Case Study

Left adrenal mass, possibly pheochromocytoma, metastatizing to the spleen in a 6 year old intact F Rottweiller

A 6-year-old intact female Rottweiler was presented for routine ovariohysterectomy but on physical examination showed weight loss, lethargy, pale mucosa, and tense abdomen on palpation. Abnormalities on CBC were anemia, thrombocytopenia, lymphocytosis, and monocytosis. On survey radiographs, a possible mass effect cranial-mid-abdomen was present.

DX

left adrenal mass, likely primary tumor pheochromocytoma, metastasizing to the spleen

Sonographic Differential Diagnosis

A 6.0 cm, irregular mass was noted deriving from the mid body of the left adrenal gland. This is presumed to be the original tumor. There is a strong suspicion for pheochromocytoma, which has a propensity towards metastatic pattern to the spleen. The left adrenal gland mass did not appear to overtly invade the vena cava.

Image Interpretation

The right adrenal gland was uniform and measured 2.07 x 0.61 cm at the caudal pole and 0.58 cm at the cranial pole. The left adrenal gland revealed a mass that measured approximately 6.0 x 5.0 cm and was moderately hypervascular. Pericapsular inflammatory pattern was noted. Uniformly swollen liver with minor heterogenous changes

Outcome

There is a strong suspicion for pheochromocytoma, which has a propensity towards metastatic pattern to the spleen. The left adrenal gland mass did not appear to overtly invade the vena cava. Technically left adrenalectomy and splenectomy would be warranted.

Comments

If chest radiographs are free of evident pathology then surgical intervention would be recommended. However, micrometastasis is a significant potential in this patient. Guarded prognosis. Serial blood pressure measurements are recommended. Blood transfusion will likely be necessary in this case. There is a mild potential that the mass in the region of the left adrenal gland may be a lymph node that has impinged significantly on the left adrenal; however, the residual left adrenal parenchyma appears to be continuous with the mass. Therefore, this is likely more of adrenal origin. However, the CBC differential reveals absolute lymphocytosis, which would fit more with the lymphoma. 25-gauge ultrasound-guided FNA of the spleen and mass in the region of the left adrenal gland would allow for further staging; however, with hematocrit of 22 blood transfusion may be an option. Bone marrow aspirates would also be ideal if not already performed.

Clinical Differential Diagnosis

Vector borne disease – ehrlichiosis, anaplasmosis, bartonellosis
Mass – neoplasia/cyst/abscess/granuloma of liver, spleen, kidney, adrenal, mesentery, lymph node
Spleen – reactive, hypersplenism, torsion

Patient Information

Patient Name : Brandy Poncharik

Gender : Female, Intact

Species : Canine

Type of Imaging : Ultrasound

Status : Complete

Liz Wuz Here : Yes

Code : 07_00197

Exam Finding

Lethargy
Pale Mucous Membranes
Tense Abdomen
Weight loss

CBC

Lymphocytes, High
Monocytes, High
Platelet Count, Low