Slate’s FNA results Take 2

February 15, 2012 § 2 Comments

The results are in for the 3 FNAs which were taken on Monday.

Two of them are probably lipomas and one was inconclusive again.

Now, the problem is that one of the two probably-lipomas, changes in size.  It is usually very small, but sometimes it gets bigger – from the size of half a lentil to a very large pea size.  And both times it has been FNA-ed, it has reacted by swelling up like this.

For this reason I’ve been worried about it being a MCT:  MCTs release histamine into surrounding tissue, causing the lump to appear to be swelling up.  It’s not really the lump itself swelling, it’s the surrounding tissue which is inflamed from the histamines being released.  Prodding and poking a MCT (or sticking a needle in it) makes it more likely to release histamine and cause this allergic response.

Slate has been suffering from itchy eyes for some years now, which have not been improved after anti-bacterial eye-drops.  When she was diagnosed with this MCT, I wondered if the allergy symptoms were all due to the histamines released into her by the MCT.  (Worryingly, if that’s the case, she still has itchy eyes now, 2 weeks after it was removed.  Does she have more??)

Although the result has come back as probably a lipoma, FNA results are not always accurate.  (Unfortunately, the more accurate you want to be, the more invasive you have to be.)  And why would a lipoma swell up or change in size?  (I asked the vet this, and he said it could be fluid coming back into the lump or something about ‘planes’ in the dermis – he lost me on that one.)

I’m also a little worried that the vet – or vet nurse, or lab – has mixed up the results, since there were 2 lumps very close to each other:  A very large one, which the vet bet was a fatty lipoma and then this tiny one I’m worried about.  I’m worried that the inconclusive result is really for this size-changing little one, and the lipoma is this other big lump.  The vet really thinks this is unlikely, since he labelled them clearly, but he is going to check if the vet nurse is sure she didn’t confuse the slides.

The vet said we can repeat the FNA again on this lump, with a bigger needle to try to get more material.  But it is in a sensitive place on her rib-cage, and Slate really didn’t like the lumps there being FNA-ed with a regular-sized needle.  (She didn’t care about the lumps in other places that much.)

At the moment we are going to ‘pause’ here for a few weeks, since we are waiting for the Ki-67 result on the MCT which was removed and we need to decide if we want to run further tests.  (Ie:  Biopsies of the lymph nodes in the groin).  Since that would be under GA anyway, a biopsy could also be taken of this lump.  However, as things stand, I don’t think we’re planning on further invasive tests because the mitotic index was so good on the MCT.

Ah yes, and then there are the raised liver enzymes from the bloods which were taken, which we still have no explanation for.  To pursue that further would mean repeating the bloods in a month’s time, to see if it was a temporary raise or if they are still high.  (In which case further investigation is needed.)

Sometimes I just think:  She is 7.5 yo.  We have done what is reasonable and necessary.  Dogs fifty years ago, before all these tests were available, didn’t get subjected to all this.  Perhaps we should just let her live out her life, whatever it will be.  And then I feel guilty, because, if she were a person, obviously all tests would be super-duperly run at whatever cost.  This is all impossible.

Here is what we have, so far.  (The lump I’m worried about is the lipoma in green which says ‘changes size’ next to it.)

§ 2 Responses to Slate’s FNA results Take 2

  • Ingrid says:

    How is your weim doing? Have more tests been done? I have 2 weims. Cooper is a blue and is 6 y/o and Otis is approx. 5. Cooper has several lipomas and I haven’t had any FNA’s done but it seems as though none have changed. What is your opinion on the subject?

    • galody says:

      Hi – Slate is doing fine with her lumps. There were no more tests which needed to be run, since the tests all came back ok. If you haven’t had any FNAs or biopsies done on Cooper, then you can’t rightly say they are ‘lipomas’ – since that is a particular type of lump. (A benign fatty lump.) And the only way you can know what a lump is, is by FNA or biopsy. So all you can know is that Cooper has lumps, not that they are lipomas.

      This lump on Slate grew very very gradually (the MCT). It began looking like just another nipple; I used to think that’s what it was. It was only when it bled a little (I think because she scratched it) that I decided it looked a little weird and got it checked out.

      FNAs are very quick and easy for the vet to do; they take seconds, and you don’t need to leave the dog there. You are looking at the cost of the lab analysis each time, though. And sometimes you do get an inconclusive result back and then you might feel you’ve wasted that money – but because they are so easy and quick to do, I really think they are worth it if you’re concerned about a lump. If you have a bunch of lumps in one go, some labs do a batch deal and will do them for much less than each one individually would have cost.

      Different vets appear to approach lumps on dogs differently: You get some vets who are very much into FNA-ing every single lump which appears, and that is the most thorough way to approach things. Since you really don’t know what a lump is until after that. Some vets (our vet, unfortunately!) say ‘oh that looks like an X to me’ or ‘I wouldn’t worry about Y unless it changes’ and so on – but the truth is that honestly you really can’t tell.

      Since this whole saga with the lumps and the FNAs, a couple of new ones have appeared on Slate. We did show them to our vet last week and he did say he ‘wasn’t worried’ about them & thought they were lipomas – but I’m not at all reassured when he says this, since I know that really it’s BS (!); you really can’t tell!

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