C09997346 / invoice 10000

Reason: AUS adn chest xraysIntern: SCHistory: Bessie (10y 3m FS JRT X) is currently being managed for multiple MCT, the original mass was a subcutaneous MCT (MI6) of the left hip completely excised on 08/11/21, additional tumours included a periauricular and perivulval MCT.Bessie initially underwent surgical excision of the mass at her referring vet on 01/11/21 but histopathology noted incomplete excision. A scar revision was performed at referring vet on 08/11/21 and histopathology confirmed complete excision. She staged clear on abdominal ultrasound on 17/11/21, and aspirates of both the inguinal lymph nodes showed no evidence of metastatic disease. Chemotherapy administration was delayed due to the presence of a surgical site seroma. She was commenced on the vinblastine protocol on 29/11/21. Bessie developed a grade 3 neutropaenia day 7 post vinblastine 2mg/m2 with NEU 0.75 x10^9/L 2.95 - 11.64, which resolved by day 10 and received a 5% dose reduction of vinblastine 1.9mg/m2 second dose onwards. She received her third dose at 1.8mg/m2 to prevent delay of chemotherapy due to risk of neutropaenia with large amount of public holidays, and was resumed on vinblastine at 1.9mg/m2 dose 4 onwards. Bessie completed her vinblastine protocol on 17/02/22.24/1/24: Staged clear. Suspected pancreatic cyst/ nodule noted on AUS. 24/7/24: Staged clear. 16/10/24: Presented to RV after noting a new mass to R pinna. PEx noted a 2cm x 2cm spherical subdermal mass to right pinna. Cytology performed: Pathologist's ReportINTERPRETATION: Mast Cell TumourCYTOPATHOLOGIC DESCRIPTION:The smears are moderately cellular and of good quality, there are small amounts of blood with scattered bare nucleiand poorly preserved cells. The smears contain a moderate number of mast cells present individually and in clusters.Cells have a moderate to high N:C ratio. Nuclei are round and chromatin appears smooth to clumped. There aresmall to moderate amounts of pale cytoplasm that generally contains large numbers of purple granules that obscurecellular detail. Anisocytosis and anisokaryosis is mild (less than 2-fold). There are low numbers of eosinophilspresent, along with occasional plump stromal cells.20/6/25: 3mm pale cutaneous mass noted to RHS of vulva.25/6/25: U/S guided FNAB l inguinal LN: Not consistent with metastatic mast cell disease The vulval MCT (2mm pale cutaneous mass) was excised – Histopathology returned Mast cell tumour (Kiupel low grade, Patnaik grade 1), complete margins CT Scan was performed - Imaging Summary:1. Soft tissue swelling in the ventral right cranial thorax Dx soft tissue neoplasm e.g. possible secondary mast cell tumour(MCT). Alternatively, infection or haematoma.2. Right sided dermal micronodule to the right of the vulva Dx previously identified as MCT3. Left sacral lymph node is enlargement DDx reactive hyperplasia or secondary neoplasia4. Atelectasis in the right cranial lung lobe.5. Small amount of subcutaneous gas over the right dorsal neck likely secondary to injection site.10/7/25: FNAB soft tissue swelling to right ventral thorax consistent with MCT. 21/7/25: Surgical excision right ventral thoracic MCT: HISTOLOGY ACCESSION No. VQ25-008768 MICROSCOPIC Within the 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. There is a scattered population of eosinophils. Margins: Lateral:6.5mm, Deep: 1-1.5mmm, composed of skeletal muscle and fibrofatty tissue. DIAGNOSIS: Subcutaneous mast cell tumour21/1/26: Presented for restaging. Doing well at home. No evidence of thoracic or abdominal metastasis, however AUS identified new L adrenal nodule. LDDST and urine catecholamines recommended. 23/1/26: LDDST performed and returned normal. Urine catecholamine returned inconsistent with pheochromocytoma. The adrenal mass is therefore considered non-functional. Bessie has been well - EDDU, no concerns. Small lump found on L/R eyelid which is new. Examination Findings: Weight  7.5 kg BARHR - 86 bpmRR -pant  bpmTemp   39C MM PinkCRT <2 secsOcular: WNL Aural: No recurrence palpable from previously excised pinna MCT (R pinna)Nasal: WNLOral: Mild calculus accumulationCardiovascular: 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. No evidence of any abnormal areas of increased resonance or dullness. LNs: Mandibular, prescapular and popliteal LNs all