T CELL LYMPHOMA ON THE MOUTH

RE: T CELL LYMPHOMA ON THE MOUTH

pablo sordo pedro — Mon, 21 May 2018 09:01:11 GMT

[quote user="Gerry Polton"]

Thank you, Beats, for digging out my reply from 2014. You'll be interested to know that nothing has really changed. The key to deciding whether to sit back and relax or to get on in there with some proper cytotoxic therapy (lomustine being the normal first choice) is to look at the terms used in the pathology report. We are broadly trying to differentiate the active and progressive disease entity from the indolent ones. The active ones are vigorously undergoing cellular processes like mitosis and as such are sensitive to the effects of genotoxic agents like lomustine; the indolent ones are simply proliferating at the normal rate and they are not so susceptible the effects of chemotherapy. The simplest indication of this active/indolent dichotomy is the histological description of cell size. It's not the only thing we look at but, trying to give you one thing that you can usually rely upon, this is the thing I think you should remember. If the lesion is full of identical small lymphocytes, consider symptomatic treatment only, i.e. an anti-inflammatory (e.g. meloxicam) and perhaps an antibiotic if clinical signs demand.

Low-grade lesions will usually develop into high-grade lesions at some point. But, let's say it takes 1 year for that to happen, you would be wiser starting lomustine after one year than starting it early. Did you know that in one study there was a 17% 1-year mortality rate from the adverse effects of lomustine alone in one (mast cell tumour) study in dogs! This means that, according to this model, we could extrapolate that one in six dogs treated with lomustine early would die of their chemo before their lymphoma progressed.

I think you'll agree, Yikes!

A good day to all

Gerry

[/quote]

Thanks Gerry, Yes I have been discussing the case with several oncologists and the consensus seems to be that is not behaving like an aggressive type of lymphoma (so far) so still undecided in terms of treatment! The client is probably going for referral anyway so I'll let you know about this!

Many thanks!

RE: T CELL LYMPHOMA ON THE MOUTH

pablo sordo pedro — Mon, 21 May 2018 08:55:17 GMT

Thanks for the reply! That's interesting as after discussion with an oncology specialist a concerned was raised about the possibility of not being lymphoma? the likelihood of being chronic leukaemia wasn't mentioned but obvs something to consider due to the fact that this lesions were first seen long time ago and the dog is not showing obvious clinical signs!

Do you remember if those cases had any enlarged lymphonodes ?

Thanks very much

pablo

RE: T CELL LYMPHOMA ON THE MOUTH

pablo sordo pedro — Mon, 21 May 2018 08:50:35 GMT

[quote user="GrooveJet"]Are there other signs of lymphoma? enlarged submandibular glands etc?[/quote]

Yes, the left submandibular lymphonode was enlarged as well! (did an FNA from this as well), the owner is very likley to go for referral after discussion with the oncology team.

RE: T CELL LYMPHOMA ON THE MOUTH

Gerry Polton — Thu, 17 May 2018 10:21:34 GMT

I think you'll agree, Yikes!

A good day to all

Gerry

RE: T CELL LYMPHOMA ON THE MOUTH

Martin Atkinson — Thu, 17 May 2018 09:21:14 GMT

[quote user="Beats"]Gerry Polton (I'm a fan so I read all his posts!) had this to say in 2014:[/quote]I'm surprised Gerry hasn't been along for this or a couple of other oncology cases recently, he's usually red hot with his replies: where are you Gerry?

RE: T CELL LYMPHOMA ON THE MOUTH

Kate Richardson — Thu, 17 May 2018 09:17:25 GMT

Does anyone have a photo?

RE: T CELL LYMPHOMA ON THE MOUTH

Julie Innes — Thu, 17 May 2018 08:41:05 GMT

Interesting case! Will try to tuck this discussion into that batcave in my memory in case I see one (will probably see one next week now!)

Let us know how it goes

RE: T CELL LYMPHOMA ON THE MOUTH

Liz Barton — Wed, 16 May 2018 23:13:20 GMT

I agree with others - there is a cost-benefit here if the dog is fine and zapping it's gingiva with radiotherapy is likely to cause ulcerating lesions albeit with a different aetiology, and potentially healing over time. If the dog is indeed clinically well and the lesions are not progressive, may be better to live with the current state off affairs, rather than risk making worse by treating?

I've had a couple of cases diagnosed as chronic leukaemia which have done fine without treatment. It seems these low grade tumours are liveable with, provided the animal isn't clinically affected.

RE: T CELL LYMPHOMA ON THE MOUTH

Beats — Wed, 16 May 2018 20:46:04 GMT

I've seen a couple of similar cases from memory.

Speak to the pathologist - how nasty / innocent did it look. Make sure pathologist has idea of time-frame of lesions and even a photo to help them interpret if possible.

I'd also get pictures and check with a reputable oncologist.

Gerry Polton (I'm a fan so I read all his posts!) had this to say in 2014:

"Lomustine is a very popular treatment for epitheliotropic lymphoma. However, treating all cases that way is wrong in my opinion. You have explained why yourself with your excellent example of the low-grade lesions that appear on the gums. At one time in my life I tried to collect a cohort of ten of these together to report as a case series as I think they are a specific entity. I had eight or so cases that I had managed on fresh air alone (ie no teratment at all). Some of them even went into spontaneous complete remission. My observations even forced the question of whether these cases are truly lymphoma cases or perhaps they are some sort of pseudo-lymphoma. Anyway, sad end to the story was that I moved house and lost all the data in the move. Whether you use prednisolone with the lomustine is a small issue; I judge it the merits of the individual case.

Just to ensure that I don't give the wrong message here, I do also see cases of low-grade oral (lip) lymphoma which absolutely do require treatment because they are progressive and they have an adverse impact on the patient's well-being.

Hope that helps.

Gerry"

To read in context see this thread: https://www.vetsurgeon.org/uk/small_animal/f/167/p/17567/105048.aspx#105048

I could swear there's another non-neoplastic lymphocytic condition of gums that this sometimes gets confused with, but can't put my finger on the name just now...

RE: T CELL LYMPHOMA ON THE MOUTH

Rob Loxley — Tue, 15 May 2018 22:49:36 GMT

[quote user="pablo sordo pedro"]Any ideas will be much appreciated[/quote]

I'd usually speak to a friendly oncologist. For T-cell there seems to be a move for lomustine based protocols

RE: T CELL LYMPHOMA ON THE MOUTH

Miriam Lodewyks — Tue, 15 May 2018 17:37:11 GMT

I am not an expert but I do most of the dentistry in the practice, so see a fair amount. Are there other signs of lymphoma? enlarged submandibular glands etc? I've never seen a localised lymphoma in the mouth with no signs of it elsewhere.

If it really is Lymphoma, then I'd start it on high dose steroids after ensuring the oral cavity is as clean as it can be, before discussing chemo options with oncology service/referrals.