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  Discussion on Extra nodal lymphosarcoma?
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Member:
nofences

Posted on Saturday, May 31, 2008 - 8:52 am:

My 21 yo paint developed two very large painless masses on his abdomen literally overnight, as well as a very swollen left eye two weeks ago. My vet at first did not think the abdominal swellings and eye were related, but ruled out bug bites, scratched cornea or irritant under eyelid. She manipulated the abdominal masses and said they do not penetrate the abdominal wall.

She prescribed a course of banamine, but I asked her to do a needle biopsy of the abdominal masses in hopes of getting a better idea of what was going on. The slides from this tissue show a lot of lymphocytes, but few if any white blood cells.

My vet returned two days ago and did an incision biopsy of one of the masses to rule out lymphosarcoma. Since then I have noticed two more smaller swellings. I have asked about starting Dex, or another steroid, but my vet wants to wait for the results of the biopsy.

I made a short video of the swellings which can be seen at this link:

https://www.youtube.com/watch?v=zewBXICaWQ0

Your thoughts and opinion would be most welcome, Dr. O! I have no lab results on Dan's blood work yet, as that was done on Thursday at the time of the biopsy. He's eating well, seems to be drinking more than usual, but he's alert and still shows no sign of pain.

Barbara
Member:
paul303

Posted on Sunday, Jun 1, 2008 - 12:02 am:

Good Heavens! That's really something, Barbara. It seemed to happen so fast....is there any possibility of bug bites? There's two horses around me that have allergic reactions to ticks and chiggers. Initially, they have huge swellings at the bite sites, then begin to exhibit general swelling and edema and hives.

Please keep us posted.
Member:
nofences

Posted on Sunday, Jun 1, 2008 - 7:19 am:

Yes, Lee, because these swellings appeared so dramatically fast my first thought was ticks or an allergic reaction because Dan has a history of hypersensitivity to bug bites. Both I and the vet examined the areas and could find nothing that pointed in that direction. As you can see on the video both abdominal swellings had been shaved to allow for the first needle biopsy, so it was possible to examine the areas carefully for even the small deer ticks that we have here. I asked if I should put him on a course of antihistamine or a steroid just to be sure, but she preferred trying banamine as an anti-inflamatory. When that did nothing, and the slides of the tissue she got with the needle showed a lot of lymphocytes and no WBC's her thoughts turned immediately to lymphosarcoma.

This young lady isn't my regular vet, but rather a new hire by my regular vet, right out of vet school, and this is the first time I've worked with her. She isn't as 'seasoned' as the owner of the practice, who I've had for close to 20 years, but that doctor is out of state right now.

I'm no expert on hives, but the few times any of my horses have had hives they did not present like this. I've also never experienced a horse with an eye as swollen as Dan's that didn't show any signs of itching or irritation. There was some slight 'weeping'last Thursday, because his upper and lower lids no longer meet, so I'm using the triple antibiotic ointment the vet gave me to try to keep his eye moist. Again, I had expected she would have given me a steroid ointment.

We will, hopefully, have the biopsy results tomorrow as we got the tissue samples into the lab last Thursday, and they need a few days to prepare them. I wanted to post the video because I wasn't able to find many still photos of masses related to lymphosarcoma, and most of the journal abstracts I've read have described horses with internal tumors. Of course I understand that Dan may have something going on internally, too, but so far he hasn't shown any symptoms. I'm hoping the biopsy and blood reports will give us a handle on what the future holds for this sweet guy.

I guess after reading the saga of Lynn Bystrom's mare Lulu, I am sharing her frustration with not being given *something* to give my poor guy. I know that Dex is used for a wide spectrum of conditions, and I guess I'm also feeling some uncertainty because this new vet isn't someone who I've had a long relationship with.

While I don't post here often, I find this site extremely useful and have the highest regard for Dr. O's knowledge and opinions. I know it's unfair to expect him to make a diagnosis based on the information I've provided so far, but I was hoping that his comments would help me ask the right questions of my own vet - and get through the weekend!

Thanks for your concern, Lee!

