How JustAnswer Works:
  • Ask an Expert
    Experts are full of valuable knowledge and are ready to help with any question. Credentials confirmed by a Fortune 500 verification firm.
  • Get a Professional Answer
    Via email, text message, or notification as you wait on our site. Ask follow up questions if you need to.
  • 100% Satisfaction Guarantee
    Rate the answer you receive.
Ask DocPaul Your Own Question
DocPaul
DocPaul, Veterinarian
Category: Dog
Satisfied Customers: 1280
Experience:  20+ yrs exp. Emerg, Int Med, Ultrasound, Gen Practice.
20798050
Type Your Dog Question Here...
DocPaul is online now

I was my 10 year old miniature pinscher, Benny, one day and

Resolved Question:

I was petting my 10 year old miniature pinscher, Benny, one day and noticed the left side of his neck was swollen. My husband took him to the vet and the vet said the lymph nodes (6 of them) needed to be biopsied by FNA. I thought this was a bit odd and over-the-top as I didn't feel the other lymph nodes were enlarged but went ahead anyway.
By the time we took him in for the FNA the swelling on his neck returned to normal but the vet said we should still biopsy as this sometimes happens and they can become enlarged again. He had to be anaesthetised for the FNA procedure. The results have come back and now the vet says she needs to take another biopsy as the results are "suspicious" for lymphoma. I'm very frustrated because we've put Benny through that procedure and we are now none the wiser.I have a copy of the cytology report: "the lymph node aspirates, however, have harvested relatively monomorphic population of lymphocytes. Whilst these are not particularly large and atypical they are monomorphic enough to be suspicious of lymphoma. Perhaps a lower grade or more indolent form of lymphoma is present if these lymph nodes have increased in size more slowly. Unfortunately the cell preservation is quite variable but, again, I still feel this is monomorphic enough to warrant representative surgical biopsies and histopathology".I'm reluctant to put Benny through more anaesthesia when the swollen lymph node returned to normal on its own within one week. Also, the report says "if the lymph nodes have increased in size more slowly". This was not the case. Benny's neck was normal one day and swollen the next. I have not felt any other enlarged lymph nodes although the vet seemed to think all this lymph nodes were enlarged??? She even thought a fatty lump was a lymph node when a previous vet said it felt like a fatty lump.
My regular vet retired and sold his practice to a company so every time I go there my dogs are seen by a different vet which makes it really difficult to build up a trust with a particular vet.
Should lymph nodes be aspirated if they are not swollen? My old vet said he doesn't like to do FNA because the results are unreliable. I am thinking I might get a second opinion before jumping ahead with a biopsy.
Submitted: 1 month ago.
Category: Dog
Expert:  DocPaul replied 1 month ago.

Hi there,

Dr. Paul here.

I know that it can be frustrating but it sounds like the veterinarian did the least invasive test first-the fine needle aspirate. It is not uncommon for these to be non-diagnostic thus prompting the need for a biopsy.

Did I read correctly that the lymph nodes are no longer enlarged?

Paul

Customer: replied 1 month ago.
I don’t think they are enlarged. I must admit I don’t regularly check his lymph nodes but we did have a scare a few years ago that turned out to be a muscle infection (vet was thinking lymphoma then) so I know how they should feel. The muscle infection was on the same side of his neck that was enlarged. I only noticed one side on Benny’s neck enlarged but when my husband took Benny to the vet she felt six needed to be biopsied. I’m assuming because she felt that all six were enlarged.
Expert:  DocPaul replied 1 month ago.

Thanks for the added info. If the lymph nodes are no longer enlarged I highly doubt this is lymphosarcoma. They may have been reactive nodes or salivary glands and now that they are no longer enlarged/palpable you are probably okay just monitoring them. You are welcome to send me a photo of the neck if you think it will help me. But I trust your assessment that they are not enlarged any more.

Paul

Customer: replied 1 month ago.
I can feel the lymph nodes but this is normal isn't it? Comparing it to when it first popped up it's definitely back to normal; i.e. I cannot feel them just by stroking his neck like when I first noticed it. I have to really search around in order to get a good feel. I just feel like the vet maybe jumped the gun by saying they needed to be biopsied. Is it normal practice or would a conservative approach be to wait a week or two to see if they returned to normal? Now I'm totally confused as what to do.
Customer: replied 1 month ago.
Also, if I sent a picture it wouldn't look like anything but a normal dog's neck. I don't think it would help you much.
Expert:  DocPaul replied 1 month ago.

Thanks for the info.

It is a tough call so dont feel bad. If the nodes are smaller then before and no longer palpable then I would wait a week as long as Benny is eating and drinking and otherwise normal. If the nodes get bigger or if Benny starts acting sick again then you should have the biopsy done. Note that I say biopsy and not aspirate. The latter was non-diagnostic and will likely be that again. So if they are going to perform a second procedure it should be a biopsy.

Hope this helps and feel free to fire more questions at me if you have them.

Sincerely, Paul

Customer: replied 1 month ago.
If it adds anymore information, he was in the kennel for 5 nights a couple weeks prior to the enlarged lymph node. Yes, I understand the difference between the aspirate and biopsy. Benny is totally normal in himself. I'm just confused as the cytology report scares me but I really don't want to put him through another procedure with anaesthesia when it appears the lymph node returned to normal even before the FNA.
Expert:  DocPaul replied 1 month ago.

Thanks for the extra information. It could be that the nodes were enlarged for a bit before you noticed-nor picking on you ha ha-in which case maybe they were enlarged secondary to kennel cough or another viral disease.

If they are normal now i would wait. If it was my dog I would wait.

Give it a few days to a week and then re-assess.

And do not hesitate to reach out to me if you have more questions!

Paul

Customer: replied 1 month ago.
It’s been a week since the biopsy and I don’t feel like they’ve enlarged, but I’m also starting to feel like I’m getting paranoid and imagining things.
Can I ask you for an honest answer? Would you have suggested an FNA straight off the bat or would you have suggested to wait a week to see if it might have been an inflammatory response before doing an aspirate.
Feel like I should have trusted my gut instinct and not rushed into the FNA.
Expert:  DocPaul replied 1 month ago.

IF the lymph nodes were enlarged I would have done the aspirate-yes.

If they were not enlarged or were significantly smaller than a few days prior I would have waited.

Paul

Customer: replied 1 month ago.
Ok, thanks for the honest answer. That was my gut instinct at the time so was questioning why the vet would still want to biopsy when the swelling went down.
Expert:  DocPaul replied 1 month ago.

You are very welcome.

Please keep me posted.

DocPaul and 2 other Dog Specialists are ready to help you