- 10 yr old, FS DSH
- Hyperthyroid, on Methimazole
- Acute onset green-black diarrhea and not eating x 2 days
- Lethargic
- BW normal except low BUN, T-4 = 4.6 high N, WBC = 7,620; 6% Monos, 14% Eos, 6% Baso (abs # 450 H)
I’ve never seen high Basophils…. MCT is listed as a possible cause.
Abd US overall normal except thick spleen with variably sized hyperechoic nodules/patches.
- 10 yr old, FS DSH
- Hyperthyroid, on Methimazole
- Acute onset green-black diarrhea and not eating x 2 days
- Lethargic
- BW normal except low BUN, T-4 = 4.6 high N, WBC = 7,620; 6% Monos, 14% Eos, 6% Baso (abs # 450 H)
I’ve never seen high Basophils…. MCT is listed as a possible cause.
Abd US overall normal except thick spleen with variably sized hyperechoic nodules/patches.
I’m planning on FNA of the spleen next week; should I do the liver as well ? The liver looks “coarse” to me…. not sure what to make of the hyperechoic areas (perivascular?). To my eyes, the liver would need a biopsy vs FNA, and I’m not sure there’s much to justify that.
My biggest concern is MCT in the spleen. Thoughts?
Thank you!!
Comments
The spleen is scallopping and
The spleen is scallopping and course surely fit mct or reactive spleen or even multiple myeloma can look like this. Very non specific but 25g fna with benadryl 1mg/# im 10 min before is what I would do. When thinking round cell neoplasia i am always a fan of fna of both spleen and liver because if just spleen and mct then remove the spleen but if liver has it in an early phase then its chemo an dno sx and prognosis drops. Plus when the cytologist has infiltrates in both spleen and liver he/she will tend to be more definitive with the dx.
This liver doesnt look bad to me and the hyperechoic areas look like mineralization in the biliary tree i think… not an mct player. If a money case then just fna spleen but if a solid checkbook behind it then i would fna both organs searching the spleen for pathology and screening the liver to see if it has joined the pathology party yet or not.
Thanks EL! Excellent
Thanks EL! Excellent points… I’ll see what the o will let me do.
Follow up…. did the spleen
Follow up…. did the spleen FNA (only, no liver FNA).
From Dr. McGill, telecytology…. came back as Eosinophilic infiltrate. No mast cells seen, hurrah!
Cat was doing better after the Benedryl inj, and got a steroid injection yesterday… am hopeful next week she’ll be back to normal.
Thanks for the help!