C09984927 / invoice 10000

Reason: CBC, re-staging +/- chemoIntern: History:Layla is a 7yr 5m FS Golden Retriever is being managed for mediastinal LSA with CHOP. Layla is historically managed by ARH Oncology for systemic plasmacytosis/ non-secretory multiple myeloma. 29/5/25: Presented to PCV for mass excision to mid backline. PreGA bloodwork, thoracic radiographs and abdominal ultrasound were stated to be within normal limits. Histolopathology results consistent with a round cell tumour, favour plasma cell tumour: MICROSCOPIC Two sections of haired skin are examined. Focally, the deep dermis and subcutis are expanded by a moderately cellular, unencapsulated, moderately infiltrative mass composed of a monomorphic population of large round cells on a sparse fibrovascular stroma. Proliferating cells have moderate to large amounts of pale eosinophilic cytoplasm, with round to indented, paracentral nuclei with 1-3 prominent nucleoli. Proliferating cells exhibit up to two fold anisocytosis and anisokaryosis, and the mitotic count is 7 per 10 consecutive high- powered field (total area 2.37 mm2). DIAGNOSIS ROUND CELL TUMOUR, SEE COMMENT MARGINS Proliferating cells do not extend to the histologic margin in the examined sections. Minimum radial histologic margin 14 mm, minimum deep histologic margin 9 mm. COMMENT Findings are consistent with a monomorphic round cell proliferation. Based on the lesion and cell morphology, we favour a plasma cell tumour. However, an unusual lymphoma or histiocytic proliferation cannot be completely excluded. Mast cell stains have been requested for completeness, and the final report will follow early next week. Immunohistochemistry may help to further characterise this neoplasm. Please call/email if you would like to request immunohistochemistry (MUM-1 for plasma cells, block 1C, cost code = VMI x1). This case has been evaluated in collaboration with Dr John Mackie.27/9/25: Represented to PCV for two newly noted masses: ~5mm small firm mass to LHS thorax (adjacent to last rib) and a ~13mm mobile soft subcutaneous mass RS ventral chest in alignment with TL. FNABs yielded cystic material and adipocytes respectively. 8/10/25: Presented to PCV for 5-6 newly noted cutaneous masses, of which in house FNAB of all 6 consistent with round cell morphology, favour plasma cell tumour. Represented 10/10/25 for surgical excision, where 18 cutaneous masses were identified and excised. AMENDED REPORT - 16/10/2025 03:30PM HISTOLOGY ACCESSION No. VQ25-012388: SEE ATTACHED FOR FULL REPORT. MICROSCOPIC 1. Within the subcutis is a well demarcated, moderately to densely cellular neoplastic mass. The tumour cells are round and they are forming sheets. They have a moderate amount of eosinophilic cytoplasm that often contains a perinuclear clear zone. They have oval to indented eccentric nuclei. There is moderate anisocytosis, mitotic count equals 35. Margins: Lateral: 10 mm, deep: 3.5 mm, composed of fibroadipose tissue. **Masses 1-11 and 13-15 all of same morphology. 12. Within the dermis and subcutis is an infiltrative, moderately cellular neoplastic mass. Tumour cells are forming sheets. The cells are round with a moderate amount of cytoplasm that contains fine basophilic granules. Nuclei are central and round to oval with finely granular chromatin and one to several nucleoli. There is mild to moderate anisocytosis, no mitotic figures are noted in 10 high power fields. Margins: Lateral: 5mm, Deep: 3mm, composed of fibrofatty tissue.Diagnosis: 1-11, 13-15: Multifocal round cell neoplasia 12. Mast cell tumour, low grade (Kiupel), Patnaik grade 2ADDENDUM 16.10.25: CD3: The cells of interest appear to be negative. IBA-1: There is a scattered population of cells interpreted as reactive. The cells of interest appear to be negative. MUM-1: Over 80% of the cells of interest are moderately positive. PAX5: The cells of interest appear to be negative.20/10/25: Presented to PCV for progressive lethargy. Occasional cough noted. Additional mass noted to neck. Sedation administered and 1cm mass