Is this a lymphoblast?

RE: Is this a lymphoblast?

Martin Atkinson — Mon, 21 Sep 2015 18:06:13 GMT

[quote user="Kate Richardson"]

I always understood that canine lymphoma is difficult to diagnose with FNAs alone, whereas in cats FNAs are usually diagnostic? Is that still current thinking?

[/quote]I suspect that its as good as the sample you give them and its less likely to be a diagnostic yield from an FNA. I've never made a distinction between dog or cat though and and FNA is the line of least resistance to start with. The dog I'm presently treating for cutaneous lymphoma had a skin biopsy which was diagnostic and an FNA from sub mandibular LN that confirmed it. Whether the lab would have been as confident without the skin biopsy is another matter.

RE: Is this a lymphoblast?

Kate Richardson — Mon, 21 Sep 2015 14:03:12 GMT

I always understood that canine lymphoma is difficult to diagnose with FNAs alone, whereas in cats FNAs are usually diagnostic? Is that still current thinking?

RE: Is this a lymphoblast?

Rob Loxley — Mon, 21 Sep 2015 13:38:13 GMT

[quote user="Sarah Keir"] I am finding conflicting reports of on one hand diagnosing lymphoma with just FNA and on the other manditatory to take biopsies[/quote]

I find it depends how good your cytopathologist is. Also you can do T/B typing on FNA samples using flow cytometry, but special sampling requirements exist

RE: Is this a lymphoblast?

Sarah Keir — Mon, 21 Sep 2015 10:16:57 GMT

Punch biopsy results come back as lymphoma so luckily I have the diagnosis confirmed. I am finding conflicting reports of on one hand diagnosing lymphoma with just FNA and on the other manditatory to take biopsies.

RE: Is this a lymphoblast?

Utlendigur — Mon, 21 Sep 2015 10:13:51 GMT

[quote user="Sarah Keir"]

I thought I was being careful enough with the samples! The dog is screaming 'lymphoma' - looks really sick, some of the lymph nodes are massive (tennis balls) and pyrexia not responding to treatment. Awaiting a punch biopsy result from prescap.

[/quote]

I saw a case a few weeks ago that I was convinced was lymphoma - sudden marked weight loss, enlarged LN, thickened guts, chronic diarrhoea. Bloods (including electrolytes) were fairly normal. LN FNA came back as reactive. It was referred and turned out to be addisons....If it looks like a duck, quacks like a duck etc - it can still end up being a chicken

RE: Is this a lymphoblast?

Martin Atkinson — Mon, 21 Sep 2015 09:58:09 GMT

I'm presently treating a dog for lymphoma and its just regressed. On the routine blood count I saw a number cells like these and sent the sample away to Axiom. They said there were no abnormal cells seen so presumably they just considered it variation in lymphocyte size,

RE: Is this a lymphoblast?

John Flynn — Mon, 21 Sep 2015 07:37:19 GMT

[quote user="Sarah Keir"]I thought I was being careful enough with the samples! The dog is screaming 'lymphoma' - looks really sick, some of the lymph nodes are massive (tennis balls) and pyrexia not responding to treatment. Awaiting a punch biopsy result from prescap.[/quote]

In that case i'd be more than happy to start some treatment while waiting for histopath - personally i'd give 0.7mg/m2 (NOT mg/kg) of vincristine iv (look up precautions if not familiar with drug) assuming not collie-type dog, along with some maropitant for sick dog and some preds.

RE: Is this a lymphoblast?

Sarah Keir — Sun, 20 Sep 2015 19:52:15 GMT

RE: Is this a lymphoblast?

John Flynn — Sun, 20 Sep 2015 19:42:08 GMT

[quote user="Sarah Keir"]Is this enough to diagnose lymphoma on?[/quote]

Not for me (a fellow GP with no special oncology knowledge), I'd repeat the lymph node aspirates by preference - if you're struggling, then sometimes drawing it out like a blood smear or using tip of needle to draw "spikes" of cells out of aspirated material might give you some intact cells to examine (also NO sucking with syringe and just stab needle in couple of times and blow out gently) - sometimes lymphoma cells are just very fragile and hard to get good cytology...

That said, if the presentation screams "lymphoma" to you then it probably is... if the lymph nodes are just a little bigger for example however, then I'd keep a more open mind, especially in a pyrexic patient.

RE: Is this a lymphoblast?

Sarah Keir — Sun, 20 Sep 2015 16:32:35 GMT

Unfortunately the lymph node aspirates were a squidgey mess - I need to be more careful next time. Is this enough to diagnose lymphoma on?

RE: Is this a lymphoblast?

Robin Grimmer — Sun, 20 Sep 2015 15:09:56 GMT

Yes I think it is. Prominent multiple nucleoli present. What were the lymph mode aspirates like?

RE: Is this a lymphoblast?

Sarah Keir — Sun, 20 Sep 2015 12:39:21 GMT

This is the same case but FNA of spleen.