Veterinary Medicine - June 2008 - (Page 312)

A challenging case PEER-REVIEWED 1. The cat at the second presentation. Note the severe chemosis and the protrusion of the nictitating membrane and mass. The globe is hidden by the mass. 2. Fine-needle aspiration of the mass and cytologic examination of a smear revealed nondegenerated neutrophils and large round cells with large nuclei and scant, basophilic cytoplasm. The latter cells are lymphoblasts, and the ﬁndings are suggestive of lymphoma (Giemsa, 40X). deemed necessary. Blood typing was performed, and the cat was given one unit of type A whole blood. Preanesthetic drugs included hydromorphone and glycopyrrolate given subcutaneously. Anesthesia was induced with intravenous propofol and midazolam, and the cat was intubated and anesthesia was maintained with inhalation oxygen and iso urane. During surgery, the cat was given a constant-rate infusion of fentanyl for analgesia. The exenteration was performed by using a transpalpebral approach. A aspirate of the conjunctiva suggested an in ltrative lymphoma (Figure 2). Tropicamide, a topical anesthetic, was administered in both eyes, and orbital ultrasonography was performed to determine the extent of the lesion. The ultrasonographic examination revealed a mass that involved the right globe and the orbit (Figure 3). The mass was hypoechoic and irregularly shaped but had a de nitive rounded region with hyperechoic edges and several anechoic cavitated regions. These ndings suggested a neoplasm invading the ocular tissues. No abnormalities were identied on ultrasonographic examination of the left eye. Given the extensive nature of the lesion, the cat’s pain, and the owner’s nancial constraints, in addition to the fact that the eye was blind, immediate exenteration of the orbit was recommended. However, the owner did not return with the cat until three weeks later, reporting the mass had bled profusely several times during the previous three weeks. An exenteration was planned to remove the eye and the contents of the orbit. complete blood count (CBC) and serum chemistry pro le before surgery revealed that the cat was severely anemic (packed cell volume [PCV] = 11%, reference range = 30% to 46%) and that the anemia was mildly regenerative (reticulocytes = 17,520/µl, reference range = 0 to 5,000/µl; nucleated red blood cells = 0.1 x 103/µl, reference value = 0 x 103/µl). The anemia presented an anesthetic and surgical risk, but because of the severity of the ocular lesion and the possibility that the anemia was due to the profuse bleeding from the mass, immediate surgery was RIGHT EYE LEFT EYE Surgery The cat had lost 4.4 lb (2 kg) since the initial examination and was weak. A 3. Ultrasonograms of both eyes. The blue arrows indicate the cornea. The left eye is normal. Within the region of the right eye, there is a hypoechoic, complex mass (yellow arrow). The mass had hyperechoic edges and contained an anechoic cavitated region. These ﬁndings are suggestive of a neoplasm. 312 June 2008 VETERINARY MEDICINE

Table of Contents Feed for the Digital Edition of Veterinary Medicine - June 2008

Veterinary Medicine - June 2008 Contents Leading Off Clinical Exposures Idea Exchange A Challenging Case: Conjunctival Lymphoma in a Cat Updates on Canine Hypoadrenocorticism Product Preview CE Form Advertiser Index Marketplace/Classifieds Mind Over Miller Clinical Edge - June 2008 Table of Contents Managing Diabetes Mellitus in Cats: What Makes it Work? Porcine Insulin Zinc Suspension in the Management of Feline Diabetes Mellitus Monitoring Diabetes Mellitus in Diabetic Cats Feline Diabetes Mellitus: Important Client Communication Points

Veterinary Medicine - June 2008

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