Hypoechoic splenic lesion in a 13 year old Rough Collie with chronic diarrhea

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Hypoechoic splenic lesion in a 13 year old Rough Collie with chronic diarrhea

  • 13 year old mn Rough Collie with polyuria-polydipsia and chronic diarrhea nonresponsive to budesonide
  • Chem prof shows elevated ALKP, CBC shows a moderate anemia
  • Abdominal US of the GI shows normal GI wall layering and thickness with no inflammation and no enlarged or reactive lymph nodes.  The liver is also unremarkable.
  • Within the splenic capsule, is a poorly defined, strongly hypoechoic lesion affecting the deep lateral aspect of the mid to caudal spleen.  FNA’s were performed on the spleen and submitted to cytology.

    • 13 year old mn Rough Collie with polyuria-polydipsia and chronic diarrhea nonresponsive to budesonide
    • Chem prof shows elevated ALKP, CBC shows a moderate anemia
    • Abdominal US of the GI shows normal GI wall layering and thickness with no inflammation and no enlarged or reactive lymph nodes.  The liver is also unremarkable.
    • Within the splenic capsule, is a poorly defined, strongly hypoechoic lesion affecting the deep lateral aspect of the mid to caudal spleen.  FNA’s were performed on the spleen and submitted to cytology.
    • My differential diagnoses for the splenic lesion includes edema, hemorrhage due to trauma (dog has bilateral rear CP deficits), benign hemangioma, and neoplasia (MCT, hemangiosarcoma, other sarcoma).  Coagulopathy has been ruled out based upon a normal PLT count (300,000) and normal PT/PTT.
    • Any other thoughts on this splenic lesion?  Should splenectomy be considered next if fna is nondiagnostic?

    Thank you!

Comments

Pankatz
June 15, 2016 at 1:19 pm -

Cool lesion. Could splenic

Cool lesion. Could splenic infarcation be a differential?

Electrocute
June 15, 2016 at 2:11 pm -

Thanks for your input. I

Thanks for your input. I should mention that CF Doppler on the splenic hilus was normal.

animage
June 16, 2016 at 5:43 pm -

Maybe focal area of bleeding?
Maybe focal area of bleeding?

animage
June 16, 2016 at 5:43 pm -

Maybe focal area of bleeding?
Maybe focal area of bleeding?

animage
June 16, 2016 at 5:43 pm -

Maybe focal area of bleeding?
Maybe focal area of bleeding?

rlobetti
June 16, 2016 at 6:06 pm -

Is the anemia regenerative or

Is the anemia regenerative or non-regenerative? Often FNA of the spleen is non-diagnostic unless dealing with lymphoma, solid tumors, or MCT. Laparotomy would not allow full visulization of the spleen but can also be used to get biopsies from the liver and GI tract.

Electrocute
June 17, 2016 at 3:06 am -

Thanks Remo.  Good

Thanks Remo.  Good point.

HCT=29.3%, %Retic=2.4%, retic ct=110.6K/mcL

The splenic aspirates came back as: 

Mesenchymal cell proliferation suspicious for mesenchymal neoplasia;
Extramedullary hematopoiesis; Reactive lymphoid hyperplasia

Hence, bad news on the spleen, but I still don’t think i have the answer to his diarrhea.  I assume that surgical laparotomy is warranted for a more defintive diagnosis for both problems, but am not sure if they will pursue it since he is 13 years old.

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