Gastro-intestinal Eosinophilic Sclerosing Fibroplasia

Re: Gastro-intestinal Eosinophilic Sclerosing Fibroplasia

Richard Fox — Wed, 18 May 2011 15:55:36 GMT

Phew

Low grade lymphoma responds quite well toe chlorambucil IIRC c.f. COP but I am no expoert in Chemo !

Good luck and feel free to give me a ring if you have any queries

Re: Gastro-intestinal Eosinophilic Sclerosing Fibroplasia

James Allsop — Wed, 18 May 2011 15:53:07 GMT

I was already concenred as he is not making a great recovery so far, so suspicious that treatment protocol not working or some underlying pathology. That would fit with your experience of these samples. I appreciate your advice even if its not what i wanted to hear . he does have a history of recurrent diet responsive vomiting which i have always attributed to IBD which is again why i though he might have lymphoma as the vomiting had been getting more frequent over the previous few days. Normally he just vomits if I change his diet and a short spell on royal canin sensitivity pouches sorts him out. I could try pred and clorambucil instead of COP although may not be as effective if it really is lymphoma. will work on getting him scanned again

Re: Gastro-intestinal Eosinophilic Sclerosing Fibroplasia

Richard Fox — Wed, 18 May 2011 15:46:24 GMT

Sorry I am not trying to worry you - We are just as likely to be dealing with an IBD type disorder but I wanted to give you my experience of biopsies from these cases. It might be best to do a scan to ID bowel thickening or further lnn enlargement? Would the treatment for IBD or lymphoma be similar i.e. drugs like clorambucil etc? Sorry I am not trying to complicate matters

Is there any evidence or hypereosinophilia so suggest hypereosinophilic disease?

Re: Gastro-intestinal Eosinophilic Sclerosing Fibroplasia

James Allsop — Wed, 18 May 2011 15:42:24 GMT

Unfortunately because i was so convinced it was lymphoma before i operated i didnt do a full ex-lap and just biopsied the lesions i found by palpation and ultrasound. I would probably have done a full exploration if it was a client - probably shouldnt treat your own pet!! Im concerned that I may have missed a window of opportunity to start chemo. I might have to scan him again and try to get FNA, dont realy want to open him up again.

Re: Gastro-intestinal Eosinophilic Sclerosing Fibroplasia

Richard Fox — Wed, 18 May 2011 15:37:04 GMT

Preds will have an effect because the signs are due to the eosinphilic inflammation but my concern with why the eos are there? We also do not know as to the extent of intestinal involvement and therefore may explain the clinical signs - d+ with just a lnn mass seems unlikely?

In my experience a reasonable proportion of these cases have lymphoma but I am not suggesting this is def the case here I am just concerned.

EDIT: Did the original path report go through differentials or perform step sections or take further tissue?

Re: Gastro-intestinal Eosinophilic Sclerosing Fibroplasia

James Allsop — Wed, 18 May 2011 15:20:12 GMT

He did initially receive a dose of convenia as he was still vomiting so didnt want to start oral doses. the vomiting stopped within 24hrs of dex inj so put onto preds at that point. now 2 weeks in and started metronidazole 4 days ago - as previously stated slight improvement in consistency of faeces but very marginal. Had a little chat with Tom Cave who hadnt seen a case before but reported that some EGC lesions can respond to interferon due to blockage of eosinophil chemotaxis from T cells - havnt tried this yet but will check with virbac to see if they have any info or doses

Re: Gastro-intestinal Eosinophilic Sclerosing Fibroplasia

Richard Fox — Wed, 18 May 2011 13:59:02 GMT

We have had several cases sent in - I don't really agree with this paper (as do some other pathologists who sent letters to the editor) but when I see it the differentials include:

T-Cell lymphoma

Bacteral infection - sometimes MRSA

Hyper-eosinophilic disease/enteritis

This is not in the same realms as the EGC found in the skin in my experience. Therefore Tx is based on whether the ddx is lymphoma, infection or primary inflammatory disorder? Unfortunately neoplastic lymphoid cells can be so diluted by EL's it becomes very difficult to discern if lymphoid cells present and inflammatory or neoplastic?

Have you tried broad spectrum antimicrobial treatment?

http://www.ncbi.nlm.nih.gov/pubmed/12238505