Case Study

CT – Followup staging CT for previously excised subcutaneous hemangiosarcoma in a 9 year old MN German Shepherd

This 9 year old MN German Shepherd presented for followup staging CT for a previously excised SQ hemangiosarcoma on the dorsal thoracic spine, several surgeries, on chemotherapy.

DX

There is no evidence of pulmonary, hepatic or lymphatic metastatic disease as well as no mass lesion at the heart base and no pericardial effusion.

Image Interpretation

CT of the thorax, abdomen and thoracolumbar spine –

Thorax: There is no evidence of metastatic spread to the lung parenchyma, mediastinal lymph nodes or heart base

Abdomen: Two faintly enhancing intraparenchymal, non-expansile nodules of 8 mm diameter are seen within the splenic body. There is no evidence of macroscopic metastatic spread to the liver or abdominal lymph nodes.

Mild enlargement of the following 3 nodules is noted when compared with the previous report:

The subcutaneous nodule to the right of the 13th rib measures 17 x 10 mm.
The subcutaneous nodule to the right of L3 measures 19 x 7 mm.
The flat subcutaneous nodule to the left of L6 measures 11 x 3 mm.

Thoracolumbar spine: There is no macroorphologic evidence of tumor recurrence.

Outcome

There also is no macromorhologic evidence of tumor recurrence at the former surgery sites. The changes noted are rather consistent with scar formation at this point. The macromorphologic features of the new splenic nodules are compatible with nodular hyperplasia. However, metastatic spread is a potential too and should be ruled out by means of ultrasound guided fine needle aspiration even if less likely.

Comments

Followup CT 3 weeks later – Appearance of new SQ nodule left cranio-ventral thorax. CT shows no significant changes from the previous CT. The multifocal subcutaneous nodules are stationary in size. New very small nodules < 1 cm diameter are noted along the lumbar spine.