Rags Lymphoma: During Thanksgiving 2005, my younger brother told me that Rags didn’t look good. I guess I had noticed, but did one of those, “He’ll be fine.” December 2005, he stopped eating and drinking water. In a panic, I took him to his vet, KC Cat Clinic, and they recommended that I take him to Mission Med Vet–an emergency and specialty clinic (see links to both of these vets at the bottom of this page).
Rags was given an evaluation and Mission Med Vet recommended that we do an ultrasound to see if there was anything going on inside of him.
Sure enough, they found a mass and recommended that we do surgery to find out if the mass was cancerous. However, Rags was extremely weak, so they weren’t keen on doing surgery until Monday (it was Friday). They said he would have to stay over the weekend, where they would give him fluids to get his levels again. Of course, there was no guarantee that he would survive the surgery. I was a nervous wreck.
In the words that follow I have included Rags Lymphoma protocol and lab work, so that if you have a kitty with lymphoma and you are thinking about chemotherapy for your cat, you can print this information and bring it to your vet. Please keep in mind, I am NOT a vet and have only re-typed the medical records for Rags Lymphoma that I received from Mission Med Vet.
Wednesday, December 28, 2005 – Rags Lymphoma
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Exploratory celiotomy, liver biopsies, LNN biopsy
An exploratory celiotomy was performed through a ventral midline incision. A 4cm hepatic mass was present at the base of the left medial lobe. Diffuse nodular disease was present throughout the liver. A large mesenteric lymph node was identified. Multiple liver biopsies were obtained of both normal and abnormal appearing tissue as well as an incisional biopsy of the mesenteric lymph node. Gel foam was used to control hemorrhage in the punch biopsies of the liver. The liver biopsies were obtained from the primary mass and the right lateral lobe. The linea was closed with 2-0 PDS in a simple continuous pattern. The subcutaneous tissues were closed with 4-0 PDS in a simple continuous pattern. The skin was closed with staples.
Monday, January 02, 2006 – Rags Lymphoma
Rags was re-evaluated 12/29 for lymphoma – hepatic. He is currently being treated with uw – 25.
Treated last week with vincristine
Not eating well over the weekend and has progressed this week.
Weight = 10#
Temperature = 101
Normal PE w/exception of mild dehydration and 2-3/6 heart murmur
Ate well last night
Vomited one time this am
Hydrated and normothermic
PCV: 24%/TS: 7.0 gm/dl, serum: Normal
WBC estimate: /ìl
WBC count: 1580/ìl (only 58 cells counted on the diff)
Segs: 18%, 490/ìl
Bands: 0%, 0/ìl
Metas: 4%, 109/ìl
Lymphs: 33%, 899/ìl
Monos: 0%, 0/ìl
Eos: 3%, 82/ìl
Basos: 0%, 0/ìl
Platelet estimate: 285 * 1000/ìl
Platelet morphology: normal
RBC morphology: anisocytosis, schistocytes
Other: reactive lymphs
Glucose: 131 mg/dl
Plan: Rags was admitted to the hospital and given iv fluids and ampicillin. His appetite improved and he was sent home on oral antibiotics. The owners will recheck this week with Dr. Wasmer.
AMOXICILLIN 100MG TABS #14
Sig: Give 1 tablet(s) every 12 hours until gone.
Rags is much better hydrated today. He ate well last night and today. He had one episode of vomiting this morning, but has remained afebrile and is bright and alert. Please give the above antibiotic as directed. Recheck in 5-7 days for chemotherapy with Dr. Wasmer. Resume Rags normal diet at home.
Friday, September 22, 2006 – Rags Lymphoma
Rags was evaluated for previous history of hepatic lymphosarcoma that has been treated with chemotherapy over the past 9 months. Abdominal ultrasound revealed an additional hepatic mass that was varied in echogenicity than previously documented masses. The owners elected abdominal exploratory to try and obtain a definitive diagnosis and possible treatment.
Physical Exam – Rags Lymphoma
QAR on presentation.
Cardiovascular = within normal limits. No murmurs or arrhythmias noted on auscultation. Growling during the examination.
Abdominal palpation = Moderate sized bladder. Small irregular kidneys bilaterally.
Thin body condition with generalized muscle atrophy.
There is a large (3.6 cm) hyperechoic, heterogenous mass in the liver (midline adjacent to diaphragm); both kidneys are small (L = 3.71 cm; R = 3.32 cm); there is a small (2.8 mm) hyperechoic splenic nodule.
