6yo female Boxer with generalized limphoadenopathy

RE: 6yo female Boxer with generalized limphoadenopathy

Anthony Todd — Wed, 10 Aug 2016 10:49:02 GMT

So what happened?

Was a complete LN biopsied?

RE: 6yo female Boxer with generalized limphoadenopathy

Anthony Todd — Fri, 22 Jul 2016 16:29:51 GMT

1. Not really a tangent but a friend of mine went to a private doctor in Canary wharf with a chest infection possibly, was put on A/Bs and rung the next day, told to return and be given some pred tablets...!!

2. Same friend then, later, developed tinnitus, same Dr again; showed me a box of pred 5mg, tapering dose after 15 days....!!

So it's not just me!

RE: 6yo female Boxer with generalized limphoadenopathy

Robin Grimmer — Thu, 21 Jul 2016 19:12:53 GMT

[quote user="Anthony Todd"]

[quote user="Robin Grimmer"]

"The administration of corticosteroids before the initial work-up of the case (of lymphoma) can complicate the diagnosis and interpretation of lab results"

and..

"an aspirate should always be taken before treatment commences since corticosteroids and cytotoxic therapy may considerably alter cellular morphology."

[/quote]

Can you tell me which chapter and which author 'cos JK Dunn is just the editor, I assume it was Jane Dobson and I then may be able to google her actual words.

[/quote]

Sorry, missed this earlier. The first quote was from p 1012 of the chapter on chemotherapy and was indeed Jane Dobson. The second quote was on p 154 of the chapter on lymphadenopathy written by JK Dunn himself.

RE: 6yo female Boxer with generalized limphoadenopathy

Anthony Todd — Thu, 21 Jul 2016 16:15:48 GMT

[quote user="Robin Grimmer"]It's pretty simple really - don't give steroids until we know what we are treating.[/quote]

Even though we've had 3 or 4 negative biopsies and sometimes some people can diagnosis lymphoma even after pred.....

[quote user="Robin Grimmer"]It's pretty simple really - don't give steroids until we know what we are treating.[/quote]Ah well, hopefully we will after the next biopsy, unless it says "reactive LN, then we'll have to wait for another biopsy, although the owner may well have gone elsewhere by then.

RE: 6yo female Boxer with generalized limphoadenopathy

Robin Grimmer — Thu, 21 Jul 2016 16:01:47 GMT

It's pretty simple really - don't give steroids until we know what we are treating.

RE: 6yo female Boxer with generalized limphoadenopathy

Anthony Todd — Thu, 21 Jul 2016 15:44:17 GMT

[quote user="Robin Grimmer"]

"The administration of corticosteroids before the initial work-up of the case (of lymphoma) can complicate the diagnosis and interpretation of lab results"

and..

"an aspirate should always be taken before treatment commences since corticosteroids and cytotoxic therapy may considerably alter cellular morphology."

[/quote]

Can you tell me which chapter and which author 'cos JK Dunn is just the editor, I assume it was Jane Dobson and I then may be able to google her actual words.

I'd love to ask her the actual question though, and explain that the dog's already over a year into the diagnosis and the diagnostic steps and reports so far but your points are taken, even though the quotes are not unequivocal.

I can't understand the second quote and it's relevance; I would assume that was the idea?

Actually, why not ring the histologist[s] who gave the reports and see how definite they feel??

Hope we get the definitive and/or next diagnosis soon.

RE: 6yo female Boxer with generalized limphoadenopathy

Robin Grimmer — Thu, 21 Jul 2016 15:21:41 GMT

[quote user="Anthony Todd"]

[quote user="Robin Grimmer"]I'm talking about lymphoma in dogs and you're quoting me a 40 year old study about leukaemia in children in Hungary! [/quote]

So find me a better one 'cos I can't, and you keep saying you can't diagnose it after steroids, not me and I've found evidence that someone did.....!

[I know it's not good, if you are going to treat, which I didn't realise before]

[/quote]

OK, rather than just Googling stuff let's look at Textbook of Small Animal Medicine by JK Dunn.

"The administration of corticosteroids before the initial work-up of the case (of lymphoma) can complicate the diagnosis and interpretation of lab results"

and..

"an aspirate should always be taken before treatment commences since corticosteroids and cytotoxic therapy may considerably alter cellular morphology."

And as for not knowing that pre-treatment with steroids will drastically reduce the effectiveness of chemotherapy - how can I put this tactfully?, I can't - this is basic stuff that has been common knowledge for years. You should really do some homework before commenting on a thread like this.

RE: 6yo female Boxer with generalized limphoadenopathy

Anthony Todd — Thu, 21 Jul 2016 14:48:35 GMT

[quote user="Clive Ansell"] I would be starting from scratch with an open mind, but lymphoma would remain one of the differentials until a LN full biopsy would hopefully say one way or the other.[/quote]

OK let's see then, but I'm betting that it isn't lymphoma, mind you I'd rather bet after the full node biopsy.....

