Needle biopsy was inconclusive for intestinal lymphoma - what now?

[Molly and Abby]

Six months ago, Molly had pancreatitis. The specialty vet did a needle biopsy on the intestines and the results came back as "inconclusive". She was diagnosed with IBD.

I thought she was out of the woods, as she is doing so much better with a change of diet. But she threw up (water) this morning, she's been hiding (she did that 6 months ago too) and hasn't eaten or drank anything.

I am going to call the vet tomorrow & get her seen. I gave her some gabapentin and ondansetron earlier today to relieve her symptoms (I had some on hand).

But - what does an inconclusive lymphoma needle biopsy mean? Is it a common finding in IBD cats? Or was the needle biopsy "inconclusive" for intestinal lymphoma because it was early stages and now the cancer is definite?

Any help you can give is appreciated. I love Molly so much! She sleeps with me every night and I cannot imagine not having my "bed buddy" with me.

 

[kittyprincesss]

I'm surprised the vet didn't inform you that a large sum of those biopsies done have a big chance of coming back as inconclusive if they don't get a good spot. I'm assuming it was the needle aspirate one?

I would not assume that it's a death sentence, and this is coming from somebody who went through the exact same thing, same tests, same worries. Those results essentially mean that they didn't get a good enough sample to accurately see if there was anything. Her primary vet warned me of this because she didn't want me to keep doing repeat biopsies, just for the probability of it being inconclusive.

So for what worked for my daughter and kept her going for 3+ years when she was given about 90 days to live, was prednisolone and compounded omeprazole into a liquid. The Pred helped her gain weight back and unfortunately it does not come without its drawbacks but for me personally I did feel like the benefit of it outweighed those and kept her around for a really long time. If she gets prescribed any medication for it always ask if there is a chance of kidney damage and any other harm to organs just so you know to keep up with blood work. We also realize she suffered from extreme IBD due to immense intestinal thickening as well as a lot of her values were low because she couldn't absorb nutrients from the food from the swelling. As soon as her inflammation went down, all her low values went up.

Keep us updated, Molly is in good hands.

 

[Molly and Abby]

I'm surprised the vet didn't inform you that a large sum of those biopsies done have a big chance of coming back as inconclusive if they don't get a good spot. I'm assuming it was the needle aspirate one?

I would not assume that it's a death sentence, and this is coming from somebody who went through the exact same thing, same tests, same worries. Those results essentially mean that they didn't get a good enough sample to accurately see if there was anything. Her primary vet warned me of this because she didn't want me to keep doing repeat biopsies, just for the probability of it being inconclusive.

So for what worked for my daughter and kept her going for 3+ years when she was given about 90 days to live, was prednisolone and compounded omeprazole into a liquid. The Pred helped her gain weight back and unfortunately it does not come without its drawbacks but for me personally I did feel like the benefit of it outweighed those and kept her around for a really long time. If she gets prescribed any medication for it always ask if there is a chance of kidney damage and any other harm to organs just so you know to keep up with blood work. We also realize she suffered from extreme IBD due to immense intestinal thickening as well as a lot of her values were low because she couldn't absorb nutrients from the food from the swelling. As soon as her inflammation went down, all her low values went up.

Keep us updated, Molly is in good hands.

Thank you so very much for your post. Yes, it was a needle aspirate.

Did your kitty ever get a definite diagnosis? How many biopsies/aspirate did your girl have?

I don't want to put Molly through all of the repeat testing. And no - no one told me an inconclusive result was possible. I even asked the specialty vet "what does an inconclusive result mean"? Does that mean she definitely does not have cancer? Is this testing result good news? " And the specialty vet was evasive IMHO. Because I thought an inconclusive result was good news.

I sincerely thank you so much for your post. You provided useful information. I appreciate it.

I am going to contact her regular vet tomorrow - and get her in tomorrow too. I have some mirataz ointment on hand too - and multiple refills.

Thank you again!

 

[kittyprincesss]

Of course, it frustrates me for you that the vet did not let you know this. Thankfully, I can pass on the knowledge I learned while treating her.

She had suspected Lymphoma, hence the 90 days to live nonsense. However, since she kept fighting for so long (3+ freaking YEARS!) and kept going, we suspect it was most likely Severe IBD that went untreated until we found her god send of a doctor who finally realized her intestinal walls were extremely thickened. She was going to have 1 aspirate, but she was very fragile her whole life and there was concern of causing harm because of the aspirate so we decided to not do it. Her vet, also told me the blatant truth of the aspirate most likely being inconclusive without them taking out like a CHUNK of her intestine which I refused to do because I did NOT want to hinder her health more.

