Hi there Fred
Thanks for your question regarding your 11 year old GSP who has developed a lump on the rear side of his lower leg
Good on you for following up on this with your local Vet already
It is a shame a good sample wasn't collected, but definitely head back to have the fine needle aspirate procedure repeated
The main thing to distinguish here is whether this mass is inflammatory or neoplastic in origin
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
As you know - we cannot say for sure without some cytology or a biopsy
I think it is very unlikely that this local reaction on his leg is due to the "Natural Flea and Tick Spray"
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
If this was purely inflammatory we may expect it to decrease in size a little
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
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
Typically no sedation is needed for this procedure
The aspirate can then be taken, put on slides and sent to a local histopathologist for evaluation and hopefully a diagnosis.
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)
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)
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
Let me know how you get on if you get a chance
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?
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 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?
It was a foxtail, which was removed
Thanks for your help