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Ask Dr. Michael Salkin Your Own Question
Dr. Michael Salkin
Dr. Michael Salkin, Veterinarian
Category: Cat Veterinary
Satisfied Customers: 24468
Experience:  University of California at Davis graduate veterinarian with 44 years of experience.
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My 13 yr old cat had a sonogram last week. She has lost 3

Customer Question

My 13 yr old cat had a sonogram last week. She has lost 3 lbs over the last year with low appetite, even with an appetite stimulant. The sonogram revealed several hyperchoic heterogeneous nodules, The spleen is markedly enlarged with rounded margins. The parenchyma is mod/severely mottled in echo texture. All other organs within normal limits. She exhibits a raspy cough/sneeze several times a day. Extensive blood tests reveal nothing abnormal.
Our vet wants to do x-rays to see the lungs are affected and a fine needle aspiration of the spleen.
Would you advise further testing or give her palliative care?
Submitted: 1 year ago.
Category: Cat Veterinary
Expert:  Dr. Michael Salkin replied 1 year ago.
Aloha! You're speaking with Dr. Michael Salkin
Can you clarify where these nodules were found, please? When such a spleen is found in cats, both mastocytosis and lymphoma need to be considered. To answer you directly, if you're amenable to having chemotherapy performed, X-rays and fine-needle biopsy is necessary. If not, hospice care is reasonable. Such a profound weight loss and the findings you mentioned are most consistent with neoplasia (cancer).
Please respond with further questions or concerns if you wish.
Customer: replied 1 year ago.
The nodules are in the liver. The ultrasound assessment is : liver- nodules of varying echotexture:r/o neoplasia (adenoma, cystadenoma, metastatic neoplasia, other) vs. reactive/regenerative vs. other
Enlarged mottled spleen: r/o neoplasia(lymphoma, MCT, other) vs. infection/inflammation vs other
Comments: consider FNA of spleen, chest radiographsWhat would be accomplished doing the workup,eg., x-rays, SNA etc.?
What is the best case scenario?
Can we do anything positive if there is cancer in the spleen or chest or liver?
In another words, is there anything good or fixable as related to the sonogram?
Is there any point in doing the testing?
Are the procedures going to change the prognosis or is it going to just give us more information?
What can we do for palliative care? Steroids like Prednislone-are these something useful in this case?
Is she in pain and do you think we should put her down and if so when?
Lastly, if this was your cat, what would you do?
Thank you in advance for all your help in this matter.Bob N.
Expert:  Dr. Michael Salkin replied 1 year ago.

Thank you for the additional information. That was my worry. When both the liver and spleen are abnormal, neoplasia must top my differential diagnosis list. Once again, a work-up accomplishes nothing more than an academic exercise if we're not going to act on the findings and that's not unreasonable in a 13 year old. I would be reticent to initiate chemotherapy in such a patient knowing that the few months of longevity I might provide aren't necessarily going to be comfortable. The best case scenario is that those findings are benign but that's not likely considering her weight loss and inappetence. Palliative care in the form of a corticosteroid such as prednisolone can be of benefit when either lymphoma or mastocytosis exists. It's important to note, however, that lymphoma often becomes refractory to prednisolone approximately 30 days after it was first initiated and her neoplasia - if, indeed, I'm correct in assuming that that's the case - might be an adenocarcinoma or another malignancy which doesn't respond to steroids at all. My cat would receive hospice care in the form of a steroid and narcotic pain relief - tramadol or buprenorphine - and when she became anorexic, I would euthanize her.

Please continue our conversation if you wish, Bob.

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