If I'm being honest, I don't like hearing when parents feel a vet is being evasive...even if the answer is not a happy one, they should still provide you with an answer. Her vet who treated her, I swear to god she was an angel on Earth, followed her case for 2 years even when we moved states and ALWAYS went through her new blood results with me, new ailments, new treatments, the whole nine. That doctor is the very reason she lived for so long after her suspected diagnosis. Is there any other internal medicine doctors you could possibly have her seen by? You and Molly deserve the same dedication that I and Enriquetta had.

Please feel free to message if you need to, someone is always here and ready to listen and help if they can. I think it is a very good idea to contact her vet and make sure everything is alright if she is showing some signs of pain or hiding. The Omeprazole helped cut her vomiting down to almost none, and this is a cat who sadly would vomit almost every other day, or every few days. Once she started it, she went WEEKS without vomiting. I'm not sure what current food Molly is on, but definitely take a look into food that has Hydrolyzed Protein, it is very easy for their stomachs to break down and can possibly help her not want to throw up so much. As always, this is what worked for my girl, and at least gives you some ideas of what to talk about with her primary veterinarian. Also I'm not sure if you are aware but if the Mirataz is the gel you put on her ears, make sure you alternate them and also clean her ears with some cat wipes just to make sure the medication is not building up. Build up = less effective. Fingers crossed that Molly feels better, my girl from above sends her kisses and healing energy.

 

[stephanietx]

We had an ultrasound with contrast done on our girl and they diagnosed lymphoma.

 

[Molly and Abby]

Of course, it frustrates me for you that the vet did not let you know this. Thankfully, I can pass on the knowledge I learned while treating her.

She had suspected Lymphoma, hence the 90 days to live nonsense. However, since she kept fighting for so long (3+ freaking YEARS!) and kept going, we suspect it was most likely Severe IBD that went untreated until we found her god send of a doctor who finally realized her intestinal walls were extremely thickened. She was going to have 1 aspirate, but she was very fragile her whole life and there was concern of causing harm because of the aspirate so we decided to not do it. Her vet, also told me the blatant truth of the aspirate most likely being inconclusive without them taking out like a CHUNK of her intestine which I refused to do because I did NOT want to hinder her health more.

If I'm being honest, I don't like hearing when parents feel a vet is being evasive...even if the answer is not a happy one, they should still provide you with an answer. Her vet who treated her, I swear to god she was an angel on Earth, followed her case for 2 years even when we moved states and ALWAYS went through her new blood results with me, new ailments, new treatments, the whole nine. That doctor is the very reason she lived for so long after her suspected diagnosis. Is there any other internal medicine doctors you could possibly have her seen by? You and Molly deserve the same dedication that I and Enriquetta had.

Please feel free to message if you need to, someone is always here and ready to listen and help if they can. I think it is a very good idea to contact her vet and make sure everything is alright if she is showing some signs of pain or hiding. The Omeprazole helped cut her vomiting down to almost none, and this is a cat who sadly would vomit almost every other day, or every few days. Once she started it, she went WEEKS without vomiting. I'm not sure what current food Molly is on, but definitely take a look into food that has Hydrolyzed Protein, it is very easy for their stomachs to break down and can possibly help her not want to throw up so much. As always, this is what worked for my girl, and at least gives you some ideas of what to talk about with her primary veterinarian. Also I'm not sure if you are aware but if the Mirataz is the gel you put on her ears, make sure you alternate them and also clean her ears with some cat wipes just to make sure the medication is not building up. Build up = less effective. Fingers crossed that Molly feels better, my girl from above sends her kisses and healing energy.

Thank you again. Yes, I alternate the ears when mirataz is used. Funny - I bought a box of those disposable gloves because of Covid19 and used very few - but that purchase turned out to be very serendipitous! And I have baby wipes for the ears.

Yes, Molly is on Royal Canin HP. She loves it. I am so grateful for it - although it can be hard to find it sometimes due to supply chain issues, etc. When it is in the stores (Pet Smart) it is snapped right up! But I am on auto-fill now, so Molly doesn't run out.

Yes, I will post an update. I am going to try to get her in to her regular vet tomorrow.

 

[FeebysOwner]

Feeby (17+ yo) had a follow up abdominal ultrasound done in December, due to some probable issues - unrelated to either IBD or lymphoma. While those issues were 'resolved', this time they found some enlarged lymph nodes in her intestinal area and proceeded with an FNA.

