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Harley had a CT scan on Monday, and needle biopsy Friday. Saturday
(yesterday) the report came back that he has cancer. It is in the
area of his right middle ear and TMJ. By the CT images, it does not
appear to be something operable - it does not have distinct borders
and there is no room to get margins. I have many things to discuss
with vets tomorrow: comfort care for the time being for sure; how
effective is radiation treatment vs. benefit to Harley; are there
any chemo protocols for this that can help? Also they push for a
full biopsy requiring surgery because the diagnosis will be more
"definitive" and they could stage the cancer then. But I question
the cost (both money and physical discomfort to Harley) vs. benefit
to him. How will the full biopsy change potential treatment? It
will cost money, has risk due to anesthesia, location of mass, and
possible infection, and will cause him some pain afterwards. Is it
worth it for the extra bit of detail? Below is the report if you're
interested, and able to read the technical stuff. One note on the
final comment that radiographs are recommended to rule out bone
involvement: the CT scan showed already showed bone lysis
(erosion), but the pathologist did not have access to the info from
the CT scan.<br>
<br>
In the meantime, Harley has gotten meloxicam or buprenorphine when
he doesn't want to eat. The anti-inflammatory effects of meloxicam
give him relief for 4 days or so, allowing him to eat comfortably.
I just worry about potential kidney toxicity with that drug, so they
have to be really careful about dosing, and the risk goes up
long-term. I wouldn't ordinarily say yes to that drug, but it helps
him. And if he's not going to make it long-term, the kidney concern
takes back seat to his comfort. The buprenorphine doesn't help
nearly as much, but may make him feel good. He has been eating all
his food for the last 5 days, and plays and grooms himself. A
little more subdued than usual, but he has a big burst of energy
after his breakfast or dinner.<br>
<br>
Marsha<br>
<br>
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<p class="western" style="margin-bottom: 0in; line-height: 100%"><font
color="#000000"><font face="Arial, serif"><font size="2">CLINICAL
INFORMATION:</font></font></font></p>
<p class="western" style="margin-bottom: 0in; line-height: 100%"><font
color="#000000"><font face="Arial, serif"><font size="2">Mass
adjacent to/involving the right tympanic bulla; painful to
open</font></font></font></p>
<p class="western" style="margin-bottom: 0in; line-height: 100%"><font
color="#000000"><font face="Arial, serif"><font size="2">mouth;
bulge palpated through skin medial to the right caudal
mandible</font></font></font></p>
<p class="western" style="margin-bottom: 0in; line-height: 100%"><font
color="#000000"><font face="Arial, serif"><font size="2">suspected
to
be the mass; blind aspirate; concern for carcinoma;</font></font></font></p>
<p class="western" style="margin-bottom: 0in; line-height: 100%"><font
color="#000000"><font face="Arial, serif"><font size="2">patient
is FeLV positive; regional node (and all peripheral nodes)</font></font></font></p>
<p class="western" style="margin-bottom: 0in; line-height: 100%"><font
color="#000000"><font face="Arial, serif"><font size="2">palpate
normal</font></font></font></p>
<p class="western" style="margin-bottom: 0in; line-height: 100%"><font
color="#000000">
</font><br>
</p>
<p class="western" style="margin-bottom: 0in; line-height: 100%"><font
color="#000000"><font face="Arial, serif"><font size="2">SOURCE:</font></font></font></p>
<p class="western" style="margin-bottom: 0in; line-height: 100%"><font
color="#000000"><font face="Arial, serif"><font size="2">Mass
adjacent to roof of mouth right side: 12 slides</font></font></font></p>
<p class="western" style="margin-bottom: 0in; line-height: 100%"><font
color="#000000">
</font><br>
</p>
<p class="western" style="margin-bottom: 0in; line-height: 100%"><font
color="#000000"><font face="Arial, serif"><font size="2">DESCRIPTION/MICROSCOPIC
FINDINGS/COMMENTS:</font></font></font></p>
<p class="western" style="margin-bottom: 0in; line-height: 100%"><font
color="#000000">
</font><br>
</p>
<p class="western" style="margin-bottom: 0in; line-height: 100%"><font
color="#000000"><font face="Arial, serif"><font size="2">Microscopic
Description:
The smears are low to moderately cellular on</font></font></font></p>
<p class="western" style="margin-bottom: 0in; line-height: 100%"><font
color="#000000"><font face="Arial, serif"><font size="2">a
clear background with moderate blood contamination, many
scattered</font></font></font></p>
<p class="western" style="margin-bottom: 0in; line-height: 100%"><font
color="#000000"><font face="Arial, serif"><font size="2">platelet
clumps
and a low to moderate number of ruptured cells. Few</font></font></font></p>
<p class="western" style="margin-bottom: 0in; line-height: 100%"><font
color="#000000"><font face="Arial, serif"><font size="2">small,
loosely cohesive clusters of polygonal to cuboidal
epithelial</font></font></font></p>
<p class="western" style="margin-bottom: 0in; line-height: 100%"><font
