– 11 year old FS Boston Terrier with intermittent history of PU/PD and moderate elevation in ALP
– bloodwork confirms diabetes; ACTH stim ruled- out Cushings and no sonographic signs to support this
– right limb of the pancreas is enlarged and hypoechoic and heterogeneous (possible chronic or acute on chronic pancreatitis)
– there is a circular mass that appears to extend from the right pancreatic limb that is closely adhered to the duodenal wall
– 11 year old FS Boston Terrier with intermittent history of PU/PD and moderate elevation in ALP
– bloodwork confirms diabetes; ACTH stim ruled- out Cushings and no sonographic signs to support this
– right limb of the pancreas is enlarged and hypoechoic and heterogeneous (possible chronic or acute on chronic pancreatitis)
– there is a circular mass that appears to extend from the right pancreatic limb that is closely adhered to the duodenal wall
– I am debating whether this is a pancreatic mass or a duodenal wall mass? Would be a weird location for the d-pap?
– I plan to rescan to monitor. Other than being diabetic (insulin started) the patient is clinically normal
Comments
Mural duodenal mass coming
Mural duodenal mass coming off the muscularis and regional hyperplastic pancreas with maybe an inflammatory component. Needs a needle or sx resection. May be a leiomyosarcoma.
Thanks EL. I actually tried
Thanks EL. I actually tried sticking a needle in this (several times) but it was too difficult with patient movement (lesion would pop out of the way) as she was only lightly sedated. I needed quite a bit of pressure to move away the overlying tissue to get to the lesions and the probe was buried deep in the tissue and angled upward under the rib cage – so totally awkward.
At recheck I will plan for heavier sedation (likely propofol) and try again. Do leimyosarcomas slough easily?
Lieos dont exfolitate easily
Lieos dont exfolitate easily in my experience. Have to go heavier gauge like 20 g and corkscrew fna technique to get anything solid or could short stick core bx with an 8 mm cut staying in the wall and out of the lumen. Heavy sedation on anything you need to corkscrew or manipulate.
Thanks!
Thanks!