Feline nasal lymphoma: Radiation therapy in a 10-year-old domestic shorthair cat
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A 10-year-old female spayed, domestic short hair cat was first presented to the Cornell University Hospital for Animals Emergency Service on December 27, 2013 for respiratory difficulty. Increased upper respiratory noise, intermittent, non-productive sneezing, and right-sided serous ocular and nasal discharge were first noted in October 2013. Signs were progressive over the next month, culminating in bloody nasal discharge. The primary care veterinarian attempted treatment with various antibiotics, steroids, and anti-histamines but clinical signs would typically resurface one week following the initiation of each treatment. The patient was therefore presented to the Cornell University Hospital for Animals at the end of December for non-resolving upper respiratory distress. On presentation, the patient was quiet but alert and responsive with vital parameters within normal limits. Her lungs were clear and both airways were patent. Stertorous breathing was noted on inspiration and expiration, with referred sounds heard in the trachea. Following stabilization and discharge from CUHA, the patient returned to the Emergency Service twice with respiratory distress before receiving a definitive diagnosis. The patient was presented on January 7, 2014 with gross obstruction of the right nostril and increased tear drainage around the right eye. Point of care blood work was relatively unremarkable, other than a respiratory acidosis presumably due to a compromised upper respiratory tract. Thoracic radiographs and abdominal ultrasound were normal and a baseline T4 ruled out hyperthyroidism. CT imaging revealed a large soft tissue opacity in the right ventral nasal passage obliterating the nasal turbinates and extending into a portion of the maxilla. Local lymph node enlargement and fluid accumulation on the right frontal sinus were also evident. A surgical biopsy was performed and immunohistochemistry later diagnosed the mass as a T-cell-rich B-cell lymphoma. Radiation treatment planning was performed but the patient was discharged on acepromazine 5 mg orally as needed for anxiety and buprenorphine 0.03 mg orally twice a day as needed for pain. The patient was returned January 12, 2014 for continued respiratory distress and medical management with prednisolone 5 mg orally once daily was initiated. Following continued respiratory distress since discharge from CUHA, the owners agreed to a palliative, 10-treatment course of radiation beginning January 16, 2014. This presentation will focus on radiation therapy and prognosis for feline nasal lymphosarcoma.