Pomeranian Cross Painful Right Foreleg - Elbow ?

RE: Pomeranian Cross Painful Right Foreleg - Elbow ?

bevs2251 — Wed, 23 Jan 2019 22:08:12 GMT

Hi All,

Update on "Simba". Unfortunately, he has been put to sleep. He developed tumour masses on his head and along his left foreleg. Since his right foreleg had been amputated, he was finding it difficult to walk and was unhappy. It was only 6 weeks from the time of the right foreleg amputation to euthanasia. We all hoped he'd have more time than this. He was only 2 years old.

Bev.

RE: Pomeranian Cross Painful Right Foreleg - Elbow ?

Emily Rainbow — Sun, 09 Dec 2018 09:05:43 GMT

Interesting case! Thanks for the update!

RE: Pomeranian Cross Painful Right Foreleg - Elbow ?

bevs2251 — Sat, 08 Dec 2018 01:15:02 GMT

Comment from oncoloy specialist on VIN below :

Polyostotic Lymphoma - Rare.

Young dog polyostotic lymphoma has been described, and most of the case reports of lymphoma in bones of dogs are in younger animals. Because it is so rare, there is little to say about best treatment options and outcome expectations. I’d start with CHOP chemotherapy and see how the dog responds. Radiation therapy has also been described in one dog. Let us know how this goes!

Best,
Mike
------------------------
Michael D. Lucroy, DVM, MS, DACVIM (Onc)
Director, Clinical Studies Center
MedVet Medical & Cancer Centers for Pets

RE: Pomeranian Cross Painful Right Foreleg - Elbow ?

David Mills — Fri, 07 Dec 2018 23:40:49 GMT

Good one for the gallery Arlo Guthrie?

RE: Pomeranian Cross Painful Right Foreleg - Elbow ?

bevs2251 — Fri, 07 Dec 2018 22:03:08 GMT

[quote user="James Dunne"]

I have had a similar case recently, which turned out to be a chondrosarcoma of the humerus. If neoplastic, the lesion could also be lymphoma, myeloma or a metastasis from a primary tumour elsewhere. This patient is a bit young for this kind of disease though. This lesion could also be infective or it could be something bizarre like an infarct or area of bone necrosis.

[/quote]

Spot on James - infarct with underlying lymphoma. Primary site not yet ascertained. Second neoplasia case in young dog I've had recently - the other was an oral MCT in 15 month old SBT, half the head affected within 4 weeks !

RE: Pomeranian Cross Painful Right Foreleg - Elbow ?

Anthony Dennison — Fri, 07 Dec 2018 17:17:19 GMT

I was about to say that matches the case of the labrador we biopsied that had similar radiographic changes up to the lymphoma diagnosis.

Lymphoma of the bone?!

RE: Pomeranian Cross Painful Right Foreleg - Elbow ?

Julie Innes — Fri, 07 Dec 2018 08:59:28 GMT

Interesting update! Now I know what it is I can see it on the original radiograph, of course! I think someone did mention lymphoma upthread? I've never seen it, so will bear it in mind. Shame for the little dog, though

RE: Pomeranian Cross Painful Right Foreleg - Elbow ?

bevs2251 — Thu, 06 Dec 2018 23:00:22 GMT

Second radiograph.

RE: Pomeranian Cross Painful Right Foreleg - Elbow ?

bevs2251 — Thu, 06 Dec 2018 22:58:09 GMT

Update on this case. Anyone seen this before ?

Here is the report for "Simba" Perrett, almost 2 year old Pomeranian cross. He initially responded to Metacam at a lower dose but then jarred his elbow again.

I re-radiographed him 2 weeks later and signs in the elbow bones were worse, more lysis and destruction of the growth plate line in the ulna olecranon. He also had decreased range of movement in this joint. Due to refractory pain and limited finances for further investigation, I referred him to my colleague for a high foreleg amputation. The owner agreed to biospy of the affected bone ends with these results below.

An unusual case, lymphoma in all 3 bones of a joint in such a young dog. Do you have any reports of other cases like this ?

Regards,

Bev Alderton.

Pathology Report Bone Biopsies x 3 Elbow - Lymphoma.

VETNOSTICS COMMENT

See results below.

HISTOPATHOLOGY REPORT Case No.V18/12916

CLINICAL NOTES

????? tumour mass distal humeral Epicondyle .

MACROSCOPIC EXAMINATION

A piece of bone 35x20x15mm. RST after decalcification. v

MICROSCOPIC EXAMINATION

Three blocks were prepared and revealed the following features:

Early healing of a haemorrhagic epicondyle infarction and early healing. Areas in the osseous intertrabecular spaces have a pattern that is suggestive of an ongoing ischaemic necrosis.

In the subarticular region there were sheets of small round hyperchromatic lymphoid cells. In one large section the subarticular zone was occupied by large lymphoid cells with a mitotic index of about 10.

SUMMARY

A distal epicondylar haemorrhagic infarct with an underlying Lymphoma

COMMENT

I asked Drs David Taylor and Stephen Yeomans for their diagnosis and they confirm the underlying lymphoma.

