Annie is an 8 year old, female spayed Golden retriever. She presents today with her housemate for routine annual wellness exams along with heartworm testing and vaccinations. Both dogs have seemed to be doing well. The history is somewhat limited as dad brought the dogs in and he just won custody in the divorce. The dogs have been with mom since the split. Vital signs are normal and body condition is moderately overweight (7/9). There is moderate tartar present on the teeth, the heart and lungs sound normal. There is a very large mass palpable in the mid-abdomen, estimated at 25cm diameter. It is round, seems smooth and firm. Dad is very surprised by the presence of the large mass.
What could the mass be and what should be done about it?
Without getting a sample, it is very difficult to say what the mass is. Given the location the suspicion is a splenic mass, although liver, kidney, lymph node or intestinal mass are possible. Some of these large tumors are benign while others are malignant. More common splenic masses are hemangioma, hemangiosarcoma, lymphoma, splenic hematoma, and leiomyosarcoma.
We discussed our options. These included: pursuing treatment and what this would mean; hospice care with euthanasia when deemed appropriate; and euthanasia. Given her good condition, euthanasia was discouraged, but could become appropriate at any time.
Dad wants to pursue treatment if it seems reasonable. At this time Annie is not showing any signs of disease. She is still active and eating well. There has been no change in weight. While this is all good, it does not really help us determine whether the mass is benign or malignant. Further diagnostics are needed to help try to make this determination.
Blood work and urinalysis are performed. Everything is normal. The abdominal X-rays show a large round mass in the mid abdomen with the intestines pushed to the edges. The tail of the spleen appears to be at the site of the mass. This appears to be distant from the liver. Abdominal ultrasound shows a large cavitated mass with what appears to be a capsule. It appears associated with the spleen. Further ultrasonographic abnormalities are not observed. The chest X-rays appear normal with no evidence of spread to the lungs.
These findings are good. We have no evidence of spread of cancer. These do not rule out malignancy, but suggest against it. Therefore, it seems reasonable to take Annie to surgery to try to remove the mass. With this plan we discussed that sometimes we take the patient to surgery only to find small tumors throughout the abdomen. If this is the case, we would recommend euthanasia prior to recovery from anesthesia. Surgery is scheduled for 3 days later.
The day of surgery Dad reports that her eating has decreased significantly in the last 2 days. Last night she only ate about 2 bites.
Surgery was uneventful. The mass was located on the spleen and was easily removed with splenectomy. No masses were found elsewhere in the abdomen. The rest of the abdominal exploration was normal. She recovered routinely.
The mass was sent out for histopathology. It came back as a benign hemangioma. This tumor is the benign cousin of the malignant hemangiosarcoma. These tumors arise from blood vessel cells. The hemangioma is not invasive and removal is generally considered curative. However, as seen with Annie, the large size can cause problems. For other patients the hemangioma can break open and bleed profusely leading to death.
Annie went on to make a full recovery. She started to eat immediately after surgery.
Annie's case is not unusual, although it was relatively dramatic. She came in for a routine wellness examination and a problem was identified. This allowed a great outcome.
During routine wellness examinations it is quite common for veterinarians to identify problems that need to be addressed. The majority are relatively minor problems like ear infections and periodontal disease. These are not life threatening but greatly impact quality of life. We often check skin lumps. Many of which are benign fatty tumors called lipomas. But we regularly find small skin tumors that are cancerous and need treatment.
Also during these wellness exams, we have the opportunity to speak with you, the owner, to learn about changes you are seeing at home. Many times, especially in older animals, there is increased urination, a change in behavior, or stiffness when rising. These often indicate that further evaluation with lab work is needed. If we can identify a problem early, we can start treatment early and improve quantity and quality of life for your fur baby.
While the vaccinations are important, the annual wellness examination's history and physical examination are really the primary tools used to help keep your pet engaged and enjoying life.