Lymphosarcoma

Elmo Yandle• 4 year old male intact American Staffordshire terrier

• Was presented to the NCSU Internal Medicine service for evaluation of 2 week history of generalized lymphadenomegaly, lethargy and inappetance. Elmo has a history of sneezing, pruritis, and red eyes.

Elmo Yandle• Physical Exam:

– BAR, TPR - Normal – EENT: Mild epiphora OU and episcleral injection OU. – Integument: 3-4 cm abrasion on right side of prepuce– MSN: ambulatory on all four limbs, good muscle tone,

neurologically alert and appropriate – GIGU: Liver and spleen enlarged on palpation. – PLN: Generalized lymphadenomegaly. Bilaterally

enlarged zygomatic, submandibular, prescapular, axillary, inguinal, and popliteal lymph nodes.

– H/L: Heart and lungs auscult normally

Elmo Yandle

• Diagnostic tests– 1. CBC - Mildly

thrombocytopenia, lymphoblast cells noted in blood smear (mild blastemia).

– 2. Chemistry panel - Mildly elevated amylase at 1122 (RR: 347-1104)

– 3. Urinalysis - Concentrated urine (1.048)

– 4. Lymph node aspirates - Consistent with lymphoma

Elmo Yandle

Diagnosis: Lymphosarcoma

Next Step: Staging for prognosis• - Stages I-V• - Substages A and B• - Phenotyping• - Hypercalcemic

Elmo Yandle

• Results of Further Diagnostics:– Thoracic Radiographs

• Possible pulmonary nodule located in left 6th intercostal space

– Abdominal Ultrasound • Splenomegaly, diffuse hypoechoic foci in spleen• Hepatomegaly• Enlarged Bilateral MILN, and enlarged hepatic LN• FNA of spleen and liver = consistent with LSA

– Bone Marrow Aspirate• Consistent with LSA

– Flow Cytometry – insufficient sample

SPLEEN

Splenomegaly with punctate hypoechoic foci within the spleen

Lymphoma of the spleen can vary in appearance from diffusely hyper to hypoechoic. This is a more classical appearance “Swiss cheese”

FNA is required to corrobarate sonographic findings

LIVER

• Hepatomegaly and normal echogenicity when compared to the spleen– The echogencity of the liver can vary

with lymphoma. Hepatomegaly is often reported. Splenic abnormalities are more common with lymphoma.

Abdominal Lymph Nodes

Enlarged Right MILN Enlarged Hepatic Lymph node

Enlarged Splenic Lymph node

Elmo Yandle

• Diagnosis:– Stage V, substage B Multicentric

Lymphosarcoma

• Treatment:– Chemotherapy:– L-asparaginase and prednisone

Elmo Yandle

• Follow Up:– Transferred to NCSU

Oncology service for chemotherapy

– Complete Remission as of 11/27/06.