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11.5 yo female with bruising, anemia, thrombocytopenia, cystic lesions in paraspinous muscles


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We have an 11.5 yo female who one month ago developed seemingly spontaneous extensive bruising on the inside of both hind legs, R>L, that over the course of a day spread up into her inguinal area and lower abdomen. She also had moderate edema on the R hind. She seemed sore and was lame. We thought maybe torn gracilis (pics looked like what google brings up for that in a grey).   We took her in and they did bloodwork. Ddimer was a little elevated. She was still ambulatory - if slightly stiff- but interested in food, alert, etc.  Her other labs showed what I now know to be a fair bit of anemia and thrombocytopenia for her, even as a greyhound (Hct 47 from 58 during a dental 4 mo prior, and Plt 99 from 197 -- also on the dental 4 mo prior).  We world told they were basically normal, and platelets were low due to clumping, and maybe repeat them, and she was sent home. Our vet did speak to an internist who said it was nothing to worry about - to his credit, he was the one who wanted the repeat labs, not the internist.  No sure it would have changed anything though.

As an aside, she had been started on meloxicam ~5 weeks before that for bilateral chronic rotator cuff disease, and had plain films of all four limbs that were negative for tumors, severe arthritis, etc. 

We stopped the meloxicam (I was paranoid) and everything resolved over about a week. She was completely back to her sassy self. 

Almost three weeks later (we got the lab results 2 weeks after the first clinic appointment and of course hadn't made the repeat blood work appointment yet) she has a small ping pong ball hematoma above her left elbow. Non tender. Maybe slightly off, but this is a dog who broke her leg in her last race, had a broken toe after that, now dx with bilateral rotator cuff disease...she's our orthopedic kid. She also has a "bump" just inside her right ilium with a few superficial abrasions next to it. We thought maybe it was a dog door scuffle gone wrong, and watched her for a day (eating, drinking, playful, active) but she developed some more swelling of the left foreleg.  Took her in, on call vet not impressed. Told us to try the meloxicam again and see how she did.  We gave her about 3-4 more doses without a lot of change. Swelling went down but she appeared to develop more bruising behind the shoulder/elbow on the chest wall.  Thought maybe it was just resolving hematoma as she was still yelling at squirrels, eating, playing with her squeakers, etc.  

A week after that second on call vet visit (off meloxicam for about 4 days, and almost 1 mo from the initial bleeding episode), the left hind developed severe ecchymoses all along the medial aspect up to her groin again with swelling. 

*at no point have we actually witnessed any trauma significant enough to cause this degree of bleeding*

As it progressed we took her immediately to the E vet.  Essentially: Lab work and plain films later, they sent us to the internist at the closest academic center that night.

Platelets have been stable in the 60s (manual diff confirmed). Hct dropped again to 37. She has a small pericardial effusion. PT and PTT normal.  Negative chest and abdominal plain films.    Bleeding appeared to have stabilized (no more gum petechiae-- she had 2 small ones-- since arrival x 2 days). 

She underwent US with FNAs today of her abdomen. We were told her spleen looked 'abnormal' but diffusely and without a discrete mass, and not consistent with appearance of hemangiocarcinoma, so they FNA'd it anyway.  (Thought it was either inflammatory/infectious, or lymphoma, or response to her bleeding episodes based on spleen appearance alone).

But while doing the US they noticed "lesions" in her epaxial muscles on the left (the bump next to her ilium is on the right). These were described as cystic/cavitary but vascular. Never a good sign.

They also looked at the "bump" which had a similar appearance, but not a discrete mass. So they FNA'd those too. She is on Amicar and doxycycline for possible bleeding/hyperfibrinolysis and tick borne illness (she is on bravecto year round, was vaccinated and negative for Lyme x 2 a year ago when we lived in the NE and her initial in-house tick panel (Ab for RSM, Lyme, Erlichia) was all negative -- however the send out for PCR and serologies is pending). 

I have read lots of heartbreaking stories about hemangioscarcoma on here, but couldn't find much of anything about these skeletal muscle lesions/mass/tumors/bumps that they found on US. The paper I found on google seemed to indicate SMMs are a late finding and usually with an obvious liver/spleen primary, which we don't have. 