Barbara
Moderator:
DrO

Posted on Sunday, Jun 1, 2008 - 12:00 pm:

Hello Barbara,
Thanks for the kudos and I wish I had some words of wisdom for you. I agree these are not hives and the relation of the eye lid and abdominal subcutaneous swellings uncertain. The best way I know of answering the question is whether the swollen eye lid feels like just edema or is there a similarity to the subcutaneous mass? We will wait for the biopsy results which should answer all the questions.
DrO
Member:
nofences

Posted on Monday, Jun 2, 2008 - 7:40 am:

You're very welcome Dr. O. I have learned so much since I joined your site, and always turn here first when I need information.

I'll be putting in a call to my vet as soon as their office opens because Dan only made 7 piles of manure in the last 24 hours. His appetite hasn't changed, and he doesn't seem uncomfortable, although he did a funny little lopsided head tossing routine yesterday morning, then laid down for a couple minutes. He didn't roll or show any signs of distress, but I am so hyper alert for anything unusual, and this fit that category.

I'll post the lab results as soon as I get them, and then I'll probably have more questions!

Barbara
Member:
nofences

Posted on Tuesday, Jun 3, 2008 - 7:47 pm:

Well, the vet didn't get a chance to contact the lab yesterday before they closed so I didn't get the results until this morning. Unfortunately the lab said that the tissue samples were not diagnostically useful because they didn't go deep enough. The vet will return tomorrow to do an ultrasound guided biopsy, then we'll wait again.

The vet said the blood work was not remarkable. I asked her to fax the report to me, but it hasn't arrived yet, so maybe she'll bring it with her tomorrow. I have to go in to work tomorrow, as I took today off to take my husband for his own exploratory surgery. I won't be here to ask questions - but I will be in contact by phone.

You asked whether Dan's eye felt like just edema or more similar to the masses on his abdomen, Dr. O., and I would have to say that it feels more like edema to me.

The masses on Dan's abdomen feel even harder now than they did last Thursday, but they are also somewhat larger - I'm surprised the stitches have held over the incision in the mass on his right side! It appears that there are 2 more, smaller, swellings on the outer edge of the one in front of his left hind leg, and two medium sized swellings behind and between his front legs. These last two are about equal in size. The one on the right appeared last Thursday evening after the biopsy, then the left side began to swell Sunday. They are both about equal in size now, and almost look like prominent pectoral muscles.

I asked the vet if it wasn't time to try some sort of meds, and she said she would be bringing prednisone with her tomorrow.

That's about it for now. Dan's manure output has increased from the 24 hour period Sunday/Monday I was so concerned about, but it's still less that usual, and at least one pile during a 12 hr. period resembles a cow paddy more than horse manure. Isn't this a sign that the manure has stayed in the gut longer than usual and absorbed more water?

I started adding about a cup of bran to his regular soaked beet pulp and small amount of Senior feed, and I'm giving him mostly second cut hay (orchard grass) because it isn't as 'stemmy' as the first cut.

Barbara
Member:
paul303

Posted on Tuesday, Jun 3, 2008 - 10:55 pm:

Boy, Barbara, you're really in a nebulous position. You really don't know what you're dealing with. I have to say, that I would be tempted to apply hot saline soaks to see if it would exhibit any drawing effects. Other than that, I can't say. Boy, oh boy, hopefully your vet's lab will come up with something more concrete. Your boy is in wonderful shape, and the lack of an obvious explanation for the swellings is really troubling. Wishing you luck, Barbara, for a good outcome.
Member:
frances

Posted on Wednesday, Jun 4, 2008 - 11:54 am:

Yes, good luck Barbara - and I just wanted to say that I hope the vet brings prednisOLONE tomorrow rather than prednisone (which doesn't work in horses). DrO, your article on the subject has made me react the minute I see any mention of this drug - thanks!
Member:
nofences

Posted on Friday, Jun 6, 2008 - 6:25 pm:

Well, the lab report came back as lymphosarcoma today so I started Dan on prednisolone tonight and will add piroxicam in the morning(500 mg pred. and 160 mg piroxicam daily for a week). My vet had decided to wait for the results before starting any meds, and I may have heard her wrong the other day LL, but I definitely have prednisolone .

I know this will only postpone the inevitable for awhile, but I'm hoping he responds well enough to have a good few months anyway. I had tried ice on Dan's eye and abdominal swellings when they first appeared, Lee, but it didn't do anything. I didn't try hot soaks because once the vet came out and felt they weren't hematoma's or fluid filled I didn't think it would do any good.

