Case Study

03_00426 Gunther A Multicentric LSA

A 4-year-old NM German Shepherd was presented for evaluation of a two-week duration of decreased appetite and energy and weight loss. On physical examination an abdominal mass was present. Urine specific gravity was 1.007 and hypercalcemia (13.5) present on serum biochemsitry.

Sonographic Differential Diagnosis

Mesenteric lymph node mass.
Renal metastatic pattern.
Hepatic metastatic pattern. Multicentric round cell neoplasia is suspected.

Image Interpretation

The liver was riddled with micronodular changes consistent with round cell neoplasia. The gallbladder was unremarkable.
Kidneys were swollen with mixed echogenic to hypoechoic masses deriving from the cranial and caudal pole of the left kidney strongly suggestive for round cell neoplasia. Fine needle aspirates recommended. Right kidney presented a complex mass with separate intestinal or lymph node mass in the mid-abdomen. The bilateral renal presentation is likely owing to metastatic disease. A mixed echoic splenic mass was also present.

DX

Multicentric LSA

Outcome

None

Clinical Differential Diagnosis

Hypercalcemia of malignancy – liver/spleen/kidney lymphoma, multiple myeloma, solid tumors of the intestine
Granulomatous disease
Fungal disease

Sampling

FNA strongly suggest lymphoma with adequate blastic cells. Did not identify hepatocytes so cannot be certain it is in the liver. The blasts strongly suggest a malignant lymphoma but there is a mixture of cells. If therapy is contemplated, then biopsy with immunohistochemistry staining is encouraged. Lymphoma appears to be the most likely interpretation of the cells collected.