Case Study

Round cell neoplasm diagnosed on FNA in a 10 year old Scottish Terrier

A 10-year-old Scottish Terrier dog was presented for evaluation of nonspecific symptoms and lethargy. Pyrexia (105.6F) and a distended abdomen were present on physical examination. Abnormalities on CBC were leukocytosis with a left shift and anemia. Blood chemistry revealed elevated ALP, elevated AST, elevated amylase, elevated bilirubin, and elevated cholesterol. The dog also had a very low total T4. Coombs and 4DX panel were both negative.

A 10-year-old Scottish Terrier dog was presented for evaluation of nonspecific symptoms and lethargy. Pyrexia (105.6F) and a distended abdomen were present on physical examination. Abnormalities on CBC were leukocytosis with a left shift and anemia. Blood chemistry revealed elevated ALP, elevated AST, elevated amylase, elevated bilirubin, and elevated cholesterol. The dog also had a very low total T4. Coombs and 4DX panel were both negative.

DX

Round cell neoplasia

Sonographic Differential Diagnosis

These images are most consistent with abdominal metastatic neoplasia involving the spleen, liver, region of the left adrenal gland, and kidneys. The neoplasia is potentially of left adrenal gland origin, which would suggest pheochromocytoma. There is a possibility of lymphatic derived neoplasia such as lymphoma or histiocytosis. No evidence of hemorrhage was noted. Poor prognosis. The patient is at risk for sudden death.

Image Interpretation

The abdomen in this patient presented multiple masses with a dramatic hypoechoic, target type appearance and capsular expansion. This pathology involved the spleen and liver as well as mesenteric root and iliac lymph nodes. Complete loss of structural detail was noted in all the organs described. A mass was noted in the region of the left adrenal gland and measured 3 x 2 cm with dramatic, hypoechoic changes. Dual hyperechoic line in the middle of the mass is suggestive of adrenal origin. However, this may be lymph node origin and obscuring the adrenal gland. Some nodular changes were noted in the renal cortices also suggestive of early infiltrative disease. The remainder of the organs were unremarkable.

Outcome

The patient was euthanized.

Clinical Differential Diagnosis

Liver disease (infectious, toxic, neoplasia), gall bladder disease (cholecystitis, obstruction, rupture), pancreatic disease (pancreatitis, neoplasia), intra-abdominal neoplasia, peritonitis.

Sampling

Splenic and hepatic ultrasound-guided FNAs were performed in regions of transition from normal parenchyma into masses. Cytological results of the liver revealed atypical round cell neoplasia, cholestasis and mild vacuolar changes. The splenic cytological results revealed mild to moderate lymphoid hyperplasia and extramedullary hematopoiesis with low numbers of atycial round cells. Mild stromal cell hyperplasia.