- 16 year old mn DSH-adr-unexplained 2lb weight loss-cat is still overweight
- Labwork shows mildly elevated ALKP, early crf
- Radiographs show a cranial abdominal mass and a cranial mediastinal mass
- 16 year old mn DSH-adr-unexplained 2lb weight loss-cat is still overweight
- Labwork shows mildly elevated ALKP, early crf
- Radiographs show a cranial abdominal mass and a cranial mediastinal mass
- Ultrasound exam shows a cranial mediastinal cyst, advanced kidney interstitial nephritis pattern, and a large, solid, complex, echogenic mass in the right medial liver with clusters of small (<4mm), coalescing anechoic cysts.
- The liver mass is not likely amenable to surgical resection as it extends cranio-dorsally to the diaphragm and it is in close association with the portal vein. The mass is distoring the liver capsule.
- The only structure that can be seen that resembles a gall bladder is displaced to the left side of the abdomen. The wall is thickened and shows evidence of mineralization.
- US guided fna’s yielded a foamy pink sample. Cytology report stated sparse celluarity with mild degree of hepatocyte atypia. No obvious evidence of lymphoma or other infiltrative neoplasia or infection.
- My primary differentials are hepatocellular carcinoma, biliary carcinoma, less likely biliary adenoma. Could this also potentially be infection or is it too aggressive looking?
- I am recommending a core biopsy next. Any other thoughts?
Comments
These masses are old cat
These masses are old cat biliary adenomas or adenocarcinoma. LSA doesnt do cysts but does parenchymal nodules or caprsular expansion and hypoechoic parenchyma or is masked buy a lipidosis pattern. Core bx could be done but you have to true cut along the parenchymal bprder of normal to abnormal liver. Im not convonced that this mass by itself is necessarily causing the weight loss and would look for otehr things too such as hairballs. ht4, triad disease and so forth. This may be causing a bulk irritation displacing the stomach caudally and hence hyporhexia. There is plenty of liver that appears solid so liver failure not likely an issue. If you can’t cut these out I look for other causes and imagine its not there and treat for other things….Or core bx for further dx but likely not resectable as you say given the diaphragm involvement. CT potential too and maybe a debulk???
Check out the archive on the basic search under biliary cystadenoma or try hepatic carcinoma or hepatic lymphoma and you will see what i mean:)
http://sonopath.com/members/case-studies/search?text=biliary+cystadenoma&species=All
These masses are old cat
These masses are old cat biliary adenomas or adenocarcinoma. LSA doesnt do cysts but does parenchymal nodules or caprsular expansion and hypoechoic parenchyma or is masked buy a lipidosis pattern. Core bx could be done but you have to true cut along the parenchymal bprder of normal to abnormal liver. Im not convonced that this mass by itself is necessarily causing the weight loss and would look for otehr things too such as hairballs. ht4, triad disease and so forth. This may be causing a bulk irritation displacing the stomach caudally and hence hyporhexia. There is plenty of liver that appears solid so liver failure not likely an issue. If you can’t cut these out I look for other causes and imagine its not there and treat for other things….Or core bx for further dx but likely not resectable as you say given the diaphragm involvement. CT potential too and maybe a debulk???
Check out the archive on the basic search under biliary cystadenoma or try hepatic carcinoma or hepatic lymphoma and you will see what i mean:)
http://sonopath.com/members/case-studies/search?text=biliary+cystadenoma&species=All
Ok, thanks!
Ok, thanks!
Ok, thanks!
Ok, thanks!