JAVMA, Vol 224, No. 2, January 15, 2004 Vet Med Today: What Is Your Diagnosis? 205

What Is Your Diagnosis?

HistoryA 10-year-old spayed female domestic longhair cat was examined for vomiting, weight loss, and lethargy of 3

months’ duration. The cat was housed indoors and had no previous history of medical illness. Its vaccination sta-tus was adequate for the lifestyle of the cat. Physical examination revealed cachexia, and a firm movable mass waspalpable in the cranial portion of the abdomen. Radiographs of the abdomen were obtained (Fig 1).

Determine whether additional imaging studies are required, or make your diagnosis from Figure 1—then turnthe page **

VETERINARY MEDICINE TODAY

Figure 1—Right lateral (A) and ventrodorsal (B) radiographic views of the abdomen ofa 10-year-old spayed female domestic longhair cat evaluated because of vomiting,weight loss, and lethargy of 3 months’ duration.

This report was submitted by Lindsay S. Williams, DVM; Julie K. Levy, DVM, PhD, DACVIM; Margaret S. Thompson, MA, DVM, DACVR; fromthe Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, FL 32610.

Address correspondence to Dr. Levy.

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DiagnosisRadiographic diagnosis—A large (10 X 10 cm),

oval soft tissue mass is evident within the cranial tomiddle portion of the abdomen. The mass contains alarge, irregularly shaped gas pocket and causes mod-erate displacement of the small intestines caudally(Fig 2). The structure is most consistent with anabnormal stomach.

CommentsTwo possible interpretations for the radiographic

findings were pyloric obstruction and thickening of thegastric wall. Gastric wall thickness cannot be accurate-ly determined from survey radiographs because fluidor food within the gastric lumen can create the falseimpression of a thickened wall. Ultrasonography of theabdomen was performed to evaluate gastric wall thick-ness, wall layering, and potential concurrent intra-abdominal abnormalities. Ultrasonography revealedthat the gastric wall at the fundus and body was severe-ly thickened (3 cm) with loss of normal layeringappearance (Fig 3). In cats, the gastric wall is normal-ly from 2 (inter-rugal thickness) to 4.4 mm (rugal foldthickness) thick.1 Mild mesenteric and portal lym-phadenopathy was identified in the cranial portion ofthe abdomen. A fine-needle aspirate of the stomachwall guided by ultrasonography was obtained for cyto-logic examination, which revealed a highly cellularaspirate with large numbers of intermediate to largelymphocytes. The lymphocytes had scant amounts ofdeeply basophilic cytoplasm with small numbers ofclear punctate vacuoles. Lymphocyte nuclei containeda single, prominent nucleolus and a mean of 1 mitoticfigure/5 microscopic fields (50X). Lymphoma of high-grade malignancy was diagnosed.

Lymphoma is the most common gastric tumor inthe cat, although the stomach is an uncommon site oflymphoma, compared with the small intestine.2 Catswith alimentary lymphoma often have a protracted his-tory of vague clinical signs that progress to overt anorex-ia, vomiting, or diarrhea. Approximately 70% to 75% ofcats with gastric lymphoma are negative for FeLV.3 Plainradiographs of the abdomen are frequently unremark-able, although thickening of the gastric wall in the

fundic area may be observed.4 Ultrasonography of theabdomen is more sensitive than radiography and mayreveal transmural thickening of the gastric wall associat-ed with disruption of gastric wall layers and enlargementof abdominal lymph nodes.5 Loss of wall layers is sug-gestive of neoplastic infiltration. In inflammatory boweldisease, there is thickening of the wall, but normal lay-ering is preserved.5 Partial gastrectomy with adjunctivechemotherapy or combination chemotherapy protocolsare used for treatment of gastric lymphoma in cats. Well-differentiated gastrointestinal lymphoma is associatedwith an improved chance of survival, compared withcats with high-grade lymphoma, because of a betterresponse to chemotherapy.6

The cat in this report was treated with a multiagentchemotherapeutic protocol, which included vin-cristine, L-asparaginase, cyclophosphamide, doxoru-bicin, and prednisone.7 Substantial reduction in thesize of the stomach mass accompanied by a 0.25-kg(0.55-lb) weight gain was observed 11 days after initi-ation of chemotherapy. Repeat radiographs were nor-mal. The cat remained in clinical remission for > 27 months and died because of complications ofchronic renal failure at 12 years of age.

1. Newell SM, Graham JP, Roberts GD, et al. Sonography ofthe normal feline gastrointestinal tract. Vet Radiol Ultrasound 1999;40:40–43.

2. Mahoney OM, Moore AS, Cotter SM. Alimentary lymphoma incats: 28 cases (1988–1993). J Am Vet Med Assoc 1995;207:1593–1598.

3. Twedt DC. Gastric neoplasia. In: Sherding RG, ed. The cat:diseases and clinical management. Philadelphia: WB Saunders Co,1994;1181–1210.

4. Gualtieri M, Monzeglio MG, Scanziani E. Gastric neoplasia.Vet Clin North Am Small Anim Pract 1999;29:415–440.

5. Penninck DG, Moore AS, Tidwell AS, et al. Ultrasonographyof alimentary lymphosarcoma in the cat. Vet Radiol Ultrasound 1994;35:299–304.

6. Moore AS, Ogilvie GK. Lymphoma. In: Ogilvie GK, MooreAS, eds. Feline oncology—a comprehensive guide to compassionatecare. Trenton, NJ: Veterinary Learning Systems, 2001;198–199.

7. Vail DC. Hematopoietic tumors. In: Ettinger SJ, FeldmanEC, eds. Textbook of veterinary internal medicine. Philadelphia: WBSaunders Co, 2000;507–523.

206 Vet Med Today: What Is Your Diagnosis? JAVMA, Vol 224, No. 2, January 15, 2004

Figure 2—Same right lateral radiographic view as in Figure 1. Noticea large (10 X 10 cm), oval soft tissue mass (arrows) in the cranial por-tion of the abdomen. The mass contains a large, irregularly shapedgas pocket. The small intestines are displaced caudally.

Figure 3—Ultrasonographic image of the abdomen of the cat inFigure 1. Notice the gastric wall at the fundus and body isseverely thickened (bar = 3 cm) with loss of normal layeringappearance. GAS = Gas within the stomach.

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