together with my associate vet. Working as a team is a pleasure of veterinary medicine as we share our workload. I asked if she objected as she was on duty, but this was not her client. My associate said: "I am OK."

HISTORY
"What did Vet 1 say?" I asked when the owner showed me the report of a pre-scapular lymph node biopsy sent to the AVA lab.
"Vet 1 said that the AVA lab cannot confirm that the dog is suffering from lymphoma."

I read the report. It stated that it needed at least 2 biopsies from 2 lymph nodes and to relate to clinical signs. The presented biopsy cells could not confirm lymphoma.

So the owners must have concluded that the dog was not suffering from lymphoma!
No further treatment.

EYES
Blood inside both eyes preventing vision.
Note: In canine lymphoma, eye involved in 25% of cases). This can lead to bleeding within the eye, uveitis, glaucoma, retinal detachment and blindness.)

BLOOD TEST RESULTS OF DOG WITH LYMPHOMA OVER AT LEAST 1 MONTH
I was checking for infection (high WCC) or immune suppression (low WCC and platelets) or cancer (e.g. leukaemia with very high WCC), liver and kidney disorder.

Results are as follows:
Haemoglobin 13.9 (12-18)
Total WCC 11.8 (6-17)
Neutrophils 70.51 Abs 8.32
Lymphocytes 16.44 Abs 1.94
Monocytes 11.19 Abs 1.32
Eosinophils 0.09 Abs 0.01
Basophils 1.95 Abs 0.23

Red cell count 5.5 (5.5-8.5)
PCV 0.38 (0.37-0.55)
MCV 69 (60-77)
MCH 25 (20-25)
MCHC 36 (32-36)
RDW 14.1%

Platelets 90* (200-500). No platelet clumps seen.

LIVER PROFILE
ALT/SGPT 169 (<59 -3.6="" -="" 0.05="" 0.1="" 0.2="" 1.="" 138="" 2.58="" 2.="" 2="" 3.="" 4.="" 4047="" 4049.="" 4a="" 54="" 5a="" 5b="" 6.3="" 7="" 8.3="" a="" abdomen.="" abdominal="" acid="" active.="" acute="" affecting="" anaemia="" and="" anterior="" as="" asked="" ast="" be="" became="" been="" bite="" bleeding.="" bleeding="" blood="" bone="" both="" but="" bw.="" calcium="" canine="" cases="" causing="" cells="" central="" chemotherapy.="" chemotherapy="" class="separator" cost="" could="" count="" counts="" creatinine="" cure="" day="" decide="" depend="" depends="" developing="" did="" disease="" div="" do="" dog.="" dog="" domitor="" dose.="" drugs.="" due="" eating.="" eating="" enlarged.="" enlarged="" experience="" eye="" eyes.="" eyes="" for="" free="" from="" function="" generalised="" give="" guideline.="" had="" happened="" has="" highly="" his="" how="" hunched="" i="" impressed="" in="" infections.="" inside="" intense="" into="" involvement="" is="" it="" iv.="" ketamine="" kg.="" kidney="" life="" live="" liver="" long="" low="" lowest="" lymph="" lymphoma.="" lymphoma="" marrow="" may="" me.="" me="" means="" mild="" ml="" monitoring.="" months="" my="" nervous="" next="" no.="" no="" node="" nodes="" normal="" normally.="" not="" now="" of="" on="" one="" or="" other="" owner="" owners="" pacing="" pain="" palpated="" pancreatitis="" permanent="" platelet="" present="" problem="" profile="" prolonging="" quite="" quoted="" reading="" red="" relieve="" remission="" reports.="" reports="" risky="" rom="" rubbed="" rubs="" s="" said="" sclera="" sedation="" see.="" see="" seizures="" several="" shows="" situation.="" slept.="" solve="" some="" spleen="" stage="" stopped="" style="clear: both; text-align: center;" sunday="" syringe="" system="" tage="" test="" the="" there="" this="" to="" treatment.="" treatment="" two="" type="" urea="" uric="" varies="" very="" vet="" vigorously="" vision="" was="" were="" what="" whether="" which="" white="" will="" with="" without="" would="" yet="">



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