C09988238 / invoice 10000

O phoned this am to say steve was a little lethargic this morning, hasnt eaten breakfast, O has to go to work but will come back and check on him around 11:30am and will call to confirm if wants the app at 3:10pm.ssmO called back midday ad advised steve is better, has eaten and O says acting normally. will monitor and call us if worried.ssm

Histo of mass and liver biopsy wedgeMICROSCOPIC Expanding the hepatic parenchyma is a fairly demarcated and multinodular neoplasm arranged in broad, solid sheetsthat often lack trabeculae and haphazardly arranged lobules of trabeculae and cords up to 10 cells thick, all supported by variablefibrovascular stroma. Neoplastic cells are polygonal shaped with abundant, eosinophilic cytoplasm that is often slightly vacuolated andcentral round nuclei with stippled chromatin and up to 2 prominent nucleoli. There is moderate anisocytosis and anisokaryosis. Themitotic count is 4 in 10 high power fields (2.37 mm2). Throughout the mass there are ectatic vascular/sinusoidal spaces and somehaemorrhage with haematoma formation. These areas often contain surrounding fibrosis with some extracellular yellow pigment(haematoidin) and surrounding haemosiderin laden macrophages.MARGINS Surgical edge (narrowest) ~ 17 mm. The surgical margins appear clear of the neoplasm.Adjacent unaffected liver shows some nodularity with focal loss of reticulin staining and a surrounding compressed stroma that lacksfibrosis (confirmed with trichrome histochemistry). Few hepatocyte groups are slightly vacuolated with clear feathery space (mostlyglycogen). Random sinusoidal spaces, central veins and portal lymphatics show slight and occasional ectasia. No copper is found withcopper rhodanine histochemistry.DIAGNOSISLiver:Hepatocellular carcinomaCOMMENTThe mass represents a hepatocellular neoplasm. There is no evidence of lymphovascular invasion however given the atypia, increasedmitotic figures and haphazard arrangement, hepatocellular carcinoma is favoured over an adenoma.Adjacent unaffected liver shows some nodularity that appears to represent nodular hyperplasia rather than neoplastic foci. These aresubtle and likely incidental. No fibrosis or significant inflammation is found.In cats, metastasis of hepatocellular carcinoma seems to be more common than in dogs. Metastasis is reported to occur at a rate of28% (5/18) for cats with spread to the local lymph nodes most common, as well as the lung and spleen. Liver lobectomy has beenassociated with prolonged survival times and a good prognosis in cats with hepatocellular carcinoma.---------------------report results to Paul, discuss option for oncology specialist consult, monitor longer term for metastases - rpt abdo u/snd, chest rads

BIB Paul- 2d post op/ex lap- eating ok except not this am ?possib suspicious going to vet, been toileting fine, sometimes hides away but does this normally- eliz collar left off as got off on way home and not able to replace, not licking at wound, remove hypafix adhesive (mostly come off already)- MM pink and moist, chest auscult stable murmur, abdo seeming comfortable, wound ok, temp 38.6- monitor ongoing recovery, eating ok, etc and update when histopath results through, earlier review if concerns