lymphoma in dogs

LYMPHOMA IN DOGS

BOBBY RAE

Border Terrier

10 years old, ME

Arrived from Vets Now

without owner or carer

Admitted over weekend

for vomiting and

lethargy

Completely flaccid

upon arrival

CLINICAL EXAM

T 37.4oC

P 108

R 66

Increased respiratory noise

Extremely lethargic

Generalised lymphadenopathy

CRT <2s but slight yellow tinge

Liver and spleen palpable

Congested scleral vessels

Opacity in L cornea

Submandibular LN

37mm x 22mm

Prescapular LN

44mm x 25mm

Inguinal LN

41mm x 21mm

Popliteal LN

28mm x 20mm

CLINICAL EXAM

Ophthalmology consult

Mass in anterior chamber of R eye

Possible dry eye (left)

Translimbal neovascularization L > R

Cataract

Severe anterior uveitis

17mmHg pressure in both eyes

Too cloudy to examine retina

CLINICAL EXAM

Ophthalmology consult

Mass in anterior chamber of R eye

Possible dry eye (left)

Translimbal neovascularization L > R

Cataract

Severe anterior uveitis

17mmHg pressure in both eyes

Too cloudy to examine retina

Lymphoma infiltration of

the eyes

PROVISIONAL DIAGNOSIS

Stage Vb lymphoma

Extranodal involvement (eyes)

Showing clinical signs

Ideally should do bone marrow aspirate to check

for bone marrow involvement

LYMPHOMA

Malignant proliferation of peripheral

lymphoid tissues

Predisposing factors

3 ways of classification

Anatomical

Histological (low/intermediate/high)

Immunophenotype (B/T/null)

CLINICAL PRESENTATION

Variable and depends on extent and

location

Generalised lymphadenopathy

Paraneoplastic syndromes

Hypercalcaemia

Cancer cachexia

Monoclonal gammopathy

Globulin

spikeAlb

APPROACHING LYMPHOMA

Bloods

Haematology, biochemistry

FNA of lymph nodes

Thoracic radiographs

Abdominal ultrasound

Bone marrow aspirate

BACK TO BOBBY

Bloods

Haematology + biochemistry + coagulation

FNA of submandibular and popliteal LNs

Cytology

PARR (PCR for Antigen Receptor Rearrangement)

Thoracic radiographs

Abdominal ultrasound

BOBBY’S BLOOD RESULTS

Thrombocytopenia?

Hypoglycaemic

Decreased TP

liver enzymes

NH3

PT 22.9s 14 – 19

aPTT >200s 75 – 105

ULTRASOUND

Lymphadenopathy

Hepatomegaly

Splenomegaly

Cholecystitis

Pancreatitis

Prostatomegaly

FNA of liver and spleen

CHEMOTHERAPY

Combination protocols

CHOP

COP

Doxorubicin single agent

Re-induction or rescue therapy

> 1m since stopping initial protocol: re-induction with

that same protocol

If re-induction fails, use rescue therapy

Extranodal lymphoma

Chemotherapy

Local therapy

PROGNOSIS

Immunophenotype

B cell

T cell

Null cell

WHO stages

I, II, III, IV, V

Sub-stage a

Sub-stage b

Any concurrent conditions

BOBBY’S INITIAL TREATMENT

IVFT (normal saline + glucose)

L-asparaginase

Maropitant

Vitamin K

Dexamethasone (reduced dose)

Ursodeoxycholic acid (Destolit)

AFTER THE INITIAL TREATMENT

QAR but no longer comatose

LN softer and smaller

Improvements in biochemistry

Appetite slowly returning

Cautiously optimistic

Continue with chemotherapy

L-CHOP protocol

Vincristine (reduced dose)

Urinalysis

AFTER THE INITIAL TREATMENT

QAR but no longer comatose

LN softer and smaller

Improvements in biochemistry

Appetite slowly returning

Cautiously optimistic

BOBBY’S PROGNOSIS

Problems

Stage Vb lymphoma

Acute liver failure

B cell lymphoma

Overcame acute liver failure, fair prognosis

6 – 9 months

DAY OF DISCHARGE

Terror terrier

Normal sized lymph nodes

Take home medications

Ranitidine

Destolit

Prednisolone

Promax

Back Thursday (yesterday)

for recheck and

cyclophosphamide

TAKE HOME MESSAGES

Step by step approach

to lymphoma

Clinical exam

Stage – measure LN

May involve other

organs

REFERENCES

Jane M. Dobson, B. Duncan X. Lascelles. (2011). Chapter 19: Tumours of the Haemopoietic System. In: Jane M.

Dobson, B. Duncan X. Lascelles BSAVA Manual of Canine and Feline Oncology. 3rd ed. London: British Small Animal

Veterinary Association. p285-291.

Edward J. Hall, James W. Simpson, David A. Williams. (2005). Chapter 3: Imaging of the Gastrointestinal Tract, Liver

and Pancreas. In: Edward J. Hall, James W. Simpson, David A. Williams BSAVA Manual of Canine and Feline

Gastroenterology. 2nd ed. London: British Small Animal Veterinary Association. p29.

Edward J. Hall, James W. Simpson, David A. Williams. (2005). Chapter 28: Therapeutics. In: Edward J. Hall, James W.

Simpson, David A. Williams BSAVA Manual of Canine and Feline Gastroenterology. 2nd ed. London: British Small

Animal Veterinary Association. p311.

Companion Animal Studies (CAS) lecture – Oncology 3: Approach to lymphoma and leukaemia. J.S. Morris, BSc, BVSc,

PhD, FRCVS

Ian Ramsey (2014). BSAVA Small Animal Formulary . 8th ed. London: British Small Animal Veterinary Association

I. Amores-Fuster, P. Cripps, P. Graham, A. M. Marrington, L. Blackwood. (2015). The diagnostic utility of lymph node

cytology samples in dogs and cats. Journal of Small Animal Practice. 56 (2), p125-129.

http://www.animalhealth.msu.edu/ClientEducation/MKTG.CARD.ANATOMICPATHOLOGY.010.PDF Information Cards

by Lab Section - For Practitioners, Anatomic & Surgical Pathology, PCR for Antigen Receptor Rearrangements

Nerschbach V, Eberle N, Joetzke AE, Hoeinghaus R, Hungerbuehler S, Mischke R, Nolte I, Betz D. (2014). Splenic and

hepatic ultrasound and cytology in canine lymphoma: effects of findings on stage migration and assessment of

prognosis. Veterinary and Comparative Oncology. 12 (4).

https://www.marshfieldlabs.org/proxy/RefPointWinter13.1.pdf Marshfield Labs

Claire Inderbinen Kaiser, Janean L. Fidel, Malgorzata Roos, and Barbara Kaser-Hotz (2007) Reevaluation of the

University of Wisconsin 2-Year Protocol for Treating Canine Lymphosarcoma. Journal of the American Animal Hospital

Association: March/April 2007, Vol. 43, No. 2, pp. 85-92.

Stephen Withrow, David Vail. (2012). Chapter 32A: Canine Lymphoma and Lymphoid Leukemia. In: Stephen Withrow,

David Vail Withrow and MacEwen's Small Animal Clinical Oncology. 5th ed. Gloucester: Elsevier Saunders. p608-627.