Odd ball

RE: Odd ball

Clive Ansell — Fri, 03 Feb 2017 17:49:35 GMT

Update: histology came back to confirm a benign haemangioma, completely excised with good wide margins, very little chance of recurrence or metastasis. No testicular tissue noted in the submitted sample.

RE: Odd ball

Braden Collins — Fri, 27 Jan 2017 01:51:44 GMT

Just seen the dog which I mentioned earlier, so have found the histopath report. Unfortunately it has presented with another scrotal mass, so I'll include any reports as they come through as well. This is what was said about the previous mass:

B. Assessment of the lesion within the scrotum reveals a nodular mass
surrounded by a fibrous capsule. This lesion comprises nests and trabeculae of
Sertoli cells within a fibrous matrix. The cells can show polygonal outlines
and eosinophilic cytoplasm with oval to rounded nuclei containing reticular
chromatin and quite prominent and irregular nucleoli. There are mitotic figures
and necrotic cells with some comediform necrosis and large cell clusters.
Interstitial inflammation is dominated by lymphocytes. Excision is complete.

The section of the scrotal mass reveals an accumulation of Sertoli cells in a
pattern typical of extra testicular Sertoli cell tumour. These are potentially
functional neoplasms that may be associated with hormonal paraneoplastic
changes. These lesions are ectopic and are usually associated with implantation
of cells following traumatic castration.

RE: Odd ball

Clive Ansell — Thu, 19 Jan 2017 17:52:16 GMT

[quote user="Elisabeth Knappett"]Intrigued - bets on what it is? And just to stir the pot.....what if the histo results come back as something that needs ongoing treatment/attention? I'm assuming the owner is unaware that the sample is being sent off - in this case do you contact him with the results or not? [/quote]

Histology was strongly advised by both practices, but the owner declined it. His problem, compounded by the fact he has now left both practices on bad terms and will need to find a third one (plenty in the area)

If the results indicate an immediate welfare issue, and I can't off hand think what that could be, I'm sure the owner of the first practice who is paying for and receiving the results will contact him. Glad I'm just the locum

RE: Odd ball

Elisabeth Knappett — Thu, 19 Jan 2017 15:22:26 GMT

Intrigued - bets on what it is? And just to stir the pot.....what if the histo results come back as something that needs ongoing treatment/attention? I'm assuming the owner is unaware that the sample is being sent off - in this case do you contact him with the results or not?

RE: Odd ball

Hannah Wynne Richards — Thu, 19 Jan 2017 09:15:15 GMT

Anthony Don't be rude to donkeys.

Remove 1 s, and add an r and an e and you'll be more accurate.

Wynne

RE: Odd ball

Clive Ansell — Thu, 19 Jan 2017 09:05:28 GMT

[quote user="Martin Atkinson"][quote user="Lucy Fleming"]not sure who the tissue belongs to though. The second practice? The dog's owner?[/quote]It has become clinical/anatomical waste so cannot legally be given back to the owner. I imagine keeping it in formalin stored for a limited time would satisfy regulations but it would be then also rendered in an unsafe form to return to the client. I imagine they would have to obtain a court order for it to released and then only with strict precautions as to its transport and subsequent handling and even then it could probably only go to a laboratory with the correct packaging protocol not back to the owner. [/quote]

Good point, who owns the sample and what can and cannot be done with it?

what we have decided between us all is to divide the mass in half, send one half for histology which the first practice will pay for, and keep the second half in storage given the possibility of litigation. Easy enough as the whole mass was kept.

It seems at surgery there was no evidence of testicular vessels, vas deferens. epididymis or panpiniform plexus, so a left behind testicle seems more and more unlikely, and an unrelated mass more likely.

RE: Odd ball

Anthony Todd — Wed, 18 Jan 2017 23:21:34 GMT

[quote user="Martin Atkinson"]Some of you are too soft, obviosuly a ploy to avoid payment. I wouldn't have given him a penny back but I'd still have told him not to darken my door again. You have enough evidence to defend a case.[/quote]

I'd have, and did, take debtors to the County Court and particularly in a case like this. the ass will be telling all his or her mates, and your reputation is not being improved.

Can do it on line and the judges are fair, very sensible, easy to appear before, and down to earth.

A [recorded] letter before action is, I think, a legal requirement and Consent to Mediation too.

A faff and irritation but I wonder if the VDS [if we don't land them in the manure with our NoBLE] will help, they probably will.

You'll fume forever if you don't do it!

Everyone on here will support you too, I'd bet.

PS or get a debt collection agency people on here should know good ones, then you won't be involved at all unless it is defended [check details though]

RE: Odd ball

Julie Innes — Wed, 18 Jan 2017 18:27:39 GMT

Yeah, I know, but to be honest with folk like that (he was really rude to the staff, made the student nurse cry) I'd rather see the back of them, and I made that quite clear- that I was giving him his money back in order to be rid of him. I think it's worth the cost to just get folk like that out of my life, to be honest! I know he had no case to pursue, and I refused to admit we were at fault (albeit in a nice way ). I'm the same with bad debtors- I'd rather just sack them than get all wound up pursuing them, my blood pressure can't take it!