The "bump" visible on the right (normal fur and skin overlying) is about the width of your fist and sticks up about 0.5 inches from the surrounding tissue. Soft. It appears to be stable since it's discovery 10 days ago.  I'm not sure the dimensions on US.  Of all the things (tick, ITP, IHA, meloxicam side effect, etc) hemangiosarcoma skeletal muscle mets was not on my radar. (They also looked at her heart with the US -- apparently HSA likes the right atrium, but they saw no visible tumor or anything else (no thrombus etc).  The pericardial effusion can apparently be present if there is cardiac HSA but also with tick borne illness).  

Also - she's never had a bleeding problem before (spay, microchipping, happy tail amputation, partial toe amputation, broken nail, yearly dentals...you get the idea). 

Does anyone have any experience with this? Or any other suggestions as to what they might be?  I am not optimistic about conclusive results from the FNA -- it is pretty hard to get diagnostic cells from a cystic mass. 


She's my once in a lifetime heart dog and any thoughts or recommendations would be appreciated.

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Reach out to Dr Couto for a review of what's been done. He's the go-to guy for all things in greyhound health issues. Mine dogs have had a few bizarre cases he helped with.

https://www.coutovetconsultants.com/

 

Charlie the iggy, Hada the podenco maneta, Georgie Girl (UMR Cordella), Lulu the podenco andaluz
Angels: Mazy (CBR Crazy Girl), Potato, my mystery ibizan girl, Allen (M's Pretty Boy), Percy (Fast But True), Mikey (Doray's Patuti), Pudge le mutt, Tessa the iggy, Possum (Apostle), Gracie (Dusty Lady), Harold (Slatex Harold), "Cousin" Simon our step-iggy, Little Dude the iggy ,Bandit (Bb Blue Jay), Niña the galgo, Wally (Allen Hogg), Thane (Pog Mo Thoine), Oliver (JJ Special Agent), Comet, & Rosie our original mutt.

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Second what Ducky suggests. Dr Couto is the best.

Good luck to you, and please let us know how your girl is doing. It is obvious how much you love her.

Old Dogs are the Best Dogs. :heartThank you, campers. Current enrollees: Aiden. Bea. Punkin. Annie. Miss M. Cletus, knot like the others.

Angels: Pal :heart. Segugio. Sorella (TPGIT). LadyBug. Zeke-aroni. MiMi Sizzle Pants. Gracie. Seamie :heart:brokenheart. (Foster)Sweet. Andy. PaddyALVIN!Mayhem. Bosco. Bruno.Dottie B. Trevor Double-Heart. Bea.

 

:paw Upon reflection, our lives are often referenced in parts defined by the all-too-short lives of our dogs.

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1 hour ago, macoduck said:

Reach out to Dr Couto for a review of what's been done. He's the go-to guy for all things in greyhound health issues. Mine dogs have had a few bizarre cases he helped with.

https://www.coutovetconsultants.com/

The other posters beat me to it.  DR.COUTO !!!!!! Thats who you need to consult with.  He will most likely be able to get to the bottom of whats going on. Call Dr. Couto before you do anything else IMO. God bless you and your dear houndie.

 

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Any reply from Dr Couto yet?  He usually replies within 12-36 hours.  Please keep us posted.

 

Charlie the iggy, Hada the podenco maneta, Georgie Girl (UMR Cordella), Lulu the podenco andaluz
Angels: Mazy (CBR Crazy Girl), Potato, my mystery ibizan girl, Allen (M's Pretty Boy), Percy (Fast But True), Mikey (Doray's Patuti), Pudge le mutt, Tessa the iggy, Possum (Apostle), Gracie (Dusty Lady), Harold (Slatex Harold), "Cousin" Simon our step-iggy, Little Dude the iggy ,Bandit (Bb Blue Jay), Niña the galgo, Wally (Allen Hogg), Thane (Pog Mo Thoine), Oliver (JJ Special Agent), Comet, & Rosie our original mutt.

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He was very gracious and willing to look at her information, but am still working on getting it sent from the vet.  FNA from the spleen came back as hematopoiesis, however the FNAs from the epaxial muscles came back as poorly exfoliating sarcoma.  Unable to tell exactly which without a biopsy, however she already has multifocal metastatic disease without a known primary.  We are heartbroken.

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