C10026080 / invoice 10000

Reason: Fna Popliteal LnsGoing wellFNA both popliteal LNs today. R larger than LAlso able to palpate prescapular LNs, Submandibulars feel normal    Vital Signs    

SAMPLE(1) Liver. Four smears are examined.(2) Medial iliac lymph node. Three smears are examined.HISTORYSevere hepatopathy CRP > 100; large liver mass and multifocal lymphadenopathy. Concern forhigh grade lymphoma.CYTOLOGIC DESCRIPTIONLiver - Smears are mildly to highly cellular, mildly to moderately hemodilute, and are of goodquality for review. Hepatocytes are present in variably sized clusters and all contain a few discreteclear lipid vacuolates in their cytoplasm. Some clusters are also associated with thin fibrovascularstructures. Within the background are low to moderate number of hematopoietic cells and mildlyincreased numbers of mixed lymphocytes. The latter comprise small lymphocytes and feweratypical intermediate to large lymphocytes. Intermediate large cells have a moderate amount ofpale blue cytoplasm and round to scalloped/ irregular nuclei are with mildly coarse chromatinpattern. Nucleoli are not overtly seen. Low numbers of macrophages with intracellular clumpedblack pigment (hemosiderin. Iri) are also seen.Lymph node - One smear is acellular. The remaining smears are minimally to moderate cellularand are of fair quality for review. The minimally to mildly hemodilute backgrounds contain low tomoderate numbers of lysed cells and scanty free lipid material. A mixed lymphocyte population ispresent, comprising well preserved small lymphocytes and poorly preserved intermediate to largelymphocytes as described above. Blood-associated leukocytes and a rare aberrant mitotic figureare also present.INTERPRETATIONLiver : (2) Evidence of reversible hepatic injury (steatosis) with extramedullary hematopoiesis andmild chronic lymphocytic inflammation; (2) Presence elf few atypical intermediate to largelymphocytesMedial iliac lymph node : Inconclusive (see comment)COMMENTDue to the presence of low numbers of lymphocytes, sometimes poorly-preserved, I cannotdefinitively confirm lymphoma in these smears. With that said, low numbers of atypicalintermediate and large lymphocytes were observed on both tissues. This may support apresumptive diagnosis of lymphoma. Surgical biopsy with histopathology however is advised forfurther diagnostic clarification.Reversible hepatic injury (steatosis) was observed and this is a non-specific finding. It may beassociated with many disorders including toxic insult, obesity, diabetes, neoplasia, anorexia,pancreatitis, primary lvier disease, etc.--- 04/03/2026 12:30:27 SK:Spoken to owner. P going really well, EDUF normally and no further vomiting.Reported results.Advise surgical biopsy recommended. O has some reservations with age etc.Advise referral to ACCWA, have sent clinical advice request on their website, will wait for their response. O very happy to do this,--- 06/03/2026 08:43:03 SK:Reply from ACCWA:Hi Sheryl,Thanks for getting in touch. I’m not sure if the history and pathology report have come through yet, as I can’t find them in our inbox.Just a couple of thoughts in the meantime. Lymphoma does not typically form discrete masses within the liver and spleen; it more commonly causes diffuse infiltration and enlargement of these organs. That said, lymphoma can do whatever it likes so cannot be completely excluded. Cytology is usually very reliable for diagnosing lymphoma, so if the cytology results are ambiguous it does raise the possibility that the lesions could represent something else, in which case a biopsy may ultimately be required to obtain a definitive diagnosis.Another option to consider would be surgical removal of the mass if it is technically feasible. Determining this can be difficult based on ultrasound alone and often requires CT imaging for more accurate assessment. For this reason, referral to a surgeon would be a reasonable next step. Dr Carla Appelgrein at VetSurg would be a good option, as they are located in the same building as us and we have a CT here. She would be able to assess surgical feasibility and, if appropriate, proceed with removal of the mass. If surgery is not possible, a surgical biopsy could still be performed to obtain a diagnosis.Hope that helps, but please feel free to send the history and pathology through when you can and I’m happy to have another look.Kind regards,Jess--- 06/03/2026 08:43:21 SK:Replied and resent hx and results.--- 09/03/2026 08:13:53 SK6:Hi Sheryl,Thanks for sending all of that through. Now that I’ve had a chance to read through it, the findings do read more like lymphoma. It’s just a shame that the lymph node aspirates were inconclusive.I did notice in the ultrasound report that the popliteal lymph nodes were described as enlarged, so it may be worth attempting repeat aspirates from those nodes to see if you can confirm the diagnosis. If lymphoma is confirmed, I would absolutely be happy to see Holly. I’m also very happy to see her and perform the aspirates here if needed, however there may be a bit of a wait time for an appointment, so it may be quicker to try sampling them through your practice first.I’m still not entirely convinced that the liver mass itself represents lymphoma - it’s possible that Holly actually has two separate conditions occurring at the same time - but if lymphoma is present, that is probably the more urgent issue to address first.Regards,Jess    Vital Signs