RE: Odd ball

Martin Atkinson — Wed, 18 Jan 2017 17:51:55 GMT

[quote user="Julie Innes"]Got all arsey, demanded his money back. I gave him his money back, told him to find himself another vet, and sent the mass for histopath myself- it turned out to be cancerous...maybe NOT the wrong lump after all[/quote]Some of you are too soft, obviosuly a ploy to avoid payment. I wouldn't have given him a penny back but I'd still have told him not to darken my door again. You have enough evidence to defend a case.

RE: Odd ball

Julie Innes — Wed, 18 Jan 2017 16:56:02 GMT

Shame you couldn't find out! I'd have paid myself to get the histology done, just out of curiosity! We had a slightly similar case recently- owner adamant we had removed the wrong lump (despite a nurse checking it at handover, and the vet then calling him to clarify the mass we were removing...) Got all arsey, demanded his money back. I gave him his money back, told him to find himself another vet, and sent the mass for histopath myself- it turned out to be cancerous...maybe NOT the wrong lump after all

RE: Odd ball

Martin Atkinson — Wed, 18 Jan 2017 16:37:09 GMT

[quote user="Lucy Fleming"]not sure who the tissue belongs to though. The second practice? The dog's owner?[/quote]It has become clinical/anatomical waste so cannot legally be given back to the owner. I imagine keeping it in formalin stored for a limited time would satisfy regulations but it would be then also rendered in an unsafe form to return to the client. I imagine they would have to obtain a court order for it to released and then only with strict precautions as to its transport and subsequent handling and even then it could probably only go to a laboratory with the correct packaging protocol not back to the owner.

RE: Odd ball

Lucy Fleming — Wed, 18 Jan 2017 16:09:49 GMT

I feel like, as the first practice I would be inclined to obtain the mass from the second practice and get histology done - not sure who the tissue belongs to though. The second practice? The dog's owner?

RE: Odd ball

Braden Collins — Wed, 18 Jan 2017 14:23:44 GMT

I did a locum once where a vet managed to leave a testicle behind. I'm not sure how they managed it (vet and nurse not paying attention to that extent is hard to explain). The owner called the day after the surgery to say they thought a testicle was still there, and sure enought there was.

RE: Odd ball

Clive Ansell — Wed, 18 Jan 2017 12:22:31 GMT

[quote user="Martin Atkinson"]It will lead no-where because there is no evidence either way so the case will be dismissed. I hope the second practice were paid. If I was the owner of the first practice I would certainly tell the client we would not be taking them back under any circumstances.[/quote]

The second practice has kept the mass/testicle, but have said they will only do so for 6 months. They had problems with the client who was rude and obnoxious and was demanding free treatment, even though that practice had never seen the dog before, so asked for payment prior to the procedure.

I've spoken to the vet who carried out the procedure who thinks it is an unrelated mass, but they will not commit further or make further comment without histology. Client still thinks it is a testicle and we are all closing ranks.

RE: Odd ball

Martin Atkinson — Wed, 18 Jan 2017 10:57:14 GMT

[quote user="Clive Ansell"]who knows where it lead.[/quote]It will lead no-where because there is no evidence either way so the case will be dismissed. I hope the second practice were paid. If I was the owner of the first practice I would certainly tell the client we would not be taking them back under any circumstances.

RE: Odd ball

Clive Ansell — Wed, 18 Jan 2017 08:58:22 GMT

[quote user="James Laidlaw"]

[quote user="Clive Ansell"]Because the practice would not agree to carry out surgery free of charge whatever the outcome, but did offer too if a normal testicle, the client took offence and went elsewhere.[/quote]

Why would this have been seen as unreasonable? If the castration hadn't been correctly carried out and one missed, or a 3rd missed if it had 3 originally then FOC would be appropriate. If it was a cancerous growth unrelated to the castration then why should the clinic cover the cost?

[/quote]

Sorry, I didn't word it very well. The practice agreed to surgery free of charge if a testicle was present in any form, but would charge if it was clear it was an unrelated mass. The client was demanding FOC whatever the outcome, insisting it must be a testicle (Based on advice from the breeder).

How it will all pan out now, I don't know. The practice will not reimburse the client as they offered FOC, but the client made the choice to go elsewhere and pay, as well as declining histology to establish a diagnosis.

RE: Odd ball

James Laidlaw — Wed, 18 Jan 2017 01:35:59 GMT

RE: Odd ball

Braden Collins — Wed, 18 Jan 2017 00:53:18 GMT

We had a case a while ago with a similar presentation. Was castrated at our clinic before we purchased it. It came back as a sminoma or similar (I can't remember exactly what), but it looks like some normalc cells may have seeded when the dog was castrated and turned neoplastic. Very strange but I guess it can happen.

