1. Lymphosarcoma Elmo Yandle 4 year old male intact American Staffordshire terrier Was presented to the NCSU Internal Medicine service for evaluation of 2 week history of generalized lymphadenomegaly, lethargy and inappetance. Elmo has a history of sneezing, pruritis, and red eyes.

2. Elmo Yandle Physical Exam: –BAR, TPR - Normal –EENT: Mild epiphora OU and episcleral injection OU. –Integument: 3-4 cm abrasion on right side of prepuce –MSN: ambulatory on all four limbs, good muscle tone, neurologically alert and appropriate –GIGU: Liver and spleen enlarged on palpation. –PLN: Generalized lymphadenomegaly. Bilaterally enlarged zygomatic, submandibular, prescapular, axillary, inguinal, and popliteal lymph nodes. –H/L: Heart and lungs auscult normally

3. Elmo Yandle Diagnostic tests –1. CBC - Mildly thrombocytopenia, lymphoblast cells noted in blood smear (mild blastemia). –2. Chemistry panel - Mildly elevated amylase at 1122 (RR: 347-1104) –3. Urinalysis - Concentrated urine (1.048) –4. Lymph node aspirates - Consistent with lymphoma

4. Elmo Yandle Diagnosis: Lymphosarcoma Next Step: Staging for prognosis - Stages I-V - Substages A and B - Phenotyping - Hypercalcemic

5. Elmo Yandle Results of Further Diagnostics: –Thoracic Radiographs Possible pulmonary nodule located in left 6 th intercostal space –Abdominal Ultrasound Splenomegaly, diffuse hypoechoic foci in spleen Hepatomegaly Enlarged Bilateral MILN, and enlarged hepatic LN FNA of spleen and liver = consistent with LSA –Bone Marrow Aspirate Consistent with LSA –Flow Cytometry – insufficient sample

6. SPLEEN Splenomegaly with punctate hypoechoic foci within the spleen Lymphoma of the spleen can vary in appearance from diffusely hyper to hypoechoic. This is a more classical appearance “Swiss cheese” FNA is required to corrobarate sonographic findings

7. LIVER Hepatomegaly and normal echogenicity when compared to the spleen –The echogencity of the liver can vary with lymphoma. Hepatomegaly is often reported. Splenic abnormalities are more common with lymphoma.

8. Abdominal Lymph Nodes Enlarged Right MILNEnlarged Hepatic Lymph node Enlarged Splenic Lymph node

9. Elmo Yandle Diagnosis: –Stage V, substage B Multicentric Lymphosarcoma Treatment: –Chemotherapy: –L-asparaginase and prednisone

10. Elmo Yandle Follow Up: –Transferred to NCSU Oncology service for chemotherapy –Complete Remission as of 11/27/06.