Met. Check CXR – nsf
Previously diagnosed hepatic lymphosarcoma + hepatic mass
Exploratory laparotomy, hepatic biopsy of left medial lobe, partial hepatic lobectomy of right lateral lobe. Rags recovered from anesthesia and surgery without complications.
A routine midline approach to the abdomen was performed. Exploratory revealed a 2-3 cm cystic mass at the hilar region of the left medial & lateral lobes intimately associated with the biliary tract on the caudal aspect of this lobe. Multiple irregular hyperemic areas were noted in the liver with a 3-4 cm mass in the right lateral liver lobe at the periphery. The kidneys were small and irregular on palpation. The ileum was subjectively thickened. A biopsy was performed of the left medial lobe with a punch biopsy and oversewn with 4-0 PDS in a cruciate pattern. A partial right lateral hepatic lobectomy was performed with a TA55 stapler. The proximal margin was ligated with a row of mattress sutures using 3-0 PDS. Gelfoam was placed on the cut margin to aid in hemostasis. The linea alba was closed with 2-0 PDS in a simple continuous suture pattern, the subcutaneous tissues were apposed with 4-0 Monocryl in a simple continuous suture pattern and the skin was apposed with 3-0 Ethilon in a Ford interlocking pattern.
Biopsies were submitted to AMC in NYC for histopathologic analysis.
Outcome & Recommendations
Rags was eating well on the first post-operative day and was discharged that afternoon. We recommended restricted activity for 3 weeks. Suture removal should be performed in three weeks. We will call with biopsy results as soon as they are available.
Friday, December 08, 2006 – Rags Lymphoma
IL-VETTEST (SINGLE) #3
Instructions: BUN, creat, calcium
Instructions: on IRMA
Na: 161.4 mEq/l (150-165 mEq/l)
K: 4.46 mEq/l (3.6-5.8 mEq/l)
iCa: 1.59 mEq/l (0.77-1.27 mEq/l)
abdominal sonography – there is a 3.5 cm heterogenois mass in the liver; the remainder of the examination was unchanged from previous exams.
1. recurring liver mass; h/o hepatocellular CA; h/o hepatic LSA (in remission) and biliary cystadenomas; LAE increased
2. Doing well clinically
3. mild hypercalcemia
r/o paraneoplastic, idiopathic
4. mild azotemia, small irregular kidneys
consider repeat surgical resection
Saturday, December 30, 2006 – Rags Lymphoma
Rags has previously been diagnosed with LSA, biliary cystadenoma and hepatocellular carcinoma and has been treated with chemotherapy over the past year. Re-evaluation with internal medicine revealed a 2-3cm mass in the right side of the liver that was not noted on previous examination. The owner has elected to pursue surgical exploration and potential resection of the mass.
Physical Exam – Rags Lymphoma
Rags was BAR on exam. Good body condition, BCS 3+/5
EENT-multiple missing teeth, some tartar/calculus on remaining teeth, MM-pink/moist
PCV: 40%/TS: 8.6 gm/dl, serum: Clear
BUN: 31 mg/dl (16-36 mg/dl)
Creatinine: 2.9 mg/dl (0.8-2.4 mg/dl)
Na: 154.5 mEq/l (145-158 mEq/l)
K: 4.31 mEq/l (3.6-5.8 mEq/l)
iCa: 1.53 mEq/l (1.12-1.42 mEq/l)
abdominal sonography – there is a 3.5 cm heterogenous mass in the liver; the remainder of the examination was unchanged from previous exams.
Multiple hepatic masses (hisopathology pending)
Multiple hepatic biopsies
Rags recovered from anesthesia and surgery without complications
A midline approach to the abdomen was performed. Exploratory revealed omental adhesions to the right middle liver lobe at the previous site of partial liver lobectomy. The liver was mottled in appearance (mild nutmeg appearance with multiple areas of petechiation). A 2-3 cm mottled/neovascularized mass was noted at the diaphragmatic surface of the right middle liver lobe. Two smaller masses (~1cm in diameter) were noted at the margin of the caudate process and the right lateral lobe. Each of the above noted masses were biopsied with a 4mm punch biopsy and hemostasis was achieved with gel foam and digital pressure. The kidneys were small and irregular in nature (left>right). The linea was closed with 3-0 PDS in a simple continuous suture pattern. The skin was apposed with 3-0 Ethilon in a Ford-interlocking pattern.
Outcome & Recommendations
Rags was discharged on the first post-operative day. He was eating well at the time of discharge. We will make further recommendations based on the pathology report.
Rags on May 9, 2008