High Grade Lymphoma Dogs
1.) A CLASSIC, CLASSIC, CLASSIC presentation for high grade lymphoma in dogs.
2.) This parameter especially should be ran on bloodwork if lymphoma is anywhere at all on your differential list with a sick dog that's not doing well.
3.) Because patients can have clinical signs associated with this state.
4.) True or False. Staging lymphoma is predicative of outcome. Substage is not important for predicting prognosis.
1.) What is giant/enlarged peripheral lymph nodes (~85%)
2.) What is Calcium
3.) What is Hypercalcemia
4.) What is: False! Staging is NOT important. Substaging (whether a dog is sick or not) is super important for predicting prognosis.
1.) T-zone low grade lymphoma is super common in this breed because they're predisposed (and they also commonly get high grade lymphoma too).
2.) You perform an FNA on a dog that you suspect to have lymphoma and get small lymphocytes on cytology. You're not sure if this is an inflammatory process or cancerous (because it could be either). This is the next diagnostic you would perform to distinguish between inflammation and cancer.
3.) Diagnostic for T-zone low grade lymphoma on flow cytometry (that allows us to use flow cytometry to diagnose T-zone lymphoma rather than lymph node biopsy)
1.) What is Golden retrievers
2.) What is Flow cytometry
3.) What is: Small to intermediate size lymphocytes. Loss of pan-leukocyte marker CD45 is diagnostic.
1.) This lymphoma in dogs can loot like hotspots, alopecic mass-like regions in some areas, dermatopathy that isn't responding to dermatopathy treatment
2.) Subcutaneous lymphoma frequently goes undiagnosed for months because...
3.) You should consider doing a _____ _____ on a dermatitis that is not responding to treatment like you want because subcutaneous lymphoma, and even mast cell tumors, can be mistaken for dermatopathy!
1.) What is Subcutaneous lymphoma
2.) What is: People think they're managing a dermatitis. (so you'll get a little bit of response with antibiotic, and you'll get a little bit of response with prednisone, and then it's gonna come back)
3.) punch biopsy
1.) Primary presentation for a cat with high grade lymphoma (like nodal disease or localized/affects primary organ system?)
2.) A gastric mass in cat is most likely this type of cancer (could still be other things) and has this tendency which can make this cat an emergency situation.
3.) True or False. We tend to not cut GI lymphoma in dogs or cats, but there are some studies that suggest patients may do better if we do.
1.) What is: Localized or affecting a primary organ system
2.) high grade lymphoma; tendency to bleed!
3.) True
1.) Low grade GI lymphoma in cats is SUPER ______ so we need to react to the possibility much earlier. It is ______ infiltrative (though you can occasionally see a mass effect rather than a solid mass). It's likely that if the cat (like the dog) is clinical enough to get an endoscope, then it's too late to cure the cancer and we're looking more at palliative care (which is why recognizing it earlier is better!).
2.) This condition that can look very similar to low grade GI lymphoma or can also be the inciting cause that leads to it as a disease progression continuum.
3.) What will low grade GI lymphoma typically look like on ultrasound?
1.) What is: common, diffusely
2.) What is Inflammatory Bowel Disease (IBD) (lots of lymphocytes from inflammation that can turn neoplastic)
3.) It'll look like a intestinal wall thickening (1-2 cm thickening of the muscularis). It may look like an intestinal mass effect.
1.) Initial response rate to chemotherapy is ____, remission duration is _______, and relapse is to be ________.
2.) You treat a lymphoma dog with chemotherapy. The dog has been in remission for a few months, but is now presenting to you for signs of relapse. We expect to send this percentage of dogs back into remission with subsequent chemotherapy treatments.
3.) You need to be gentle when doing an FNA because lymphoma cells are super ______; and, the tumors tend to ______ exfoliate, so it is easy to get an FNA sample.
1.) What is: high (response rate), variable (remission duration), expected (relapse)
2.) What is 50%
3.) What is: FRAGILE, readily
1.) Reason that samples submitted for flow cytometry need to be shipped immediately/directly and handled carefully.
2.) TIMING of treatment for a dog diagnosed with T-zone low grade lymphoma.
3.) First line treatment in dog diagnosed with T-zone low grade lymphoma.
4.) Expected outcome for a dog treated for T-zone low grade lymphoma
1.) What is Cells have to be ALIVE for flow cytometry!
