C09986472 / invoice 10000

Reason: delay Vinblastine due to detection of new MCT Notes incomplete Bill completePet Primary Diagnosis/Suspected Diagnosis/Location:  MCT at the left lower lip, new MCT at the left elbow Suspect cause:          neoplasia           Any other conditions being treated (if any):  thyroid carcinoma Known health concerns: Date of first clinical signs (if known):  Performed by RSHHistory:Dressie, 8yo 3mth, FS, Golden Retriever is being managed for cutaneous LG, G2 MCT of the left lower lip, HN2 to left mandibular node. Left thyroid carcinoma detected incidentally during CT staging. Surgery 9/12/25.28/11/25: Dressie presented to Koala Park Vet Surgery for 14 x 12 x 8mm mass at the left lip which was detected incidentally by the family and in house cytology confirmed MCT. Chlorpheniramine injection was administered. 3/12/25: CT staging with sentinel node mapping which identified left mandibular node. Incidental detection of left thyroid nodule (TT4 within normal limits). CT findings:1. Left lower lip nodule consistent with known mast cell tumour. No evidence of local or distant metastatic disease.2. Left thyroid gland nodule might represent an enlarged parathyroid gland, which could be associated with primary hyperparathyroidism) or an early thyroid lesion (e.g., adenoma/adenocarcinoma).3. Nonspecific right lateral liver lobe nodule, likely benign.4. Bilateral chronic renal infarcts, considered incidental.5. Non-obstructive gastric foreign bodies, representing 3 stones.6. Right aberrant subclavian artery, considered incidental, otherwise normal thorax.9/12/25: Surgical resection of MCT at left lower lip, extirpation of left mandibular node and resection of left thyroid nodule. QML lab reference: 25-59655668 MACROSCOPIC1. Left rostral chin MCT: The specimen consists of an approximately rectangular excision of skin and lip margin measuring 35 x 32 x 10 mm. On the skin surface there is a slightly raised nodule measuring 10 mm in diameter. The mucosa is arbitrarily placed at 12 o'clock and the 6 o'clock border is scored. Sections indicated on photograph with 1LS 3 o'clock and 1TS 1A, 1TS and 1LS 9 o'clock 1B. Cassettes require further fixation prior to routine processing.2. Left submandibular LN: The specimen consists of a lymph node measuring 19 x 13 x 10 mm. Bisected 2A and submitted for overnight fixation prior to routine processing.3. Left thyroid gland: The specimen consists of a thyroid lobe measuring 25 x 16 x 10 mm. Section shows a variegated solid white to red and spongy nodule measuring up to 9 mm in diameter. Submitted in toto as 3TS 3A, 3TS 3B. Note, there is some retraction of the inked capsule overlying the lesion.MICROSCOPIC1. Left rostral chin MCT: Expanding the dermis and deeper tissue is a poorly circumscribed, unencapsulated, moderately cellular round cell neoplasm. Neoplastic cells are arranged in sheets and cords that dissect between a moderate collagenous stroma. Neoplastic cells havedistinct cell borders and moderate amounts of amphophilic cytoplasm that is often filled with fine basophilic granules (mast cells). Nuclei are oval with moderately stippled chromatin and sometimes a single nucleolus. Anisocytosis and anisokaryosis are mild and the mitotic index is 1 per 10 HPF. Moderate numbers of eosinophils are infiltrating the neoplasm. In the planes examined the neoplasm appears completely excised with minimal lateral margins of approximately 2.7 mm and deep margins approximately 1.5 mm.2. Left submandibular LN: Examined are 2 sections of lymph node up to approximately 12 x 5 mm. The lymph node is draining moderate numbers of macrophages with fewer eosinophils. Multifocally clusters of neoplastic mast cells are seen within sinuses, without significantdamage to architecture.3. Left thyroid gland: Expanding the thyroid