Case Study

03_00163 Tucker S Lymphoma

A 14 year old FS DSH with a history of constipation was presented with anorexia and intermittent episodes of diarrhea and obstipation. The patient was still drinking, but was less active and had been losing weight. The cat was dehydrated and a heart murmur was auscultated upon examination. Thrombocytopenia was present on the CBC. Blood chemistry showed hyperbilirubinemia, hyperphosphatemia, an increased ALT enzyme activity, and hyperamylasemia. Urinalysis showed proteinuria, hematuria, increased numbers of RBCs, and bilirubinuria. Microalbuminuria level was high.

A 14 year old FS DSH with a history of constipation was presented with anorexia and intermittent episodes of diarrhea and obstipation. The patient was still drinking, but was less active and had been losing weight. The cat was dehydrated and a heart murmur was auscultated upon examination. Thrombocytopenia was present on the CBC. Blood chemistry showed hyperbilirubinemia, hyperphosphatemia, an increased ALT enzyme activity, and hyperamylasemia. Urinalysis showed proteinuria, hematuria, increased numbers of RBCs, and bilirubinuria. Microalbuminuria level was high.

DX

Lymphoma, liver and spleen

Sonographic Differential Diagnosis

Splenic nodule suggestive for a neoplastic process such as lymphoma or mast cell disease. Focal nodular hyperplasia or abscessation less likely.

Image Interpretation

A solitary hypoechoic splenic nodule is noted with focal capsular expansion and loss of structural detail. US-guided 22-gauge FNA is performed.

Outcome

The patient was sent home on oral medication and was to start palliative therapy of subcutaneous fluids at home.

Clinical Differential Diagnosis

Cholangitis/cholangiohepatitis, cholelithiasis causing a biliary obstruction, pancreatitis with secondary cholestasis and/or cholangiohepatitis, Triaditis with an ascending bacterial infection, hepatic neoplasia (lymphoma, adenocarcinoma, leiomyoma, leiomyosarcoma, mast cell tumor,) biliary carcinoma, leptospirosis, toxoplasmosis and feline infectious peritonitis are less likely, but cannot be excluded depending upon the cat’s previous history/risk of exposure, etc.