Harley had a CT scan on Monday, and needle biopsy Friday. Saturday
(yesterday) the report came back that he has cancer. It is in the area
of his right middle ear and TMJ. By the CT images, it does not appear
to be something operable - it does not have distinct borders and there
is no room to get margins. I have many things to discuss with vets
tomorrow: comfort care for the time being for sure; how effective is
radiation treatment vs. benefit to Harley; are there any chemo protocols
for this that can help? Also they push for a full biopsy requiring
surgery because the diagnosis will be more "definitive" and they could
stage the cancer then. But I question the cost (both money and physical
discomfort to Harley) vs. benefit to him. How will the full biopsy
change potential treatment? It will cost money, has risk due to
anesthesia, location of mass, and possible infection, and will cause him
some pain afterwards. Is it worth it for the extra bit of detail?
Below is the report if you're interested, and able to read the technical
stuff. One note on the final comment that radiographs are recommended
to rule out bone involvement: the CT scan showed already showed bone
lysis (erosion), but the pathologist did not have access to the info
from the CT scan.
In the meantime, Harley has gotten meloxicam or buprenorphine when he
doesn't want to eat. The anti-inflammatory effects of meloxicam give
him relief for 4 days or so, allowing him to eat comfortably. I just
worry about potential kidney toxicity with that drug, so they have to be
really careful about dosing, and the risk goes up long-term. I wouldn't
ordinarily say yes to that drug, but it helps him. And if he's not
going to make it long-term, the kidney concern takes back seat to his
comfort. The buprenorphine doesn't help nearly as much, but may make
him feel good. He has been eating all his food for the last 5 days, and
plays and grooms himself. A little more subdued than usual, but he has
a big burst of energy after his breakfast or dinner.
Marsha
CLINICAL INFORMATION:
Mass adjacent to/involving the right tympanic bulla; painful to open
mouth; bulge palpated through skin medial to the right caudal mandible
suspected to be the mass; blind aspirate; concern for carcinoma;
patient is FeLV positive; regional node (and all peripheral nodes)
palpate normal
SOURCE:
Mass adjacent to roof of mouth right side: 12 slides
DESCRIPTION/MICROSCOPIC FINDINGS/COMMENTS:
Microscopic Description: The smears are low to moderately cellular on
a clear background with moderate blood contamination, many scattered
platelet clumps and a low to moderate number of ruptured cells. Few
small, loosely cohesive clusters of polygonal to cuboidal epithelial
cells are observed. This population exhibits mild to moderate
anisocytosis and anisokaryosis. The cells have a small amount of
variably staining purple cytoplasm and a round central nucleus. The
nuclei have finely stippled to reticular chromatin and often 1-2,
small prominent nucleoli. There are also rare mesenchymal cells noted
displaying oval nuclei, one to three small nucleoli and moderate
amounts of basophilic cytoplasm. This population exhibits mild to
moderate anisocytosis and anisokaryosis and occasionally surrounds a
small to moderate amount of pink extracellular matrix. No infectious
agents or cytologic evidence of inflammation are observed.
Microscopic Findings: EPITHELIAL NEOPLASIA; MILD TO MODERATELY
ATYPICAL MESENCHYMAL CELLS
Comment: The observed epithelial population exhibits only mild atypia
but based on the number seen and the provided history raise concern
for a well-differentiated, malignant neoplasm. Cell morphology of
this population is most consistent with a basal cell, ceruminous gland
or apocrine gland population. Significance of the rare mesenchymal
cells is uncertain (they could be a fibrous component associated with
the mass/granulation tissue, connective tissue, possibly rare cells
associated with a well-differentiated mesenchymal tumor). Tissue
biopsy with histopathology is recommended for a specific diagnosis.
Radiographs of the area are also recommended to completely rule out
underlying bone involvement.
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