scott@vtx-cpd.com

Replying to Sarah Clements 02/12/2021 - 20:53

HAHAH!

Fair enough! I have popped the path report below! Hope that helps:

Site Spleen

Microscopic Description

Ten scanned sections from three aspirated smears are examined. The cellularity is variable, with areas
containing numerous neoplastic cells. The preservation is good. The background contains and large
amount of blood. The neoplastic cells have often exfoliated in aggregates, occasionally associated with small capillaries. Lower numbers of cells are individualized. They are mononucleated with occasional multinucleated forms.
They are plump oval to spindleoid and display moderate anisokaryosis and anisocytosis. They have large, round to oval nuclei with granular chromatin and often multiple small and variably visible nucleoli. The nucleoli occasionally vary in size within the same nucleus. The cytoplasm is moderate in amount and moderately basophilic, with poorly defined margins. It occasionally contains small clear vacuoles and rarely amorphous phagosomes. Scattered around there are also low numbers of mixed haematopoietic precursors and low numbers of mixed lymphoid cells.

Microscopic Interpretation

Malignant neoplasm. Differential diagnoses: sarcoma (e.g. splenic stromal sarcoma) and histiocytic
sarcoma.

Comments

As you suspected, the aspirate from the spleen are consistent with a neoplastic process. The primary
differential diagnoses would include a sarcoma, such as a splenic stromal sarcoma and possibly and a
histiocytic sarcoma. Subjectively, a histiocytic sarcoma appears in this case possibly less likely because,
although the individual cell morphology is compatible with this neoplasm, the arrangement of the cells in
aggregates is quite unusual. Nevertheless, it cannot be excluded. A haemangiosarcoma appears unlikely
morphologically.

Similar cells are not observed in these sections from the liver where no significant cytological abnormalities
are observed, beside the very mild and non specific hepatocellular vacuolation. However, depending on the
imaging findings, these preparations may not be fully representative.

Replying to Alice L 05/12/2021 - 20:49

Hey Alice.

Brilliant question! I will add it to the list.

Hopefully see you Thursday!

Scott 🙂

Replying to Madeleine Smith 01/12/2021 - 12:14

Never too late.

You have access to the lessons and discussion forum for 6 months… keep asking questions!

This is a really brilliant question. honestly, there is not any evidence to promote one 2nd line immunosuppression over another. You colleagues are right, there are some studies that show a varying time of effect with azathioprine, two weeks or more in some in vitro studies. I would go with any of the following:

Azathioprine: 2 mg/kg or 50 mg/m2 PO q24h. After 2-3 weeks, the dosing interval may be increased to every other day until treatment is discontinued.

Cyclosporine: 5 mg/kg PO q12h. Adjustment of this dosage may be guided by therapeutic drug monitoring (TDM) (see recommendation #28).

Mycophenolate mofetil: 8-12 mg/kg PO q12h.

The only other reason mycophenolate might be a good option is that there is an injectable form.

In short, any of the above will be fine!

Scott 🙂

Replying to Jeanette Tungesvik 26/11/2021 - 16:37

Hello.

Really interesting question and really challenging cases. I am glad the cat is doing well. Is this the only medication the cat is currently on? Is the cat urinating normally?

There are various different drug combinations that can be used, including diazepam, prazosin, bethanechol, a combination of diazepam and prazosin, or a combination of diazepam, prazosin and bethanechol.

I generally find diazepam is not necessary. I tend to use a combination of bethanechol and prazosin. Regarding the phenoxybenzamine; I would probably reduce this gradually. Reducing to once daily for a week and then every other day. I think it is worth weaning but impossible to know if this might be needed long term without trying.

Hope that helps.

Scott 🙂

Replying to Louise Groot 29/11/2021 - 15:11

This is a really great question Louise.

I am afraid there is not a straightforward answer! In veterinary medicine, colloids are indicated primarily for bolus intravascular volume support. Much of the decision making will be based on the individual case and what is available:

1. In hypovolaemic cases I would typically use a combination of isotonic crystalloids, hypertonic saline and blood products (if appropriate).

2. In cases where hypotension is the biggest issue I would use isotonic crystalloids, hypertonic saline and blood products when appropriate and consider vasopressors if this was not effective.

3. Cases where colloid support can be most tricky is cases with severe hypoalbuminaemia. Right now due to concerns about cost, safety, and availability of albumin products, synthetic colloids (HES) are used extensively for resuscitation and improvement of colloid oncotic pressure (COP) in veterinary medicine. Colloid CRIs have been used historically for improvement of COP, but the possible risk of increased side effects with cumulative doses and lack of improvement in outcome data from human studies indicate this practice should be further examined. Also, no large-scale human study has found a significant outcome advantage in patients given any colloid (natural or synthetic) over balanced isotonic crystalloids alone. As with any drug, the risks versus benefits of colloids should be carefully considered and their use titrated as needed for each individual patient. The lowest possible dose of HES should be used for the shortest period of time to minimize potentially underrecognized adverse effects in our veterinary patients. Further studies are needed to see if the use of natural albumin products such as canine serum albumin is superior to crystalloids alone in improving outcomes in veterinary patients.

Ultimately, I would be using them in cases where other options had been exhausted as far as supporting blood pressure and COP.

Hope that helps. Happy to chat through this more at Q&A too.

Scott 🙂