1 / 117

Managing Lymphoma in Small Animal Practice

Managing Lymphoma in Small Animal Practice. Wendy Blount, DVM. Lymphoma. aka lymphosarcoma (LSA) Other than euthanasia in shelters, cancer is the #1 killer of dogs most common cancer in dogs and cats Most common cause of hypercalcemia in dogs and cats 30% of cats with cancer have lymphoma

devi
Télécharger la présentation

Managing Lymphoma in Small Animal Practice

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Managing Lymphoma in Small Animal Practice Wendy Blount, DVM

  2. Lymphoma • aka lymphosarcoma (LSA) • Other than euthanasia in shelters, cancer is the #1 killer of dogs • most common cancer in dogs and cats • Most common cause of hypercalcemia in dogs and cats • 30% of cats with cancer have lymphoma • 24% of dogs with cancer have lymphoma • Most common spinal cord tumor in the cat • Most common brain tumor in the cat • Most common nasal tumor in the cat • Most common liver tumor in the cat

  3. Etiology • GI lymphoma can be preceded by IBD in cats • Helicobacter spp increase risk of GI adenocarcinoma in people, and are often present in gastric LSA histopath in cats • FeLV predisposes to LSA in cats • Lymphoma respects age less than other tumors

  4. Clinical Signs Vary tremendously by tumor location Multicentric lymphoma most common • Multiple painless enlarged lymph nodes, hepatomegaly, splenomegaly in dogs • Enlarged mesenteric lymph node, hepatomegaly, splenomegaly in cats • Fever • Other locations Ocular lymphoma • Third eyelid or conjunctival mass in cats • rapidly enlarges • Anterior or posterior uveal infiltrates and/or uveitis

  5. Clinical Signs

  6. Clinical Signs

  7. Clinical Signs

  8. Clinical Signs

  9. Clinical Signs

  10. Clinical Signs

  11. Clinical Signs

  12. Clinical Signs Fred Holt – Tioga TX Gregory Wood – Katy TX Holly Hoffman – Wichita Falls TX

  13. Clinical Signs Vary tremendously by tumor location • GI lymphoma (focal or diffuse) • Vomiting, diarrhea, steatorrhea, melena • Hematochezia, mucoid feces, tenesmus • Mass on rectal palpation • Anorexia, weight loss, lethargy • Abdominal pain or effusion • Palpable abdominal mass, thickened loops of bowel • Pallor, anemia if GI bleeding • Icterus if obstruction of bile duct

  14. Clinical Signs Nasal lymphoma • Unilateral or bilateral nasal discharge • Epistaxis, Sneezing • Dyspnea, stertor, nasal stridor • Facial distortion and ocular discharge • Intermediate to large cells

  15. Clinical Signs Nasal lymphoma • Unilateral or bilateral nasal discharge • Epistaxis, Sneezing • Dyspnea, stertor, nasal stridor • Facial distortion and ocular discharge • Intermediate to large cells

  16. Clinical Signs Nasal lymphoma • Unilateral or bilateral nasal discharge • Epistaxis, Sneezing • Dyspnea, stertor, nasal stridor • Facial distortion and ocular discharge • Intermediate to large cells • Neurologic signs if invasion of the cribriform plate – anterior forebrain • Seizures • Behavioral changes, obtunded, head pressing • Blindness, circling • CP deficits worst in rear

  17. Clinical Signs Spinal cord lymphoma • Extramedullary tumor • Onset chronic or acute • More common in cats than dogs • Localized severe spinal pain • Extramedullary tumors seem to be more painful than medullary • More pain receptors in these areas • LMN signs (flaccid weakness) 2 vertebrae caudal to the area of spinal pain • UMN signs (spastic paresis) caudal to that • Usually part of multifocal disease • Younger cats, up to 2 years of age • Difficult to diagnose, CSF often not diagnostic

  18. Clinical Signs Brain lymphoma • Symptoms caused by • Displacement of brain tissue • Disruption of blood brain barrier • Disruption of CSF and blood flow • Seizures the most common symptom in dogs (cerebral) • Lethargy, weight loss, obtunded • Circling, behavior changes, head pressing • Contralateral CP deficits worse in rear • Head tilt and ataxia in cats (caudal brain stem) • Brain herniation in the late stages • Coma, dilated pupils, death

  19. Clinical Signs Acute Lymphoblastic Leukemia (ALL) • Usually non-specific signs • May have coagulopathy of thrombocytopenia • Petechiae • Epistaxis, bleeding from the gums • Primary hemostasis disorder • Often part of multicentric disease • Usually atypical cells in circulating but not always • “Aleukemic leukemia” • Cytopenias prompt bone marrow sample

  20. Clinical Signs Lymphomatoid granulomatosis • aka eosinophilic pulmonary granulomatosis • aka lymphoid granulomatosis • aka lymphoproliferative angitis • aka granulomatosis • Destructive angitis in the lungs • Atypical T-cell lymphoma • History of treated heartworm disease • May progress to lymphoma • Symptoms of pneumonitis

  21. Clinical Signs Renal lymphoma (feline) • Bilateral large, bumpy kidneys • The many signs of renal failure Mediastinal lymphoma (feline) • Dyspnea, coughing • Regurgitation • Horner’s Syndrome Hepatic lymphoma • Marked hepatomegaly, liver failure • Large cell in dogs, small cell in cats

