– 10 year old FS Sheltie
– on and off vomiting for 3-4 months – mainly bile
– eating a little less lately
– routine bloodwork unremarkable and stool sample negative for parasites
– abdominal ultrasound showed marked thickening of the fundic stomach wall with loss of wall layering – the rest of the stomach transitioned into normal appearence
– no other abnormal findings noted on u/s – obviously biopsy is warranted
– 10 year old FS Sheltie
– on and off vomiting for 3-4 months – mainly bile
– eating a little less lately
– routine bloodwork unremarkable and stool sample negative for parasites
– abdominal ultrasound showed marked thickening of the fundic stomach wall with loss of wall layering – the rest of the stomach transitioned into normal appearence
– no other abnormal findings noted on u/s – obviously biopsy is warranted
– my concern is neoplasia in this patient however can severe inflammatory gastritis look like this?
– would you attempt an U/S guided FNA of this?
Comments
Neoplasia most likely
Neoplasia most likely etiology with granulomatous gastritis a possibility. Would recommend an FNA as wall is thick enough to get a 22-23G needle into it. If negative or non-diagnositic then gastroscopy, however, may also be non-diagnostic if lesion has not penetrated into the gastric mucosa.
Neoplasia most likely
Neoplasia most likely etiology with granulomatous gastritis a possibility. Would recommend an FNA as wall is thick enough to get a 22-23G needle into it. If negative or non-diagnositic then gastroscopy, however, may also be non-diagnostic if lesion has not penetrated into the gastric mucosa.
This meets neoplastic
This meets neoplastic criteria but the loss of detail is minor and the mucosae is echogenic suggestive for fibrosis and chronicity. Sclerosing carcinomas can do this but there is peristalsis that is uniform which to me fits more non neoplasia. This has also the criteria for hypertrophic pyloric gastropathy: hypertrophied muscularis and thick wall at pyloric outflow.
Pennincks neoplastic criteria is loss of mural detail, excessive thickening, and lack of peristalsis. there are neoplasia that don;t have all these and inflammatory disease that dioes but its a good parameter set to go from as a start. I like full thickness all in all on this and manual palpation of the pylorus and potential pyloroplasty at that moment. If you have a financially viable owner this is what i would suggest. Scope may help and possibly show some helicobacter, fna go 20 gauge and corkscrew it to get a sample but wont have any structure with it.
If a financial case my blanket tx for this looking into the archive: pepcid carafate, clavamox, metro x 4 weeks and bid canned hypoallergenic diet small feedings. Then rescan at 4 weeks and see what it looks like.
check out this case in the clinical search just cut and paste. Looks like neoplasia but wasnt
04_00239 Murray B Gastritis
attached is an image of HPG as well and looks similar but the pathology CD has many cases of neoplasia and non that meet penninck criteria
This meets neoplastic
This meets neoplastic criteria but the loss of detail is minor and the mucosae is echogenic suggestive for fibrosis and chronicity. Sclerosing carcinomas can do this but there is peristalsis that is uniform which to me fits more non neoplasia. This has also the criteria for hypertrophic pyloric gastropathy: hypertrophied muscularis and thick wall at pyloric outflow.
Pennincks neoplastic criteria is loss of mural detail, excessive thickening, and lack of peristalsis. there are neoplasia that don;t have all these and inflammatory disease that dioes but its a good parameter set to go from as a start. I like full thickness all in all on this and manual palpation of the pylorus and potential pyloroplasty at that moment. If you have a financially viable owner this is what i would suggest. Scope may help and possibly show some helicobacter, fna go 20 gauge and corkscrew it to get a sample but wont have any structure with it.
If a financial case my blanket tx for this looking into the archive: pepcid carafate, clavamox, metro x 4 weeks and bid canned hypoallergenic diet small feedings. Then rescan at 4 weeks and see what it looks like.
check out this case in the clinical search just cut and paste. Looks like neoplasia but wasnt
04_00239 Murray B Gastritis
attached is an image of HPG as well and looks similar but the pathology CD has many cases of neoplasia and non that meet penninck criteria
Thanks Remo and Eric
There
Thanks Remo and Eric
There was definitely good stomach peristalsis present in the area of the lesion (didn’t know absence was a criteria of neoplasia – will have to review Pennick). This is going to be a medically managed one – no biopsy unfortunately. Plan is to re-ultrasound in 1 month.
Thanks Remo and Eric
There
Thanks Remo and Eric
There was definitely good stomach peristalsis present in the area of the lesion (didn’t know absence was a criteria of neoplasia – will have to review Pennick). This is going to be a medically managed one – no biopsy unfortunately. Plan is to re-ultrasound in 1 month.