Case Study

Reactive lymphoid hyperplasia and extramedullary hematopoeisis diagnosed on splenic FNA in a 10 year old MN Golden Retriever

A 10 year old NM Golden Retriever was presented with a history of systemic hypertension, emerging pulmonary hypertension, and mitral insufficiency, which was being managed with 2.5 mg amlodipine once a day. A soft tissue sarcoma had been removed previously from the dog’s back. Arrhythmia, multiple soft movable subcutaneous masses, weight loss, and muscle wasting were noted on physical examination. Urinalysis was within normal limits. On CBC, thrombocytosis, lymphocytosis, and monocytosis were present. The only abnormality on serum biochemistry was elevated GGT activity.

DX

Reactive lymphoid hyperplasia and EMH

Sonographic Differential Diagnosis

Small splenic mass with micronodular splenic changes (hepatoma, hemangiosarcoma, infiltrative neoplastic disease).

Image Interpretation

The spleen presented diffuse nodular hypoechoic changes with an overt 3.2cm mass at the caudal pole with mixed echogenic hypoechoic changes.

Outcome

Splenectomy was recommended, which is being considered by the owner.

Clinical Differential Diagnosis

Subcutaneous masses – neoplasia, cysts, abscessation, hematomas. Arrhythmia – cardiomyopathy, left ventricular hypertrophy secondary to the hypertension. Splenic disease – neoplasia (primary or metastatic), hypersplenism, torsion, infarction. Hypertension – primary/essential, renal disease, cardiac disease, Cushing’s disease.

Sampling

Ultrasound guided FNA of the spleen. Cytology revealed reactive lymphoid hyperplasia with moderate extramedullary hematopoiesis. The subcutaneous masses were diagnosed as myxosarcoma and trichoepithelioma on biopsy.