noted to left ear base elliptically excised. Paracetamol, omeprazole and chlorpheniramine prescribed. Gabapentin prescribed @ 23/10/25 @ 600mg PO TID. 30/11/25: Initially presented to ARH oncology department. CT pertinent findings as follows:Imaging Summary:1. Spinal cord compression at the level of L3 secondary to a mass within the vertebral canal. The location (extradural, intradural-extramedullary or intramedullary) is not determined on the CT but the contact with the spinal cord is irregular and intramedullary origin or infiltration of the spinal cord could be suspected.2. Multiple bone lesions at the level of the left 12th rib with pathological fracture, of the sternebrae in particular the 4th, in L4, in the right ulna, left radius and tibias.3. Multiple cutaneous and subcutaneous lesions consistent with the reported lesions in the anamnesis.4. The bone lesions associated with the reported differential diagnosis of the skin lesions could represent a diffuse neoplasticprocess such as multiple myeloma, plasmocytoma, histiocytic sarcoma. Other neoplasia or multiple neoplasia cannot be completely ruled out.5. Severe bilateral hip dysplasia.6. Mild bronchial thickening could represent chronic bronchitis and/or age-relatedUrine protein electrophoresis was negative for Bence Jones proteinuria. VETERINARY CYTOLOGY Cytology Reference: 205-9736 SPECIMEN:  1. FNA left rib lesion (12 slides) 2. FNA liver (5 slides) 3. FNA spleen (6 slides) MICROSCOPIC:  1. The smears show moderate numbers of individualised neoplastic round  cells in a moderately haemodilute, proteinaceous, fatty background. Neoplastic round cells have distinct cell margins, small to moderate amount of medium blue cytoplasm, often with perinuclear clearing, and eccentric round to irregular nucleus with fine to slightly clumped chromatin and occasional inconspicuous nucleolus. Binucleation is infrequent, anisocytosis and anisokaryosis are moderate, and mitotic figures are rare. 2. Smears show numerous hepatocytes and low numbers of individualised neoplastic round cells as described above. Hepatocytes exhibit moderate indistinct vacuolation (glycogen, presumed) and are otherwise morphologically unremarkable. There are also sparse macrophages, small lymphocytes, and neutrophils. 3. The smears show low numbers of nucleated cells consisting of a mixture of tri-lineage haematopoietic precursor cells, heterogeneous lymphocytes, splenic stromal elements, and infrequent neoplastic round cells as described above. INTERPRETATION:  1-3. MALIGNANT ROUND CELL NEOPLASIA. 30/11/25: Melphalan commenced @ 0.1mg/kg PO SID. 9/11/25: Layla presented to ARH ECC for a total of 11 x vomits throughout the day. O reports other household dog had vomited two days prior, and had developed diarrhoea. AFAST noted a mild to moderately filled stomach and normal intestinal motility. Maropitant administered, with ondansetron commenced. Cease chemotherapy. 11-12/11/25: Layla was recently hospitalised following development of haemorrhagic diarrhoea. Was managed in hospital with IVFT and oral supportive medications. 14/11/25: Since discharge, Layla has been clinically well, EDDU normally and passing normal faeces. Recommencement of Melphan and Prednisolone.  FAECAL FLOTATION Faecal Flotation: No ova, cysts or parasites detected. Giardia Antigen: Not Detected Crytosporidium Antigen: Not Detected Kristen Todhunter Veterinary Pathologist Vetnostics North Ryde NATA Accreditation Number: 14599. Results apply to the sample as received. Measurement of uncertainty (MU) may be applicable when interpreting borderline changes in results. Please refer to www.vetnostics.com.au for MU information.17/11/25: Layla has been doing well at home with no O concerns. Faeces have firmed up but was noted to be very dark brown/almost black. O described the loosest stool to be of more like cow pat consistency and has had once accident inside the house. Prokolin to be recommenced. 19/11/25: Layla is still having blood in her stool, have been advised to commence Metronidazole and Ondasetron. 