Biopsy Intepretation Help Please: Purulent Macrophagic Inflammation

[PatricksMom]

Murphy's bioposy came back with a result of Purulent Macrophagic Inflammation. The specifics are "Nucleated cells are primarily neutrophils (>95%) with a low proportion of large macrophagic monocuclear cells. Neither foreign material nor microorganisms are identified and cell degeneration/necrosis is not appreciated."

 

In layman's terms, the vet noticed a large lump (about the size of a nickel) very close to Murphy's spine and sent out a needle biopsy out. It feels hard and somewhat embeded in the underlying tissue to me. Our new vet is out of town, but the vet covering for her said this could be a result of some kind of infection, possibly related to a small foreign body (like a thorn) that the needle biopsy missed or it could possibly be malignant, which the needle biopsy missed.

 

So what would you do? The vet's suggestion was to wait 2 weeks and remeasure the mass, and then possibly to go in and try to remove at least enough of it to get a better biopsy. Ordinarily I'd have it removed completely as a precaution, but next to the spine makes me nervous. He has an ecoli induced UTI and is taking Ciprox but is otherwise healthy and his bloodwork all looked fine.

 

Thoughts? Anyone with experience with this? We have completely fallen in love with Murphy in 2 weeks and I'm terrified that we're going to lose him.

[tydyelady]

I went through the same thing with Opie, and his lump was on a rib. It too seemed hard and embedded in the tissue. Needle biopsy was inconclusive. I would do xrays and full biopsy. We did the waiting 2 week thing, and the lump was growing. We took xrays. Our vet took a chunk out of the lump, and the cells were still hard to pinpoint, although it appeared to be some type of cancer. The earlier you know what you are dealing with, the better your chances of helping Murphy. Praying that you get a good diagnosis.

[PatricksMom]

Xrays weren't on her suggestion list--what would we be looking for?

[tuff]

Usually when a pathologist uses the word purulent it implys a lot of acute inflammation (neutrophils). I am a pathologist. It is fairly uncommon for purulence to be associated with malignancy, and this would suggest to me that this is likely infectious. a lot depends on how good the sample was. Ciprofloxacin should be an appropriate antibiotic for a skin/soft tissue bacterial infection. Do you know if the vet sent some of the sample for culture? If ithe lump does not respond to the antibiotics, then I would think an appropriate next step would be excise the lesion or get a true tissue biopsy rather than a fine needle aspiration (I'm assuming you had an FNA). An Xray will probably not help unless the vet thought it was actually involving bone, which is not the impression I get. I would not get yourself too worried yet. I know, easier said than done.

[PatricksMom]

That's encouraging, thank you. He's been on the Ciprox since Friday evening, so perhaps with more time it will help. There was no suggestion about it involving the bone, I'm just nervous because it is close to the spine. DH just throughly poked poor Murphy just now and feels like the actual hard lump is much smaller than I thought, but that there is a feeling of fluid perhaps in the area.

 

He also thinks we may have initially overlooked it because Murphy was so underweight and bumpy in that area anyway. I'm paranoid at this point after having just lost Patrick and moving and not feeling very comfortable with our local veterinary options.

 

Eta: I called, and because the tissue was sent on a glass slide it can't be cultured. We would have to do another biopsy.

Edited May 8, 2013 by PatricksMom

[EllenEveBaz]

No knowledge here, just sending cyberhugs and earscritches.

[PatricksMom]

Murphy is going to see a surgeon on Wednesday to see about having it removed and biopsied at the VCA specialist clinic. Good thoughts pleased for a good outcome. Murphy will take all the cyperhugs he can get--he can't get enough cuddling.

[carronstar]

Cyberhugs to Murphy. Keeping you both in my thoughts and prayers.

[Guest RMarie]

[EllenEveBaz]

I'm sure you're glad to get him seen on Wednesday and not have to wait around longer. Sending lots of good thoughts and even more cyberhugs. Will keep all paws crossed, too.