palpated within normal limits. Abdomen: WNLIntegument: WNL, no new lesions noted. The left hip is a little asymmetric compared to the right hip but no discrete lesion.MSK: WNL, deficit palpable R pectoral region (previous surgical site)Gait: WNLUrogenital: WNL, no recurrence of previously excised MCTNeurological: WNLRectal: Not performed Laboratory: Nil todayRadiographic Findings: Views: 3 view chest radiographsHeart: WNLGreater Vessels:  WNLLungs: WNL, normal lulmonary parenchyma cranially, mild bronchial pattern throughout caudal lung fieldsPleural space: WNL, no evidence of pneumoperitoneum or pleural effusionCranial mediastinum: WNL, no evidence of distension/mass effect/pneumomediastinumTrachea: WNL, no evidence of stenosis/distension/mass effectOesophagus: WNL, no evidence of stenosis/distension/aerophagia Lymph nodes: WNL, no observed lymphadenopathy External structures: thoracic musculature and soft tissues WNL, diaphragm intact and continuous, visible abdominal structure. Bridging of cranial T6 vertebrae. Interpretation: no evidence of metastasis, spondylosis deformans of T6. formal report pending Ultrasound report: Bladder: lumen measures 1.43cm, no sediment present and normal echogenicity. Wall thickness measure 0.18 cm. LMILN: 0.36cm x 1.52cm, normal echogenicity and fusiform shapeRMILN: 0.23cm x0.96cm, normal echogenicity and fusiform shapeL Kidney: 3.97cm, normal CMJ, no pyelectasia or cystic structuresR Kidney:3.84cm, normal CMJ, no pyelectasia or cystic structuresL adrenal: 0.83cm cau pole, 1.24c,m cr pole  total measurment 1.17cm heigh x 2.01cm long, normal echogenicityR adrenal: 0.45cm, normal echogenicitySpleen: subjectively normal size, normal echogenicity and echotexture. No capsular distortion, normal blood flow. Liver: normal parenchyma echogenicity and echotexture generally. Singular hypoechoic lesion measures 0.81cm Gall bladder: lumen measured 1.84cm, no sediment presentPancreas: R limb measures 0.77cm, cytsic lesion measures 1.07cm x 0.69cmStomach: Wall thickness0.29 cm, normal wall layeringSI: Wall thickness 0.26cm, normal wall layeringDuodenum: Wall thickness 0.3cm, normal wall layeringDesc Colon: Wall thickness 0.07cm, normal wall layeringL ING LN: 0.15cm x1.7cm, normal echogenicity and fusiform shapeR ING LN:0.16cm x 1.55cm, normal echogenicity and fusiform shapeL Ax LN: 0.28cm x 0.6cm normal echogenicity and fusiform shapeR Ax LN: 0.29cm x 0.73cm normal echogenicity and fusiform shapeInterpretation: Moderate enlargement of the left adrenal mass. Mild progression of pancreatic cystic lesion. Assessment: Subcutaneous mast cell tumour MI6 - CR - Incompletely excised 01/11/21 - Scar revision 08/11/21 with complete excision Vinblastine commenced 29/11/21, completed 17/02/22- Grade 3 neutropaenia day 7 post vinblastine 2.0mg/m2, resolved by day 10- 5% dose reduction vinblastine 1.9mg/m2 dose 2 - 5% dose reduction vinblastine 1.8mg/m2 dose 3 due to public holidays and reduce risk of neutropaenia - Dose increase vinblastine 1.9mg/m2 dose 4 onwardsAural MCT diagnosed cytologically 16/10/24CT staging 23/10/24 - No clear morphological changes consistent with metastasisSLNM - right prescapular LN. In house cytology not metastatic. Staged clear:- 24/7/24- 12/11/25- 21/1/26Vulval MCT : 2mm pale cutaneous mass - FNA consistent with MCT - Excised 25/6/25. Histopathology pending. S/C MCT pectoral region- Excised 21/7/25- MC = 0 Nodule on cranial pole of L adrenal gland (0.55 cm cau pole, 1.53 cm x 0.97 cm cra pole, normal echogenecity)- Noted on AUS on 21/2/26- LDDST 23/01/26 and urine catacholamine returned normal --> concluded to be non-functional tumour  --->  Left adrenal mass 0.83cm cau pole,1.24cm cranial pole, total measurement 1.17cm heigh x 2.01cm long, Small pancreatic nodule that previously appeared more cystic. It has slowly been growing- The nodule was 4/5mm in Feb 2025- The nodule was 7mm in Nov 2025- The nodule was 8mm in Jan 2026- The nodule is 10mm todayTreatment: Butorphanol 0.1mg/kg IV insufficient to facilitate imaging. Additional 0.2mg/kg butorphanol IM plus 25mg trazodone PO administered to achieve sufficent sedation for imaging. Client communication: Plan:Repeat staging in 2-4 weeks    Vital Signs    Weight: 7.5;       MMColour: pink;       Temperature: 39.0;       HeartRate: 86;       RespirationRate: pant;       CRT: 2 secs;