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Mast cell disease diagnosed by FNA of mesenteric lymph nodes in a 9 year old MN DSH cat

Case Study

Case Study

Mast cell disease diagnosed by FNA of mesenteric lymph nodes in a 9 year old MN DSH cat

A 9-year-old MN DSH was presented for the evaluation of lethargy, and vomiting. The cat had been previously diagnosed with multiple cutaneous mast cell tumors. He also had a history of receiving Depo-medrol injections. The cat was febrile and had a painful abdomen on palpation. Previous blood work had shown an elevation of the ALT enzyme activity. Serum biochemistry revealed a high ALT and hyperglycemia. No abnormalities were noted on the CBC. The urine had a cloudy appearance.

A 9-year-old MN DSH was presented for the evaluation of lethargy, and vomiting. The cat had been previously diagnosed with multiple cutaneous mast cell tumors. He also had a history of receiving Depo-medrol injections. The cat was febrile and had a painful abdomen on palpation. Previous blood work had shown an elevation of the ALT enzyme activity. Serum biochemistry revealed a high ALT and hyperglycemia. No abnormalities were noted on the CBC. The urine had a cloudy appearance. The urine pH was within the normal reference range, but the specific gravity was elevated and there were a few amorphous urates. A urine microalbumin was negative. The buffy coat evaluating for the presence of mast cells was negative.

Sonographic Differential Diagnosis

Aggressive mesenteric root lymphadenopathy was evident with hypervascular pattern and peripheral inflammatory pattern. Given the history, visceral mast cell disease is of primary concern. Lymphoma, FIP, aggressive lymhadenitis should also be considered.

Image Interpretation

A dramatically hypoechoic and micronodular lymph node enlargement was present in the mesenteric root with surrounding hypervascular mesenteric artery and tributaries. The lymph node has lost internal curvilinear architecture and possesses hypoechoic parenchyma. Minor hyperechoic ill-defined regional fat is also present suggestive for associated reactive surrounding fat.

DX

Mast cell neoplasia

Outcome

The patient was lost to follow-up.

Clinical Differential Diagnosis

Metastatic disease associated with the mast cell tumors, pancreatitis, inflammatory bowel disease (not controlled with administration of Depo-medrol injections), cholangitis/cholangiohepatitis (not controlled with administration of Depo-medrol injections), other forms of neoplasia (lymphoma, adenocarcinoma, leiomyoma and leiomyosarcoma).

Sampling

US-guided FNA of mesenteric lymph nodes revealed mast cell neoplasia.

Video

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Patient Information

Patient Name : Garrett C
Gender : Male, Neutered
Species : Feline
Type of Imaging : Ultrasound
Status : Complete
Liz Wuz Here : Yes
Code : 11_00007

Clinical Signs

  • Lethargy
  • Vomiting

History

  • Elevated Liver Enzymes
  • Neoplasia
  • Steroid therapy

Exam Finding

  • Abdominal Pain
  • Fever

Images

ColorLymphadenopathy

Blood Chemistry

  • ALT (SGPT), High
  • Glucose, High

Clinical Signs

  • Lethargy
  • Vomiting

Urinalysi

  • Appearance Turbid
  • Specific Gravity High
  • Uric Acid Crystals Present