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Pet Doc
Pet Doc, Dog Veterinarian
Category: Dog
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Experience:  Veterinarian
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Our German Short-haired pointer is 11 years old. He developed

Customer Question

Our German Short-haired pointer is 11 years old.
He developed a rapid onset (over hours) of a lump under the skin about 1 cm in diameter at the rear side of the lower leg.
The overlying skin seems normal. The lump is not particularly tender nor warm to the touch. Clinically, it appears cystic to palpation but does not readily transilluminate, but the torch may not have been suitable. (I'm a retired doctor!)
The Vet aspirated, but drew only a small amount of blood-stained fluid. and stopped the procedure quickly as the dog reacted strongly to the procedure (?improper preparation) and I suspect the needle was too narrow.
He prescribed benadryl (in case it was a mast cell tumor) and asked me to return the dog in 1 week to review.
What could be the most likely diagnosis and what should be done?
He had "Natural Flea and Tick spray for dogs" (Natural Chemistry) - active ingredient benzaldehyde 4-hydroxy-3-methoxy) the day before. Applied to all body skin.
Thank you
Fred
Submitted: 1 year ago.
Category: Dog
Expert:  Pet Doc replied 1 year ago.

Pet Doc :

Hi there Fred

Pet Doc :

Thanks for your question regarding your 11 year old GSP who has developed a lump on the rear side of his lower leg

Pet Doc :

Good on you for following up on this with your local Vet already

Pet Doc :

It is a shame a good sample wasn't collected, but definitely head back to have the fine needle aspirate procedure repeated

Pet Doc :

The main thing to distinguish here is whether this mass is inflammatory or neoplastic in origin

Pet Doc :

The fact that this lump came up so quickly makes me think it is more likely to be inflammatory in nature (perhaps a local skin reaction, a bug/bee bite or foreign body for example) rather than anything nasty

Pet Doc :

As you know - we cannot say for sure without some cytology or a biopsy

Pet Doc :

I think it is very unlikely that this local reaction on his leg is due to the "Natural Flea and Tick Spray"

Pet Doc :

You could continue with some benadryl a couple of times per day for a couple of days to see if the mass changes in size at all

Pet Doc :

If this was purely inflammatory we may expect it to decrease in size a little

Pet Doc :

If there is no change in the mass, or if the mass is bigger after the 1 week has passed - definitely get him along to your local Vet again

Pet Doc :

Here the Vet could give him a little sedation, or just get yourself and a nurse to hold him carefully and apply some topical local anesthetic to the lump before trying the procedure again

Pet Doc :

Typically no sedation is needed for this procedure

Pet Doc :

The aspirate can then be taken, put on slides and sent to a local histopathologist for evaluation and hopefully a diagnosis.

Pet Doc :

If this wasn't inflammatory in origin, then potential masses include a mast cell tumor, basal cell tumor, sebaceous cyst, lipoma, histiocytoma (to name but a few common possibilities)

Pet Doc :

Depending on the diagnosis the mass may be able to be left, your boy may need antibiotics, or he could potentially need the mass taken off with wide margins (particularly if it is a mast cell tumor)

Pet Doc :

Does that make sense to you, ?

Please let me know if you have ANY other questions. My goal is to give you 100% satisfaction and if you are not yet satisfied, please Reply so I can clarify for you

Pet Doc :

Let me know how you get on if you get a chance

Pet Doc :

Kind Regards,

Pet Doc :

Dr Edwards

Pet Doc, Dog Veterinarian
Category: Dog
Satisfied Customers: 5496
Experience: Veterinarian
Pet Doc and other Dog Specialists are ready to help you
Expert:  Pet Doc replied 1 year ago.
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Customer: replied 1 year ago.

Thanks for such a thoughtful answer


 


1. Will a week be enough time to monitor change?


Expect not much will happen over this time.


We may have to wait a bit longer to reach a conclusion


 


2. I'm not clear whether the aspirate was traumatic (bleed from needle) or real. Hence I agree this should be repeated as required.


Certainly this is a cyst. The issue whether it is a complication of something else - trauma, local allergy, tumor is unclear at this stage.


 


3. I don't think waiting an extra week or so would be harmful, though some mast cell tumours can be quite malignant.


 


4.What is the approximate rate for mast cell tumours at this age and what percent age malignant?


 


Fred

Expert:  Pet Doc replied 1 year ago.
No problem Fred

In answer to your questions:

1.) IF this is inflammatory, then you would likely see a change within a week, be it the mass decreasing in size, or perhaps even 'coming to a head'. If you haven't seen any change within a week however Fred, I really would encourage you to get Luther back to the Vet for the repeat Fine Needle Aspirate. It is better to be proactive with these fast growing lumps to get a diagnosis as to what it is. Waiting a week would be ok, but at that point getting the FNA repeated would be the best idea.

