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Dr. Karing
Dr. Karing, Veterinarian
Category: Dog Veterinary
Satisfied Customers: 429
Experience:  General veterinarian with a special interest in internal medicine and emphasis on individualized care.
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My dog has a piece skin hanging off her nipple(fine like thread)

Customer Question

My dog has a piece skin hanging off her nipple(fine like thread) with a sack ,(you can see through it) hanging off the the little thread like skin. My vet aspirated them (Cocoa has a lot of lipomas)and put them on a slide. She said it was a mass cell. Then today we did ultrasounds to see if everything else was clear. Lungs clear, liver clear, stomach clear , lymph nodes clear. They found a tiny spot on the spleen, that they aspirated and are sending it in. The oncologist said this could just be from age , and mostly that are not malignant but doing a "stat" on it since she's having surgery Thursday. She said if it came back positive, they would start her on chemo, but not do surgery. This makes no sense to me. 1. Because if it is a tiny spot, then it may not have spread anywhere else so why not take the spleen out too while taking off the small mast tumor and large border. Saying that if would "Probably spread to the other organs anyway makes no sense to me. "Probably isn't 100 percent, and if it is that small and the ultrasound shows no other problems in the organ , why would you not take the spleen too and then do chemo and make sure if it did spread that it would kill the cancer??????? Plus I read that even the benign ones can kill them if they rupture. But at this point today. it is just a spot but I am freaking out. My dog is going to be 12 in December, and acts fine, not even sick . Could I please have your opinion. thank you. I would like a oncologist to answer this question please. But if not , someone else highly experienced with mast cell tumors . thank you
Submitted: 2 years ago.
Category: Dog Veterinary
Expert:  Dr. Karing replied 2 years ago.
Hi there,

I'mCustomerand I would be glad to help with your question since there is not a veterinary oncologist on this forum. I do have a lot of experience with treating mast cell tumors surgically and with chemotherapy.

If there are mast cells in the spleen, it is for one of three reasons:
1) There are normally some mast cells in the spleen
2) There is metastatic disease from the mast cell tumor on the nipple or from another mast cell tumor on the skin or under the skin that hasn't yet been found
3) There is a visceral mast cell tumor (primary site of cancer is the spleen which is very rare and these tumors are very aggressive with median survival of 2 months)

The pathologist looks at the characteristics of the cells (i.e. normal versus unusual) and the number of cells based on the total number of cells in the sample provided from the fine needle aspirate to try and decide if this looks like cancer. Cancer of the spleen, mast cell or otherwise, cannot be ruled out by an aspirate. Splenic aspirates are notoriously false negative.

For a small nodule on the spleen that cannot be diagnosed by aspirate, serial ultrasound measurement would be advised to see if the site changes over time. If it becomes significantly larger, then you can reaspirate to try and learn more or remove the spleen. The reason for not removing the spleen without monitoring the nodule for changes is that a lot of dogs have small nodules in the spleen that are insignificant. While you can live without a spleen, splenectomy is still a major surgery and is not something to be entered into lightly. A small nodule is not a great risk. I've monitored many and never had one lead to hemorrhage yet although some where identified as cancer over time (i.e. note, most do not change or require further attention).

If your dog is determined to have metastatic mast cell disease (i.e. tumor on the nipple that has metastasized to the spleen), then the skin tumor is removed but the spleen is not. The reason is that the tumor moved from the skin to the spleen through the lymphatic and vascular system. Although you may see no evidence elsewhere on imaging, there is undoubtedly microscopic disease present in the lymph nodes and other organs. You won't be helping your dog by removing her spleen but chemotherapy can help slow the disease process. The prognosis would depend a lot of the grading of the tumor removed from the skin (i.e. 1, 2 or 3) and the ability to get clean wide surgical margins.

On that note, if the mast cell tumor removed from your dog's nipple is a grade 1 but they did see mast cells in her splenic aspirate, then I would hesitate to do chemotherapy unless you get a second opinion from another oncologist and another pathologist. The reason is that grade 1 mast cell tumors almost never metastasize and visceral mast cell tumors are rare in dogs and unlikely to present as a small nodule on the spleen. You would really need to have overwhelming evidence that the mast cells aspirated from the spleen were present in large enough numbers or atypical enough to suggest cancer before I would pursue chemotherapy if a grade 1 mast cell tumor is removed from the nipple. If that situation arises, I would consider that there may be another mast cell tumor elsewhere that is the primary site from which metastasis occured as that is far more likely than a grade 1 mast cell tumor metastasis and/or viseral mast cell disease of the spleen presenting as a small nodule.

I hope that the information I provided has been helpful. Please remember to select REPLY TO EXPERT if you have more questions or would like additional information. It is my goal to provide you with the most complete information possible prior to you leaving a feedback rating. If you received all the information you needed, then kindly submit a rating.

Customer: replied 2 years ago.

Some of that makes since, some, I am still confused. I read that 85% of mast cell tumors that are on the skin are benign. So, if that is the case why do they call them mast cell tumors?My dr. said while looking at the slides it looked like cancerous mass cell tumor. But she said class I or possibly two. My dog has surgery to take off the capsule size tumor hanging off her nipple. Thursday. Is it true that older dogs sometime get spots on their spleen that are benign? Her liver test are just slightly elevated from the test she had 6mths ago. She said she did have a slightly highter protein level. But all the other tests were good. Are you saying that the tumor could be coming from the spleen even though the little tumor (looked like a almost clear sac with veins)and hanging from a fine thread of skin? My dog acts fine. She has some arithris in her hip, but other then that seems to be great. Dr. Ball just now called and said that the chance of this being a mast cell in her spleen would be very rare. That the majority of the mast cells in older doctors never metastisize. So she thinks Coca will be fine

Expert:  Dr. Karing replied 2 years ago.
All mast cell rumors in dogs are cancerous. The grade (1,2 or 3) determines the degree of malignancy and likelihood of metastasis (spread from original site to a distant location in the body). Mast cell tumors can only be graded with a whole tissue sample (not an aspirate).
Yes, many times older dogs will have small nodules on their spleen that are benign. I doubt the nodule seen in your dog's spleen is a mast cell tumor. However if it were, then it would be most likely that it originated from a mast cell tumor on her skin (nipple).
If the mast cell tumor is grade 1 or 2 and has adequate clean margins (area free of cancerous cells around the tumor), then it is likely surgery alone will cure your dog and no further action will be required. I would still advise rechecking the size of the splenic nodule by ultrasound every 3 - 6 months.
Thanks, Customer
Customer: replied 2 years ago.

this makes perfect sense. I will always recheck her every couple of months with labs too. thank you.

Expert:  Dr. Karing replied 2 years ago.
You're very welcome. Please let me know if I can be if further assistance.