Confused and Overwhelmed-Diagnosed Anal Sac Carcinoma (Woody has passed)

Hi Tracy - have done my best to put a few comments in below, hope it helps :)
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Originally Posted by Woodydog

Evening - Sharlene we are both feeling pretty good, I just take my lead from Woody and do what he feels up to be it a long walk in the woods or playing in the leaves then I,m gonna be right beside him :D I can,t cure him god I wish I could but I,m going to make every day he is here count by doing things he loves.:D

I,ve read through his reports until my brain hurts and have came up with a few questions, if anyone has any clue then let me know.

His haematology investigation :- revealed a very mild leukocytois but with evidence of a left shift - no idea what any of that means
Increased white cells, usually inflammation. Left shift just means that there is a higher amount of baby white cells as opposed to older more mature ones. This is due to inflammation prompting the bone marrow to make more white cells so you end up with more immature ones in circulation and is very common when there is inflammation in action - his GU enterococcus for example
Biochemistry:- revealed increases in triglycerides and cholesterol and a mild increase in ALT 103/U/1. ALT liver test, good that only mildy up Ionised Calcium unremarkable previous 2 calcium were high
Ionised Calcium is the best test to do, so that is good it was normal. I was just talking about that test with my IMS and he said that is the one to do.
T4/cTSH had shown a high cTSH no numbers available now I think this has something to do with thyroid but not sure. It is thyroid but I am no expert on thyroid sorry so will have to leave that one to the others!
Liver was enlarged with rounded margins and a mixed generally patchy bright echogenicity (possible fatty change) they weren,t worried about this should I be worried. No, I don't think so
Prostate was small with a discrete capsule and bright hyperechoic areas of suggestive of previous prostatitis. again there not worried it usually gets bigger with inflammation, it looks like he has had it previously which could account for the multi drug resistant bug he has
Thoracic radiographs: Diffuse moderate interstitial lung pattern, associated with a mild bronchial lung patter (related with expiratory status, patient corporal condition or chronic broncho-pulmonary inflammation +/- hyperadrenocorticism related mineralisations). No evidence of pulmonary metastasis or thoracic lymphadenopathy. I,m assuming that the cancer at this time has not spread to the chest but not sure what the rest means.
Has Woody had chest infections or asthma or anything like that previously?? GREAT no sign of cancer in there, no lymph nodes swollen (lymphadenopathy) :)
Blood pressure 163/83 consistent with borderline hypertention - they put this down to white coat syndrome.
Yep, my vet would not be too concerned about that level either.
Urinalysis USG 1.016, ph 6.5 UPC 0.06 - I can,t find the normal range for this.
That urine is a little dilute judging by Specific gravity... was he drinking or have IV up when it was done, it can fluctuate through the day so this could be OK. pH fine. UPC (urinary protein creatinine ratio which is an indicator of renal problems) pretty good too, normal is <0.05 so Woody not far off there!! I would love Flynny to have that kind of result there!!

Liver FNA: Sheets of hepatocytes which in some areas show mild swelling. Other areas show fine cytoplasmi granular pigment. Several mast cells are present overlying these areas. The mast cells are most likely travelling through the liver rather than indicative of mast cell disease - I take this as liver is patchy and enlarged a little but no cancer in it (I dunno) I agree with you there
Microbiology Report:- Prostrate wash a MDR (multi drug resistant) Enterococcus was found and isolated (then it lists 25 AB,s its resistant to) That's weird, we are seeing more and more of this in humans too. Enterococcus is a bug more commonly seen in the bowel but it does pop up in the urine. It is usually fairly resistant to drugs and we use either amoxil or nitrofurantoin.