2.) Yes - it sounds like a cyst, but any mass that appears quickly is best to be evaluated via cytology. Looks can sometimes be deceiving and this could even be a caviated neoplasm that has grown quickly! Unlikely I know - but we have to consider all possibilities and the FNA will (hopefully) give a clear diagnosis on cytology. If this is indeed a cyst, then a decision could be made at that stage whether it can be left, or whether it should be removed.

3.) A week would be ok, even it this was a grade 3 mast cell tumor. However - if the mass gets much bigger in the next couple of days, pull the appointment forward. As above - it is always better to be proactive with fast growing lumps.

4.) This is a very difficult question I'm afraid Fred. I don't have any firm stats for you, but older dogs are much more prone to mast cell tumors than younger dogs (although not by much). All mast cell tumors are 'malignant', however there are 3 grades (1 to 3). It is probably easiest to direct you to a reliable site for further reading: http://www.veterinarypartner.com/Content.plx?A=1600

5.) Thanks very much Fred!

Let me know if you have any further questions.

Kind Regards,

Dr E
Expert:  Pet Doc replied 1 year ago.
Hi Fred Zerfas,

I'm just following up on our conversation about Luther. How is everything going?

Pet Doc
Customer: replied 1 year ago.

Up until Tuesday Sept 4, the cyst remained about the same size.


Slight pressure on it resulted in a powerful squirt of some 1cc of serous fluid, with the size of the cyst reducing. There was a similar occurrence on Wednesday. The current size of the cyst is much reduced, although there is a residual palpable lump (much less in size).


History recalls that the skin of the paws for the foot corresponding to the location of the cyst was slightly raw, reddened and irritable. Also he has been walking in areas where foxtail abounds.


So the most likely diagnosis is foxtail.


The questions are:


A. What is the most favorable management?


1. Do nothing and wait (in the meantime cytologic examination)


2. Widen the current aperture that the needle made and wait in case the suspected foxtail drains (perhaps unlikely)


3. Incision and removal of the foxtail, if located. It is most probably embedded in the soft tissues, although it could be in the cavity.


4. Incision and curettage of the area, checking for location of the foxtail.


5. Complete surgical removal of the affected area.


B. Assuming A 2&3 (and perhaps 1, although sedation and a nerve block might suffice) requires a general anesthesia.


Q: What is the risk of death from the anesthesia (best guess)


Less than 1%, 1-4%, 5-9%, >9%? - given Luther is a healthy 11 yr old.


Thanks you.


 


 


 


 


 

Expert:  Pet Doc replied 1 year ago.
Hi Fred,

Very interesting! If this was a foxtail and it managed to cause a foreign body reaction - it would have been much more likely that the discharge would have been purulent in nature rather than serous. Of course - it is still possible this is due to a foreign body, but if the area where the cyst was doesn't appear inflammed or infected, I think it is less likely. The fact the lump came up so quickly on the other hand would lend itself to making a foxtail more likely.

If your boy is otherwise absolutely fine and the cystic area doesn't appear inflammed, then waiting and cytological examination would be fine. The aperture could be widened if possible to aid drainage if this is inflammatory, and even warm compresses could be tried. If this is indeed a cyst, then this would have no effect. If it was due to a foxtail - then you could see an improvement over the next few days.

Either way, if this appears infected - then get your boy seen, as he will likely need some antibiotics.

IF you go ahead with getting a GA done to have the cyst (or foxtail foreign body reaction) removed, then I would probably put Luther's anaesthetic risk at typically around 5%. With a clear pre-anaesthetic blood test, IV fluids and careful monitoring, this would lower even more.

Best of luck,

Dr E
Customer: replied 1 year ago.

thanks for your prompt and detailed answer.


Problem is that he has been booked at the Vet for a GA and lump removal at 8am this morning - with a cost of $1100!!


Although the cost is not the most important consideration, I am a bit concerned about the speed of the operation, given a significant chance of GA complications.


I would rather consider conservative treatment at the current time or at least another vet's opinion.


Thinking about if this was my son!!


I don't want to mention names, etc., and put you on the spot - you have been most helpful. Problem is it's not my dog, but a close relative's.


So I have to take care.


But my personal opinion is to wait, as it is not too urgent at this stage.


Also, a complete check up 2 days ago, including blood and serological tests including C Reactive protein was normal in all respects.


His WBC was normal, which is confirmatory of no infection.


Would you agree on conservative treatment at this stage?


And should we have another opinion?


Thank you.


 

Expert:  Pet Doc replied 1 year ago.
Hi Fred,

Sorry your message only just came through.

Did you go ahead with the lump removal? Given what you have seen as well as WBC's being normal - chances are that this is a cyst rather than an inflammatory reaction.

Let me know how you get on if you get a chance.

Thanks,

Dr E
Customer: replied 1 year ago.

It was a foxtail, which was removed


Thanks for your help

Expert:  Pet Doc replied 1 year ago.
You were spot on with your tentative diagnosis Fred!

Great to hear all is resolved here.

Kind Regards,

Dr E

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