RE: 6yo female Boxer with generalized limphoadenopathy

Clive Ansell — Thu, 21 Jul 2016 14:25:57 GMT

[quote user="Anthony Todd"]What after over a year of trying to prove it's lymphoma, I just don't understand why everyone won't accept what we've got already and accept it isn't lymphoma.....??[/quote]

I wouldn't be trying to prove it's lymphoma. I would be starting from scratch with an open mind, but lymphoma would remain one of the differentials until a LN full biopsy would hopefully say one way or the other.

[quote user="Anthony Todd"]Of course if a whole node had been taken to start with maybe some might accept the result...[/quote]

But it wasn't, so we will have to work with what we've got. Access to a retrospectoscope and hindsight surely are wonderful things ................

RE: 6yo female Boxer with generalized limphoadenopathy

Anthony Todd — Thu, 21 Jul 2016 14:10:40 GMT

[quote user="Robin Grimmer"]I'm talking about lymphoma in dogs and you're quoting me a 40 year old study about leukaemia in children in Hungary! [/quote]

So find me a better one 'cos I can't, and you keep saying you can't diagnose it after steroids, not me and I've found evidence that someone did.....!

[I know it's not good, if you are going to treat, which I didn't realise before]

RE: 6yo female Boxer with generalized limphoadenopathy

Anthony Todd — Thu, 21 Jul 2016 13:54:09 GMT

[quote user="Clive Ansell"]f I were presented with this one, I would start again from scratch with full bloods including a real haematologist looking at a film for cell morphology and a whole LN for histology. Need to keep looking to try and achieve a diagnosis.[/quote]

What after over a year of trying to prove it's lymphoma, I just don't understand why everyone won't accept what we've got already and accept it isn't lymphoma.....??

Of course if a whole node had been taken to start with maybe some might accept the result...

RE: 6yo female Boxer with generalized limphoadenopathy

Anthony Todd — Thu, 21 Jul 2016 13:52:31 GMT

What after over a year of trying to prove it's lymphoma, I just don't understand why everyone won't accept what we've got already and accept it isn't lymphoma.....??

Of course if a whole node had been taken to start with maybe some might accept the result...

RE: 6yo female Boxer with generalized limphoadenopathy

Clive Ansell — Thu, 21 Jul 2016 13:28:41 GMT

Getting back to the OP.

I would go as far as saying that corticosteroids would be contraindicated in this case. The only exception might be where there is no money or willingness on behalf of the client so it would be a case of "here's your preds, suck it and see" maybe a long trial course of antibiotics?

So far, we know that an FNA and trucut biopsies have shown reactive lymph node and no sign of neoplasia. Haematology has shown a high wbc count with granulocytosis, which all points towards infection/inflammation?

f I were presented with this one, I would start again from scratch with full bloods including a real haematologist looking at a film for cell morphology and a whole LN for histology. Need to keep looking to try and achieve a diagnosis.

RE: 6yo female Boxer with generalized limphoadenopathy

Robin Grimmer — Wed, 20 Jul 2016 23:43:33 GMT

[quote user="Anthony Todd"]

[quote user="Robin Grimmer"]I would want to rule out lymphoma as it is so common - before starting preds. Not only will preds scupper your chance of treating the dog, it will also make diagnosing it impossible. [/quote]

Not according to this related paper way back then, just found it;

Between 1971 and 1981, 699 children were diagnosed to have acute lymphoblastic leukemia (ALL) in Hungary. 34 of these children had received prednisolone therapy prior to the establishment of the diagnosis

[my italics and bold]

[/quote]

I'm talking about lymphoma in dogs and you're quoting me a 40 year old study about leukaemia in children in Hungary!

RE: 6yo female Boxer with generalized limphoadenopathy

Anthony Todd — Wed, 20 Jul 2016 21:26:45 GMT

PS But I should have added the rest of the summary, and the citation, which makes your point, my previous quote having made mine.

Although they entered remission at the same rate as the other patients, the length of continuous complete remission was significantly shorter in the prednisolone pretreated group. It appears that prolonged prednisolone therapy given before remission induction imparts a distinct unfavorable prognosis.

Cancer 551637-1640, 1985.

RE: 6yo female Boxer with generalized limphoadenopathy

Anthony Todd — Wed, 20 Jul 2016 20:50:01 GMT

Not according to this related paper way back then, just found it;

[my italics and bold]

RE: 6yo female Boxer with generalized limphoadenopathy

Anthony Todd — Wed, 20 Jul 2016 14:15:43 GMT

[quote user="Robin Grimmer"]Well you don't treat lymphoma by removing the lump do you?[/quote]

Well they did with my sister in law and after an inconclusive FNA, with the delays between operations.......

Sorry re "lump removal" I was thinking of "lumps" as discrete from LNs.

RE: 6yo female Boxer with generalized limphoadenopathy

Anthony Todd — Wed, 20 Jul 2016 12:09:05 GMT

[quote user="Robin Grimmer"]No, it's had one FNA and that was 15 months ago. [/quote]

Sorry I read history as:

FNA in April 15,

Xray ultrasound Trucut x2 nodes in May 15,[and ruling out neoplasia].

