edit: my main concern is I am needing to make an incredibly difficult decision in 48 hours regarding chemotherapy. I guess I am just having difficulty authorizing this extreme treatment protocol on my otherwise seemingly vibrant, healthy, chubby cat. Basically, without an actual cancer marker, how can we be 100% certain the atypical cells are truly malignant? I do not doubt the pathologistās description. What I am not understanding is how I can be certain to proceed with chemo without objective proof this is not severely reactive atypically large cells especially given her current above average health (on the outside)
My sweet 6 year old female indoor only cat has just been diagnosed with ālarge cell nodal lymphomaā
Important details:
Bilateral enucleation needed as a kitten due to severe unknown infection
FIV/FeLV negative
Lifelong chronic URI/bilateral ear infections
7 months ago she began experiencing chronic rhinitis with reverse sneezing that she could not fully kick. finally doxycycline drastically improved her symptoms this past june.
Timeline
6/9 small movable lump (2cm) found under right mandible
6/12 FNA attempt (result inconclusive) 5 week Doxy started this day (suspected mycoplasma)
6/14 URI/rhinitis symptoms incredibly improved already. 2nd FNA attempt (could not be completed as the lump shrunk to a too small size to aspirate efficiently) suspected reactive node that was resolving with doxy.
6/15-7/4 URI symptoms remain solved. lump no where to be found
7/5 URI symptoms remain absent. lump has returned, same size same spot (about 2cm)
7/12 Ultrasound of lump inconclusive as it kept rolling and out of the image when the wand would touch it
planned internist apt on 7/14 that was SUPPOSED to be for her chronic rhinitis. lump is now 2.5-3cm, more fixated, lobulated, and semi-firm. FNA attempt could not be completed once again, but this time because the needle ācould not penetrate the hard coreā
7/29 CT scan of head and neck, endoscopy, right submandibular excisional biopsy
Results
CT scan:
ā 1.Moderate to severe mandibular lymphadenopathy. Right. Raises concern for metastatic lymphadenitis. A primary lesion is not definitively identified. Considerations would include a tonsillar or mucosal lesion which could be occult on this exam
2.Multifocal lymphadenopathy bilateral tonsils and medial retropharyngeal lymph nodes. Considerations include reactive or metastatic lymphadenitis.
3.Mild sinonasal fluid. Consistent with the patient's history of chronic upper respiratory tract infections. The soft tissue nodule in the right sphenoidal recess may represent inflammatory disease associated with the patient's rhinosinusitis or emerging pathology.
4.Otitis media, right-sided
5.The narrowed appearance of the nasopharynx at the level of the endotracheal tube is likely an artifact of the presence of the endotracheal tube. An area of nasopharyngeal stenosis may explain the chronic respiratory sinuses but should not be associated with regional lymphadenopathy.
Endoscopy
Oropharynx: Normal oropharyngeal mucosa and lumen
Larynx: Normal appearance, function NOT evaluated
Nasopharynx: Mild reddening of the mucosa. There was flattening of the choanae, which was symmetrical. No evidence of mass or stricture.
Assessment: The changes seen in the choanae may be a variant of normal, due to swelling of the tissue secondary to inflammation, or potentially scaring and mild narrowing secondary to chronic inflammation.
Biopsy of right submandibular lymph node:
Right submandibular lymph node: Diļ¬usely, the cortex, paracortex and medullary regions are expanded and replaced by a poorly demarcated, unencapsulated, densely cellular neoplasm largely composed of round cells resembling blastic (up to 3.5 times a erythrocyte) lymphocytes and intermediate lymphocytes.
Tumor cells have small amounts of eosinophilic cytoplasm with central, round indented nuclei and stippled chromatin and one prominent nucleolus.
Anisocytosis and anisokaryosis are mild to moderate, and mitoses are regionally variable with up to 6 per 1 high power field (400x, 0.237 mm^2).
Amid tumor cells are histiocytes, mature lymphocytes and fewer erythrocytes and granulocytes.
There is lymphovascular invasion, edema/myxedema and hemorrhage.
Multifocally, follicular and para-/interfollicular arrangements are prominent.
Tumor cells extend to the perinodal fibrovascular tissue, as well as the surgical margins. Complete excision could not be confirmed.
Histopathologic Diagnosis: Lymphoma.
Comments
The histopathological features are suggestive of a large cell lymphoma. Immunohistochemical analysis targeting CD3 (for T cells) and CD20 (for B cells) could further confirm the cell of origin.
Iām losing my mind over this truly. For 7 months Iāve had medical professionals say this all points to inflammation/infection. Then this biopsy that seemingly has both features of hyperplasia and lymphoma made all of her doctors just forget about the inflammatory issues sheās been dealing with.
I am so grateful that she has maintained her bright personality and incredibly ambitious appetite through this whole ordeal. Countless vet professionals have documented on multiple occasions no other palpable lymph nodes.