- 14 year old FS West Highland Terrier was treated for a urinary tract infection 1 month ago. Labwork showed mild azotemia (BUN=31, Creat=1.5), inappropriate USG=1.008, and elevated ALT and ALKP. The patient was placed on Clavamox for 14d.
- Recheck bloodwork done last week shows progressive elevation of the liver enzymes. The patient is PU/DP and has a decreased appetite.
- 14 year old FS West Highland Terrier was treated for a urinary tract infection 1 month ago. Labwork showed mild azotemia (BUN=31, Creat=1.5), inappropriate USG=1.008, and elevated ALT and ALKP. The patient was placed on Clavamox for 14d.
- Recheck bloodwork done last week shows progressive elevation of the liver enzymes. The patient is PU/DP and has a decreased appetite.
- Abdominal US shows a 2.0cm hypoechoic gastric wall mass originating from the mucosal surface of the left ventral stomach (greater curvature), projecting into the stomach lumen. The stomach is otherwise empty.
- The kidneys show mild degenerative changes, the liver parenchyma is homogeneous with prominent portal markings, and the splenic parenchyma shows mild micronodular changes without any capsular abnormalities.
- FNA’s of the gastric mass were not very productive. FNA’s were also performed on the liver.
- Just wondering, could this mass be the cause of the dog’s clinical signs or is this just an incidental finding?
- What would be best to do next….endoscopy or exploratory surgery?
- My differential diagnoses for the mass include benign tumor (leimyoma, epitheliod), neoplasia (leiomyosarcoma, lymphoma, carcinoma), and much less likely artfact (kibble, pill-patient was presumably fasted and mass really seems to connect to the wall).
Comments
The clinical signs are more
The clinical signs are more typical for renal disease than gastric pathology As the mass does not exfoliate easily would tend to point towards a leimyoma/leiomyosarcoma and possibly a granuloma. Although it may be an incidental finding it has the potential to become a problem. With the renal disease I would suggest a scope and biopsy first.
Thank you, Dr. Lobetti. I am
Thank you, Dr. Lobetti. I am also trying to figure out the role of the elevated liver enzymes as that is the reason they scheduled the ultrasound. Can you see elevated ALKP/ALT as a reaction to a gastric mass or would it more likely be a separate problem? I hope to find out the liver FNA cytology results today.
Liver most likely an
Liver most likely an additional problem which may be contributing to the overall clinical signs. Let’s see what the FNA cytology shows
You can add power doppler to
You can add power doppler to ensure its a tissue mass and not kibble.. looks like epithelial tumor to me …well differentiated because the muscularis isnt inviled and these dont exfoliate readily on fna so would have to core bx it or scope and take a chunk as its right in the lumen