Case Study

Small cell lymphoma diagnosed on FNA in a 5 year old FS DSH cat

A 5-year-old FS DSH cat, with a history of bladder stones, was presented for vomiting and reduced appetite. Urinalysis showed proteinuria, hematuria, and pyuria. Abnormalities on CBC and serum biochemistry were lymphopenia and thrombocytopenia; Serum biochemistry revealed an elevated ALT activity, elevated total bilirubin, and elevated BUN. Survey radiographs showed reduced body fat and a full stomach.

DX

Small cell lymphoma, splenitis

Sonographic Differential Diagnosis

Aggressive hepatopathy, splenitis, and/or potential neoplasia are possible in this case. Coagulation panel and fine-needle aspirates of the spleen and liver are recommended. Free fluid may be due to portal hypertension, lymphatic obstruction, or neoplasia. The lymphadenopathy of the upper gastrointestinal and mesenteric root lymph node groups is likely mild reactive appearing lymphadenitis. Concurrent pancreatitis is likely. Renal dystrophy and calculi, non-obstructive at this time, is also noted.

Image Interpretation

The spleen was enlarged and measured 1.5 cm with a mottled echotexture. Free fluid was noted near the spleen. The liver in this patient was swollen in contour with decreased portal markings. The gallbladder was mildly thickened and slightly dilated. No masses were noted. However, heterogenic parenchyma was present. The common bile duct was dilated at 0.46 cm and continued into the dilated pancreatic duct. The pancreas was also swollen in contour, and mild lymphadenopathy of the upper gastrointestinal and mesenteric root lymph node groups was noted.

Outcome

The patient was eventually humanely euthanized due to rapid decline.

Clinical Differential Diagnosis

Vomiting/inappetance – foreign body, neoplasia, IBD, infectious (bacterial, viral, protozoal, helminths), toxins, pancreatitis, peritonitis, neoplasia. Increased liver values – vacuolar hepatopathy, toxins, cholangitis-cholangiohepatitis complex, lipidosis, neoplasia. Urinary tract disease – chronic kidney disease, pyelonephritis, renoliths.

Sampling

Ultrasound guided FNAs of the spleen, liver, and free fluid were performed. Cytology of the spleen revealed splenitis. Fluid analysis of the peritoneal effusion revealed sterile serosanguinous exudate with lymphocytic component (intermediate-sized lymphoid elements) and atypism, which could indicate small cell lymphoma. Cytology of the liver revealed atypical lymphocytic infiltrate suggestive of small cell lymphoma.