color="#000000"><font face="Arial, serif"><font size="2">cells
are observed. This population exhibits mild to moderate</font></font></font></p>
<p class="western" style="margin-bottom: 0in; line-height: 100%"><font
color="#000000"><font face="Arial, serif"><font size="2">anisocytosis
and
anisokaryosis. The cells have a small amount of</font></font></font></p>
<p class="western" style="margin-bottom: 0in; line-height: 100%"><font
color="#000000"><font face="Arial, serif"><font size="2">variably
staining
purple cytoplasm and a round central nucleus. The</font></font></font></p>
<p class="western" style="margin-bottom: 0in; line-height: 100%"><font
color="#000000"><font face="Arial, serif"><font size="2">nuclei
have finely stippled to reticular chromatin and often 1-2,</font></font></font></p>
<p class="western" style="margin-bottom: 0in; line-height: 100%"><font
color="#000000"><font face="Arial, serif"><font size="2">small
prominent nucleoli. There are also rare mesenchymal cells
noted</font></font></font></p>
<p class="western" style="margin-bottom: 0in; line-height: 100%"><font
color="#000000"><font face="Arial, serif"><font size="2">displaying
oval
nuclei, one to three small nucleoli and moderate</font></font></font></p>
<p class="western" style="margin-bottom: 0in; line-height: 100%"><font
color="#000000"><font face="Arial, serif"><font size="2">amounts
of basophilic cytoplasm. This population exhibits mild to</font></font></font></p>
<p class="western" style="margin-bottom: 0in; line-height: 100%"><font
color="#000000"><font face="Arial, serif"><font size="2">moderate
anisocytosis
and anisokaryosis and occasionally surrounds a</font></font></font></p>
<p class="western" style="margin-bottom: 0in; line-height: 100%"><font
color="#000000"><font face="Arial, serif"><font size="2">small
to moderate amount of pink extracellular matrix. No
infectious</font></font></font></p>
<p class="western" style="margin-bottom: 0in; line-height: 100%"><font
color="#000000"><font face="Arial, serif"><font size="2">agents
or cytologic evidence of inflammation are observed.</font></font></font></p>
<p class="western" style="margin-bottom: 0in; line-height: 100%"><font
color="#000000">
</font><br>
</p>
<p class="western" style="margin-bottom: 0in; line-height: 100%"><font
color="#000000"><font face="Arial, serif"><font size="2">Microscopic
Findings:
EPITHELIAL NEOPLASIA; MILD TO MODERATELY</font></font></font></p>
<p class="western" style="margin-bottom: 0in; line-height: 100%"><font
color="#000000"><font face="Arial, serif"><font size="2">ATYPICAL
MESENCHYMAL
CELLS</font></font></font></p>
<p class="western" style="margin-bottom: 0in; line-height: 100%"><font
color="#000000">
</font><br>
</p>
<p class="western" style="margin-bottom: 0in; line-height: 100%"><font
color="#000000"><font face="Arial, serif"><font size="2">Comment:
The
observed epithelial population exhibits only mild atypia</font></font></font></p>
<p class="western" style="margin-bottom: 0in; line-height: 100%"><font
color="#000000"><font face="Arial, serif"><font size="2">but
based on the number seen and the provided history raise
concern</font></font></font></p>
<p class="western" style="margin-bottom: 0in; line-height: 100%"><font
color="#000000"><font face="Arial, serif"><font size="2">for
a well-differentiated, malignant neoplasm. Cell morphology
of</font></font></font></p>
<p class="western" style="margin-bottom: 0in; line-height: 100%"><font
color="#000000"><font face="Arial, serif"><font size="2">this
population is most consistent with a basal cell, ceruminous
gland</font></font></font></p>
<p class="western" style="margin-bottom: 0in; line-height: 100%"><font
color="#000000"><font face="Arial, serif"><font size="2">or
apocrine gland population. Significance of the rare
mesenchymal</font></font></font></p>
<p class="western" style="margin-bottom: 0in; line-height: 100%"><font
color="#000000"><font face="Arial, serif"><font size="2">cells
is uncertain (they could be a fibrous component associated
with</font></font></font></p>
<p class="western" style="margin-bottom: 0in; line-height: 100%"><font
color="#000000"><font face="Arial, serif"><font size="2">the
mass/granulation tissue, connective tissue, possibly rare
cells</font></font></font></p>
<p class="western" style="margin-bottom: 0in; line-height: 100%"><font
color="#000000"><font face="Arial, serif"><font size="2">associated
with
a well-differentiated mesenchymal tumor). Tissue</font></font></font></p>
<p class="western" style="margin-bottom: 0in; line-height: 100%"><font
color="#000000"><font face="Arial, serif"><font size="2">biopsy
with histopathology is recommended for a specific diagnosis.</font></font></font></p>
<p class="western" style="margin-bottom: 0in; line-height: 100%"><font
color="#000000"><font face="Arial, serif"><font size="2">Radiographs
of
the area are also recommended to completely rule out</font></font></font></p>
<p class="western" style="margin-bottom: 0in; line-height: 100%"><font
color="#000000"><font face="Arial, serif"><font size="2">underlying
bone
involvement.</font></font></font></p>
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