C09992092 / invoice 10000

Reason: ChemotherapyIntern: SCHistory: Bonnie is a 6y 7m FS Rottweiler who presents for ongoing management of B cell lymphoma on CHOP. 23/01/26: Presented to RV for firm, swollen submandibular LNs. Owner reported lymphadenopathy first noticed 20/01, otherwise well. Owner administering meloxicam at home (dose not given). PEx noted lymphadenopathy of submandibular, prescapular and popliteal LNs, bilobed submandibular LNs. FNA of submandibular and popliteal nodes submitted to IDEXX. Meloxicam discontinued, no medical therapy commenced. 24/01/26: CYTOLOGY INTERPRETATION: Lymphoma; intermediate to large cell.COMMENTS:The presence of a monomorphic population of intermediate to large lymphocytes in multiple sitesconfirms lymphoma, and in this case the morphology is suggestive of a form a lymphoma that is likelyto have a shorter clinical course without treatment (e.g. DLBCL, PTCL etc. in contrast to moreindolent forms of lymphoma such as TZL). There are numerous subtypes of lymphoma with varyingbiological behaviours, and immunophenotyping may assist in further refinement of the diagnosis. Thesmears provided are suitable for immunocytochemistry (code: ICCA; internal note: C2, C3) to assist indetermination of B- or T-cell lineage - this can be requested in Vetconnect Plus or through CustomerService. Alternatively, flow cytometry could assist in further evaluation of the type of lymphomapresent. Please note that, whilst I would favour B cell lymphoma based on the morphologic features andprevalence of B- vs. T-cell large cell lymphoma affecting the peripheral LNs of dogs, morphologicevaluation alone can be unreliable (some T cell lymphomas can have similar morphology to what isobserved here), and immunophenotyping via ICC or flow would be required for more definitivecharacterisation.CYTOPATHOLOGIC DESCRIPTION:Evaluation is performed using digital whole slide imaging and the findings are similar across thesites so are reported together. The best preparations are highly cellular and well preserved, stainedand scanned. They contain numerous lymphocytes and occasional neutrophils and macrophages, amongst apale blue background containing a small amount of blood and frequent blue cytoplasmic fragments. Thelymphoid population is predominantly (estimate greater than 85%) comprised of intermediate to largelymphocytes, with occasional small lymphocytes noted. The intermediate to large lymphocytes have around to indented nucleus of fine chromatin with a central distinct round nucleolus, and contain asmall amount of deep blue cytoplasm which often has an area of perinuclear clearing. Mitotic figuresare occasional to frequent. Infectious agents are not observed.28/01/26: Presented to ARH Oncology. Owner reports retrospective lethargy for the past few weeks with episode of unusual behaviour. Normal appetite and thirst, no weight loss. Vomits semi-regularly after swimming (drinks pool water). PEx identified global peripheral lymphadenopathy. VBG identified mild respiratory alkalosis, hypokalemia, ionised calcium WNL. CBC identified a mild monocytosis (2.47) with suspected nRBC, NEU and PLT WNL. Biochemistry identified a mild elevation in SDMA (15). Scheduled for lateral radiograph +/- AUS and commencement of vincristine on 29/01. 29/1/26 - Lateral radiographs: Normal thorax, no evidence of sternal, cranial mediastinal or gross metastatic disease. AUS Vincristine #1 commenced @ 0.7mg/m2. Day 7 nadair (5/2) N:5.70x10^9/LICC returned: Immunocytochemistry (IDEXX Interpretation) aMICROSCOPIC EXAMINATION T/B cell immunocytochemical staining addendum report: Immunocytochemical staining findings revealed a plethora of lymphoid cells (approximately 90%) staining positively with the B-cell marker whilst approximately 10% of lymphoid cells stain positively with the T-cell marker. The control slide stained appropriately.DIAGNOSIS: B-cell lymphomaCOMMENT: Immunocytochemical staining findings here appear to be most consistent with a B-cell lymphoma. 