Case Study

03-00142 Princess M Lymphoplasmacytic hepatitis; possible splenic lymphoma -RESEARCH ONLY

A 12-year-old FS German Shepherd, currently on Rimadyl and DES, was presented for decreased appetite, shaking of the head, defecating in the house, and knuckling on the front limbs. Abnormalities on physical examination were pyrexia (103°), bilateral cataracts, splenomegaly, hepatomegaly, a pendulous abdomen, and weak hindquarters. Abnormalities on urinalysis were 2+ proteinuria, leukocyturia, and elevated microalbumin. On CBC and blood chemistry anemia, monocytosis, and hyperglobulinemia were evident. T4 was low and a 4DX test negative. A coagulation panel was within normal limits.

A 12-year-old FS German Shepherd, currently on Rimadyl and DES, was presented for decreased appetite, shaking of the head, defecating in the house, and knuckling on the front limbs. Abnormalities on physical examination were pyrexia (103°), bilateral cataracts, splenomegaly, hepatomegaly, a pendulous abdomen, and weak hindquarters. Abnormalities on urinalysis were 2+ proteinuria, leukocyturia, and elevated microalbumin. On CBC and blood chemistry anemia, monocytosis, and hyperglobulinemia were evident. T4 was low and a 4DX test negative. A coagulation panel was within normal limits.

DX

Lymphoplasmacytic hepatitis; splenic lymphoma or lymphoid hyperplasia and EMH

Sonographic Differential Diagnosis

Splenomegaly-hyperplasia, EMH, mast cell, lymphoma, splenitis Hypoechoic Liver – hepatitis, infiltrative neoplasms such as lymphoma or mast cell

Image Interpretation

Spleen-enlarged, predominantly hyperechoic, diffuse miliary hyperechoic regions,no evidence of significant congestion Liver-enlarged, predominantly hypoechoic, mild to moderate periportal vein prominence, slightly irregular margins, no significant congestion Gallbladder-wall thickened, irregularly hyperechoic.

Comments

Video 1 runs too fast. Both are very poor quality as if they had not undergone the new conversion.

Clinical Differential Diagnosis

Pyrexia – infection/inflammation/neoplasia, splenomegaly – infection/congestion/torsion/neoplasia/hyperplasia, hepatomegaly – congestion/inflammation/neoplasia/infection, weak hindquarters – anemia/DJD/degenerative myelitis/spinal cord compression

Sampling

US-guided FNAs and an US-guided Tru-cut biopsy of the liver were taken. FNAs of the liver revealed mixed inflammatory hepatitis and hepatocellular vacuolization. FNAs of the spleen showed either lymphoma or lymphoid hyperplasia and extramedullary hematopoiesis. On liver biopsy mild, multifocal, chronic, lymphoplasmacytic hepatitis was diagnosed.Due to the high suspicion of lymphoma a biopsy of the liver or lymph node was recommended. The patient was treated with Deramaxx and famotadine. A few days later she was presented for vomiting. On physical examination the mucous membranes were pale (PCV 24), there was peripheral lymphadenopathy, and weight loss was evident. The patient was treated with Cimetidine, Prednisone, and subcutaneous fluids. Survey thoracic radiographs were within normal limits. A recheck ultrasound showed splenic, periportal and hepatic infiltrative disease, and a thoracic effusion. As metastatic disease was likely a poor prognosis was given. The patient was then treated with cimetidine and Cytoxan, Leukeran, and tramadol. The patient was euthanized a few weeks later.