COMMENT:

Should sub-classification between B and T cell lymphomas be required for treatment, reliable T and B cell markers are now available. Further charges will apply for this test. Please speak to Drs. Taylor /Yeomans

regarding this matter.

Furthermore, it is suggested that since the diagnosis of lymphoma is confirmed,treatment options be discussed, and chemotherapy started while the immunophenotyping is in progress. Protocols for T and B-cell lymphoma are usually the same for the first few weeks and delaying chemotherapy until the immunophenotyping results are available risks progression of signs which can affect prognosis.

Professor Rolfe Howlett

RE: Pomeranian Cross Painful Right Foreleg - Elbow ?

bevs2251 — Fri, 02 Nov 2018 01:51:31 GMT

Boss thinks there is a "step" lesion b/w radius and ulna so joint not meeting properly. Common in small dogs. Surgical issue - removal of section of ulna. Loss of density in radial and ulna heads and distal humeral epiphysis possibly due to lack of use ? The dog carries the leg most of the time. Not overly convinced this is the source of such severe pain when the joint is palpated. There has been no response to Pred at all so I guess osteomyelitis/septic arthritis would seem less likely (no swelling of joint area, no increased heat compared to L side. I have sent the radiographs to specialist radiologists (as I wanted to do originally) so will update with their findings.

RE: Pomeranian Cross Painful Right Foreleg - Elbow ?

Martin Atkinson — Mon, 29 Oct 2018 13:02:16 GMT

It might be my imagination but is there an OCD lesion in the caudal humeral head in the second radiograph? I looks as though a substantial slab of cartilage is separating.

RE: Pomeranian Cross Painful Right Foreleg - Elbow ?

Anthony Dennison — Mon, 29 Oct 2018 10:25:26 GMT

We had a case of an 18 month old labrador being acutely painful on one of his elbows. CT showed an area of lysis in the proximal radius with a possibility of osteosarcoma. We biopsied, and it came back as just severe inflammation.

RE: Pomeranian Cross Painful Right Foreleg - Elbow ?

Julian Earl — Sat, 27 Oct 2018 17:08:38 GMT

This talk of mysterious painful elbows reminds me of a Labrador that suffered acute and severe elbow pain. After radiographs and close inspection of these, he had fractured a large Osteophyte . The joint was otherwise okay it seemed apart from the osteoarthritis of course. Rest, exercise restriction, joint support and liberal use of non-steroidals and it settled down eventually. Poor dog! Fracturing a joint that was already painful!

I mention this because it flummoxed me at first. I'd been thinking some other traumatic elbow-pain. Is it common? Have been lucky/unlucky in not seeing more?

RE: Pomeranian Cross Painful Right Foreleg - Elbow ?

James Dunne — Sat, 27 Oct 2018 14:07:57 GMT

I think this lucency is real, not artifactual. I have had a similar case recently, which turned out to be a chondrosarcoma of the humerus. If neoplastic, the lesion could also be lymphoma, myeloma or a metastasis from a primary tumour elsewhere. This patient is a bit young for this kind of disease though. This lesion could also be infective or it could be something bizarre like an infarct or area of bone necrosis. You could adopt a number of approaches; needle aspiration of the lesion may yield a diagnosis or not. As mentioned already, repeat radiography in 3 weeks time may at least indicate whether the lesion is static or changing in any way.

RE: Pomeranian Cross Painful Right Foreleg - Elbow ?

Richard Carter — Sat, 27 Oct 2018 12:27:15 GMT

when we get suspected lucency type lesions, if sampling joint out of question, would start a good ab (doxycyline covers most bugs) and re-assess the lameness, poss re-xray 2-3 weeks later. Exposure to ticks?

Unfortunately most of our density/ lucency 'lesions' turn out to be the digital xray having a laugh.

There doesn't seem to be any soft tissue or periosteal reaction taking place around these areas though for a lameness exceeding 1 month? Is there a step notch in the shoulder/ prox humerus?

Have also had hypothyroid dogs show severe lameness in forelimbs although your case may be a bit young

RE: Pomeranian Cross Painful Right Foreleg - Elbow ?

bevs2251 — Sat, 27 Oct 2018 00:10:16 GMT

Sixth Radiograph

RE: Pomeranian Cross Painful Right Foreleg - Elbow ?

bevs2251 — Sat, 27 Oct 2018 00:08:42 GMT

Fifth Radiograph

RE: Pomeranian Cross Painful Right Foreleg - Elbow ?

bevs2251 — Sat, 27 Oct 2018 00:07:47 GMT

Fourth Radiograph

RE: Pomeranian Cross Painful Right Foreleg - Elbow ?

bevs2251 — Sat, 27 Oct 2018 00:06:07 GMT

Third Radiograph

RE: Pomeranian Cross Painful Right Foreleg - Elbow ?

bevs2251 — Sat, 27 Oct 2018 00:04:38 GMT

Second radiograph