20/11/25: Layla is bright and eating very well but still producing soft serve faeces with frank blood. Was advised to stop prednisolone and melphan until blood in faeces have resolved. \05/02/26: Presented for CT staging. Layla doing very well at home, EDDU normally. CT staging identified a novel mediastinal mass, in house cytology highly suggestive of intermediate/large cell LSA. Cytology sent to QML. 06/02/26: VETERINARY CYTOLOGYCytology Reference: 206-1280SPECIMEN:Mediastinal mass: 5 FNA smearsMICROSCOPIC:The smears show high numbers of variably preserved lymphocytes, withregions of well-preserved intact cells comprising approx. 90%intermediate to at times large lymphocytes which have an eccentric ovoidnucleus of stippled chromatin with 1 or 2 indistinct nucleoli and amoderate amount of deep blue cytoplasm with a small perinuclearclearing. Mitoses are occasionally seen. These are accompanied by lownumbers of small mature lymphocytes and moderate numbers of neutrophilsand macrophages including tingible body macrophages.INTERPRETATION:Intermediate cell lymphomaCOMMENT:T/B immunocytochemistry will follow.INTERIM report 6/2/2610/2/26: QML ICCLow numbers of small lymphocytes stain with B-cell marker PAX5. Thedominant population is negative.Thus the neoplastic population fails to stain with our routine T andB-cell markers. This outcome could indicate a null cell lymphoma,although the possibility of non-lymphoid malignancy should be borne inmind. Histopathology, with the benefit of a broader array of antibodymarkers, may be of value, or flow cytometry which includes lymphoidmarkers, MPO and CD34 blast marker.6/2/26: Commenced CHOP- vinc @ 0.6mg/m2 (CBC on 5/2, N: 5.07). Prednisolone increased to 20mg PO SID 8/2/26: Post vincristine, developed hemorrhagic diarrhoea and was presented to ECC team. She was noted to be clinically stable and managed as outpatient. 13/2/26: Week 2 cyclophosphamide delayed due to neutropenia (N: 1.66)CBC 24 hours later (14/2)- neutropenia persistent (N: 1.25)Layla is here today for CBC, staging +/- chemo.Layla has been well since last appt on Monday - energy levels back to normal from yesterday. Lump on rostral face still present. Examination Findings: Demeanour: BARBCS: 6/9Weight: 29.9 kg - Prev 29.3 kg T: 38.6 C             MM: Pink, moistP: 92 bpm        CRT: 1-2secR: pantOcular: WNL Aural: WNL Nasal: WNL Oral: WNL Cardiovascular: No evidence of murmurs or arrhythmias. Femoral pulses strong and synchronous. Respiratory: Lung sounds clear in all 4 quadrants with no evidence of any crackles or wheezes. Abdomen: Comfortable on palpation. Lymph nodes: peripheral LNs palpate WNLIntegument: Subcutaneous mass measuring approximately 0.8cm x 1cm palpated in the left axillary region. Fluctuant subcutaneous mass ventral thorax LHS of mid line measures 1cmErythematous lesion measuring approximately 0.8cm x 0.8cm on the right muzzle region (02/03/26)MSK and Gait: - PL gait. No crossing of hind limbs. Normal weight distribution to both limbs, no longer toe touching. No knuckling noted today. Urogenital: WNL Neurological: WNL Rectal: not performed Diagnostics:CBC-  InhouseNEU  3.4x10^9/L (2.95 - 11.64)PLT167  K/µL (148 - 484)Blood smear: Consistent with CBC findings. Noted increased abnormal populations of large lymphocytes and increased numbers of neutrophils Assessment: Systemic round cell neoplasia, plasma cell neoplasia - > 20 cutaneous lesions since 05/25 --> histopathology favours round cells tumour. >80% MUM-1 +ve. - 18 lesions excised 10/10/25, additional lesion excised 20/10/25 - CT staging 24/10/25 - diffuse disease in bone, visceral organs and spinal lesion- FNAB rib #12 lesion, liver and spleen cytology to QML - confirmed round cell infiltrate - Urine electrophoresis 24/10/25 - no evidence of BJ - Additional IHC 24/10/25 - kappa and lambda light chain positive - Melphalan commenced @ 0.1mg/kg PO SID on 30/11/25- Resolution of rib lesion on 9/1/26 Cutaneous low grade/grade II MCT - Unknown exact location - Excision by PCV on 10/10/25- Complete excision, MC = 0 