Case Study

Early lymphoma and hepatic lipidosis in a 10 year old FS DSH cat

A 10-year-old FS DSH cat was presented for weight loss, vomiting, and anorexia. On physical examination, the patient was quiet and cachexic. The patient had lost 5-pounds over seven months, was tachycardic, and had thickened intestines and small kidneys. CBC showed lymphopenia, polycythemia, and thrombocytopenia. On blood chemistry, there was elevated ALP, ALT, and hyperbilirubinemia. The serum was icteric. The patient was treated with intravenous fluids containing 5% dextrose, antibiotics, liver protectants, appetite stimulants, gastroprotectants, pain medication, and lactulose.

A 10-year-old FS DSH cat was presented for weight loss, vomiting, and anorexia. On physical examination, the patient was quiet and cachexic. The patient had lost 5-pounds over seven months, was tachycardic, and had thickened intestines and small kidneys. CBC showed lymphopenia, polycythemia, and thrombocytopenia. On blood chemistry, there was elevated ALP, ALT, and hyperbilirubinemia. The serum was icteric. The patient was treated with intravenous fluids containing 5% dextrose, antibiotics, liver protectants, appetite stimulants, gastroprotectants, pain medication, and lactulose. Radiographs did not demonstrate any significant findings. After two days on fluid therapy, the patient was showing no menace, could not see, was head pressing, and was icteric.

DX

Stomach: early lymphoma. Liver: hepatic lipidosis

Sonographic Differential Diagnosis

Gastric wall thickening, potential lymphoma. Probable hepatic lipidosis. Possible hepatic lymphoma.

Image Interpretation

The esophageal stomach revealed 1.3 x 1.5cm thickening that was aspirated by fine needle aspirate. The liver was diffusely hyperechoic compared to falciform fat in the near field most consistent with lipidosis.

Outcome

The initial therapy was continued and a feeding tube was placed. The follow day the head pressing had resolved, menace had improved, but there was still ongoing anorexia and icterus. The owners declined any surgical intervention, decided to continue treating the cat for hepatic lipidosis, and would pursue an oncology consult for possible chemotherapy. Recheck blood work showed some improvement in the liver enzyme activity and bilirubin. The patient was tolerating tube feedings well but was still not eating on her own. The patient was started on the Madison-Wisconsin chemotherapeutic protocol. She starting eating on her own, however, after the second dose of chemotherapy, her appetite waned. The owner decided to cease any further chemotherapy and instead treat the patient with steroids and appetite stimulants. At last communication, the patient was stable.

Clinical Differential Diagnosis

Liver disease – lipidosis, cholangiohepatitis, infectious, neoplasia. GI disease: IBD, intestinal neoplasia, lymphoma.

Sampling

US-guided FNA cytology from the stomach wall was suggestive of early lymphoma; whereas the liver aspirates were consistent with hepatic lipidosis. (PT and APTT were done prior to obtaining the aspirates).