1. Ultrasound Case Presentation Hollie Schramm Block 17

2. Signalment and History Nero-presented on 12-19-06 Nero-presented on 12-19-06 8 year old, Male, Belgian Malinois police dog 8 year old, Male, Belgian Malinois police dog 2 month history of intermittent diarrhea, intermittent straining to defecate, weight loss 2 month history of intermittent diarrhea, intermittent straining to defecate, weight loss When diarrhea resolves he develops a thin ribbonlike form to his stool When diarrhea resolves he develops a thin ribbonlike form to his stool

3. Physical Examination On abdominal palpation- mass effect is palpable in the caudal abdomen On abdominal palpation- mass effect is palpable in the caudal abdomen Tail carriage is dropped Tail carriage is dropped Extremely painful near rectum Extremely painful near rectum Palpable enlargement (bilaterally) on rectal examination (sedated) Palpable enlargement (bilaterally) on rectal examination (sedated) Other other parameters were WNL Other other parameters were WNL Peripheral lymph nodes are WNL Peripheral lymph nodes are WNL

4. Diagnostic Abnormalities CBC- mild monocytosis, moderate eosinophilia CBC- mild monocytosis, moderate eosinophilia Chemistry- elevated Amylase and Lipase Chemistry- elevated Amylase and Lipase U/A (catheterization) U/A (catheterization) -urine color: gold -urine turbidity: opaque -proteinuria (3+) -bilirubinuria (4+) -hematuria (3+) -specific gravity and pH are normal -clumped epithelial cells present

5. Ultrasound on 12/19

8. Any mets?

9. Where would you look for a lesion (metastisis)?

10. Ultrasound Prostatomegaly- the gland contains diffuse anechioc cyst and occasional mineral foci Prostatomegaly- the gland contains diffuse anechioc cyst and occasional mineral foci Bilateral medial iliac lymphomegaly; rule out metastatic disease Bilateral medial iliac lymphomegaly; rule out metastatic disease Mild hypogastric lymphomegaly Mild hypogastric lymphomegaly

11. Differential Diagnoses Benign Prostatic Hyperplasia and/or prostatic adenocarcinoma Benign Prostatic Hyperplasia and/or prostatic adenocarcinoma

12. Treatment and Plan Nero had a reaction following propofol sedation (for catheterization) and had a very rough recovery Nero had a reaction following propofol sedation (for catheterization) and had a very rough recovery He was sent home on antibiotics (as prescribed by rDVM) and pain medications He was sent home on antibiotics (as prescribed by rDVM) and pain medications Recommendations: castration Recommendations: castration

13. Re-evaluation on 1/22/07 Post-castration Post-castration Physical examination: Physical examination: -caudal abdominal mass effect still present -painful on rectal palpation (under sedation) -firm prostate is noted, especially on the right side (possible anal sac, lymph node, ect)

14. Prostate at re-check

15. Prostate

16. Prostate

17. Right Medial Iliac Lymph Node

18. Enlarge right and left adrenals

19. Nodule in the Spleen

21. Ultrasound Prostatomegaly Prostatomegaly Hypoechoic splenic nodules; possible benign nodules (hyperplasia or extramedullary hematopoiesis) or neoplasia. Hypoechoic splenic nodules; possible benign nodules (hyperplasia or extramedullary hematopoiesis) or neoplasia. Bilateral anal gland degenerative change, abscess or neoplasia Bilateral anal gland degenerative change, abscess or neoplasia Hypogastric and right medial iliac lymphomegaly; reactive nodes or metastatic disease. Hypogastric and right medial iliac lymphomegaly; reactive nodes or metastatic disease. Bilateral adrenomegaly; rule out pituitary dependent hyperadrenocorticism Bilateral adrenomegaly; rule out pituitary dependent hyperadrenocorticism Bilateral degenerative renal changes Bilateral degenerative renal changes Hyperechoic hepatic nodule; possible regenerative nodule Hyperechoic hepatic nodule; possible regenerative nodule

22. Assessment No change in the size of the prostate No change in the size of the prostate Medial Iliac is still enlarged (especially on the right side) Medial Iliac is still enlarged (especially on the right side) Since Nero was neutered and there has been hormone deprivation with no response it is likely that he has a prostate carcinoma Since Nero was neutered and there has been hormone deprivation with no response it is likely that he has a prostate carcinoma

23. Assessment continued A carcinoma can only be definitively diagnosed with a tru-cut biopsy of the prostate (requiring general anesthesia) A carcinoma can only be definitively diagnosed with a tru-cut biopsy of the prostate (requiring general anesthesia) Suggested that he receive palliative radiation therapy (two daily treatments for two consecutive days with repeat therapy in one month) and/or give an NSAID to relieve pain and inflammation Suggested that he receive palliative radiation therapy (two daily treatments for two consecutive days with repeat therapy in one month) and/or give an NSAID to relieve pain and inflammation Recommend monthly re-evaluation and ultrasounds every 2 months Recommend monthly re-evaluation and ultrasounds every 2 months