Marked bilateral hip dysplasia- Conservatively managed with 4Cyte and fish oil 3000mg/day Hospitalised 11-12/11/25 for haemorrhagic diarrhoea. Faecal analysis no evidence of infectious parasite.CT staging 05/02/26 -> mediastinal mass.NEW 05/02/26 - Mediastinal LSA-> QML cytology 06/02/26: Intermediate LSA -> ICC 10/02/26: Low numbers of small lymphocytes stain with B-cell marker PAX5. The dominant population is negative. Ddx null cell lymphoma, non-lymphoid malignancy-> Conversion to CHOP commenced 06/02/26- week 3/25 (vincristine 0.6mg/m2)- Vincristine 0.6mg/m2 06/02/26 - Grade 1 neutropaenia (N: 1.66) 13/02/26 -> Stage (20/01/26) - Thoracic radiograph and ultrasound performed. --> Grade 4 neutropaenia (N: 0.89) 02/03/26Treatment: Commence: Enrofloxacin 300mg PO SIDContinue: Prednisolone 20mg PO SID Gabapentin 300-600mg PO TID Amantadine 100mg PO BIDParacetamol 375mg PO BID-TIDAs required: Ondansetron 8mg PO TIDMaropitant 60mg PO SIDProKolin 6mg PO BID Melphalan currently discontinued. Client Communication: Plan:Await QML CBC resultsRevisit in 3 days for Doxorubicin  (05/03/26)    Vital Signs    Weight: 29.9;       MMColour: pink;       Temperature: 38.6;       HeartRate: 92;       RespirationRate: pant;       CRT: 2 secs;       

--- 03/03/2026 17:41:30 RSH: Tried to call Sue, but unable to get through. Unable to leave a voicemail either Flow cytometry has been added by the lab    Vital Signs    

Reason: CBCPerformed by RSH Intern: JLHistory:Layla is a 7yr 5m FS Golden Retriever is being managed for mediastinal LSA with CHOP. Layla is historically managed by ARH Oncology for systemic plasmacytosis/ non-secretory multiple myeloma. 29/5/25: Presented to PCV for mass excision to mid backline. PreGA bloodwork, thoracic radiographs and abdominal ultrasound were stated to be within normal limits. Histolopathology results consistent with a round cell tumour, favour plasma cell tumour: MICROSCOPIC Two sections of haired skin are examined. Focally, the deep dermis and subcutis are expanded by a moderately cellular, unencapsulated, moderately infiltrative mass composed of a monomorphic population of large round cells on a sparse fibrovascular stroma. Proliferating cells have moderate to large amounts of pale eosinophilic cytoplasm, with round to indented, paracentral nuclei with 1-3 prominent nucleoli. Proliferating cells exhibit up to two fold anisocytosis and anisokaryosis, and the mitotic count is 7 per 10 consecutive high- powered field (total area 2.37 mm2). DIAGNOSIS ROUND CELL TUMOUR, SEE COMMENT MARGINS Proliferating cells do not extend to the histologic margin in the examined sections. Minimum radial histologic margin 14 mm, minimum deep histologic margin 9 mm. COMMENT Findings are consistent with a monomorphic round cell proliferation. Based on the lesion and cell morphology, we favour a plasma cell tumour. However, an unusual lymphoma or histiocytic proliferation cannot be completely excluded. Mast cell stains have been requested for completeness, and the final report will follow early next week. Immunohistochemistry may help to further characterise this neoplasm. Please call/email if you would like to request immunohistochemistry (MUM-1 for plasma cells, block 1C, cost code = VMI x1). This case has been evaluated in collaboration with Dr John Mackie.27/9/25: Represented to PCV for two newly noted masses: ~5mm small firm mass to LHS thorax (adjacent to last rib) and a ~13mm mobile soft subcutaneous mass RS ventral chest in alignment with TL. FNABs yielded cystic material and adipocytes respectively. 8/10/25: Presented to PCV for 5-6 newly noted cutaneous masses, of which in house FNAB of all 6 consistent with round cell morphology, favour plasma cell tumour. Represented 10/10/25 for surgical excision, where 18 cutaneous masses were identified and excised. AMENDED REPORT - 16/10/2025 03:30PM HISTOLOGY ACCESSION No. VQ25-012388: SEE ATTACHED FOR FULL REPORT. MICROSCOPIC 1. Within the subcutis is a well demarcated, moderately to densely cellular neoplastic mass. The tumour cells are round and they are forming sheets. They have a moderate amount of eosinophilic cytoplasm that often contains a perinuclear clear zone. They have oval to indented eccentric nuclei. There is moderate anisocytosis, mitotic count equals 35. Margins: Lateral: 10 mm, deep: 3.5 mm, composed of fibroadipose tissue. **Masses 1-11 and 13-15 all of same morphology. 