Serology in March 16

Bloods in April 16 and nothing showing lymphoma or blood changes showing neoplasia.

[Still can't believe steroids can totally mask histologically, what is a pretty serious neoplasia over a year into the disease if all the tests to date have been negative, and it turns out to be neoplastic down the line.]

[quote user="Robin Grimmer"]Then you could get an instant diagnosis with no delay and very little cost.[/quote]

Sure, but if you get a negative and you're still suspicious and you've still got the lump or lumps[!], then what, more FNAs or remove the lump and multiple targeted biopies or sections??

PS a bit sensitive at the moment as a relative had a lump in her neck, FNA, wait, excision, wait for "healing", radiation, wait...... [now 6 months at least]

I'd cope with the "healing" and blast the area on day one if it was me.....

RE: 6yo female Boxer with generalized limphoadenopathy

Robin Grimmer — Wed, 20 Jul 2016 10:29:29 GMT

[quote user="Anthony Todd"]

[quote user="Robin Grimmer"]Well you don't treat lymphoma by removing the lump do you?[/quote]

No you don't, but we're over 12 months[!] into a possibly very serious condition, we've already had 2 FNAs and other exams no conclusive diagnosis.

[/quote]

No, it's had one FNA and that was 15 months ago. If you take an FNA, stain one of the slides and look at it yourself. Then you could get an instant diagnosis with no delay and very little cost.

RE: 6yo female Boxer with generalized limphoadenopathy

Anthony Todd — Wed, 20 Jul 2016 10:27:06 GMT

[quote user="Robin Grimmer"]mast cell tumour[/quote]

[this is just a question]

All the mast cell tumours I've ever seen weren't in a LN, certainly not multiple LNs so is a mast cell tumour common in multiple LNs?

RE: 6yo female Boxer with generalized limphoadenopathy

Anthony Todd — Wed, 20 Jul 2016 10:20:55 GMT

[quote user="Robin Grimmer"]Well you don't treat lymphoma by removing the lump do you?[/quote]

No you don't, but we're over 12 months[!] into a possibly very serious condition, we've already had 2 FNAs and other exams no conclusive diagnosis.

Almost certainly the pathologist would have got you a definite diagnosis on day one if he'd had the "lump"! If in doubt he could/would take more sections.

Pretty obvious, to me anyway, and others, that an excision on day one, in a case of multiple LN enlargement would have been, and still is the way to go.

RE: 6yo female Boxer with generalized limphoadenopathy

Robin Grimmer — Tue, 19 Jul 2016 23:35:07 GMT

[quote user="Anthony Todd"]

[quote user="Robin Grimmer"]But if done correctly you can get a rapid diagnosis with no ga or sedation required.[/quote]

But then, surely, you'll remove the lump whatever the histo. diagnosis?

How often is a lump, any lump, not removed?

So why not always remove a lump, be sure of getting a diagnosis; certainly make a definite diagnosis; and you've removed the lump too....

[obviously a liver tumour etc. might require a different approach...]

[/quote]

Well you don't treat lymphoma by removing the lump do you?

Even if it is something you treat surgically, eg a mast cell tumour you need a much wider excision than for a benign tumour, so doing a fna first helps you plan the surgery.

RE: 6yo female Boxer with generalized limphoadenopathy

Anthony Todd — Tue, 19 Jul 2016 19:41:56 GMT

[quote user="Robin Grimmer"]But if done correctly you can get a rapid diagnosis with no ga or sedation required.[/quote]

But then, surely, you'll remove the lump whatever the histo. diagnosis?

How often is a lump, any lump, not removed?

So why not always remove a lump, be sure of getting a diagnosis; certainly make a definite diagnosis; and you've removed the lump too....

[obviously a liver tumour etc. might require a different approach...]

RE: 6yo female Boxer with generalized limphoadenopathy

Robin Grimmer — Fri, 15 Jul 2016 18:41:47 GMT

[quote user="Anthony Todd"]

[quote user="Clive Ansell"]I'm not overly a fan of FNA's,[/quote]

No, me neither, if I had an enlarged LN I'd want it removed and looked at by a crack oncologist and, if any doubt sent to another. FNAs seem to be more hit and possible miss, but I'll be corrected on here I'm sure

[/quote]

Depends on the type of tumour. For sarcomas they are generally poor, as the cells don't exfoliate well (don't come up into the needle). For other tumours eg mast cell tumours, lymphoma they can work well. For lymphoma in particular you do need to be gentle when you make the slides as if not done carefully the cells may rupture. But if done correctly you can get a rapid diagnosis with no ga or sedation required.

RE: 6yo female Boxer with generalized limphoadenopathy

Anthony Todd — Fri, 15 Jul 2016 18:18:59 GMT

[quote user="Clive Ansell"]I'm not overly a fan of FNA's,[/quote]