A visiting vet has an ultrasound probe that he would like to use to check Dan internally. I'm grateful as it might give us a better idea of what's going on inside and help with planning the meds, and give a better idea of Dan's life expectancy. I asked if it would be possible to get some still images, and she thought there would be. I'd be happy to share them here if you thought it would benefit anyone, Dr.O.

Barbara
Member:
paul303

Posted on Friday, Jun 6, 2008 - 9:27 pm:

So sorry to hear that Barbara. If you could continue to post, I know I'd really be grateful. My heart goes out to you.
Moderator:
DrO

Posted on Friday, Jun 6, 2008 - 11:31 pm:

I am sorry to hear the diagnosis Barbara, we will hope for the cutaneous form being only present as the prognosis better. 500 mg of pred once daily would be a lower dose of glucocorticoid activity than with the middle ranges of the dex dosage recommended in the article. Dex is roughly 20 times as potent on a mg to mg basis with a much longer half life. Have your veterinarian recheck the dosage recommendation, I certainly will when in my office tomorrow.
DrO
Member:
lilo

Posted on Saturday, Jun 7, 2008 - 9:29 am:

Barbara - so sorry to hear about the diagnosis. Hoping that your treatment works!
Good luck,
Lilo
Member:
frances

Posted on Saturday, Jun 7, 2008 - 3:43 pm:

Very sorry to hear such a disappointing diagnosis, Barbara.
Member:
erika

Posted on Saturday, Jun 7, 2008 - 4:26 pm:

Well, Barbara, we were all hoping for better news. I hope your horse's journey is as comfortable as possible, and wish you the strength to help him.
Erika
Member:
corinne

Posted on Sunday, Jun 8, 2008 - 10:59 am:

Barbara my prayers are with you and your horse as well. Thank you for the You Tube link. It's so nicer easier to get the full picture (so to speak) from video than from a still image. What a great tool. So Sorry to hear about the diagnosis and I hope you both hang in there. Let us know if we can be of any assistance.

Corinne
Member:
sunny66

Posted on Sunday, Jun 8, 2008 - 11:26 am:

Barbara, I'm very sorry to hear of the diagnosis. I watched the video and he seems like such a sweet boy. Sending healing thoughts to him and strength to you (((Barbara)))
Member:
vickiann

Posted on Sunday, Jun 8, 2008 - 2:59 pm:

Thank you for sharing this, Barbara, so that we can all learn from it. I am very sorry to hear of this diagnosis for your lovely horse.
Member:
jowidner

Posted on Monday, Jun 9, 2008 - 2:38 pm:

Barbara, I'm so sorry to hear of this prognosis. Your boy does look so very sweet. Wishing you strength and healing to your boy. I know you will be watching him closely to keep him comfortable.

My dear old mare passed away at age 31 from complications of her cancer. She did very well for several months (much longer than her initial prognosis) and those months were a treasure because she did quite well until her final few days. We were able to spent many sweet hours together and I wish this for you and your horse as well.
Member:
nofences

Posted on Wednesday, Jun 11, 2008 - 8:38 am:

Thank you all for your kindness and concern. My vet did the ultrasound yesterday and found that there is quite a bit of fluid in Dan's abdomen, but his spleen and what she could see of his kidneys look normal. It also showed that there are definitely more masses growing near the obvious swellings. The swelling between & behind his front legs is edema, as they go from being firm to flabby, and almost disappearing for a short time.

We will be doing an abdominal tap when the weather cools down a bit. It was so hot and humid here in New England that I didn't want to stress Dan since this wouldn't change the treatment or outcome of his disease, but would only be academically useful.

When I asked why she had chosen prednisolone over Dex, Dr. O., she said it was because of concerns with laminitis when using Dex.

I am so glad that Dan doesn't appear to be in any pain, and still gets excited when it's dinner time, or grooming time (he loves to be brushed). I will cherish the good times we have together.

Barbara
Moderator:
DrO

Posted on Thursday, Jun 12, 2008 - 6:22 am:

Hello Barbara,
For more on dex and founder refer to the articles on steroids but in short I personally do not feel the dex represents a significant risk but it is a choice that can be made if the pred does not work. Belly taps, though they sound awful, are not stressful to the horse and can be performed at anytime with very light sedation (to insure the horse stays still) and a local.
DrO
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