5/2/26- commenced cyclosporine 300mg PO for 4 days duration and prednisolone 40mg PO SID. 12/2/26 - Vincristine #2 @0.7mg/m2. 19/2/26 - Doxorubicin @ 30mg/m2 and commenced prednisolone for 14 days. Day 7 Nadair (26/2) N: 6.59x10^9/LToday owner reports Bonnie has been great at home. Owners discontinued prednisolone tablets on Monday. EDDU. No diarrhoea or vomiting. Owner mentioned that Bonnie has not required her two small meals during the day since. Owner aware it is probably due to prednisolone stopping. Past pertinent medical history: - Bilateral TPLO June 2025 - Chronic vomiting - improved following food trial, egg identified as allergen. Currently managed on strict diet. Current medications: - Antinol joint supplement Trazodone 200mg PO 2hr prior to veterinary appointments Examination Findings: Demeanour: BAR, anxiousWeight: 43.80 kg, BCS: 6/9 T:  38.3C                        MM: pink, moist HR: 112bpm                   CRT: 1-2 s R: PantingCardiovascular: no auscultable murmur or arrhythmia, femoral pulses strong and synchronousRespiratory: clear bronchovesicular sounds bilaterally across lung fields, respiratory effort normal Abdomen: WNL; soft and comfortable to palpate, no immediately palpable masses or fluid wavePeripheral LNs: All peripheral lymph nodes firm and palpably enlarged. See below for LN measurements. Eyes: WNL; eyes clear and symmetrical, no ocular discharge, inflammation or blepharospasmEars: WNL; ears externally clean, no discharge or inflammation Integument: WNL; coat in good condition, no visible external lesions  Oral exam: WNL; mucous membranes pink, dentition WNL  Musculoskeletal: WNL; weight bearing x4 limbs, no noted muscle asymmetry, no noted neck pain on movement. Full MSK examination not performed. Gait: WNL; ambulating well, no observed lameness or ataxiaNeurological: WNL; mentation appropriate, response to environment appropriate. CPs appear intact, menace and palpebral intact. Full neurological examination not performed. Rectal exam: not performed Lymph node measurements (12/2/26)Mandibular: L 1.5cm ; R 1.5cm Pre-scapular: L  1.8cm; R 1.9cm Axillary: NADInguinal: L 1.2cm; R 1.1cmPopliteal: L 1.5cm; R 1.5cmLymph node measurements (19/2/26)Mandibular: L 1.3cm ; R 1.3cm Pre-scapular: L 1.5cm; R 1.6cm Axillary: NADInguinal: L 1.1cm; R 1cmPopliteal: L 1.4cm; R 1.5cm26.02.2026 LN measure WNLLaboratory:Inhouse IDEXX CBC - see attached resultsHct 35.1 % (ref 37.3-61.7)NEU: 6.25 x10^9/L (ref 2.95-11.64)PLT: 265 K/uL (ref 148-484)Blood smear: Confirmed above countsAssessment: B cell Lymphoma IVa-> generalised peripheral lymphadenopathy -> IDEXX immunocytochemistry requested 27/1/26 -> returned B cell lymphoma  -> CHOP commenced 29/01/26  - Vincristine #1 @ 0.7mg/mg2 IV on 29/1/26 - day 7 nadir N: 5.70x10^9/l- cyclosporine and prednisolone on 5/2/26- Vincristine #2 @ 0.7mg/m2 iV on 12/2/26- Doxorubicin @ 30mg/m2 and prednisolone for 14 days on 16/2/26- day 7 nadir N:6.59x10^9/L --> clinical remission 26/2/26Staging:- 29/1/26: No mediastinal mass, generalised lymphadenopathy and changes to splenic parenchyma most likely consistent with neoplastic infiltration of LSA on AUS. Stage IVa transitioning to IVbTreatment: Trazodone 200mg administered PO AMTwo Person Holder and muzzle - very well behavedVincristine 0.7mg/m2 (0.86mg/0.86ml) slowly administered in left medial cephalic vein via equashield systemFlushed with 20mls saline Administered by JK, held by KR and JDBDispensed for use at home PRN: - Maropitant 80mg PO SID - Pro Kolin 8ml PO BID O can collect diarelieve 2 x 3.25g PO BID for ongoing diarrhoea not responsive to prokolinClient Communication: Plan:    Vital Signs    Weight: 43.80;       MMColour: Pink;       Temperature: 38.3;       HeartRate: 112;       RespirationRate: Pant;       CRT: <2sec;