Multiple Neoplasias in a Geriatric Canine

Patient Information:

Age: 14

Gender: Neutered Male

Breed: Terrier Mix

Species: Canine

History:

Patient had history of apocrine gland anal sac adenocarcinoma in September 2020. He recently had a decrease in appetite and increase in coughing. Liver values were newly elevated. Ultrasound was requested to check for any metastasis.

Ultrasonographic Findings:

The liver was normal size and mildly irregularly contoured with a coarse hypoechoic echogenicity. The periportal lymph nodes were prominent (1.4x2.1cm) and rounded with a heterogenous hypoechoic echogenicity. Additionally, the spleen was noted to have multiple ill-defined small (<1.0cm diameter) homogenous hypoechoic nodules throughout the parenchyma.

Abdominal Ultrasound Interpretation:

Liver - the findings are moderate- DDx:
a) Common: Hepatitis (acute or active): Vacuolar hepatopathy, Passive congestion (e.g., dilated hepatic veins and CVC), Cholangiohepatitis/cholangitis (acute or active), Neoplasia (e.g., lymphoma, sarcoma, histiocytic neoplasia, or mast cell disease)
b) Less Common: Immune-mediated hemolytic anemia, Leptospirosis, Histoplasmosis, Amyloidosis, Leukemia
Lymph nodes - the findings are moderate - DDx: infiltrative neoplasia (lymphoma vs. mast cell vs. other) vs. reaction vs infection vs. metastatic neoplasia
Spleen nodules- the findings are mild - DDx: extramedullary hematopoiesis (EMH) vs. infiltrative neoplasia vs. benign nodular regeneration vs reactive nodules

Additional Diagnostics:

Ultrasound guided fine needle aspirate of the liver was performed and submitted to Eastern VetPath for analysis.

Cytology Findings:

Microscopic findings:
The slides are moderately cellular and consist of many red blood cells and a nucleated cell population predominated by intermediate to large immature lymphocytes, other leukocytes in proportions consistent with peripheral blood, and several clusters of uniform and well-differentiated hepatocytes. The intermediate to large lymphocytes consist of a small amount of basophilic cytoplasm and an intermediate to large round nucleus with a finely-stippled chromatin pattern. Occasional mitotic figures are noted. The background consists of many lymphoglandular bodies and occasional free nuclei.

Diagnosis:
High-grade lymphoma-100% confidence

Treatment:

Treatment options included referral to oncologist for chemotherapy, palliative corticosteroids or humane euthanasia. Sadly, our patient’s condition rapidly deteriorated and he was euthanized.

Discussion:

While initially metastasis of previously diagnosed apocrine gland anal sac adenocarcinoma was clinically suspected, this patient had developed an additional unrelated neoplasia. Unfortunately, this can occur particularly in our geriatric patients. It is important to consider additional neoplasias as part of our differentials.

Sonographer: Kara Woody, DVM