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Lymphoblastic Lymphoma in a 14 year old MN DSH Cat

Case Study

Lymphoblastic Lymphoma in a 14 year old MN DSH Cat

A 14-year-old MN DSH was presented due to the development of a voracious appetite and restlessness. The cat was previously diagnosed with hyperthyroidism and previous serum biochemical changes included hyolesterolemia and hyperlipasemia. CBCs and urinalyses were normal. On physical exam, the patient was tachycardic and a low grade heart murmur was auscultated, in addition to a mild increase in respiratory effort. Systemic blood pressure measurements were taken, but the results were inconsistent, ranging from 110-236 mm Hg. The fT4 result was elevated.

A 14-year-old MN DSH was presented due to the development of a voracious appetite and restlessness. The cat was previously diagnosed with hyperthyroidism and previous serum biochemical changes included hyolesterolemia and hyperlipasemia. CBCs and urinalyses were normal. On physical exam, the patient was tachycardic and a low grade heart murmur was auscultated, in addition to a mild increase in respiratory effort. Systemic blood pressure measurements were taken, but the results were inconsistent, ranging from 110-236 mm Hg. The fT4 result was elevated. Medications for the treatment of hyperthyroidism and hypertension were initiated. The cat was re-presented for the development of vomiting for a 2 ВЅ day period. The owner described the cat as being hungry and wanting to eat, but being unable to keep anything down. The cat was bright, alert and responsive and had a normal temperature. No abnormalities were noted on abdominal palpation. Subcutaneous fluids, anti-emetics, and vitamins were administered and he was discharged the next day. The cat returned 2 months later; his owner had noticed that his appetite had been steadily declining over the last few weeks and had been losing weight. He had lost 1 lb 8 oz. since his previous visit. The patient was admitted to the hospital for blood work and supportive care. No abnormalities were noted on the blood chemistry and a low RBC count was present on the CBC. Abdominal radiographs showed thickened intestines which appeared to be bunched together without having any definitive edges.

DX

Lymphoblastic lymphoma

Sonographic Differential Diagnosis

Small bowel mural mass with moderate mesenteric lymphadenopathy consistent with neoplasia. Lymphosarcoma is primarily suspected.

Image Interpretation

The first image demonstrates a short axis view of a segment of small bowel which is markedly, asymmetrically, thick walled. The fragmented linear echogenicity within the mural mass represents a 22 gauge needle. Video 1 demonstrates the transition from mildly thickened bowel without detail loss into overtly thickened bowel mass with loss of layering. The mural thickening is hypoechoic with loss of wall layering. Note the needle placement in video 3 stays within the mural portion of the infiltrated wall. The second image reveals moderately enlarged, markedly hypoechoic lymph nodes adjacent to the mesenteric root. Color flow Doppler evidences the mesenteric vasculature. The regional mesentery is mildly echogenic, which is not an uncommon finding with severely reactive or infiltrative lymphadenopathy.

Outcome

The owner declined chemotherapy after consultation with an oncologist. The patient was euthanized 10 days post diagnosis.

Clinical Differential Diagnosis

GI pathology: Neoplasia (intestinal), IBD, maldigestion, foreign body.

Sampling

22 and 25g US guided FNA of the intestinal wall and mesenteric root lymph node revealed lymphoblastic lymphoma.

Patient Information

Patient Name : Oreo D
Gender : Male, Neutered
Species : Feline
Type of Imaging : Ultrasound
Book : yes
Status : Complete
Liz Wuz Here : Yes
Code : 04_00117

Clinical Signs

  • Polyphagia
  • Vomiting
  • Weight loss

History

  • Hyperthyroidism

Exam Finding

  • Heart Murmur
  • Respiratory Distress
  • Tachycardia

Images

Oreodthicklosswall_04022011093244OreoDLN_04022011093301

Blood Chemistry

  • Hyperthyroidism

CBC

  • RBC, Low

Clinical Signs

  • Polyphagia
  • Vomiting
  • Weight loss