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Really need a second opinion. My abyssinian cat (4y.o,

female) began feeling lethargic, lost...
Really need a second opinion. My abyssinian cat (4y.o, female) began feeling lethargic, lost 2 lbs(in a week), lost appetite about 2 wks ago. We took her to the vet. Blood work and urinalysis(ph=6.5, traces of protein) came out normal (ALT on the low side 19), comp CBC (low platelet 135, high monocyte 666). After that x-rays were taken, which did not detect abnormalities in the thoracic region; however, the xray of the abdominal region was very hazy. So, the next step was the ultrasound which indicated a mass effect medial to the spleen (dark, coarse and irregular) with suggestion to perisplenic node or other. Other findings of various thickening of small bowel, region of the pancreas. Also, variable sized lymph nodes noted. Then, the aspirate of the mass by the spleen was sent to a pathologist, whose findings were tentatively suggesting of lymphoma. As a result the diagnosis is not definitive of right now and exploratory surgery is the next step as our vet mentioned. Is there a way to make sure that the only possible procedure to confirm the diagnosis is the surgery, what are other possible diseases that need to be ruled out in this case?
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Answered in 3 minutes by:
3/27/2018
DocPaul
DocPaul, Veterinarian
Category: Cat Veterinary
Satisfied Customers: 4,367
Experience: 20+ yrs Experience. Int. Med, Emerg, Ultrasound, General Practice
Verified

Hi

Dr. Paul Brazzell here

I specialize in ultrasound and my wife is a double board-certified veterinary pathologist

Can you send me the U/S report and the cytology reports please

We will review and opine

Paul

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Customer reply replied 28 days ago
Thanks, Paul! sending the reports

Very welcome

Give me a minute

Paul

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Okay all good so far

Just waiting on U/S and cytology :)

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Customer reply replied 28 days ago
did u get it?

Nope

Just blood and urine results

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Customer reply replied 28 days ago
resending
Customer reply replied 28 days ago
let me know if you got them
Customer reply replied 28 days ago
please, take your time. I'll be back in 20-30 min

First comment is that the person doing the cytology is NOT a board certified pathologist so I dont trust their findings

Did they only aspirate the lymph node?

Paul

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Customer reply replied 28 days ago
They aspirate the mass by the spleen....according to the vet (who performed it I assume) and then the sample was sent to a pathologist
Customer reply replied 28 days ago
How do you know he is not board certified?

Okay

Well the person who read the slide is NOT board certified-> It says it on the report- DVM.MS.PhD.

If board certified it would also say: Diplomate ACVP

So we want a second opinion from a board certified pathologist first and foremost

And not sure why didnt they aspirate or do U/S biopsy of stomach-> There were lesions there

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Customer reply replied 28 days ago
Well, because they want to do it separately during the exploratory surgery, but if you say it was possible to do it during the u/s then it does rise a concern. The oncologist the vet contacted for further treatment is nowhere to be found either....well I don’t think I could trust them anymore

I ran mobile ultrasound services for years and did thousands of aspirates and biopsies

Yes, I would have done all those things when I was there

And having a wife who spent nine extra years to get board certified I am very particular who reads my slides :)

I will send that report to her at the office now and get her thoughts

But why put kitty through surgery when we can hopefully pin it down with less invasive and costly measures

Paul

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Customer reply replied 28 days ago
Thank you! We are definitely clarify the situation with “pseudo-experts” who do all of the interpretations for our vet clinic which used to have a good reputation in Chicago area. Please, let me know what your wife thinks of the results. We definitely do not want to make our cat to go through all of the invasive procedures if it is not absolutely necessary

Sent it to her and waiting to hear back :)

Paul

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Wife not happy with report

Wanted them to re-aspirate node and also aspirate spleen and liver and stomach wall

Paul

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Customer reply replied 28 days ago
What are your thoughts on the u/s report?

It was done by an internist and not a board certified radiologist but that is okay

Looked pretty thorough but based on what was seen I would have aspirated spleen, liver stomach and lymph node and tried to get that bit of fluid that was in the abdomen also

Paul

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Customer reply replied 28 days ago
The vet stressed out the big picture of rapid weight loss, enlarged lymph nodes( with abnormal lymphocytes)...which is in his opinion is indicative of lymphoma. However, IBS was not ruled out and other conditions that could contribute to this big picture.....so it is frustrating
Customer reply replied 28 days ago
What would you suggest to do?

Correct

So if spleen, liver, node and stomach normal then cat does not have lymphoma

I would request aspirates of those structures and that slides go to board certified pathologist

And also try to get some of peritoneal fluid

Paul

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Customer reply replied 28 days ago
Ok, will do! Thanks. Will be waiting for your wife’s opinion as well

She did review that first report you sent

And she requested the aspirates of those structures

Paul

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Customer reply replied 28 days ago
Can you recommend how to find a board certified pathologist in the area?

Have the veterinary clinic that submits request that the samples ONLY be read by a board certified clinical pathologist

Paul

DocPaul
DocPaul, Veterinarian
Category: Cat Veterinary
Satisfied Customers: 4,367
Experience: 20+ yrs Experience. Int. Med, Emerg, Ultrasound, General Practice
Verified
DocPaul and 87 other Cat Veterinary Specialists are ready to help you
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Customer reply replied 28 days ago
Thank you! Please, let me know if there will be any other thoughts regarding this case
Customer reply replied 28 days ago
One additional question, are aspirate samples and slides being stored or discarded after a pathologist interprets them?

They are legally obligated to hold on to them

Paul

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Customer reply replied 28 days ago
Do you know for how long?

Not sure that there is a legally defined period of time but my wife's lab keeps them for at least 5 years

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Hi,
I'm just following up on our conversation about Luba. How is everything going?
DocPaul
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Customer reply replied 20 days ago
Hi DocPaul! Thank you for following up. So, we decided to proceed with the surgery and are waiting on the results of biopsies, the cytology results this time were somewhat different (see attached). Luba is still recovering though (not eating, not moving:(
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