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LYMPHOMA IN DOGS
BOBBY RAE
Border Terrier
10 years old, ME
Arrived from Vets Now
without owner or carer
Admitted over weekend
for vomiting and
lethargy
Completely flaccid
upon arrival
CLINICAL EXAM
T 37.4oC
P 108
R 66
Increased respiratory noise
Extremely lethargic
Generalised lymphadenopathy
CRT <2s but slight yellow tinge
Liver and spleen palpable
Congested scleral vessels
Opacity in L cornea
Submandibular LN
37mm x 22mm
Prescapular LN
44mm x 25mm
Inguinal LN
41mm x 21mm
Popliteal LN
28mm x 20mm
CLINICAL EXAM
Ophthalmology consult
Mass in anterior chamber of R eye
Possible dry eye (left)
Translimbal neovascularization L > R
Cataract
Severe anterior uveitis
17mmHg pressure in both eyes
Too cloudy to examine retina
CLINICAL EXAM
Ophthalmology consult
Mass in anterior chamber of R eye
Possible dry eye (left)
Translimbal neovascularization L > R
Cataract
Severe anterior uveitis
17mmHg pressure in both eyes
Too cloudy to examine retina
Lymphoma infiltration of
the eyes
PROVISIONAL DIAGNOSIS
Stage Vb lymphoma
Extranodal involvement (eyes)
Showing clinical signs
Ideally should do bone marrow aspirate to check
for bone marrow involvement
LYMPHOMA
Malignant proliferation of peripheral
lymphoid tissues
Predisposing factors
3 ways of classification
Anatomical
Histological (low/intermediate/high)
Immunophenotype (B/T/null)
CLINICAL PRESENTATION
Variable and depends on extent and
location
Generalised lymphadenopathy
Paraneoplastic syndromes
Hypercalcaemia
Cancer cachexia
Monoclonal gammopathy
Globulin
spikeAlb
APPROACHING LYMPHOMA
Bloods
Haematology, biochemistry
FNA of lymph nodes
Thoracic radiographs
Abdominal ultrasound
Bone marrow aspirate
BACK TO BOBBY
Bloods
Haematology + biochemistry + coagulation
FNA of submandibular and popliteal LNs
Cytology
PARR (PCR for Antigen Receptor Rearrangement)
Thoracic radiographs
Abdominal ultrasound
BOBBY’S BLOOD RESULTS
Thrombocytopenia?
Hypoglycaemic
Decreased TP
liver enzymes
NH3
PT 22.9s 14 – 19
aPTT >200s 75 – 105
ULTRASOUND
Lymphadenopathy
Hepatomegaly
Splenomegaly
Cholecystitis
Pancreatitis
Prostatomegaly
FNA of liver and spleen
CHEMOTHERAPY
Combination protocols
CHOP
COP
Doxorubicin single agent
Re-induction or rescue therapy
> 1m since stopping initial protocol: re-induction with
that same protocol
If re-induction fails, use rescue therapy
Extranodal lymphoma
Chemotherapy
Local therapy
PROGNOSIS
Immunophenotype
B cell
T cell
Null cell
WHO stages
I, II, III, IV, V
Sub-stage a
Sub-stage b
Any concurrent conditions
BOBBY’S INITIAL TREATMENT
IVFT (normal saline + glucose)
L-asparaginase
Maropitant
Vitamin K
Dexamethasone (reduced dose)
Ursodeoxycholic acid (Destolit)
AFTER THE INITIAL TREATMENT
QAR but no longer comatose
LN softer and smaller
Improvements in biochemistry
Appetite slowly returning
Cautiously optimistic
Continue with chemotherapy
L-CHOP protocol
Vincristine (reduced dose)
Urinalysis
AFTER THE INITIAL TREATMENT
QAR but no longer comatose
LN softer and smaller
Improvements in biochemistry
Appetite slowly returning
Cautiously optimistic
BOBBY’S PROGNOSIS
Problems
Stage Vb lymphoma
Acute liver failure
B cell lymphoma
Overcame acute liver failure, fair prognosis
6 – 9 months
DAY OF DISCHARGE
Terror terrier
Normal sized lymph nodes
Take home medications
Ranitidine
Destolit
Prednisolone
Promax
Back Thursday (yesterday)
for recheck and
cyclophosphamide
TAKE HOME MESSAGES
Step by step approach
to lymphoma
Clinical exam
Stage – measure LN
May involve other
organs
REFERENCES
Jane M. Dobson, B. Duncan X. Lascelles. (2011). Chapter 19: Tumours of the Haemopoietic System. In: Jane M.
Dobson, B. Duncan X. Lascelles BSAVA Manual of Canine and Feline Oncology. 3rd ed. London: British Small Animal
Veterinary Association. p285-291.
Edward J. Hall, James W. Simpson, David A. Williams. (2005). Chapter 3: Imaging of the Gastrointestinal Tract, Liver
and Pancreas. In: Edward J. Hall, James W. Simpson, David A. Williams BSAVA Manual of Canine and Feline
Gastroenterology. 2nd ed. London: British Small Animal Veterinary Association. p29.
Edward J. Hall, James W. Simpson, David A. Williams. (2005). Chapter 28: Therapeutics. In: Edward J. Hall, James W.
Simpson, David A. Williams BSAVA Manual of Canine and Feline Gastroenterology. 2nd ed. London: British Small
Animal Veterinary Association. p311.
Companion Animal Studies (CAS) lecture – Oncology 3: Approach to lymphoma and leukaemia. J.S. Morris, BSc, BVSc,
PhD, FRCVS
Ian Ramsey (2014). BSAVA Small Animal Formulary . 8th ed. London: British Small Animal Veterinary Association
I. Amores-Fuster, P. Cripps, P. Graham, A. M. Marrington, L. Blackwood. (2015). The diagnostic utility of lymph node
cytology samples in dogs and cats. Journal of Small Animal Practice. 56 (2), p125-129.
http://www.animalhealth.msu.edu/ClientEducation/MKTG.CARD.ANATOMICPATHOLOGY.010.PDF Information Cards
by Lab Section - For Practitioners, Anatomic & Surgical Pathology, PCR for Antigen Receptor Rearrangements
Nerschbach V, Eberle N, Joetzke AE, Hoeinghaus R, Hungerbuehler S, Mischke R, Nolte I, Betz D. (2014). Splenic and
hepatic ultrasound and cytology in canine lymphoma: effects of findings on stage migration and assessment of
prognosis. Veterinary and Comparative Oncology. 12 (4).
https://www.marshfieldlabs.org/proxy/RefPointWinter13.1.pdf Marshfield Labs
Claire Inderbinen Kaiser, Janean L. Fidel, Malgorzata Roos, and Barbara Kaser-Hotz (2007) Reevaluation of the
University of Wisconsin 2-Year Protocol for Treating Canine Lymphosarcoma. Journal of the American Animal Hospital
Association: March/April 2007, Vol. 43, No. 2, pp. 85-92.
Stephen Withrow, David Vail. (2012). Chapter 32A: Canine Lymphoma and Lymphoid Leukemia. In: Stephen Withrow,
David Vail Withrow and MacEwen's Small Animal Clinical Oncology. 5th ed. Gloucester: Elsevier Saunders. p608-627.