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Adrenal Mass and Caudal Abdominal Mass

Sonopath Forum

Adrenal Mass and Caudal Abdominal Mass

– 11 MN Rat Terrier presented for diarrhea and vomiting; unusual masses noted in the scrotum on palpation

– history of mildly elevated ALP, LDDST ruled out Cushings

– rDVM felt a mass on rectal palpation

– hypoechoic mass found between the urinary bladder and colon on u/s (not sure what this could be? part of the prostate?LN? other?)

– neck of urinary bladder was intrapelvic therefore could not get into the proximal urethra/prostate region

– both L and R medial iliac LN’s were identified and looked normal

– 11 MN Rat Terrier presented for diarrhea and vomiting; unusual masses noted in the scrotum on palpation

– history of mildly elevated ALP, LDDST ruled out Cushings

– rDVM felt a mass on rectal palpation

– hypoechoic mass found between the urinary bladder and colon on u/s (not sure what this could be? part of the prostate?LN? other?)

– neck of urinary bladder was intrapelvic therefore could not get into the proximal urethra/prostate region

– both L and R medial iliac LN’s were identified and looked normal

– FNA’s of the mass taken – had to push ventrally rectally and compress abdominal wall and go through the ub to get at

Mass #2 – left adrenal mass?

– could not find normal left adrenal; right adrenal normal

– I think this is a large adrenal mass with CVC invasion? what do you think?

Thanks!

 

 

Comments

rlobetti

Video clips of the second

Video clips of the second mass do not open. Caudal mass a bit cranial for the prostate, most likley a lymph node – see what the FNA shows.

rlobetti

Video clips of the second

Video clips of the second mass do not open. Caudal mass a bit cranial for the prostate, most likley a lymph node – see what the FNA shows.

Pankatz

Weird – I can open all of the

Weird – I can open all of the clips on my end?

FNA Result: “Exfoliation of uniform polygonal epithelial cells – possibly prostate. Clinical evidence of a mass, identification of epithelial cells and lack of inflammtion support epithelial tumor. Criteria of malignancy is insufficient to support a cytological diagnosis of carcinoma, but tissue biopsy may be considered for further assessment”

I don’t think I can get at this to do an u/s guided core biopsy.

 

 

Pankatz

Weird – I can open all of the

Weird – I can open all of the clips on my end?

FNA Result: “Exfoliation of uniform polygonal epithelial cells – possibly prostate. Clinical evidence of a mass, identification of epithelial cells and lack of inflammtion support epithelial tumor. Criteria of malignancy is insufficient to support a cytological diagnosis of carcinoma, but tissue biopsy may be considered for further assessment”

I don’t think I can get at this to do an u/s guided core biopsy.

 

 

EL

 
 
Jacquie if you approach

 
 

Jacquie if you approach it from right lateral recumbency and go thru the left groin with left hind leg held up by the handler. Eith your probe hand push down the prostate will be inperfect position for bx. I can see an angle for a 2.2 cm cut but a series of 1.2 cm cuts would work as well.

This case was an fna but can bx at the same angle

http://sonopath.com/members/case-studies/cases/prostatic-carcinoma-14-year-old-mn-labrador-retriever-dog

 
EL

 
 
Jacquie if you approach

 
 

Jacquie if you approach it from right lateral recumbency and go thru the left groin with left hind leg held up by the handler. Eith your probe hand push down the prostate will be inperfect position for bx. I can see an angle for a 2.2 cm cut but a series of 1.2 cm cuts would work as well.

This case was an fna but can bx at the same angle

http://sonopath.com/members/case-studies/cases/prostatic-carcinoma-14-year-old-mn-labrador-retriever-dog

 
Pankatz

Do you think there is any

Do you think there is any connection here with the adrenal mass?

Pankatz

Do you think there is any

Do you think there is any connection here with the adrenal mass?

EL

 
 
Looking at this again.

 
 

Looking at this again. Sorry I was on a bad connection before, I think this adrenal mass is invading the cvc at the level of the adrenal and infiltrating the cvc caudally til it expands outward and wraps the cvc at the level of the UB. I have seen this happen before i.e. in and out cvc invasion of adrenals. Its likely escaping caudally at another venous entry into the cvc these tend to follow the path of least resistence entering the phrenic and exting through other veins. The other initial images are too far cranial to be prostate. I think this is all caval invading adrenal carcinoma. Alien invasion of adrenal tumors:) Way cool case. Case of the month material for sure.

Regarding adrenal carcinomas they can be non functional or functional cushings or estrogen or progresterone or other cortical hormones.

 
EL

 
 
Looking at this again.

 
 

Looking at this again. Sorry I was on a bad connection before, I think this adrenal mass is invading the cvc at the level of the adrenal and infiltrating the cvc caudally til it expands outward and wraps the cvc at the level of the UB. I have seen this happen before i.e. in and out cvc invasion of adrenals. Its likely escaping caudally at another venous entry into the cvc these tend to follow the path of least resistence entering the phrenic and exting through other veins. The other initial images are too far cranial to be prostate. I think this is all caval invading adrenal carcinoma. Alien invasion of adrenal tumors:) Way cool case. Case of the month material for sure.

Regarding adrenal carcinomas they can be non functional or functional cushings or estrogen or progresterone or other cortical hormones.

 
Pankatz

No problem Eric – I

No problem Eric – I understand you are a traveling man 🙂

Cool case for sure – would you stick this adrenal? It would be much easier to get at then the caudal mass.

Pankatz

No problem Eric – I

No problem Eric – I understand you are a traveling man 🙂

Cool case for sure – would you stick this adrenal? It would be much easier to get at then the caudal mass.

EL

 
 
I would.. light slide no

 
 

I would.. light slide no jab. 25 gauge and usuall 2-3 opasses at different angles is what you need. Check HR and bp before and after sticking for adrenalin surge. Only happened once to me and it self resolved.

Here are 5 pages of adrenal masses to peruse in the basic search. skip the first one

http://sonopath.com/members/case-studies/search?text=adrenal+mass+fna&species=All

 
EL

 
 
I would.. light slide no

 
 

I would.. light slide no jab. 25 gauge and usuall 2-3 opasses at different angles is what you need. Check HR and bp before and after sticking for adrenalin surge. Only happened once to me and it self resolved.

Here are 5 pages of adrenal masses to peruse in the basic search. skip the first one

http://sonopath.com/members/case-studies/search?text=adrenal+mass+fna&species=All

 
marty

I agree with Eric – almost

I agree with Eric – almost certain this is all adrenal mass in which case a reaspiration of the caudal abdominal mass should confirm whats in the adrenal too.  That said, according to Claudia Barton, adrenal tumors are often not able to be diagnosed on FNB alone and require histopath for an accurate diagnosis.

marty

I agree with Eric – almost

I agree with Eric – almost certain this is all adrenal mass in which case a reaspiration of the caudal abdominal mass should confirm whats in the adrenal too.  That said, according to Claudia Barton, adrenal tumors are often not able to be diagnosed on FNB alone and require histopath for an accurate diagnosis.

Pankatz

Good to know Marty. After

Good to know Marty. After talking with the rDVM and the owner, we have decided not to do any further biospes as anything that invades the CVC is bad news and not really surgical anyway.

Pankatz

Good to know Marty. After

Good to know Marty. After talking with the rDVM and the owner, we have decided not to do any further biospes as anything that invades the CVC is bad news and not really surgical anyway.