Case of the Week: Feline Medicine

RE: Case of the Week: Feline Medicine

Lucy Fleming — Tue, 29 Oct 2019 12:52:12 GMT

[quote user="Anthony Dennison"]Yes, a CT was over the top[/quote] To be fair, despite my glib comments I actually don't think it necessarily was. The advice I have had from the case I had seen was to stage to ensure disease remained local, by performing thoracic and abdo CT. Sure, there's an argument to be had about the probability of disease being found elsewhere, but given you were possibly expecting something neoplastic, the absence of disease elsewhere is useful information to have prior to excisional biopsy.

RE: Case of the Week: Feline Medicine

Anthony Dennison — Tue, 29 Oct 2019 09:29:39 GMT

[quote user="Evelyn Barbour-Hill"]What was the problem (that only CT could identify)? [/quote]

Apical bone loss around the root. I was wondering whether the lymph node was reactive from this, but it would appear not.

Yes, a CT was over the top and next time I wouldn't do it unless the FNA did come back with thyroid tissue to check local invasion prior to removal.

RE: Case of the Week: Feline Medicine

Joyce Whitehead — Fri, 25 Oct 2019 23:42:37 GMT

Well you’ve educated me Anthony, as I’ve never seen a case, but will be more aware in the future. So thank you.

RE: Case of the Week: Feline Medicine

Beats — Fri, 25 Oct 2019 20:21:32 GMT

FNA first, then probably surgically explore with view to excision (preferably, but watch out for recurrent larynglea nerve!)/biopsy and histopath. If I was a betting man, I'd put my money on feline Hodgkin's lymphoma, with differentials including other neoplastic lesions, TB and botryomycosis.

Given came in with miliary dermatitis, however, I'd consider no intervention as (less fun) alternative.

I've had a look, and can't see anything else new published on Hodgkin-like lymphoma in cats since: https://www.ncbi.nlm.nih.gov/pubmed/11572557. Spreads from node-to-node and responds surprisingly well to benign neglect in my limited experience.

RE: Case of the Week: Feline Medicine

Evelyn Barbour-Hill — Fri, 25 Oct 2019 19:28:27 GMT

[quote user="Anthony Dennison"] (as well as remove the problem tooth identified on CT).[/quote]

What was the problem (that only CT could identify)?

RE: Case of the Week: Feline Medicine

Lucy Fleming — Fri, 25 Oct 2019 19:20:22 GMT

[quote user="Anthony Dennison"]

[quote user="Kate Richardson"]

Hodgkins type lymphoma? Excisonal biopsy to confirm.

[/quote]

Awwww... nuts. This forum is full of clever people. I thought I'd be able to keep this going for longer!

Yes it was Hodgkins Lymphoma. Rare type of lymphoma that normally affects cats over the age of 10 according to the pathologist

[/quote]

Kate beat me to it! But it would only have been in my mind as I had a case last week, diagnosed on FNA. We've not removed it yet though, so not confirmed.

Didn't need a CT though must admit I did pop an ultrasound on it prior to popping a needle in it!

RE: Case of the Week: Feline Medicine

Kate Richardson — Fri, 25 Oct 2019 18:18:05 GMT

[quote user="Anthony Dennison"]

[quote user="Kate Richardson"]

Hodgkins type lymphoma? Excisonal biopsy to confirm.

[/quote]

Awwww... nuts. This forum is full of clever people. I thought I'd be able to keep this going for longer!

Yes it was Hodgkins Lymphoma. Rare type of lymphoma that normally affects cats over the age of 10 according to the pathologist. Removed the entire lymph node (it came away really easily) and removed the problematic tooth. All fine now, just going to monitor for now.

Will have to think of a harder one for next time

[/quote]

Try to skip the unnecesary CT next time!!!

RE: Case of the Week: Feline Medicine

Anthony Dennison — Fri, 25 Oct 2019 18:02:42 GMT

[quote user="Kate Richardson"]

Hodgkins type lymphoma? Excisonal biopsy to confirm.

[/quote]

Awwww... nuts. This forum is full of clever people. I thought I'd be able to keep this going for longer!

Will have to think of a harder one for next time

RE: Case of the Week: Feline Medicine

Kate Richardson — Fri, 25 Oct 2019 17:30:55 GMT

Hodgkins type lymphoma? Excisonal biopsy to confirm.

RE: Case of the Week: Feline Medicine

Anthony Dennison — Fri, 25 Oct 2019 16:49:52 GMT

[quote user="Joyce Whitehead"]I presume CT would show that Lymph nodes in the area were all ok?[/quote]

CT came back as the mass being a single enlarged retropharyngeal lymph node

[quote user="Joyce Whitehead"] If so I think I’d be inclined to check bloods (you’ve probably done this)[/quote]

Bloods all unremarkable, including T4

[quote user="Joyce Whitehead"]consider removal if not invasive then send for histo[/quote]

Once we got the CT report this is what we decided to do (as well as remove the problem tooth identified on CT).

So, a single enlarged lymph node, with normal bloods... new differential list?

RE: Case of the Week: Feline Medicine

Joyce Whitehead — Fri, 25 Oct 2019 14:06:25 GMT

I presume CT would show that Lymph nodes in the area were all ok? If so I think I’d be inclined to check bloods (you’ve probably done this) and consider removal if not invasive then send for histo. Although maybe an incisional biopsy would let you have more info too.

RE: Case of the Week: Feline Medicine

Anthony Dennison — Fri, 25 Oct 2019 13:40:22 GMT

[quote user="Neil Wheadon"]Expected that but as David said, it's about the thought process and that would have been too simple.[/quote]

Sorry, just trying to extend it! I was concerned about a possible thyroid mass, like a non functioning carcinoma. Cat also wasn't very amenable to having a needle stuck into it's neck conscious, so after discussion we went for CT to check it wasn't a very vascular thing that I was about to stab. Realise some people may think that's OTT, but it was my thought process at the time.

CT showed a large, well encapsulated non invasive soft tissue mass just lateral to the trachea, no significant blood supply to it. Also apical bone loss around the upper '08 of that side.

Did an FNA, report came back as possible lymphoma, but couldn't be certain as cell preservation was very poor. Could be just a reactive lymph node.

Next steps?

RE: Case of the Week: Feline Medicine

Neil Wheadon — Fri, 25 Oct 2019 12:29:53 GMT

[quote user="Anthony Dennison"]Did that, no pus. [/quote]

Expected that but as David said, it's about the thought process and that would have been too simple. Did you do anything with what may or may not have been in the needle?

Neil

RE: Case of the Week: Feline Medicine

Anthony Dennison — Fri, 25 Oct 2019 12:27:07 GMT

[quote user="Neil Wheadon"]Never rule out a cat bite abscess[/quote]

Fair point, but this is an indoor cat that lives on it's own.

[quote user="Neil Wheadon"]I'd pop a needle in it (conscious)[/quote]

Did that, no pus.

RE: Case of the Week: Feline Medicine

Neil Wheadon — Fri, 25 Oct 2019 11:59:04 GMT

Never rule out a cat bite abscess

I'd pop a needle in it (conscious)

This would double for an FNA, but I always warn people that if I send it away, then a percentage (how many, that would be interesting) come back as nothing seen as no cellular content.

Cheap and cheerful

Neil