What came out of Feeby's 2nd ultrasound was also 'inconclusive' to either IBD or lymphoma. The FNA showed no cancer cells, just some sort of unknown inflammation. The vet at the specialty group I went to said I could either have a biopsy done, start Prednisolone and/or chemotherapy, or have another ultrasound done in a few more months. Her preferences were the former two options.

There is no intestinal wall thickening, and Feeby does not demonstrate any other symptoms, but just because of the lack of appetite and weight loss (despite these also being related to H-T & CKD that Feeby has, along with a suspicion of chronic pancreatitis) the vet felt it could be IBD. However, as I have been told, treating IBD with Prednisolone will skew the results of any future testing, meaning to me that no 'true' diagnosis will ever be made.

I am telling you this for a reason, so bear with me. I was also told by a support group for small cell lymphoma (most common intestinal cancer in cats), that a PARR (PCR for antigen receptor rearrangements) test could have been run on the FNA tissue to further aide in identifying cancer cells if they exist. When I asked the specialty vet about this, her response was that there was no reason, pathologically, for running the PARR, so it was not done. This support group seems to feel this test is essential to confirming or denying lymphoma.

I have chosen to have yet another ultrasound done in a few months, as I am not treating Feeby for either condition without additional reason to do so. I will also not put her through a biopsy. I will however specify that I want the PARR test done in conjunction with another FNA and hope this group will comply.

I have attached a link to an article about PARR in case that might be of any help to you in possibly being able to rule out lymphoma.
Microsoft Word - Avery PARR.doc (delawarevalleyacademyvm.org)

 

[Molly and Abby]

Thank you!

How is your kitty doing?

 

[FeebysOwner]

Thank you! How is your kitty doing?

Thanks for asking! Feeby is 'holding her own' with the help of Mirataz and her H-T meds. Her January full spectrum blood work showed a still slightly high but stable thyroid count and no change in her CKD values from the previous blood work done 6 months prior. No new developments of any other sort to date. I am not crazy about yet another ultrasound, but I don't feel like the other options are something I should forge ahead with at this time.

 

[fionasmom]

As FeebysOwner pointed out, you can easily get into cross hairs with these diagnoses.

I am only going to address the "inconclusive" part of your post as you have a great deal of good information already.

When my Chelsea was suspected of having intestinal lymphoma, I discussed diagnostic measures with her cat vet. She told me that, in her experience, both the ultrasound and the FNA can come out as inconclusive and, if the owner really wants an answer, it normally comes from doing an excisional biopsy. I am not saying that you should be considering this approach or that you need an invasive biopsy; just my experience with the nature of these tests.

 

[Molly and Abby]

Can they treat a cat for lymphoma with an inconclusive test?

 

[FeebysOwner]

Can they treat a cat for lymphoma with an inconclusive test?

The specialty group I went to was willing to do so. Treatment involves chemotherapy, accompanied by - in most cases - Prednisolone (steroids). I won't agree to treating Feeby without at least one more ultrasound/FNA, as long as they will run the PARR test that I mentioned to you earlier. While cats generally do well with chemo (compared to humans), and many cats are already on Prednisolone, for an abundance of other reasons, I personally do not feel comfortable with giving Feeby these meds if they may not actually be needed, especially since her only issues - so far - are poor appetite (treated with Mirataz) and weight loss (also be controlled by Mirataz).

How is Molly doing now? Was it ever suggested she might be experiencing a flare-up of the pancreatitis? It seems from what I have read, this condition can become chronic and, if so, flare-ups may happen. Besides a food change, what else did your vet do to help with her pancreatitis 6 months ago? You might want to talk to the vet about the possibility of a flare-up.

You might also want to do some research on small cell lymphoma (most common form in cats) and see over a period of 6 months, what would be the 'typical' symptoms as the cancer advances, and the average time for advancement. It won't be totally accurate, as all cats are different, but it would give you an idea of other signs she might showing if she has had it for at least 6 months. Ask the vet as well.

Just my opinion...

 

[Molly and Abby]

Thank you for asking.

I took Molly in for an exam & testing on Monday. My vet was able to see her. They ran the whole shebang of blood tests & the IDEXX pancreatitis test. Her WBC were elevated but and the vet may change her diet because of the kidney bt results. But no pancreatitis - yay! So the Royal Canin HP seems to be working for the IBC.

They vet said she probably had gastritis and was fighting a "bug" so gave her fluids, antibiotics, flagyl, gabapentin and cerenia. She doesn't act like she is in pain, So I haven't had to give her gabapentin.