gland is a moderately well-circumscribed, partly encapsulated, infiltrative neoplasm. Neoplastic cells are polygonal and forming variably discrete tubular acinar structures supported by a mild fibrous stroma and sometimes surrounding eosinophilic fluid. Cells have indistinct cell borders with moderate amounts of eosinophilic cytoplasm. Nuclei are oval with moderately stippled chromatin and variably distinct nucleoli. Anisocytosis and anisokaryosis are mild moderate and the mitotic rate is 8 per 2.37 mm2 (approximately 10 high-power fields). Neoplastic cells are sometimes infiltrating through the capsule and are closely associated with the surrounding vasculature. Also within the excised tissue there is a parathyroid gland approximately 4 x 2 mm. Neoplastic cells appear to extend to within 0.1 mm of the surgical margin.DIAGNOSIS1. Left rostral chin MCT: Mast cell tumour, low grade2. Left submandibular LN: Early mast cell metastasis3. Left thyroid gland: Thyroid follicular carcinomaCOMMENT/S1. Left rostral chin MCT: I can confirm this is a mast cell tumour. In the planes examined excision appears complete.This neoplasm has been assessed as low grade using a consensus grading system endorsed by ACVP and WSAVA (Kiupel et al, Vet Pathol 2011, 48:147-55). Using the Patnaik grading system I would grade this grade 2.2. Left submandibular LN: The degree of neoplastic mast cell infiltration within the sections examined is consistent with early metastasis (HN2) as classified by the paper in J. Comp. Path. 2014, Vol. 151, 329e338 by Weishaar et al.3. Left thyroid gland: This is a malignant thyroid tumour, the features of which are most consistent with thyroid follicular origin. Neoplastic cells appear to extend very close to the surgical margin in some areas, therefore I would also suggest monitoring for recurrence.18/12/25: She developed dehiscence of surgery site. Dressie is here today for recheck and Vinblastine.Dressie's pertinent history include:- she had 4 litter of puppies before being desexed a few years ago (Mary unable to recall when she was desexed). - she tends to have a sensitive gut so she is maintained on regular dietPhysical Exam: Weight 31.3kgBCS  5/9BARHR  108bpmRR - PantT 38.7MMs: Pink, CRT 1-2sOcular: NADAural: NADNasal: NADOral: mild dental disease; previous surgery site at left lower lip look good Cardiovascular: no murmur audible, heart rhythm regular. Femoral pulses strong and synchronous. Respiratory: Lung sounds clear in all 4 quadrants with no evidence of any crackles or wheezes. No evidence of any abnormal areas of increased resonance or dullness. LNs: all peripheral nodes palpably within normal parameters Abdomen: overall comfortable and pliableIntegument: good skin coat overall; - 5 x 7mm  cutaneous mass at left elbow with 1x 1.,4cm SC component MSK: ambulating well in consult roomUrogenital: NADNeurological: NAD Laboratory: IDEXX in house CBC with blood smearHct 37.8%Neu 4.26  x 10^9/L (ref 2.95-11.64)Platelet 345 K/u/L (ref 148-484)Blood smear: Assessment:Left rostral mandibular lip -cutaneous MCT, LG, G2- CT staged clear with sentinel node mapping (4/12)- left medial mandibular node - surgery 9/12/25 with HN2 to left mandibular node, MC 1- commenced adjuvant vinblastine chemotherapy 31/12/25- MCT prognostic panel requested today (31/12)Pertinent:- incidental LEFT thyroid carcinoma during CT staging, surgery 9/12/25 with narrow margins Treatment:  No treatment in houseDispensed:Chlorpheriramine 8mg BIDUse PRN:Maropitant 60mg PO SID Prokolin 6ml PO BID for diarrhoea, stop after 2 days of formed stoolClient communication:Plan:Recheck 7d for CBC + vinblastine #2Await MCT panel (requested 31/12)MBA due    Vital Signs    Weight: 31.3;       MMColour: Pink;       Temperature: 38.7;       HeartRate: 108;       RespirationRate: Pant;       CRT: <2sec;