12. Within the dermis and subcutis is an infiltrative, moderately cellular neoplastic mass. Tumour cells are forming sheets. The cells are round with a moderate amount of cytoplasm that contains fine basophilic granules. Nuclei are central and round to oval with finely granular chromatin and one to several nucleoli. There is mild to moderate anisocytosis, no mitotic figures are noted in 10 high power fields. Margins: Lateral: 5mm, Deep: 3mm, composed of fibrofatty tissue.Diagnosis: 1-11, 13-15: Multifocal round cell neoplasia 12. Mast cell tumour, low grade (Kiupel), Patnaik grade 2ADDENDUM 16.10.25: CD3: The cells of interest appear to be negative. IBA-1: There is a scattered population of cells interpreted as reactive. The cells of interest appear to be negative. MUM-1: Over 80% of the cells of interest are moderately positive. PAX5: The cells of interest appear to be negative.20/10/25: Presented to PCV for progressive lethargy. Occasional cough noted. Additional mass noted to neck. Sedation administered and 1cm mass noted to left ear base elliptically excised. Paracetamol, omeprazole and chlorpheniramine prescribed. Gabapentin prescribed @ 23/10/25 @ 600mg PO TID. 30/11/25: Initially presented to ARH oncology department. CT pertinent findings as follows:Imaging Summary:1. Spinal cord compression at the level of L3 secondary to a mass within the vertebral canal. The location (extradural, intradural-extramedullary or intramedullary) is not determined on the CT but the contact with the spinal cord is irregular and intramedullary origin or infiltration of the spinal cord could be suspected.2. Multiple bone lesions at the level of the left 12th rib with pathological fracture, of the sternebrae in particular the 4th, in L4, in the right ulna, left radius and tibias.3. Multiple cutaneous and subcutaneous lesions consistent with the reported lesions in the anamnesis.4. The bone lesions associated with the reported differential diagnosis of the skin lesions could represent a diffuse neoplasticprocess such as multiple myeloma, plasmocytoma, histiocytic sarcoma. Other neoplasia or multiple neoplasia cannot be completely ruled out.5. Severe bilateral hip dysplasia.6. Mild bronchial thickening could represent chronic bronchitis and/or age-relatedUrine protein electrophoresis was negative for Bence Jones proteinuria. VETERINARY CYTOLOGY Cytology Reference: 205-9736 SPECIMEN:  1. FNA left rib lesion (12 slides) 2. FNA liver (5 slides) 3. FNA spleen (6 slides) MICROSCOPIC:  1. The smears show moderate numbers of individualised neoplastic round  cells in a moderately haemodilute, proteinaceous, fatty background. Neoplastic round cells have distinct cell margins, small to moderate amount of medium blue cytoplasm, often with perinuclear clearing, and eccentric round to irregular nucleus with fine to slightly clumped chromatin and occasional inconspicuous nucleolus. Binucleation is infrequent, anisocytosis and anisokaryosis are moderate, and mitotic figures are rare. 2. Smears show numerous hepatocytes and low numbers of individualised neoplastic round cells as described above. Hepatocytes exhibit moderate indistinct vacuolation (glycogen, presumed) and are otherwise morphologically unremarkable. There are also sparse macrophages, small lymphocytes, and neutrophils. 3. The smears show low numbers of nucleated cells consisting of a mixture of tri-lineage haematopoietic precursor cells, heterogeneous lymphocytes, splenic stromal elements, and infrequent neoplastic round cells as described above. INTERPRETATION:  1-3. MALIGNANT ROUND CELL NEOPLASIA. 