  22. Clinical Signs Cutaneous lymphoma • Usually diffuse in the dog • Intense pruritis, resistant to treatment • Two forms in cats • Epitheliotropic – diffuse • “Mycosis fungoides” • Intradermal nests of 5-10 cells • Usually large but sometimes small T cells • Non-epitheliotropic • Large B cells deeper in the dermis

  23. Clinical Signs CBC • Neutrophilia • Lymphocytosis • atypical lymphocytes if ALL • May not have atypia with CLL • Anemia • Anemia of chronic inflammatory disease • Mild nonregenerative anemia • Iron deficiency anemia if GI bleeding • Regenerative or non-regenerative • Pancytopenia if leukemia is present

  24. Clinical Signs Panel • Hypercalcemia • Elevated ALT, SAP, GGT if hepatic LSA • Icterus – GI, hepatic, pancreatic LSA • Low albumin • PLE due to intestinal LSA • GI bleeding due to GI LSA • High globulins – B cell lymphoma • Low globulins – GI bleeding due to GI LSA • High BUN • Pre-renal • GI bleeding due to GI LSA • Feline renal LSA

  25. Clint Duncan – Spring TX John Wood – Lufkin TX Kevin Acuna – Nacogdoches TX

  26. Clinical Signs Panel - icterus with normal liver enzymes • A unique presentation in the cat • Differential diagnosis: • Pancreatitis – elevated fPLI • Lymphoma – cytology or histopathology • FIP – histopathology or diagnostic trifecta • Lymphopenia <1500/ul • Titer 1:160 or greater • Globulins >5.1 g/dl • Positive predictive value 89% • Negative predictive value 99% • Histopath and fluid analysis supportive • Fluid analysis chart

  27. Clinical Signs Abdominal Imaging (rads) • Abdominal mass – gut or lymph node • Hepatomegaly, splenomegaly • Gut obstruction • Abdominal effusion • Chyle or modified transudate • Thickened gut wall (muscularis) • Pneumoperitoneum if GI perforation • Mucosal craters • Soft tissue calcification if hypercalcemia • Bilateral renomegaly in cats

  28. Clinical Signs Bilateral renomegaly in cats

  29. Clinical Signs Cat with mid-abdominal mass and ascites

  30. Clinical Signs Hepatosplenomegaly due to multicentric lymphoma in a dog

  31. Clinical Signs Abdominal Imaging (US) • Enlarged mediastinal lymph node • Hepatomegaly • Hypoechoic focal to multifocal lesions • Generalized hypo- or hyper-echogenicity • Normal hepatic sonogram • Splenomegaly • Nodular to diffuse • hyper or hypoechoic

  32. Clinical Signs Lila • 1.5 year old female Rottweiler • Acute onset of abdominal pain and tachypnea • Has not eaten for 2 days, no vomiting, mucus in the stool • Abdominal splinting on palpation • Fever – 103.8F • CBC, panel – NSAF • cPLI – abnormal (>400) • Fecal float negative • No response to treatment with IV fluids and antibiotics for 2 days (began vomiting)

  33. Clinical Signs

  34. Clinical Signs Ileus and abdominal effusion

  35. Clinical Signs Lila • Abd US declined due to financial limitations • Elected diagnostic surgery • Generalized peritonitis, serosanguinous abdominal fluid • No obstruction or foreign body • Fluid analysis • Modified transudate • Neoplastic very large lymphoid cells • Responded to chemo within a few days • Remission 6 months • End – recurrence of initial clinical signs

  36. Clinical Signs Abdominal Imaging (US) • Abdominal effusion • Soft tissue calcification if hypercalcemia • GI lesions • Gut obstruction – dilated fluid filled bowel • Thickened gut wall (muscularis) • Obliteration of gut layers • Pneumoperitoneum if GI perforation • Mucosal craters • Decreased motility

  37. Clinical Signs Renal lymphoma in a cat

  38. Clinical Signs Renal lymphoma in a cat

  39. Clinical Signs gastric lymphoma in a cat with ascites

  40. Clinical Signs Abdominal effusion and infiltrated omentum in a cat

  41. Clinical Signs Hypoechoic liver - lymphoma

  42. Clinical Signs Hyperechroic liver - lymphoma

  43. Clinical Signs Stomach & duodenum in a dog with lymphoma

  44. Doug Ashburn Lufkin TX Andre Michael Tyler TX Elizabeth Beck Luling TX

  45. Clinical Signs Thoracic Imaging (rads) • Enlarged perihilar lymph nodes • Interstitial nodular pattern • Enlarged sternal lymph node • Mediastinal mass • Pleural effusion • Soft tissue calcification if hypercalcemia • Lymphoid granulomatosis • Soft tissue masses in the lungs • Interstitial to alveolar pattern • Enlarged lymph nodes • Pleural effusion

  46. Clinical Signs

  47. Clinical Signs Enlarged mediastinal lymph nodes and chylothorax in a cat with LSA

  48. Clinical Signs Enlarged mediastinal, sternal and perihilar lymph nodes in a dog with LSA

  49. Clinical Signs

  50. Clinical Signs Interstitial pulmonary nodules in a dog with lymphoma, enlarged lymph nodes

More Related