AVP Vol 52 Issue 1 March 2022 - Flipbook - Page 25
Case Report
25
Figure 3
Post-contrast CT images
of dorsal (A) and sagittal
(B) planes with a soft
tissue window. There is
marked enlargement of
the lumbar aortic lymph
nodes (white arrows), with
heterogenous contrast
enhancement, consistent
with tumour metastasis.
A CBC was within reference limits and no
abnormalities were detected on abdominal
ultrasonography, indicating clinical remission.
The dose of toceranib phosphate was reduced
to 130 mg (2.45 mg/kg) orally on Monday,
Wednesday and Friday, because of the postsurgical weight loss.
Two months after lymphadenectomy, the
dog was presented for pelvic limb lameness,
which the owner mentioned had occurred
twice previously. Orthopaedic examination
revealed 2/5 lameness in the left pelvic limb,
with no appreciable joint swelling or pain
elicited on palpation. Treatment with toceranib
phosphate was temporarily discontinued,
because lameness is a known adverse effect
of toceranib.10 The lameness rapidly resolved
and toceranib phosphate was recommenced
one week later.
Three months after lymphadenectomy, the dog
developed generalized alopecia and reduction
in coat quality. A CBC and urinalysis were
within reference limits. Abdominal ultrasound
revealed multiple hypoechoic LLALN; two
adjacent to the aorta measuring 0.81 cm x
1.59 cm and 0.42 cm x 0.64 cm, and two
intermuscular nodules in the ventrolateral
inguinal region. Fine needle aspiration
biopsies of the intermuscular nodules were
performed. Smears were stained with DiffQuik and examined by a medical oncologist
at 400x magnification. Cytology revealed
a population of neuroendocrine appearing
cells, with vacuolated cytoplasm, marked
anisokaryosis and multiple prominent nucleoli.
This was consistent with metastatic SCT and
progressive disease. The recommendation
was made to the owners to consider surgery
or adjunctive palliative radiation therapy,
however, due to financial constraints and the
guarded prognosis, they opted to continue
with the current protocol.
Four weeks later (4 months after
lymphadenectomy), the dog’s body weight
had increased and the dose of toceranib
phosphate was increased to 150 mg (2.62
mg/kg). The dog continued to be monitored
closely for the next 5 months and retained
an excellent quality of life as assessed by the
owners and the attending clinicians.
At 9.5 months after lymphadenectomy,
a further progression in the size of the
metastatic LLALN was detected on
ultrasonography (now 2.50 cm x 3.20 cm,
1.11 cm x 2.46 cm and 2.49 cm x 2.72
cm). Eight weeks later (11.5 months after
lymphadenectomy), in-house CBC revealed
thrombocytopenia (51 x 109/L [RR 148-484
x 109/L). However, platelet clumps were
evident on a blood smear and the number
