Case Study

High grade lymphomatosis in a 11 year old MN Snowshoe cat with ascites including telecytology

This 11 year old MN Snowshoe cat has a history of distended abdomen and inappetance.

Physical exam: alert and responsive, ambulatory, exploring room, not eating. thin cat. fluid filled abdomen, not painful.

CBC/Chem: globulin low, K+ slightly elevated, Tbili slightly increased at 1.4

This 11 year old MN Snowshoe cat has a history of distended abdomen and inappetance.

Physical exam: alert and responsive, ambulatory, exploring room, not eating. thin cat. fluid filled abdomen, not painful.

CBC/Chem: globulin low, K+ slightly elevated, Tbili slightly increased at 1.4

Reason for Ultrasound Exam: looking for cause of ascites. no fluid in the chest on ultrasound peek. Noted no overt mass. T4 not run yet but will submit. fluid analysis is 1.4 protein (1.020 specific gravity) serosanguinous with glucose, blood, mild bilirubin in fluid, 7.0 pH, 300+ protein and over 7000/uL WBC (almost as many as RBC). cell population is mixed neuts and monos…sending to the telecytology

DX

High grade lymphomatosis of abdominal fluid, likely affecting spleen, kidney and liver

Sonographic Differential Diagnosis

Infiltrative splenic and renal pattern.
Enlarged liver with nodular changes and free fluid.
Nodular coalesced omentum was noted in the cranial abdomen enveloping the
pancreas.
Likely lymphomatosis or carcinomatosis. FNA of the left kidney, spleen and abdominocentesis with cytospin and FNA of the
liver would all be warranted. Poor prognosis.

Image Interpretation

The left kidney in this patient was distorted with complete loss of corticomedullary definition and subcapsular halo. This is strongly suggestive for lymphoma or similar. The right kidney presented cortical infarct and irregular contour. The spleen was enlarged and irregular measuring approximately 1.5 cm in width. This is strongly suggestive for infiltrative disease. The liver presented mixed, hypoechoic nodular changes with heterogenous parenchyma. A moderate amount of ascites was noted in this patient. Nodular omental changes were noted.

Outcome

poor prognosis

Sampling

FNA of abdominal fluid:
Observations:
The images have large numbers of erythrocytes interspersed with moderate numbers of nucleated cells. The
majority of the nucleated cells are mononuclear cells. There are reactive mesothelial cells with a foamy cytoplasm
and scattered neutrophils. The most common cell appears to be a lymphoid cell and many of these cells are
atypical. They have irregular nucleoli to multiple nucleoli and the nuclei are eccentric. The cytoplasm is minimal
and bluish gray. The nuclei are 3 to 6 times the size of red blood cells. Occasionally these cells are aggregated.
Small mature lymphocytes are rare.
Interpretation:
Consistent with high-grade lymphoma with hemorrhage
Comments:
The cellularity is most characteristic of a high-grade lymphoma. There is hemorrhage and inflammation as a
prominent part of this collection. There are reactive mesothelial cells and neutrophils. With the atypical cells, highgrade
lymphoma appears to be the most likely diagnosis.