Note: I also posted this on VIN…
this cat was presented initially for lethargy. Blood work normal.
RDVM wanted to look at the pancreas via US. It was normal. The spleen wasn’t.
There was one enlarged mesenteric lymph node. Parameters matched inflammation over neoplasia. FNA came back as hyperplastic.
Note: I also posted this on VIN…
this cat was presented initially for lethargy. Blood work normal.
RDVM wanted to look at the pancreas via US. It was normal. The spleen wasn’t.
There was one enlarged mesenteric lymph node. Parameters matched inflammation over neoplasia. FNA came back as hyperplastic.
One small (less than 0.5cm) hypoechoic nodule in tail of spleen. One large (1.47×1.27×1.38 cm) mass body/head of spleen. Distorting the capsule. Non-shadowing hyperechoic areas in the hypoechoic mass. Appear hyperechoic enough to think mineralized, but no shadow.
FNA of spleen non-diagnostic. I warned the RDVM they can be. I recommended a splenectomy. I haven’t seen a splenic mass in a cat before and I know the recommendation for dogs is usually splenectomy if it has a mass that looks like this.
No splenectomy being done because this RDVM consults with an internist at Medi-cal and the internist said definitely do not remove the spleen because it will adversely effect the cat’s immune system.
Maybe i’ve forgotten something. Can’t say I’ve ever had to do a splenectomy in cats. Can removing the spleen mess up the immune system to the point of being worse that a possible neoplastic mass being left in the abdomen??
Comments
Thats a new one to me re
Thats a new one to me re splenectomy and immune system. I have seen plenty of cats do just fine without a spleen and splenic lesions in cats, in my experience, are more often malignant than in dogs. Dogs can get benign hyperplasia readily but this has a target appearance. I think the risk of leaving it, assuming there are no mets, strongly outweighs the risk of removing it and having some sort of immune collapse. The RES (reticuloendothelial system) lives elsewhere as well in the liver, bone marrow, LN, galt and malt and so forth so there is plenty of immune system to go around. Maybe Remo Lobetti can chime in on this if he has heard of anything re immune collapse and splenectomy in cats. He is an infectious disease expert. When in doubt cut it out… chest rads and met screen right before sx as well. Abscess is also possible here but too precarious to leave regardless.
Thats a new one to me re
Thats a new one to me re splenectomy and immune system. I have seen plenty of cats do just fine without a spleen and splenic lesions in cats, in my experience, are more often malignant than in dogs. Dogs can get benign hyperplasia readily but this has a target appearance. I think the risk of leaving it, assuming there are no mets, strongly outweighs the risk of removing it and having some sort of immune collapse. The RES (reticuloendothelial system) lives elsewhere as well in the liver, bone marrow, LN, galt and malt and so forth so there is plenty of immune system to go around. Maybe Remo Lobetti can chime in on this if he has heard of anything re immune collapse and splenectomy in cats. He is an infectious disease expert. When in doubt cut it out… chest rads and met screen right before sx as well. Abscess is also possible here but too precarious to leave regardless.
I tend to agree with Eric as
I tend to agree with Eric as the risk versus benefit is in favor of removing the spleen. As in the dog the cat would then be more susceptible to the vector-borne diseases so strict tick and flea control should thus be adhered to. Also the spleen is only one of many immunity organs. These factors are, however, not contraindications for doing a splenectomy
There is very little in the literature about splenectomy in cats. In humans the long-term consequences of splenectomy still remains incomplete with the best-defined and most widely understood complication being increased susceptibility to infection. Here is one article in cats, which does not seem to contradict the procedure:
Gordon SS, McClaran JK, Bergman PJ, Liu SM. Outcome following splenectomy in cats J Feline Med Surg. 2010, 12:256-261
No studies have yet examined whether there are prognostic factors for survival for cats undergoing splenectomies. The medical records of 19 cats that had complete splenectomy were reviewed for information on preoperative, intraoperative, and postoperative factors. The most common presenting signs were a palpable abdominal mass in 58% and anorexia in 47% of the cats. Mast cell tumors were the most common reason for splenectomy and were found in 10/19 cats (53%); followed by hemangiosarcoma in 4/19 (21%); and lymphoma in 2/19 (11%). The Kaplan-Meier median survival time (MST) was 197 days, with a range from 2 days to 1959 days. Three cats were noted to have preoperative weight loss, and this was the only factor that had prognostic significance for survival following surgery. For cats with weight loss the MST was 3 days, for cats with no weight loss noted the MST was 293 days (P=0.008).
I tend to agree with Eric as
I tend to agree with Eric as the risk versus benefit is in favor of removing the spleen. As in the dog the cat would then be more susceptible to the vector-borne diseases so strict tick and flea control should thus be adhered to. Also the spleen is only one of many immunity organs. These factors are, however, not contraindications for doing a splenectomy
There is very little in the literature about splenectomy in cats. In humans the long-term consequences of splenectomy still remains incomplete with the best-defined and most widely understood complication being increased susceptibility to infection. Here is one article in cats, which does not seem to contradict the procedure:
Gordon SS, McClaran JK, Bergman PJ, Liu SM. Outcome following splenectomy in cats J Feline Med Surg. 2010, 12:256-261
No studies have yet examined whether there are prognostic factors for survival for cats undergoing splenectomies. The medical records of 19 cats that had complete splenectomy were reviewed for information on preoperative, intraoperative, and postoperative factors. The most common presenting signs were a palpable abdominal mass in 58% and anorexia in 47% of the cats. Mast cell tumors were the most common reason for splenectomy and were found in 10/19 cats (53%); followed by hemangiosarcoma in 4/19 (21%); and lymphoma in 2/19 (11%). The Kaplan-Meier median survival time (MST) was 197 days, with a range from 2 days to 1959 days. Three cats were noted to have preoperative weight loss, and this was the only factor that had prognostic significance for survival following surgery. For cats with weight loss the MST was 3 days, for cats with no weight loss noted the MST was 293 days (P=0.008).
Thanks to you both. I’m not
Thanks to you both. I’m not sure what will happen with this kitty. Apparently the client was very upset that the FNA’s were not 100% diagnostic. It’s sad that even vets with years of experience still fail to tell clients that FNA’s are not 100%. I’ve heard them talking to clients and saying, “we will take these samples and it will give us the answers we need”. No “mights” or “maybes”. Then they are surprised when the client is upset. I even warned this vet that splenic FNA’s are often unrewarding. :/
Thanks to you both. I’m not
Thanks to you both. I’m not sure what will happen with this kitty. Apparently the client was very upset that the FNA’s were not 100% diagnostic. It’s sad that even vets with years of experience still fail to tell clients that FNA’s are not 100%. I’ve heard them talking to clients and saying, “we will take these samples and it will give us the answers we need”. No “mights” or “maybes”. Then they are surprised when the client is upset. I even warned this vet that splenic FNA’s are often unrewarding. :/