The final report goes a bit like this - Woody,s diagnosis remains rather uncertain as the medial ilial lymph node histology is suggestive of a metastatic neuroendocrine tumour why is it "suggestive" I guess it would be good to know if it IS or if it isn't neuroendocrine, adrenal adenocarcinoma being high on the differential list so this means that if neuroendocrine is ruled out, then the adrenal tumour becomes more likely to be causing problems. But I wonder how they come to the adenocarcinoma conclusion as they have not biopsied it, it might be just a nodule and not causing the tumour cells in the node, so I guess it could be a bit of a red herring like Flynny's adrenal nodule has turned into??? The anal sacs on both sides do not indicate a primary anal sac neoplasm despite cytology prior to surgery being suggestive of a metastatic anal sac adenocarcinoma in the node Jeepers they really do not have a good handle on this node either preop or postop with it all being suggestive and I am sorry he had to go through that big surgery for that to turn out negative. Interesting Woody has a history of PU/PD although endocrine testing has failed to confirm a functional adrenal carcinoma Is he still drinking and peeing a lot. There are therefore a number of un answered questions and consultation with the pathologist has been initiated yes that is definitely needed! . It is hard to understand why an adrenal mass on the right (this has been measured at 9.9 mm) would mtastasise caudally to the medial iliac LN on the contralateral side rather than to a cranial abdominal node Good point, not usual as if it was in adrenal it would go to node closest that gland. One thing is certain, there are metastatic tumour cells in the bloods vessels adjacent to the enlarged medial ilac LN. So all they have so far is tumour in the lymph node that "could" be neuroendocrine and an enlarged adrenal that "could" be adenocarcinoma. I hope there further research shows up some definitive answers for Woody, be nice to know where the primary is as it may very well not be the adrenal. From what I know of neuroendocrine and I apologise as it is not much is that adrenal is much less likely for it to originate from. :confused::confused::confused: Woody is certainly turning into a mystery, but the best news is that he is doing so well!! Hope this helps

So this is pretty much the outline of the report and basically comes up with in my option Woody has an neuroendocrine cancer, that they are not sure where its coming from possibly adrenal gland, so far it hasn,t invaded any other organ but there are little terry,s running round his body trying to grab an organ to latch onto. The only treatment is chemo but as he,s not a good candidate for that then we,re not left with much, which is why Woody continues to be a mistery to them.

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Tracy:
Thinking of you and Woody. I said many special prayers as I was up most of the nite. But thank God Tipper is blessed with a good report. Blessings
Patti

Patti I read Tippers results and I,m so so g lad.

Trish - Thank you so much for the reply,s and taking the time to answer them specially when you are looking after Flynny at the moment. That's why I love this board, people taking time to read and answer despite having their own drama,s.

I couldn,t quote your answers but just a few things you brought up, he,s never had any chest infections, kennel cough, or asthma like symtoms you really don,t hear anything from him, but now you know I will be listening out for them lol. His urine sample which was dilute was taken first thing in the morning by me at home as the hospital wanted it to be as stressless as possible gives a better reading they said. He is still peeing a river and drinking for Scotland which to be fair is his original symptoms.

I have read his pathology report the first one says Two sections of the medial iliac lymph node are examined which are similar in appearance. With and expanding the capsule and effacing all normal lymph node architecture is a large, poorly demarcated neoplasm. Several arteries within the overlying capsule are partially or completely occluded by emboli of neoplastic cells similar to those in the main tumour mass. It talks about the size, shape of the node and cells within it. So defo cancer in the node. His comment says: There is no evidence of a neoplastic process or a lesion which would correspond to a grossly evident mass in the sections of anal sac and glands examined. Further sections and turned sections will be ordered. It was at this point that Ian oncologist asked for them to be re examined and re cut and re stained.
The next pathology report says: - The histological appearance of the mass in the medial iliac node, with prominent packeting of neoplastic cells is consistent with a neuroendocrine carcinoma. The finely vacuolated cytoplasm variably present in neoplastic cells is most consistent with the cells of the of the adrenal cortex and so an adrenocortical carcinoma should be firstly ruled out as a primary. Immunochistochemical staining is consistent of a neuroendocrine carcinoma. These are rare tumours in dogs and are reported to arise in the adrenals, intestine, liver (hepatic Carcinoid), skin (merkel cell carcinoma) oesophagus, nasal cavity, bile duct, gallbladder, liver and the nasopharynx. Apart from Merkel cell carcinomas which are usually benign in dogs, a characteristic immunohistochemical staining pattern has not been recognised for the different manifestations of these neoplasms. Further IHC may therefore not be useful in determining the organ of orgin.