As for the FNA question raised earlier, I would definately encourage an FNA on all lumps where posssible before removal, otherwise you can't properly plan the surgery. If it's a benign mass and you take big margins, you've given the dog a bigger and more painful surgery than it needed, and if it's malignant you need to plan the surgery to get adequate margins. I think it was a very valid step.

We expect all vets to be able to answer "what is it and where is it?" before they plan surgery, though of course an excisional biopsy is sometimes needed.

RE: Odd ball

Clive Ansell — Tue, 17 Jan 2017 22:22:25 GMT

Update.

Turned in to an idiotfest.

Because the practice would not agree to carry out surgery free of charge whatever the outcome, but did offer too if a normal testicle, the client took offence and went elsewhere.

Outcome - a scrotal mass was removed but the client declined histology. Given it could lead to litigation the practice and the vet carrying out the surgery will not pass any comment whatsoever on the "mass" without histology.

Owners want to "get" somebody for it, so who knows where it lead.

RE: Odd ball

Lucy Fleming — Tue, 03 Jan 2017 10:52:39 GMT

Not that this is helpful, but I saw something similar when I was a final year student seeing practice. Last appointment on a busy over-run Friday was booked in as 'check if castrated, fighting a lot' - I was asked to see it, have a quick check, explain to owners that castrated male cats will still fight etc. The owners pulled the chubbiest-cheeked tom cat you have ever seen from the basket, and a quick grope revealed what was almost certainly an inguinal testicle. The practice had formed from a few city practices amalgamating a few years ago so his original index-card history was unearthed, which read 'castration, only right testicle present'...

RE: Odd ball

Clive Ansell — Tue, 03 Jan 2017 10:21:18 GMT

[quote user="Yantha Smyth"]

[quote user="Anthony Todd"]

[quote user="Yantha Smyth"]FNA suggested interstitial cell or seminoma.[/quote]

Why do this first when it will, inevitably, be removed when you can do your histo with a better decisive sample?

[/quote]

i think we could have just gone straight to surgery, but the dog was in for a glucose curve, and not been that stable recently, so it is possible the owners wanted to know a GA and surgery was justified at this point and get more info before committing to it.

[/quote]

I can't understand why Yantha has been one starred?

I'm not normally a fan of FNA's, much prefer to just remove a mass entire, but there cases where I would FNA.

A presumably older patient that is an unstable diabetic and therefore an increased GA risk, surely a conscious FNA to try and identify a lesion is a perfectly rational and sensible thing to do.

RE: Odd ball

Yantha Smyth — Sat, 31 Dec 2016 14:33:57 GMT

[quote user="Anthony Todd"]

[quote user="Yantha Smyth"]FNA suggested interstitial cell or seminoma.[/quote]

Why do this first when it will, inevitably, be removed when you can do your histo with a better decisive sample?

[/quote]

RE: Odd ball

Clive Ansell — Sat, 31 Dec 2016 13:22:01 GMT

[quote user="Anthony Todd"]Just remove the "mass", solve the problem and do your histo afterwards if you want to.[/quote]

Exactly what I'm going to do.

[quote user="Anthony Todd"]Why can't it be a granuloma-ish reaction to the tied off spermatic cord, or probably the vessel at the other end of the testicle [can't remember the name, but it's the one that fills the scrotum with blood if you don't tie off both ends of the testicle][/quote]

Could well be, and the practice did have a run several ears ago of reactions to buried braided nylon sutures used in routine neuters (Not by me I hasten to add). I am fairly sure that I can palpate an enlarged testicle with epididymis though.

RE: Odd ball

Anthony Todd — Sat, 31 Dec 2016 13:16:44 GMT

[quote user="Yantha Smyth"]FNA suggested interstitial cell or seminoma.[/quote]

Why do this first when it will, inevitably, be removed when you can do your histo with a better decisive sample?

RE: Odd ball

Yantha Smyth — Sat, 31 Dec 2016 13:01:38 GMT

Funnily enough I just had a similar case In the last 2 weeks. Records indicated routine closed castration 9 yr ago. At a diabetic monitoring exam a few months ago the owners pointed out a small lump in scrotum. At the time is was pea size, firm, and moved freely as if passing toward the inguinal canal. A few months delay in addressing it when he went off to have cataract surgery...had gradually enlarged to 2x3cm, still mobile and well defined. FNA suggested interstitial cell or seminoma. Removed surgically as if closed castration and histopath revealed seminoma. I cannot understand how this has come about. Was also wondering prior to histo result if could be functional and could explain humping behaviour, and unstable diabetes in recent months after being stable on same dose for a year before this. Apparently seminoma are not functional though, so probably not.