2.) What is: We don't always treat these cases. We treat depending on clinical signs, how big lymph nodes are, if there are other cytopenias, phases of the moon (lol), how we're feeling that day (haha).
3.)What is If we do treat, chlorambucil.
4.) What is: We don't expect a rapid response. Low grade lymphoma is a slowly progressing disease, so we expect it to be a slowly responding disease. Dogs can live 2-3 years easy.
1.) Cutaneous lymphoma in dogs is when neoplastic lymphocytes infiltrate ___ layers.
2.) Consider this type of therapy for localized disease and this type of therapy disseminated disease in regards to cutaneous lymphoma.
1.) What is Skin
2.) What is: Radiation (for localized disease) and Chemotherapy (for disseminated disease)
1.) When you see ___ lymphoma in cats, they're usually going to present azotemic, sick, and it's a very fast progression. The kidneys usually will feel firm and kind of knobby, and sometimes they're huge. Those cats will progress so ___, and they will go downhill so fast that they need IV ____ support, and they need to get to an ________ immediately if that's what they're gonna do. They can do really well, but they will progress clinically very fast, so you don't have a lot of time if you're suspecting a renal lymphoma in a cat.
What is: renal, fast, fluid, oncologist
1.) Gold standard diagnostic for low grade GI lymphoma and the complication with using it to diagnose
2.) Rationale for recommend testing for PLI/TLI/cobalamin/folate in cats with low grade GI lymphoma.
3.) This diagnostic strategy on (mildly) enlarged abdominal lymph nodes is NOT a reliable way to diagnose intestinal neoplasia - whether LSA or not - if there is a targetable lesion in the intestine, better to sample that directly.
1.) What is: Intestinal biopsy = gold standard. Complication: Distribution of low grade GI lymphoma in cats is patchy.
2.) What is: Tend to be deficient in these areas. And supplementation can help them a lot.
3.) FNA (on LN's is NOT reliable to dx intestinal neoplasia; sample a mass directly)
1.) Average rate of metastasis to the lungs
2.) Reason I would like to do thoracic radiographs before treating a dog for lymphoma even though I don't absolutely NEED it (especially if owner cannot afford).
3.) Reason I would like to do abdominal imaging before treating a dog for lymphoma even though it's fine if I don't and isn't super necessary in most cases.
1.) What is pulmonary infiltration up to 25%
2.) What is pulmonary infiltration up to 25%, so I would like to check for that.
3.) What is patient is have GI clinical signs so I would like to check for a primary GI mass
1.) 2 forms of low grade lymphoma in dogs.
2.) This low grade lymphoma can be diagnosed after the following: small-intermediate size lymphocytes on FNA, flow cytometry revealing loss of CD45 markers on the lymphocytes
3.) This low grade lymphoma is likely to be diagnosed after the following: persistently elevated lymphocyte counts over time, small-intermediate size lymphocytes cytology, negative results for tick-borne diseases common in your area, flow cytometry results indicative of this lymphoma (*Hint: We're not going to treat unless there are clinical signs/issues. If the patient is healthy, continue to monitor q2-3 months)
4.) What chemotherapy drug do we use to treat Chronic Lymphocytic Leukemia in dogs?
1.) What is T-zone and Chronic Lymphocytic Leukemia
2.) T-zone lymphoma
3.) Chronic Lymphocytic Leukemia
4.) Chlorambucil
1.) Dogs with disseminated disease from cutaneous lymphoma have a guarded prognosis with the median survival time of 6-7 months. They tend to respond better with this chemotherapy drug over CHOP-based chemotherapy.
2.) Dogs with disseminated disease from cutaneous lymphoma have a guarded prognosis. Unfortunately, we only control them for a few months on average by reducing their ______/________.
1.) What is respond better with CCNU.
2.) What is lesions/discomfort
1.) What we use in cats to predict their prognosis when they have high grade lymphoma
2.) Median survival time in a cat treated with chemotherapy for lymphoma that responded well to the chemotherapy.
1.) What is: BEST prognostic factor = their response to chemotherapy! (so we don't know until we try)
2.) What is: Most cats less than 1 year (a few cats have been seen to live 2+ years)
1.) Treatment for low grade GI lymphoma in cat
2.) Reason you should not wait to do something with the typical "random vomiting cat" until the owner notices that it's a problem.
3.) CLL is not common in dogs, and it is SUPER super ____ in cats.