30/11/25: Melphalan commenced @ 0.1mg/kg PO SID. 9/11/25: Layla presented to ARH ECC for a total of 11 x vomits throughout the day. O reports other household dog had vomited two days prior, and had developed diarrhoea. AFAST noted a mild to moderately filled stomach and normal intestinal motility. Maropitant administered, with ondansetron commenced. Cease chemotherapy. 11-12/11/25: Layla was recently hospitalised following development of haemorrhagic diarrhoea. Was managed in hospital with IVFT and oral supportive medications. 14/11/25: Since discharge, Layla has been clinically well, EDDU normally and passing normal faeces. Recommencement of Melphan and Prednisolone.  FAECAL FLOTATION Faecal Flotation: No ova, cysts or parasites detected. Giardia Antigen: Not Detected Crytosporidium Antigen: Not Detected Kristen Todhunter Veterinary Pathologist Vetnostics North Ryde NATA Accreditation Number: 14599. Results apply to the sample as received. Measurement of uncertainty (MU) may be applicable when interpreting borderline changes in results. Please refer to www.vetnostics.com.au for MU information.17/11/25: Layla has been doing well at home with no O concerns. Faeces have firmed up but was noted to be very dark brown/almost black. O described the loosest stool to be of more like cow pat consistency and has had once accident inside the house. Prokolin to be recommenced. 19/11/25: Layla is still having blood in her stool, have been advised to commence Metronidazole and Ondasetron. 20/11/25: Layla is bright and eating very well but still producing soft serve faeces with frank blood. Was advised to stop prednisolone and melphan until blood in faeces have resolved. \05/02/26: Presented for CT staging. Layla doing very well at home, EDDU normally. CT staging identified a novel mediastinal mass, in house cytology highly suggestive of intermediate/large cell LSA. Cytology sent to QML. 06/02/26: VETERINARY CYTOLOGYCytology Reference: 206-1280SPECIMEN:Mediastinal mass: 5 FNA smearsMICROSCOPIC:The smears show high numbers of variably preserved lymphocytes, withregions of well-preserved intact cells comprising approx. 90%intermediate to at times large lymphocytes which have an eccentric ovoidnucleus of stippled chromatin with 1 or 2 indistinct nucleoli and amoderate amount of deep blue cytoplasm with a small perinuclearclearing. Mitoses are occasionally seen. These are accompanied by lownumbers of small mature lymphocytes and moderate numbers of neutrophilsand macrophages including tingible body macrophages.INTERPRETATION:Intermediate cell lymphomaCOMMENT:T/B immunocytochemistry will follow.INTERIM report 6/2/2610/2/26: QML ICCLow numbers of small lymphocytes stain with B-cell marker PAX5. Thedominant population is negative.Thus the neoplastic population fails to stain with our routine T andB-cell markers. This outcome could indicate a null cell lymphoma,although the possibility of non-lymphoid malignancy should be borne inmind. Histopathology, with the benefit of a broader array of antibodymarkers, may be of value, or flow cytometry which includes lymphoidmarkers, MPO and CD34 blast marker.6/2/26: Commenced CHOP- vinc @ 0.6mg/m2 (CBC on 5/2, N: 5.07). Prednisolone increased to 20mg PO SID 8/2/26: Post vincristine, developed hemorrhagic diarrhoea and was presented to ECC team. She was noted to be clinically stable and managed as outpatient. 13/2/26: Week 2 cyclophosphamide delayed due to neutropenia (N: 1.66)CBC 24 hours later (14/2)- neutropenia persistent (N: 1.25)Layla is here today for recheck and CBC.Layla 3 days become very lethargic and inappetant. Unwilling to exercise. Owner noticed a lesion on nose near right eye. Took into PV. Treated for a sting and administered anti-histamines (history not available). 