Case Study

Intestinal and renal lymphoma in a 7 year old MN DSH cat

A seven-year-old MN DSH cat was presented with lethargy with the owner reporting that the cat’s behavior and temperament had changed. On urinalysis the urine was straw in color and clear; USPG was inappropriate (1.021), hematuria was present. The urine protein/creatinine ratio was 1.1. Abnormalities on CBC and serum chemistry were anemia, neutrophilia, lymphopenia, monocytosis, hypoproteinemia, and azotemia. Abdominal radiographs revealed an left nephromegaly and a mass effect in the gastrointestinal tract.

A seven-year-old MN DSH cat was presented with lethargy with the owner reporting that the cat’s behavior and temperament had changed. On urinalysis the urine was straw in color and clear; USPG was inappropriate (1.021), hematuria was present. The urine protein/creatinine ratio was 1.1. Abnormalities on CBC and serum chemistry were anemia, neutrophilia, lymphopenia, monocytosis, hypoproteinemia, and azotemia. Abdominal radiographs revealed an left nephromegaly and a mass effect in the gastrointestinal tract.

DX

Lymphoma, intestinal and renal

Sonographic Differential Diagnosis

Lymphoma

Image Interpretation

Both kidneys were enlarged and the contours were irregular. A scant amount of subcapsular fluid was noted. The renal cortices were also irregular and hyperechoic. The medullae were depressed with thickened pelvis. This presentation is consistent with immune derived infiltrative disease such as lymphoma, or possibly an aggressive interstitial nephritis. Examination of the gastrointestinal tract revealed a thickened portion of the colon where there was a loss of mural detail. The thickest portion of the mass measured 1.14 cm from the lumen to the serosa. The mass appeared to be circumferential and localized. There did not appear to be any lymph node enlargement associated with this portion of the intestine.

Outcome

The pet was treated with depomedrol injections. The owner elected to humanely euthanize the pet a few weeks later.

Clinical Differential Diagnosis

Renal pathology- kidney failure, neoplasia, hydronephrosis, ureteroliths, pyelonephritis, abscess, granuloma . GI pathology – obstruction, intestinal lymphoma/neoplasia

Sampling

Ultrasound guided fine needle aspirates were taken from the kidney and intestinal mass and were submitted to a pathologist. The cytological interpretation of the cells revealed lymphoma.