RADIOLOGIST ASSESSMENT  (10:56 am  MAN Valerie Sadler, DVM DACVR/nyc)

02/10/09

Today’s exam is compared with a study dated 01/08/09.

Thorax

Findings: There is partial mineralization of the tracheal rings and proximal bronchial tree, which highlights these structures.  The pulmonary parenchyma is characterized by a very mild uniform increase in interstitial opacity.  Minimal bronchial markings are also noted.  The cardiovascular structures are within normal limits.  There are sites of spondylosis in the thoracic spine.

Impression:  Nonspecific pulmonary parenchymal changes indicative of past or current lower airway disease.  No evidence of pulmonary metastasis or intrathoracic lymphadenopathy.  Degenerative changes, spine.
Relayed the above to Dr. Oberthaler

VS/ljj

t:  02/13/09

ULTRASONOGRAPHY  (11:08 am  QUE Suliman Al-Ghazlat, DVM, DACVIM/que)

ABDOMINAL ULTRASOUND REPORT

Liver:  Slightly hyperechoic but otherwise normal

Gallbladder:  slightly distended and contains  gravity dependent sludge

Right Kidney:  mild decrease in corticomedullary distinction

Left Kidney:  smaller has less defined architecture compared to the right kidney

Urinary Bladder:  Normal

Right Adrenal:  Normal

Left Adrenal:  Normal

Stomach:  Normal

Small Intestine:  Normal

Lymph nodes:  Normal

Peritoneum:  Normal

Spleen:  Normal. There is a large 6 x 6cm complex mass caudal and lateral to the left kidney. Most likely a splenic mass

Colon:  Normal

Pancreas:  Normal
Impression:

Chronic renal disease

Gall bladder sludge

R/O  steroids hepatopathy vs much less likely infiltrative liver disease

R/O Splenic mass: HSA vs other sarcomas or benign splenic tumor vs LSA

Antech ID:130261

Lab:

Antech Diagnostics

1111 Marcus Avenue

Lake Success, NY 11042

Reported: 02/12/09 12:13 PM

Received: 02/11/09

Reference No. NYCA02923531

Cytology

Microscopic Description: 5 slides, left mandibular LN, 8 yr old ridgeback with hx of lymphoma in remission

The smears are thin and cellular with lymphoid cells dispersed on an unstained background. The lymphoid population is heterogeneous, composed mainly of lymphocytes and includes some plasma cells and

lymphoblasts. Lymphoblasts are less than 10% of total lymphoid cells.

Microscopic Findings: Normal or reactive lymph node, no detectable lymphoma infiltrate

Comment: The cytologic pattern is consistent with aspiration of a normal sized lymph node or one enlarged by lymphoid hyperplasia in an immune response.

Julia Blue, DVM, PhD, Diplomate ACVP

Entered by Linda L.

Reference No. NYCA02923541

Cytology

Microscopic Description: 4 slides, splenic mass, 8 yr old ridgeback with hx of lymphoma in remission

The largest smear contains partilcles of red pulp stroma that are heavily loaded with hemosiderin, and blood that is moderately cellular with splenic lymphoid cells. Most of the cells are lymphocytes. Plasma cells and lymphoblasts are present but in low numbers. The other smears are smaller and composed of blood with a

few lymphoid cells and macrophages. None of the smears show an increase in lymphoblasts, or any unusual cells.

Microscopic Findings: Normal splenic stroma and cells

Comment: There is no evidence of lymphoma or other form of neoplasia. The mass is probably hyerplastic nodule or hematoma.

Julia Blue, DVM, PhD, Diplomate ACVP

Entered by Linda L.

Last week a Tanzi was put through xrays , ultrasounds and aspirated of lymphs and spleen. The good news is that Tanzi is officially in clinical remission. Everything that was there back on Jan 9th is gone i.e. from lymphs , spleen, liver and lungs. Everything but one 6 cm x 6 cm mass. The diagnosis is that its  a hyperplastic nodule i.e. a benign growth. However, the doctors wanted the spleen removed. After much agony we decided not to. The operation would have meant setting back Tanzi a month on his chemo and we felt that would kills his odds to beat the lymphoma. It is also a major operation which can be risky and has its seto of pretty dire complications. To us its a game changer. Tanzi’s odds of beating cancer were on the line but frankly we felt that his general quality of life would have gone down hill from there. On the other hand any growth on the spleen can burst leading to internal bleeding which requires immediate surgery. We’ll take the chance. We are lucky that we currently can watch him 24×7 since my wife works from home.

Tanzi has been feeling well all week, so far the doxyrubicin has not floored him at all except for diarrhea which started on Friday. As a matter of fact , although he has been having watery diarrhea  we still managed to do a 3 hour on Sunday. He is still quite hungry even though we stopped the preds this past thursday. Tanzi had developed a twitch and at nite would almost incessantly it seems lick both of his front legs. All that has stopped and we are guessing that the preds  were just making him very anxious. As to the diarrhea we decided to not go back on the Flagyl which somehow seems to make him very lethargic. So far it seems that the antibiotics cut down on his energy level much more than the actual chemo. Instead we are going with increasing his dosage of l-glutamine as well as using Thorne Research’s Gastroplex product. We actually bought a lot of Thorne Research at www.wellvet.com. Hopefully, these will manage to contain his diarrhea. The other good news is that he is still no longer showing any signs of blood in either his stool or penis discharge.

Today is another big day. Tanzi is going through a set of tests in order to “re-stage” him i.e. in order to understand if he is in remission and whether he can proceed with two sessions of radiation. Let’s hope.