8 hours post PV visit MO mentioned that Layla was back to her normal self. BAR. EDDU since. Very happy. Exercise tolerance normal. Examination Findings: Demeanour: BARBCS: 6/9Weight: 29.3kgT: 38.8C             MM: Pink, moistP: 104bpm        CRT: 1-2secR: 36bpmOcular: WNL Aural: WNL Nasal: WNL Oral: WNL Cardiovascular: No evidence of murmurs or arrhythmias. Femoral pulses strong and synchronous. Respiratory: Lung sounds clear in all 4 quadrants with no evidence of any crackles or wheezes. Abdomen: Comfortable on palpation. Lymph nodes: peripheral LNs palpate WNLIntegument: Subcutaneous mass measuring approximately 0.8cm x 1cm palpated in the left axillary region. Fluctuant subcutaneous mass ventral thorax LHS of mid line measures 1cmErythematous lesion measuring approximately 0.8cm x 0.8cm on the right muzzle region (02/03/26)MSK and Gait: - PL gait. No crossing of hind limbs. Normal weight distribution to both limbs, no longer toe touching. No knuckling noted today. Urogenital: WNL Neurological: WNL Rectal: not performed Diagnostics:CBC-  InhouseNEU 0.89 x10^9/L (2.95 - 11.64)PLT 161 K/µL (148 - 484)Blood smear: Consistent with CBC findings. Noted abnormal populations of large lymphocytes at feathered edge2 EDTA tubes and blood smear sent out to QML for CBC interpretation. Flow cytometry to be performed if required. Assessment: Systemic round cell neoplasia, plasma cell neoplasia - > 20 cutaneous lesions since 05/25 --> histopathology favours round cells tumour. >80% MUM-1 +ve. - 18 lesions excised 10/10/25, additional lesion excised 20/10/25 - CT staging 24/10/25 - diffuse disease in bone, visceral organs and spinal lesion- FNAB rib #12 lesion, liver and spleen cytology to QML - confirmed round cell infiltrate - Urine electrophoresis 24/10/25 - no evidence of BJ - Additional IHC 24/10/25 - kappa and lambda light chain positive - Melphalan commenced @ 0.1mg/kg PO SID on 30/11/25- Resolution of rib lesion on 9/1/26 Cutaneous low grade/grade II MCT - Unknown exact location - Excision by PCV on 10/10/25- Complete excision, MC = 0 Marked bilateral hip dysplasia- Conservatively managed with 4Cyte and fish oil 3000mg/day Hospitalised 11-12/11/25 for haemorrhagic diarrhoea. Faecal analysis no evidence of infectious parasite.CT staging 05/02/26 -> mediastinal mass.NEW 05/02/26 - Mediastinal LSA-> QML cytology 06/02/26: Intermediate LSA -> ICC 10/02/26: Low numbers of small lymphocytes stain with B-cell marker PAX5. The dominant population is negative. Ddx null cell lymphoma, non-lymphoid malignancy-> Conversion to CHOP commenced 06/02/26- week 3/25 (vincristine 0.6mg/m2)- Vincristine 0.6mg/m2 06/02/26 - Grade 1 neutropaenia (N: 1.66) 13/02/26 -> Stage (20/01/26) - Thoracic radiograph and ultrasound performed. --> Grade 4 neutropaenia (N: 0.89) 02/03/26Treatment: Commence: Enrofloxacin 300mg PO SIDContinue: Prednisolone 20mg PO SID Gabapentin 300-600mg PO TID Amantadine 100mg PO BIDParacetamol 375mg PO BID-TIDAs required: Ondansetron 8mg PO TIDMaropitant 60mg PO SIDProKolin 6mg PO BID Melphalan currently discontinued. Client Communication: Discharge with Glen (advised Sue is welcome to touch base if she has further queries)Communicated to the owner that the CBC results today are concerning. Neutrophil counts are low, and blood smear findings of abnormal populations of lymphocytes raise concerns for leukaemia or progression of the current disease. Recommended rechecking bloods on Wednesday and sending blood to QML today for interpretation and, if required, for flow cytometry. Also recommended potentially further imaging on Wednesday to further work up the possible causes and monitor disease progression. Advised the owner to start antibiotics for the time being due to the low neutrophil count and to continue current analgesia at home. Currently, chemotherapy is recommended to manage the mediastinal lymphoma. The plan is to recheck CBC bloods in 48 hours, with possible further diagnostic imaging and doxorubicin administration.Communicated to the owner to bring Layla fasted (ie no breakfast and no dinner past midnight, water access to overnight is fine) on Wednesday morning. Plan:Recheck bloods +/- diagnostic imaging (thoracic radiograph and ultrasound) on Wednesday (7.30-8.30am) Await QML CBC resultsRevisit in 3 days for Doxorubicin  (05/03/26)    Vital Signs    Weight: 29.3;       MMColour: Pink;       Temperature: 36;       HeartRate: 104;       RespirationRate: 36;       CRT: <2sec;