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Histiocytic Sarcoma In A 3-Year-Old FS Golden Retriever: Our Case Of the Month July 2020

Patient Information

Age
3 Years
Gender
Female, Spayed
Species
Canine

Keywords

Clinical Signs

Images

Edematous gallbladder wall.
Severely mottled irregular and nodular liver.
Irregular hepatic capsule/margins.
Needle passing into liver for FNA.
These large irregular cells are most characteristic of neoplastic histiocytic cells.

Being a sweet, 3-year-old pup is unfortunately not a fail safe to developing cancer. Definitive cytology interpretation was expedited using the SonoPath Telecytology services so that the owners had an answer the same day. Dr. Liz Gray owner of Wavelength Veterinary Services provided the diagnostic images, ultrasound interpretation, performed the FNA of the liver and submitted the cytology images. SonoPath's pathologist Larry McGill, DVM, Ph.D., DACVP provided the cytology interpretation.

History

A 3-year-old FS Golden Retriver was presented for acute onset lethergy, mild weight loss and decreased appetite over a week's time. No vomiting or diarrhea. Blood chemistry found ALT 303, ALP 266, T. bili. 0.4, both albumin and BUN were WNL, neutrophilia was present, PT was normal, PTT was slightly elevated. Ultrasound showed a severely nodular liver and the gallbladder wall was edematous. Fine needle aspirates of the liver were performed utilizing a 22 gauge 1.5" needle and sent out for STAT telecytology read to expedite a diagnosis.

Image Interpretation

8 videos and 1 still image of the patient's liver aspirate were submitted for interpretation. The videos demonstrate moderate cellularity. Hepatocytes were identified. There are large irregular cells in almost all of the videos. The cells have prominent bluish gray cytoplasm and the nuclei are demonstrating anisokaryosis. Several of the cells appear to be phagocytosing nuclear debris and RBCs. There is a background of erythrocytes interspersed with neutrophils and lymphocytes. The lymphocytes appear to be mature. One mitotic figure was identified but there may have been more.

Sampling

U/S-guided FNA of the liver was performed without complication.

DX

Liver - Large numbers of irregular large rounded cells consistent with histiocytic sarcoma.

Outcome

Within an hour the RDVM had the diagnosis and reason for the patient's weight loss and inappetance. Notes from our pathologist Dr. Larry McGill: "The large irregular cells are most characteristic of neoplastic histiocytic cells. With some of the hemophagocytic appearances of the cells, hemophagocytic histiocytic sarcoma should be considered. It could be a histiocytic sarcoma or malignant histiocytosis with secondary inflammation. An unfavorable prognosis is expected."

Videos

Screening cytology images looking for nucleated cells at 10x magnification and 40x magnification.
Histiocytic cells at 100x magnification under oil immersion.