She has been eating & drinking but the last time she pooped - the best I can tell as I have 2 other cats - was Monday at her appointment. She pooped in her carrier at the vet's office.

So I brought her back to vet. She threw up again this morning. They are doing X-rays to see if she has a bowel obstruction.

But I wonder if she has lymphoma (elevated WB cells and all).

Well, I won't know until the vet calls me back with the xray results.

 

[Molly and Abby]

Molly doesn't act sick - other than the vomiting twice. She is at her heaviest at 14 lbs - that Royal Canin HP diet is a hit with her!

 

[FeebysOwner]

Again, just my personal opinion, but I would not put her on a kidney food diet for a couple of reasons. 1.) lower protein in those foods, which is really not in the best interest of older cats, even ones with kidney disease, and 2.) she likes what she is eating now, and for some reason a lot of cats do not like the kidney diet food - or grow tired of it easily. Also, what were her kidney values?

You would do her more favors if she would eat canned food - I believe the Royal Canin HP is dry food only? The moisture is really better even for cats with kidney issues. Just something to consider. I suppose you could try adding water to the RC HP and if she would eat it that way, it would offer her more moisture.

That is the other thing about lymphoma, most - I am sure not all - cats tend to lose weight regardless of how much they eat. She is also doing well with her weight, even if she has IBD - those cats tend to lose weight, and many have loose stools. Again, that is fairly typical but surely cannot be applied to all cats. Not sure what to think about a possible bowel obstruction, I hope not! But, another reason to consider canned food, or adding extra moisture to her diet.

Keep us posted, please!

 

[Molly and Abby]

Thank you again. Your information is so helpful.

The vet prescribed Flagyl too. Now, can lead to constipation? My cats have taken it when they had diarrhea. Abby had a giardia parasite. And even I was prescribed it when I got an c. diff infection (long story)

 

[FeebysOwner]

Yep, Flagyl can cause constipation. So, I guess you will have to wait and see what the vet says about the x-rays. Good thing you don't seem to need the gabapentin - a lot of pain meds also can attribute to constipation.

Do you know what her kidney values are? Just curious.

 

[daftcat75]

FNA biopsies tend to be inconclusive. Vets push for surgical biopsies which are a lot more accurate but also a lot harder on the cat. I would pick up a baby scale and monitor Molly's weight. Weigh her no more than once a week for everyone's sanity--preferably the same time and place. I leave my baby scale out on the top platform of one of the cat trees. Betty, my new cat, her first weigh-in she was a little squirmy. But baby scales are fairly tolerant of this. It would be so much easier if this one was food or treat motivated. But she'll learn the routine. As long as Molly maintains or can gain weight, it is most likely not (yet) lymphoma. The weight loss from lymphoma is rather dramatic and relentless. The difference in treatment between IBD and lymphoma is the addition of chemo. The chemo drug comes with fewer risk and fewer side effects than the steroids. So why vets insist on expensive and invasive surgical biopsies on cats who aren't doing great to begin with baffles me. Just try the steroids and if that doesn't work, add the chemo. The drug is less risk than the diagnosis in my opinion. The other trouble with a surgical biopsy (if that's what your vet is pushing for) is that negative for lymphoma today only means negative for today. It can always become lymphoma at a future date. How many times should you subject your cat to this procedure? In Krista, her transition from IBD to lymphoma was noticeable when her stools became liquid no matter what we tried and her weight loss was dramatic. She lost over half her weight in just a few months. Her weight loss stopped and her stools firmed up within a dose or two of the chemo. I still had a trigger food in her diet--the fish flakes I was wrapping her nightly prednislione pills in--which kept the cancer smoldering and kept her from remission until a surgery forced a change in our medicine regimen. Out with the fish flakes and in with the transdermal pred and boom! Her poops were finally perfect and she finally reached remission. If you don't know Molly's butt or gut triggers, keep working towards a clean, wet food only diet that will help you figure that out. Because as I learned with Krista, even steroids and chemo can't put out the fire if there's still a trigger in the diet.

Monitor her weight. And anytime she's given antibiotics, you should also give her s. boulardii to keep her poops in fine form.

More info on s. boulardii:
My Cat Has Diarrhea - What Do I Do?

 

[Molly and Abby]

Are those part of a blood test?

 

[FeebysOwner]

Also, what were her kidney values?

Are those part of a blood test?

They would be part of what would have been labeled Chemistry Panel (not the CBC Panel). But, yes most vets run both when they do blood work. Creatinine, BUN, to name the primary two related to kidneys.