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  #11  
Old 05-10-2008, 04:16 PM
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Default Re: Kitty Gus is sick

Gus has been doing okay, not really well and not really bad if you know what I mean. He's been allowed to eat as much as he wants, much to Katie's dismay. Fortunately, so far (knock on wood til my knuckles bleed!) the various foods haven't caused a digestive problem.

I haven't had a chance to discuss it with the vet yet but I got a faxed copy of the pathology report on the needle aspirates of the liver, spleen, and ileum (end of small intestine). I'm not 100% certain but I think it says basically what the vet was saying - looks like it could be early lymphoma but it's not certain. The blood tests that will help sort out the diagnosis will take another week to come back.

Everything he's been experiencing seems to be consistent with lymphoma from the intestine, if he has lymphoma at all. The blood test will determine whether the calcium is being raised by the parathyroid or by lymphoma.

Natalie


Pathology Report

Diagnosis:

1. Liver - Moderate to marked hepatocellular vacuolication with scattered neutrophils and lymphocytes. (I think this may be related to the concern about fatty liver from not eating enough)

2. Ileocolic - Neutrophilic, lymphocytic, and eosinophilic inflammation; possible lymphoma of small granular lymphocytes.

3. Lymph node - Atypical lymphoid hyperplasia; possible early small lymphoma of small granular lymphocytes.

4. Spleen - Lymphoid hyperplasia.

Comments:

The aspirate of the liver contains evidence of hepatocellular lipidosis. Excessive accumulation of lipid in hepatocytes may result in hepatic dysfunction. Feline hepatic lipidosis syndrome is most common in obese anorectic cats but may also be seen in association with rapid weight loss, nutritional imbalances, diabetes mellitus, pancreatitis, or metabolic liver disease. In many cases, no underlying cause can be identified (idiopathic hepatic lipidosis).

The splenic aspirate contains lymphoid cells as well as hematopoietic precursors. There are not features of neoplasia evident in the splenic aspirate, although there are many lysed cells.

In the aspirate from the bowel, there is a mixture of cells, including lymphocytes, eosinophils, and neutrophils. Some of these lymphocytes have a slightly increased volume of cytoplasm in which visible pale granules can be found. Similar cells are seen in the node aspirte. When more than 10% of the cells in the node contain these granules (as is suspected here), there is often associated lymphoma of granular lymphocytes. This type of lymphoma usually originates in the small intestine or mesenteric nodes in cats but may infiltrate other organs. Granular lymphocytes are thought to be cytotoxic T lymphocytes or NK cells. Historically, this type of lymphoma has been variabley responsive to chemotherapeutics.
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  #12  
Old 05-10-2008, 05:15 PM
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Default Re: Kitty Gus is sick

It looks to me like what you think. FWIW, here's the wiki page on hepatic lipidosis--fatty liver:

http://petdiabetes.wikia.com/wiki/Hepatic_lipidosis

They seem to be saying that the signs are there for a possible bowel lymphoma, but that it isn't "absolute" but possible. Guess there's no "for sure" until the blood results come back. Sure hope if Gus HAS to have a problem that the parathyroid's the one!

Keep up the Good Work, Gus!
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  #13  
Old 05-11-2008, 07:09 PM
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Default Re: Kitty Gus is sick

I'm sorry you didn't get more definative answers yet. Those results aren't what I'd want to read as possibilities!

Hope you find out it's the parathyroid thing. I know people who've had this and it's not a big deal but makes a big difference in their health.

Will watch for your update.
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  #14  
Old 05-12-2008, 01:11 PM
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Default Re: Kitty Gus is sick

Natalie,
Your report on Gus is to many big words for me!!!! Can you explain in laymans terms when u get the blood work back??
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  #15  
Old 05-12-2008, 08:50 PM
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Default Re: Kitty Gus is sick

Marianne, I hope so but don't count on it!! I had to do a fair amount of looking up terms on the internet to make sure I was understanding it!

I'm relying on the inclusion of "possibly lymphoma" to take the meaning to be it's not a conclusive diagnosis. So I'm very very anxious for the blood tests to come back so we know what to do next. Still haven't talked to the vet - I think he may be waiting for the blood tests too.

Natalie
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  #16  
Old 05-15-2008, 01:58 PM
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Default Re: Kitty Gus is sick

Just got off the phone with the vet now that all of Gus' test results are back. He also discussed them with the pathologist who reviewed the biopsies as it's kind of a muddy picture.

The hypercalcemia (high calcium level in the blood) has been diagnosed as idiopathic, which means they don't know why the calcium is high. The only thing to be done for that would be to give subq fluids to help flush the kidneys.

The test for parathyroid hormone came back in the normal range so that suggests there is no growth on the parathyroid gland.

The PTH-related hormone test came back negative, which says there's no raging lymphoma.

