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Hi, I’m looking for some info or advice on lymphoid hyperplasia.

I have a 6yr old mixed breed (possibly sheltie or spaniel x) dog. I recently discovered a small lump under the skin on his flank. The vet did a FNA last week and got a couple of samples, which were sent to pathology, and the results came back as lymphoid hyperplasia. In the samples, there is no sign of infection or inflammation. My vets have never seen lymphoid hyperplasia in this location and the cause is a mystery. At the moment we are monitoring for a few days then will start with antibiotics, then possibly a biopsy. He is otherwise well, acting normally, lymph nodes are not swollen.

From what I’ve read and been told, it could be the lymph nodes reacting to a viral or bacterial infection, allergy(?), or something else. But I’ve also read that early lymphoma can start out looking like lymphoid hyperplasia? Without knowing what the cause is, it’s hard to know how to treat it. So I’m wondering if you have heard of it in this location before, if perhaps there are other things that can cause it or be used to treat it, and if there is a way of ruling out lymphoma.

Thanks.

Hi Kayla,
you are spot on. Lymphoid hyperplasia means the immune system is reacting to something nearby. Fine needle aspirate cytology is a good technique but gives the pathologist very little to work on. So yes, there is a small chance that it could be lymphoma, which will be diagnosed in 90% of cases by histopathology which requires a piece of tissue. The remaining10% will require special tests done on the tissue, and about 1% will still be uncertain! But, being optimistic, the immune reaction will sort itself out and further tests will not be needed. If it does turn out to be lymphoma and it is limited to a single site, there is no problem in the diagnosis being delayed a month.
Good luck!

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Dr Ken Wyatt BSc BVMS FANZCVS
Specialist Veterinary Oncologist
Perth Veterinary Oncology

Thanks for your reply Dr Ken.

Antibiotics didn't appear to help. The lump was smaller after the FNA was taken but has now increased in size again. So it looks like the vet will need to take a biopsy, or remove the entire lump. Hopefully that will tell us more.

Thanks for your help.

It's definitely the right thing to do. Good luck!

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Dr Ken Wyatt BSc BVMS FANZCVS
Specialist Veterinary Oncologist
Perth Veterinary Oncology

Unfortunately the results of the biopsy have come back as soft tissue sarcoma. The vet is thinking that the lymphocytes picked up in the FNA, and also the biopsy, are attacking the tumour. They don't think there is two different types of cancer in the same spot.

Only narrow margins were taken when the lump was removed, because the FNA only showed lymphocytes, so the vet is recommending further surgery to remove wider margins.

Apparently it's an unusual situation. It's just so unexpected I don't know what to think. From what the vet said, it sounds like the sooner the next operation is done the better. Though it will be a longer recovery because the tumour was between muscle, so they're going to have to remove some muscle near the stomach.

So it looks like Maxie will have that done probably next week.

I hope all goes well. Sarcomas need wide margins - if your vets aren't confident of achieving cure on the first go it might be worth referral to a specialist surgeon

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Dr Ken Wyatt BSc BVMS FANZCVS
Specialist Veterinary Oncologist
Perth Veterinary Oncology

Thanks Dr Ken. I'm going to call a couple of the specialist oncology centres on Monday, not sure if there is a wait to get in.

I've got the pathology report now. It's an unusual lesion, inflamed grade 2 soft tissue sarcoma. Underlying lesion is sarcoma but with extensive inflammation. Lymphocytes indicate it could be a lymph node infiltrated by STS but insufficient architecture to confirm. Reason for inflammation is not clear. Anyway, just thought you might be interested in the details.

Thanks very much for taking the time to reply.

absolutely interested! node infiltration is uncommon (<10%) for soft tissue sarcomas. your oncologist might want to dig deeper - immunohistochemical stains can be put over the biopsy sample to rule out other tumours masquerading as soft tissue sarcomas, such as histiocytic tumours for example. Hopefully, not a long wait for you to see someone.

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Dr Ken Wyatt BSc BVMS FANZCVS
Specialist Veterinary Oncologist
Perth Veterinary Oncology

Thanks Dr Ken, I passed that information on to the surgeon today.

I ended up taking him to a specialist centre and he had a ct scan yesterday. His chest and abdomen look ok which is good.

The surgeon said it will be a complicated surgery as he needs to go deep to remove the remaining tumour and/or inflammation, and he may have to remove some of the abdominal wall and replace with mesh. Also as a drain was placed under the incision after the first operation, the surrounding tissue there is compromised and will also have to be removed.

So I'm very glad I took him to a specialist, but I'm just so worried for Maxie and am trying to tell myself it's the right thing to do.

Everything you're saying sounds like you've found a good surgeon. I hope all goes well! Definitely the right decision.

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Dr Ken Wyatt BSc BVMS FANZCVS
Specialist Veterinary Oncologist
Perth Veterinary Oncology