Case Study

Splenic lymphoma in a 14 year old MN Bernese Mountain Dog

A 14-year-old MN Bernese Mountain Dog was initially presented for trouble walking and weight loss, but was seen more recently for lethargy, poor appetite, and one episode of vomiting. On physical examination, the dog had a thin body condition, pyrexia, and a stiff gait. Urinalysis was within normal limits. Abnormalities on CBC and serum biochemistry were anemia, eosinopenia, monocytosis, hypoproteinemia, hypoalbuminemia, low bicarbonate, and elevated chloride. T4 was low.

DX

Splenic lymphoma

Sonographic Differential Diagnosis

These images are highly suspicious for infiltrative neoplasia such as lymphoma or malignant histiocytosis involving the spleen, potentially liver, and periportal lymph nodes. The appearance of the liver is suggestive for aggressive inflammatory disease, hepatic remodeling, or early infiltrative disease. Fine-needle aspirates of the uniformly swollen liver were performed.

Image Interpretation

The spleen was severely enlarged with scalloping contour and normal blood flow. There was no indication of splenic infarction or torsion; normal vasculature is demonstrated on Power Doppler. The liver was swollen in contour with increased and coarse portal markings. An aggressive periportal lymphadenopathy was noted and measured 6.4 x 2.5 cm with loss of corticomedullary definition.

Outcome

The patient was referred to a specialty hospital were he was diagnosed with stage IV lymphoma. The patient started on the CHOP protocol and owner reports that the patient appears to be doing better.

Comments

Fine needle aspirates of coarse livers like this one can be unrewarding due to a lack of adequate cellular exfoliation. Core biopsy becomes necessary to reveal the structural changes in the portal triads that would be consistent with lymphoma.

Clinical Differential Diagnosis

Vomiting – IBD, neoplasia, ulceration, foreign body, intestinal perforation with focal peritonitis. Hematological abnormalities – blood loss, liver disease.