Diagnosis Of Growths Requires Pathologist Input

Regular readers will recall our Auburn University College of Veterinary Medicine junior class story in which our Pathology professor gave us quite a fright by hitting us with a pop quiz on the very first day of class.

No notice.

notsebaceouscyst

This little dog, no longer young, had an ugly tumor. Fortunately, she had a good outcome.

No reading assignment.

No preparation. (Click here to read the story.)

The gist of his frightening exercise was to make the point that mere observance of a mass cannot convey a diagnosis.

Interestingly, I’ve had two emails on that very topic this week.

One was from a pet owner whose dog had a mass she thought was a cyst. She sent along photos and I immediately told her (1) it didn’t look cystic to me, (2) it’s definitely not a sebaceous cyst and (3) if that thing were on my dog I would want it off yesterday! Her story had a happy ending when she told me her veterinarian had removed the mass, and it was cancerous, but the pathologist felt the doctor had removed all of it and there was little worry going forward.

not_sebaceouscyst

This growth has no external features indicating it to be cystic in nature.

We love great news like that!

The other inquiry was a little different. Here is the text of her email: My almost 12-yr old American Cocker has a tumor-like open sore on the back of her head. The veterinarian wanted to cut it out and have it analyzed. I feel terrible about not letting the veterinarian do what she suggested, but the fact is that we have recently had some very bad luck financially. I recently became ill, then my husband was laid off from his job. We love Bailie very much, but we know she is getting old. The problem is that we don’t want her to suffer. To date, she appears to be fine and still likes to play.

First, an otherwise-healthy Cocker spaniel can easily live to be 16 to 18, which gives Bailie another third of her life if no other complicating factors arise.

Second, if there’s anything you don’t want to put your dog through, it’s cancer! The doctor has already pronounced this lesion to be an “open tumor.” That, in itself, is sufficient reason to proceed to surgical removal. Even though we cannot say what cell type or behavior to expect from this growth, I’m sure her veterinarian would agree with me that erupting types of tumors such as this are worrisome, and need to come off right away, before metastasis (spread) occurs.

bailietumor

See how the tumor growth is moving the skin out of the way? That's an indication this mass originates from deeper tissues and is worrisome.

 

Third, there are ways around the money problem. Your veterinarian may be willing to set up a payment plan for you. Care Credit is accepted at many veterinarians’ offices and may be an option for you, and the interest rates are usually lower than credit card debt.

Bailie is slightly past middle age and has been a faithful friend for 12 years.

The real take-home point is that even her attending veterinarian can’t say what the mass is until it is submitted to a pathologist for histopathology. While I am happy to look at the pictures, there is no way I’m going against the recommendation of the doctor who looked at it firsthand and pronounced it an open tumor that needed removal.

An interesting side note in Bailie’s case:

A couple of weeks ago I noticed a lump on her neck when I was washing her. I thought whatever it was had spread. Two days ago, we had to wash her head and neck area because the wound seeps and smells terrible. I gently squeezed the lump on her neck in case there was pus in it, and to my surprise and horror, a large grey larva came out! It appeared that the larva was a “Cuterebra.” It just seems that such awful things are happening to her and I’m beside myself with worry.

To read more about Cuterebra, click here.

See you next week,

Dr. Randolph

2 comments

  1. Missy Hafner says:

    My 7 year old Basset had a cyst rupture internally on his neck. Four days later he suddenly became distressed (with no previous symptoms) and despite our veterinarian’s efforts, died within 6 hours of symptom onset. X ray showed no bloat and initial blood work looked fine. Could the cyst have caused this?

    • Missy, please accept our condolences on the loss of your precious Basset hound. They are wonderful and loving dogs and we know this is heartbreaking for you. While we cannot give you a definitive answer to your question, we will tell you what we can. Yes, it is within the realm of possibility that this cyst caused an anaphylactic reaction and massive response from the immune system. Without knowing the exact nature of the “cyst” that would be hard to substantiate. The harsh reality is that there are zillions of possible causes. Sadly, for all the advances medicine has made, we still cannot save every patient. And, that breaks your veterinarian’s heart right along with yours. Please visit this page to read a piece I wrote on grieving. In sympathy, Dr. Randolph.

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