Case Study

Severe renomegaly with infiltrative pattern in a 5 year old MN Lynx Point Siamese

A 5-year-old MN Lynx Point Siamese cat was presented for evaluation of vomiting, lethargy, polydipsia, and weight loss of 4 pounds since the previous year. On physical examination, bilateral renomegaly (R>L) was palpated, and confirmed on X-ray. Bloodwork showed WBC 28760, Neut 81%, Monos 3.8%; BUN 89, Creat 6.0, Phos 10.1. Urinalasis showed SG 1.014, Prot 2+, Blood 1+.

DX

Severe renomegaly with infiltrative pattern

Image Interpretation

The kidneys revealed severe bilateral enlargement with loss of corticomedullary definition. The kidneys revealed an irregular medulla and subcapsular halo. The subcapsular halo was vascular. Peri-capsular inflammatory pattern was noted around both kidneys. This is indicative of proliferative disease. The right kidney revealed ureteral dilation. The left kidney measured 6.8 cm.The right kidney measured 9.6 cm with areas of mineralization. An overt mass is noted in the right kidney.

The urine within the urinary bladder presented with some mildly echogenic debris consistent with mucous, exfoliated cells from renal or bladder origin, and/or blood clots as these echogenic changes can all present similarly.

Outcome

There is a strong suspicion for renal lymphoma. Coagulation panel and 25-gauge FNA of the subcapsular halo region as it junctions into the kidney is recommended. An overt mass is noted in the right kidney.
The prognosis is poor. This may be chemoresponsive depending upon cytology results. The pathology appears to be limited to the kidneys. The dilated ureter in the right kidney may be owing to infiltrative process within the ureter itself.