Hello & welcome, I am Dr. B, a licensed veterinarian and I would like to help you with your wee one today.
Now to help me to help you, can you post the report so that I can read and then interpret it for you?
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ok, Leo was sedated in the consulting room. He then inserted a needle (no syringe attached) and moved it around , withdrew it, did it again, and then he attached the syringe and put the end of the needle on a microscopic glass plate and depressed the syringe, at which point the contents of the needle appeared on the slide.
Thank you,That is fine, Aaon. The reason I ask is because this would mean that Leo had a fine needle aspiration (FNA) sample collected and not a biopsy. The reason why this is important is because while we can diagnose lymphoma from an FNA, we cannot grade or type (ie T or B cells) without a biopsy. Therefore, this is why his report has no mention of grade or type; though it does suggest that we at least have a lymphoblastic (as the cells are immature in appearance) as opposed to lymphocytic (mature or small cell) lymphoma.Now despite that I have translated the report to make it more readable for you. If there is anything else that you need explaining from my translation, do let me know.Here is the report in a bit more English:
Cytology (not biopsy)
The vet submitted three slides to the lab. This suggests aspirates were taken from an enlarged lymph node instead of a biopsy of tissue being sent.
Each slide had a large number of good quality intact cells (which is key for identifying the nature of any mass) that were mostly large round cells (blast or immature lymphocytes). The background material is typical of what we see from a lymph node.That majority of large round cells that were seen have abnormal nuclei with abnormally visible chromatin (the genetic material of the cell). Instead of having one nucleoli like a normal cell should; these cells are often showing numerous nucleoli. The nucleus are bigger then they should be and thus there is very little cytoplasm. There is evidence of low grade cellular division on the slide (the ”mitoses”).The pathologist has also seen a few small lymphocytes (which tend to be the normal ones) and some other white blood cells (that are not significant here).
Overall, these large round cells are demonstrating a number of the criteria for malignancy (the overrepresentation of large blastic lymphoid cells, the appearance of the overly big nuclei, the multiple nucleoli within them and visible chromatin). Therefore, these multiple changes suggest abnormal cells which are the basis of cancer. Hence why this is lymphoma per the pathologist’s exam and not just a reactive lymph note.
The slide is showing a large volume of immature lymphoid cells that have abnormal changes that support lymphoma. From here the pathologist, advises to check for a mass in the mouth or any other internal organ or lymph node enlargement.
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Okay, thank you. So, do I assume that we are at the very early stages of cancer then. You say that there is a 'suggestion' of abnonrmal, cancerous cells - is it not a 'cut and dried' situation - either he has cancer or he doesn't?
I see in your translation again there is no mention of T cells or B cells - are these only tested on a full biopsy and so not visible here?
he has been examined thoroughly - joints etc, and the vet says there is no evidence of anything anywhere else. He is no different in his manner, actions or activity than he has been for years (he has always been a bit 'laid back', so to speak).
Therefore, I guess I am asking you not for a prognosis, but in your opinion (I accept you have not seen Leo, and that this is only an opinion based on your experience etc etc and I promise not to sue you) what stage in the illness are we, and can we expect a while yet with our boy?
We looked into Chemo tablets but decided against, and when the time comes we will give him steroid treatment until the point where we know tha time is right.
We have 10 dogs at the moment - we have lost 3 this year already to illness and old age, so I just want to try and get some idea of what to be prepared for over what sort of period of time.
Your opinion would be appreciated
Sorry - I missed a bit of your reply - just read about hte T/B cells, but I also note that you say "we at least have a lymphoblastic (as the cells are immature in appearance) as opposed to lymphocytic (mature or small cell) lymphoma."
Is that good? Can we do more to slow down the rate of cancer growth because of that?
Hi again Aaron,
I would never call cytology cut and dry (the pathologists would smack me if I did). The findings of the pathologist is very much dependent on the quality of the samples, slides, and what cells are present to see. Still in this case, with the multitude of abnormal cells showing those abnormal features that are characterized by cancer; the diagnosis is quite clearly lymphoma. So, even though lymph nodes can be tricky to diagnose, in this case I am sorry to say that all the features described are clear and tell us that we have a cancerous lymph node.
As I mentioned prior to translating the report for you, without a biopsy there can be no diagnosis of B vs. T cell lymphoma.So, I do promise I am not being coy, but rather it is not possible to tell which cell type is present on FNA or cytology alone. The cells will look too similar to be identified on cytological examination and differentiation is determined by the use of special stains, which require a fixed section of tissue that would be obtained by biopsy only.
The reason biopsy and typing/grading is so important even after one has a diagnosis via FNA is because this is the only way to truly get an idea of prognosis for a dog’s individual cancer. It tells us whether we have B vs T cell based lymphoma but is also the means in which we can determine a tumor grade and stage. Therefore, without these we can only speculate in general and cannot truly get an idea of their prognosis or survival time.
And without the knowledge the biopsy would provide, we can only call this a lymphoblastic (as the cells are immature) lymphoma that would be potentially a stage I (since its only in a single lymph node) and it would be an “a” since he is clinically well. So, if we were pushed to stage without a biopsy we could only say a lymphoblastic lymphoma at stage IA.
Just to note the blastic vs. cytic is not going to be significant here, I was just saying that the cancer is arising from early stage cells and is less developed. In the majority of canine cases, this is what we see as opposed to cancers arising from later stages along the lymphocyte maturation. So, it is just a character of the cancer but wouldn't give us any hints with B/T cell type or prognosis here.
Overall, without a cell type or histological grade, we do have to consider the standard lymphoma survival times. Therefore, generally speaking, the life expectancy of these untreated dogs averages 4 to 6 weeks. With steroids alone, survival time has been found to be around 2 - 3 months. Since he has only one node affected and the number of cell divisions were not massive, we would hope that these time frames would be expanded for Leo.