C09977744 / invoice 10000

Reason: ChemotherapyIntern: JLHistory: Molly is a 10yr 11mo FS Beagle X currently managed for T zone indolent LSA - stage 5A. Initially presented for evaluation of lymphadenomegaly which had been present since May 2020. 14/1/21 seen at ARH and cytology and flow cytometry of lymph node performed. Results consistent with T zone LSA (CD45-, CD 3,4,5+). Indolent-cell lymphoma. Molly had a lumpectomy performed of mass on the left forelimb mid antebrachium (aspirated keratin) was removed at primary vet, not submitted for histopathology. Since early May, Molly has also developed nasal depigmentation, nasal irritation and serous nasal discharge. She was trialled on a course of antibiotics on 27/05/21 with amoxyclav 375mg PO BID x 10 days. 26/7/21 CT and rhinoscopy with biopsies performed by EC. Histopathology returned as lymphoplasmocytic perivascular change. Commence antihistamines. Molly presented to ARH oncology 17/02/2022. Her LNs had progressed in size and she was drinking lots of water and very tired. There were low numbers of intermediate sized lymphocytes on blood smear and splenic changes on ultrasound. Her owners had elected to start chemotherapy treatment and she was induced using vincristine 0.718.7 mg/m2. She was converted to chlorambucil 01.03.22 (loading dose 4mg PO SID for 6 days then 2mg PO SID ongoing) and maintenance chlorambucil dosing commenced 15.03.22 thereafter (2mg PO SID) Her disease has remained relatively stable.Eyelid mass removed by referring veterinarian - 23/09/24:  Diagnosis: Meibomian gland epithelioma. Margins: Neoplastic cells appear to abut the deep tissue margin.HISTOLOGY ACCESSION No. VQ25-010399 Diagnosis: 1. Meibomian gland adenoma with lipogranuloma/chalazion 2. Meibomian gland epithelioma 3. Cutaneous melanocytoma16/9/25: chlorambucil recommenced. At pevious revisit on 9/12/25, mandibular LNs palpated slightly more firm than previous. Molly has been well at home. Mostly EDDU normal. Owners have seen her eat some leaves from garden then vomit them back up 1-2 times but it is not a normal or ongoing thing. The left cranial cycst on her head has ruptured a couple of days ago. Owners have squeezed clear fluid out of it and have approved having it clipped and cleaned today.She presents today for CBC and more Chlorambucil.Physical Exam:Weight: kgOverall: BAR  Temp: CHR:  bpmRR: Pant MM: Pink and moistCRT: 1-2sEyes OU: WNL. No new masses noted. No scleral or conjunctival erythema noted. No epiphora or blepharospasm. Ears: mild ceruminous discharge and mild odourAbdomen: soft non painful on palpation Integument: pea sized, mobile subcutaneous mass, approx 1cm at occipital. Non-pigmented 3mm skin tag L and R ante-brachium - Left ear 6 mm cutaneous mass- FNAB - keratin cyst- L shoulder 1cm cutaneous mass FNAB- keratin cyst (repeated 9/5/24, 28/10/25)- Right ear ~1cm x 0.9cm ovoid firm mass at base of pinna. FNAB - keratin cyst. - L cranium/temporal region ~1cm diameter ovoid subcutaneous firm nodule - FNAB keratin cyst Musculoskeletal: Ongoing lameness noted at a walk to LPL. Neurological: appropriate mentation, posture and gait, full exam not performed Nasal: no recurrence of previous lesion evident 01/04/25 - lymph nodes: PAROTID L: unable to palpate R: unable to palpate SM            L: 0.8 cm               R: 0.5 cmPS             L:   0.5cm,             R:  0.5cmAX             L: - WNL                 R: -  WNLING           L:  - WNL                 R: - WNLPOP          L: 0.5 cm    R: 0.7cmlymph nodes: static measurements today, however palpate more firm today as previous on 9/12/25. Laboratory:CBC - inhouse - see attachment NEU:  x10^9/L 2.95 - 11.64PLT:  K/uL (148-484)Blood smear: adequate platelet clumping at feathered edge. FNAB L cranial mass: large clumps of keratin only and acelullar debris. No other cell types visualised. Dx: keratin cyst. Treatment:Chlorambucil 0.1mg/kg PO - 2mg PO SID on Mon- Sat. Day off SundayDispensed by JK, checked by IMGMetronidazole 200mg PO BID PRN for diarrhoea As required for left stifle pain: Meloxicam 0.1mg/kg PO SIDParacetamol 250mg (~15mg/kg) PO BIDAssessment: T zone indolent T cell  LSA (CD45-, CD3,4,5+) - stage 5A- Vincristine 17/2/22- Commenced chlorambucil 01/03/22, recommenced 16/9/25 post surgery - SD- Nasal lesions - resolvedMultiple eyelid masses - excised 26/8/25- L upper eyelid = meibomian gland adenoma (complete excision)- R upper eyelid = meibomian gland epithelioma (complete excision)- R lower eyelid = cutaneous melanocytoma (complete excision)Suspect L CrCl injury Client communication: Molly continues to Molly continues to tolerate oral chlorambucil, and remains in SD. Dosing remains unchanged, and 6 weekly rechecks remains appropriate at this time. Mandibular LNs were slightly more firm on palpation today as previously noted in December 2025. Static compared to previous. Ongoing monitoring warranted. Matthew and Rebecca wish to continue to conservatively manage cruciate injury with brace at home, rest and daily meloxicam use. Plan:Return for CBC  and more medications in 6 weeks.MBA April 2026    Vital Signs    Weight: 15.9;       MMColour: pk;       Temperature: 38.4;       HeartRate: 120;       RespirationRate: 32;       CRT: <2;