Postop recovery was uneventful. Pain was managed well with buprenorphine given at time of surgery, and Metacam given postop. Arrangements were made by the owner to pick Agnes up the following evening.
Home care detailed cage rest and limited activity for a week and to return for re-exam if there were any concerns.
During home recovery, Agnes and her sister, Darlene (who had undergone a mammary tumor removal and spay the day before), were housed in a one level cage, on newspaper and paper towels with fleece, along with a cardboard cereal box to hide in. Bedding was changed completely each night. They remained housed in a one level cage throughout the healing process for 14 days.
Nutrition for Agnes and Darlene throughout the recovery process consisted of:
A histopathology report of the removed mass showed the following:
The most accurate diagnosis for this lesion is a round cell tumor or round cell sarcoma. Some of these cells with more voluminous pale-staining cytoplasm and occasional fine, sparse granularity are vaguely reminiscent of mast cells. Therefore, a special stain will be performed to attempt identification of possible mast cell granules and therefore a more specific tumor classification. An addendum to this report will follow to relate the results of a special stain procedure.
************ ADDENDUM COMMENTS - 12/03/11 ************
ADDENDUM FOR SPECIAL STAINING:
Special staining for mast cells using the Giemsa procedure it is negative. Although this fails to confirm a poorly differentiated mast cell tumor, it still does not totally rule out this possibility since undifferentiated mast cells with no intracytoplasmic granularity are negatively staining. Other differential diagnostic considerations include an unclassified round cell sarcoma or a round cell tumor of plasmacytic or lymphoreticular origin. The lesion is locally infiltrative, and the neoplastic cells extend to and form all margins of the specimen.
Necropsy and histopathology report as follows:
The kidney is histologically unremarkable, maintaining normal tubuloglomerular microstructure with no interruption in renal parenchymal integrity by inflammation, necrosis/infarction, or neoplasia. There is moderate congestion of the microvasculature existing at the corticomedullary interface. Glomeruli are devoid of excessive mesangial cellularity or thickening of glomerular capillary basement membranes. Tubules are devoid of casts of proteinaceous or other variety. There is no interstitial nephritis or fibrosis, glomerulonephritis, or pyelonephritis. Liver is characterized by partial severe effacement of pre-existing hepatocellular plate and sinusoidal microstructure by multiple independent to confluent foci of acute coagulative to liquefactive necrosis. Independent foci of necrosis isolate foci of intact upon sites, the latter appearing with some uniformity around the portal areas, suggesting that the necrosis is predominantly centrilobular. The necrotic foci are characterized by the complete dissociation of hepatocellular plates and hepatocellular drop-out or obsolescence. Subsequently the sinusoids have become confluent to create pools of blood within the necrotic foci. Section of the neoplasm is a compactly, solidly cellular, monotonous sheet of pleomorphic mesenchymal cells. Cytomorphology includes ovoid, polyhedral, and laterally flattened shape with round to ovoid nuclei of variable size and chromatin distribution. The latter includes occasionally condensed chromatin which creates an hyperchromatic appearance or marginated chromatin which contributes to an open-faced/vesicular appearance and exposes nucleoli variable from solitary and large to multiple and small. No mitotic figures are observed. The neoplasm also contains foci of acute coagulative to liquefactive necrosis devoid of secondary inflammatory infiltrates. There are no characteristic cellular organizational patterns or cytologic features. Lung is characterized by multiple foci of the pleomorphic neoplastic foci scattered randomly and haphazardly as well as multifocally circumscribing small-caliber pulmonary arterioles and venules.
Considered collectively, the multiple foci of metastatic mesenchymal cells occupy an estimated approximation of one-third to one-half of the pulmonary cross-sectional surface area. The interalveolar septal microvasculature is moderately-congested. Alveoli are devoid of stainable fluid content but contain occasional macrophages (indirect evidence of pulmonary edema).
Kidney- no microscopic lesions
Liver- severe, acute coagulative to liquefactive necrosis
Mass- poorly differentiated malignant mesenchymal tumor (sarcoma)
Photo 1 shows a healthy Agnes. Photo 2taken at time of necropsy shows site where mass was previously located. Photo 3 shows liver necrosis. Photo 4 shows kidney with no significant microscopic lesions.
Veterinary surgeon: Anthony Pilny DVM, DABVP
Necropsy and Synopsis: Anthony Pilny DVM, DABVP
Pathologist for both biopsy reports: Ken Mero, DVM, PhD
Photos: Anthony Pilny DVM, DABVP and Karen Borga
Case history courtesy of: Karen Borga
Posted on September 27, 2012, 14:55,
Last updated on September 27, 2012, 20:59