Spleen mass

RE: Spleen mass

Silvia Maldonado — Fri, 25 Aug 2017 14:59:09 GMT

[quote user="Chris Milligan"]

You can't say it's a tumour without doing histology. Cytology is not that useful for splenic lesions, certainly not in reaching a definitive diagnosis. If you biopsy something you should be sending it to a lab.

There are various studies on the matter but some report as high as 50% chance it's totally benign splenic nodular hyperplasia and not even a tumour benign or otherwise. Also how can you form an appropriate followup treatment plan if you don't know what it is?

[/quote]

Hi, Chris,

That's the thing, the decision to send it to an external lab and a follow up treatment would be done at the dog's practice (this is one of the cons of emergencies services). I should be back tonight, and perhaps I can find out what's been decided on this case.

RE: Spleen mass

Glenn Hodgson — Fri, 25 Aug 2017 13:37:12 GMT

[quote user="villagevet"]

where chemo is not a valid option (availability/cost/poor prognosis for HSA) - how exactly does the histo result change post-op management?

Curious as I have removed many spleens for nodules/masses/ruptured lesions; >80% have done very well for 5yrs plus with conservative management only regardless of the unidentified cause.

Out of those which did less well, 1 had already developed generalised lymphadenopathy in the regional nodes prior to initial presentation/surgery - did less well but owners happy with the temporary improvement (may have improved survival length with chemo?); 1 had cardiac signs on presentation and stabilised temporarily with heart meds until crisis at 3months post-op (suspct metastatic HSA?). A couple have developed atrial fibrillation post op but have done well with medical management and weaned off over 3-6months; a couple required blood transfusions during recovery due to blood loss from rupture - both survived 3-6years. Recent one had adhesions to most organs when opened - PTS on table prior to histo! Submitted a few initially - unequivocal results with 'possible benign hyperplasia...' for most?

[/quote]

Nationwide lab tends to give us categorical answers.

The septic spleen went onto antibiotics. The owners on the dogs with benign lesions can given good news and be relaxed, less monitoring etc. We also had a lymphoma masquerading as HSA. Masses on the liver too. Still alive 2 years post Chemotherapy. ( To answer your question though the pred option would also have Helped)

RE: Spleen mass

Lindsey Edwards — Fri, 25 Aug 2017 12:56:18 GMT

where chemo is not a valid option (availability/cost/poor prognosis for HSA) - how exactly does the histo result change post-op management?

Curious as I have removed many spleens for nodules/masses/ruptured lesions; >80% have done very well for 5yrs plus with conservative management only regardless of the unidentified cause.

RE: Spleen mass

Braden Collins — Fri, 25 Aug 2017 07:05:20 GMT

I always send any neoplastic/potentially neoplastic mass to the lab after removal, regardless of location or gross appearance. If it's worth removing, it's worth knowing what it is and if you've got the whole thing out. I treat histopathology as an opt-out rather than an opt-in.

RE: Spleen mass

Glenn Hodgson — Fri, 25 Aug 2017 07:00:25 GMT

Histo, IMO, is really important for splewnectomy masses.

Gross appearance can be very deceptive. lymphoma, septic, traumatised, haemangiosarc, then can all pretend to look like each other.

Agree with above re cytology. No experience in it though as have never performed on a spleen.

RE: Spleen mass

Chris Milligan — Fri, 25 Aug 2017 04:18:36 GMT

[quote user="Silvia Maldonado"]Do you routinely request histo/cytology for a splenic tumour? [/quote]

RE: Spleen mass

Allison Gleadhill — Sat, 19 Aug 2017 21:46:54 GMT

Find a number of splenic masses I've removed even presenting with haemoabdomen have had benign histo result. Owner relief in knowing that is worth doing histo for, they then know prognosis is fine.

RE: Spleen mass

Lindsey Edwards — Sat, 19 Aug 2017 20:53:01 GMT

I put the options to the owners but given the limited opportunities to change treatment plan regardless of results many wish not to pursue histo. If cachexic/respiratory signs on initial presentation would push for chest radiographs during pre-med but otherwise operate as delicately as possible, minimise possible seeding and look carefully for visible mets. General reluctance in small rural area to proceed with chemo even if a lymphoma and HSA very limited options. Monitor with view to palliative care if any symptoms of metastatic spread develop.

Is some vets desire to insist on histo on every case for clinical curiosity or patient/client benefit? I discuss options with owners, record conversation and decision in clinical notes and often offer to store a small representative sample in formalin in case required in future.

RE: Spleen mass

Emily Rainbow — Sat, 19 Aug 2017 17:44:24 GMT

Yep have seen before but ditto rob if it concerned you enough to remove it find out what it is!

RE: Spleen mass

Rob Loxley — Sat, 19 Aug 2017 12:42:22 GMT

[quote user="Silvia Maldonado"]Do you routinely request histo/cytology for a splenic tumour?[/quote]

I'd always do histo on an excised spleen with a mass - you can't say it's a tumor or not or whether benign/malignant without

RE: Spleen mass

Lindsey Edwards — Sat, 19 Aug 2017 10:30:21 GMT

I have often come across adhesions to an otherwise stable spleen and would imagine that mild trauma, inflammation or nodules could indeed cause a mild bleed or other focus for omentum to stick to. As far as I am aware in human medicine mild bleeds are often monitored for resolution without surgical removal so unless significant haemoabdomen or tumour presents I would not recommend removal. Many traumatic cases are nor FAST-scanned (or even presented to the vet clinic!) so I would imagine many minor splenic injuries go completely undetected