- 14 yr old FS DSH with history of chronic vomiting and weight loss as well as stage 2 crf;
- Abdominal ultrasound showed tissue just caudal to the caudal spleen with a hypoechoic nodule in it. Not sure at the time if this was an extension of the spleen or really long left limb of the pancreas. The kidneys were at the small end in size with thickened, echogenic cortices and poor corticomedullary definition.
- I performed FNA’s on the splenic-left pancreatic lesion as well as the right renal cortex (to rule out LSA or look for amyloid).
- 14 yr old FS DSH with history of chronic vomiting and weight loss as well as stage 2 crf;
- Abdominal ultrasound showed tissue just caudal to the caudal spleen with a hypoechoic nodule in it. Not sure at the time if this was an extension of the spleen or really long left limb of the pancreas. The kidneys were at the small end in size with thickened, echogenic cortices and poor corticomedullary definition.
- I performed FNA’s on the splenic-left pancreatic lesion as well as the right renal cortex (to rule out LSA or look for amyloid).
- FNA cytology of the lesions came back as:
1. Spleen (2 slides): Smears are comprised of fresh blood lacking distinctive spleenic elements (such as lymphoid tissue, stromal cells, erythroid precursors), and is comprised of several small to large aggregates of epithelial cells occasionally forming acinar-like structures. Cells contain a single, uniform, round nucleus, inconspicuous nucleoli, and moderate granular basophilic cytoplasm resembling pancreatic type. Mitoses are absent; inflammation is absent. Lymphoid tissue is absent.
2. Kidney (4 slides): Smears are comprised of fresh blood and scattered intact and disrupted well-differentiated renal epithelial cells, frequently exhibiting one or more cytoplasmic vacuoles. Inflammation is absent. Lymphoid tissue is not observed.
Diagnosis
1. Spleen: Splenic elements are not appreciated on the specimen submitted. Findings favor sampling of epithelial tissue with pancreatic features. Considerations include pancreatic epithelial hyperplasia, a well-differentiated pancreatic carcinoma, or inadvertant sampling of pancreatic tissue. No evidence of lymphoma is observed.2. Kidney: Well-differentiated epithelial tissue consistent with renal epithelium. No evidence of inflammation or neoplasia is observed on this specimen.
So, I am not sure where to go next with this case. I don’t know if the vomiting and weight loss are due to the crf or due to pancreatic lesion which apparently may be benign or neoplastic. Chest rads taken later showed a lung nodule. Since fna was already done, would you go to surgery next and biopsy the left pancreas and GI tract?
Comments
This is a chronic left panc
This is a chronic left panc lesion … when the left panc gets enlarged it will extend caudal to the spleen and even go up around the left kidney. This is a degenerative cystic portion of pancreas and carcinoma can do this but unlikley given the fna results. Check maldigestion/absorption or neoplasia elsewhere.
if you follow the splenic capsule and the panc capsule on your video you will see thay are separate… hence separate organs. Sonographic interpretation is all about following the lines in and around tissues.
You can surgically remove this portion of panc and do a shopping spree of bx as well on the other organs but chase that lung nodule (serial rads to see if growing or fna us guided if accessible) may be something completely different… old cats get lung carcinoma often that cause the weight loss and the vomiting may just be old cat ibd.
Thanks Eric. In the images
Thanks Eric. In the images presented, the spleen and pancreas look separate. In other images, I wasn’t sure if the spleen was folding up. I have not seen the left pancreas extend this far caudally, but it is good to be remindend that it can :).