The vet says there is a gradient in cats from IBD to lymphoma. They believe that lymphoma often gets started with IBD and it may even be that most cats with IBD eventually will develop lymphoma.

So Gus' diagnosis is severe IBD and/or emerging lymphoma - that he's likely somewhere in the middle of that gradient.

He's being prescribed prednisolone (steroid) for the IBD and leukeran (low-grade chemo drug that's good at targeting lymphocytes).

And he's to stay on a novel-protein diet in case his diet is part of the IBD.

This is a cat who basically can't be pilled. Still working on a solution for that. The vet says it could be compounded into a single medicine but I'm going to try the pills first.

And will try to get him to eat the Lamb IVD.

Natalie

Last edited by k9diabetes; 05-17-2008 at 04:55 PM. Reason: typo
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  #17  
Old 05-15-2008, 03:33 PM
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Default Re: Kitty Gus is sick

You go, GUS!!!!!!!!
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  #18  
Old 05-16-2008, 05:21 AM
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Default Re: Kitty Gus is sick

This is what I went through with Reba, lots of tests bt nothing that made it a clear dx showing we HAD to use Lysodren. Argh!

Steroids can be compunded into a creanm to rub on the ear, I believe, but I wouldn't think a chemo drug could. You have a pill popper? Saves your fingers but their claws still get your arms.

I've even ahd help with some cats and it can still be a chore! some of mine are famous for holding and spitting them out later.

IBD to lymphoma?

You might consider all meat food since some think that carbs feed cancer cells. I'm getting all mine switched over because of Bubba but it's going to take awhile, I have several kibble lovers and a couple that don't give a hoot about canned so....

How's he feeling now? Any signs of ANYTHING?
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  #19  
Old 05-16-2008, 11:46 AM
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Default Re: Kitty Gus is sick

The IBD to lymphoma continuum was really interesting to me. I noticed that an article by Dr. Tam, who is an IBD expert, covered IBD and lymphoma in cats in one article. He didn't directly relate them but I can see where a chronic case of IBD could lead to lymphoma in the intestinal tract. I'm hoping to get a chance to research this a little.

The thing I "like" about that explanation is it makes sense of Gus' test results. He's not lymphomic enough to come up positive on the tests but there are also lymphoma signs in the ileum and lymph node.

Gus is about the same but doesn't want to eat the IVD.

I managed to get at least part of the prednisolone in him last night. It's syrup and he's wearing part of it on his cheek. The leukeran had to be ordered so will pick that up today. If it's a pill, I"ll try pill pockets but he may not eat them.

He and Katie both fight like kamikaze warriors when they need pills and they're very strong and muscular in the front legs... plus Gus is doublejointed, which makes him very very good at reaching around and snagging skin. I was thrilled that his last antibiotic was a tasteless liquid that could be put in canned food gray.... we shall see how it goes!

Natalie
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  #20  
Old 05-17-2008, 04:09 PM
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Default Re: Kitty Gus is sick

For those interested in the IBD/Lymphoma link in cats, it didn't take much digging to find references to it...

http://www.vin.com/proceedings/Proce...2980&O=Generic

Quote:
Feline Alimentary Lymphoma

One well-recognized, but poorly defined, example of inflammation-associated neoplasia is the proposed progression from inflammatory bowel disease (IBD) to alimentary lymphoma. This progression is documented in human patients with coeliac disease, and although reported in both the dog and cat, this appears to be far more of an issue in the feline species.

In fact, the distinction between IBD and alimentary lymphoma on histopathological examination of gut biopsies still provides one of the most challenging interpretations for the diagnostic pathologist. Determining whether a mononuclear cell infiltration of the intestinal lamina propria is reactive or neoplastic has now been aided by the techniques of immunohistochemistry and clonality testing. Immunohistochemical labeling for the expression of molecules restricted to T (e.g., CD3) or B (e.g., CD21, CD79a) lymphocytes can determine whether an infiltrate is mixed in nature or monomorphic--the latter being more likely associated with neoplasia.3

In a recent investigation, we reviewed 32 cases diagnosed as alimentary lymphoma by routine examination of HE-stained intestinal biopsies taken from cats with chronic diarrhoea.4 Immunohistochemistry defined these as predominantly T cell tumours, with fewer B cell or null cell lymphomas. Of greater interest, was the group of 5 cases in which immunohistochemistry was able to demonstrate a mixed infiltrate of morphologically-normal cells more consistent with chronic inflammation than neoplasia. The recent introduction of 'clonality testing' (at least in the United States) has provided a second means of making this distinction.5 This methodology determines whether the population of lymphocytes infiltrating the mucosa is monoclonal (i.e., carries a single type of T or B cell receptor) or polyclonal (i.e., a mixed population with numerous different T and B cell receptors)--the former associated with neoplastic transformation. Clonality testing has to date been most widely applied to blood samples or fresh lymphocyte suspensions, but can also be performed with fixed tissue biopsies.
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