So this is where we are up to, as there is no specific test to determine where his tumour is we are all at a stand still waiting to see where it will appear next. I have emailed the hospital with a few questions but haven,t heard back from them. Woody is really well at the moment which is great, but I need to know what I should be looking out for symtoms wise. Oh dear I appear to have written an essay again.

Well I guess adrenocortical tumour can be neuroendocrine, that must be pretty rare... trust our K9C dogs to be in the miniscule percentages... I wish they would start getting some of the run of the mill diseases that can be easily managed!

So they are taking the watch and wait approach? We had to do that with Flynn last year before the adrenal cancer was visible. Hard knowing something is wrong but they cannot just pinpoint it.

It looks like they are trying very hard to get the answers for Woody, so currently the adrenal tumour is not functional, do they have any idea what is causing the PU/PD?

Yes he.s a mystery lol. They still say possible cushings for the pU/pd but there not sure everything with Woody is all just possible this or possible that nothing concrete which is rather frustrating.

In other news I had Channel 4 TV station on phone asking if they can use the the filming they took of Woody and his microphone at the hospital off course they can. I will post a link as soon as I get it,

Tracy:
I am sorry that you continue to be plagued with more questions than answers on Woody. I am so thrilled that we will get to see the clip of Woody stealing the microphone cover, that should be a blast. I am hoping all this stuff with Woody is wrong and that her goes on for many years. Blessings
Patti

Tracy:
thank you for all the well wishes. I am much better today. got my meds straightened out and everything is pretty good this morning except my hands are still swollen. We have more snow this morning, I am waiting for them to plow the roads so we can walk. We are to get a lot more tonite. I am not going out anywhere so I do not care. I hope you and Woody are still doing well. I really want to see that clip of Woody stealing the microphone cover, you have me all excited to see it. God Bless you both
Patti

Thanks patti good to hear your on the mend. I took a video of Woody versus the fridge last night but I don't know how to post it up, it is rather funny I will go and see if I can manage it

I read a bit about neuroendocrine and the tumour Flynn had in his adrenal the pheochromocytoma is actually a form of neuroendocrine! On the websites there are many different types of these tumours. Has Woody had BP checked at any stage? I would guess so when he had his surgery.

When I was talking to my vet yesterday we were going through the difficulties pathologists have identifying some tumours, for example I wanted to know why they cannot say whether Flynn's tumour is an adenoma or a carcinoma. Similar to how they cannot tell where the tumour cells have come from in Woody's lymph node. He explained it to me as the tumours grow the cells become more disorganised and revert to types of cells they often see in the early life of the animal when they are developing (embryonic) which can all look quite similar and they can lose the appearance of an "adrenal" cell or a "bowel" cell or wherever it came from. So that must be the trouble they are having making a definitive diagnosis for our Woody. Just thought I would post that while we try and make sense of it all.

I hope you work the video out to, love to see the little fridge burglar!!

Thanks Trish yeah I did read that a pheo is a type of neurosndocrine tumour. I've read so much on this that I end up getting all muddled lol. Woody Bp is checked regularly and is always unremarkable. He has no symptoms of any endocrine tumour except the Pu/pd all other results are good except his ALT are slightly elevated, so you can see why it's frustrating to know he has a tumour somewhere and my fear is that by the time it shows itself or the decide a plan it will be too late:mad: I try and focus on the here and now and he.s good at the moment except this darn colitis may need to look at his diet next see if it can be altered to help the colitis.

In other news my mother has to go into hospital on Monday for an op as she has cancer of the eyelid so there taking it away. Also my wonderful niece has told me she is 3 months pregnant and as she is only 18 my sister isn't taking it well, so will go over at wknd and try and help her smooth it out,