1.) What is: Steroids (Prednisolone), Chemotherapy if there is a diagnosis of GI lymphoma from intestinal biopsy, and Hydrolyzed or novel protein diet
2.) Low grade GI lymphoma is more common than we're used to diagnosing in cats, even in the "random vomiting cat".
3.) rare
1.) Diagnostic approach need at MINIMUM for treatment
2.) Go-to treatment (gold standard) and its basic components
3.) Median survival time after initiating gold standard treatment option
1.) What is confirmed cellular diagnosis of high grade lymphoma (on FNA). CBC/Chem/UA
2.) What is CHOP-Chemotherapy. [Cyclophosphamide, doxorubicin, vincristine, prednisone]
3.) What is Median survival time 12-14 months
1.) This type of low grade lymphoma in dogs persistent/progressively elevated circulating lymphocyte count with normal to abnormal looking lymphocytes in circulation that are small to slightly intermediate in size.
2.) You see a mildly elevated lymphocyte count (let's say 15,000) on routine labs and the dog is otherwise just fine. As an astute veterinarian you ran a blood smear and saw normal small sized lymphocytes. You think Chronic Lymphocytic Leukemia is a possibility. The approach I would take is...
1.) What is Chronic Lymphocytic Leukemia
2.) What is: Consider a tick-borne panel to look for infectious diseases in your area (because CLL can look like tick-borne diseases). If that comes back negative, recheck ~2 months the CBC and P.E. If the lymphocytes are still persistently elevated, consider flow cytometry on blood. If that test confirms CLL, monitor q2-3 months (because this is a slowly progressive disease) until progression necessitates treatment (Lymphocyte count >50-60k, Other cytopenias, Clinical signs (nonspecific), solid disease somewhere, or a big spleen).
Reason why a skin biopsy is important to diagnose cutaneous lymphoma in a dog
What is: Can look like dermatopathy or mast cell tumor, and depending on what it is changes the treatment plan.
Nasal lymphoma in cats, more commonly than not, is a stage one disease, meaning it's confined to the ____ cavity. And they can do exceptionally well with radiation therapy. They can have very ___-term survival, 3 years plus. It's critical obviously to ____ if you're thinking about only doing radiation.
What is: nasal, long, stage
1.) These are the 4 most common variable GI signs that can be seen in a low grade GI lymphoma cat (*Hint: Random vomiting cat).
2.) Low grade GI lymphoma in cats can be variable in intensity and almost always is ________ over time. The duration of symptoms can last from weeks to months to years.
1.) What is Weight loss, Reduced appetite, Vomiting, Diarrhea
2.) What is: progressive
1.) If an owner cannot afford CHOP-based chemotherapy, this is the treatment I would recommend next.
2.) This is the median survival time on that recommended treatment.
3.) The 2 chemotherapy drugs approved for veterinary use in treating lymphoma in dogs.
1.) What is Prednisone
2.) What is 60 days (~1-2 months) on prednisone
3.) What is Tanovea and Laverdia
1.) It is extremely ____ to see a low grade nasal lymphoma in a dog.
2.) It is extremely ____ to see a low grade diffuse intestinal lymphoma in a dog.
3.) Sometimes you see a giant splenic mass that is also a low grade lymphoma. Interestingly, those have a really good prognosis (long survival > 1,000 days) after surgery (which would be a _______) alone.
1.) rare
2.) rare
3.) splenectomy
If you're going to do radiation for localized lesion of lymphoma of ANY kind, then you must complete this process...
What is Staging! You must look at the rest of the body to make sure there is nothing there.
Reason why gastric high grade lymphoma and renal high grade lymphoma in a cat need to be treated/delt quickly.
What is: Gastric high grade lymphoma has a tendency to bleed, which can put the cat in a state of shock. Renal high grade lymphoma progresses so fast that the cat will die if you wait too long to act.
This lymphoma is a regionalized or localized form of lymphoma that is highly treatable in people. And there are a few case studies reported in cats of a possibly similar syndrome, so this is gonna be rare. But in case you see it, it's really big lymph nodes in the head and neck. You have to have a tissue biopsy. There's a specific type of neoplastic cell called this Reed-Sternberg cell that you need to have a biopsy to see the architecture and then to have that sample be available for immunostaining. The reason this is relevant is because even though our information about what to expect is limited for this condition, surgery alone might do really good things for these guys. So you might not go down a chemotherapy road if you manage to see one of these at some point in your career.
Hodgkin's lymphoma (Hodgkin's-like lymphoma)