Some friends of ours recently had a problem with one of their ferrets that was fairly common in symptoms, but had an uncommon outcome. Thanks to the thoroughness of Dr. Richard Henderson of the Galveston Veterinary Clinic, in consultation with Drs. Kawasaki and Williams, Patty is a healthy ferret today and should live a full life. Dr. Henderson suggested that, due to the unusual outcome of this case, the case history and pathology report should be posted to the FML. It could very well change the decisions that a ferret owner might make, should their ferret exhibit the same symptoms. In short, what looked like it might have been lymphoma was, in fact, an entirely different problem that was effectively cured by the removal of the spleen and a short course of treatment with prednisone. Please pardon the length of this post. But we all feel that this kind of information is important and needs to be dissiminated as widely as possible. The Case History and an excerpt from the Pathology Report Follow. ------------------------------- Additional Notes to Pathology Report: Case History, Patty (Grant) At her annual physical examination on 30 September, 1993, Patty a gill ferret of Marshal Farms stock and approx. 4-5 years old, presented with an enlarged spleen, but no other apparent symptoms. The attending veterinarian, Richard Henderson, DVM, of Galveston Veterinary Clinic, recommended monthly examination to observe for other symptoms. >From October 1993 to late January 1994, the splenic enlargement became more marked. The animal was increasingly lethargic and bloodwork (CBC) showed severe anemia and a high production of leucocytes. Tentative diagnosis was lymphoma and 5.5 cc of whole donor blood was transfused. Chemotherapy course was started, consisting of dosage-by-weight of vincristine, cytoxin and prednisone. One dose of vincristine was administered intravenously, at the time of transfusion, and one dose of cytoxin given orally two days later. One-quarter (1/4) tablet of prednisone was given daily, by mouth. Dr. Henderson contacted Dr. Kawasaki, in Virginia, a well-known authority on diseases in ferrets, and specifically in ferret oncology. After consultation with Dr. Kawasaki, Dr. Henderson decided to perform a splenectomy, since, by this time, the spleen had grown to such size that it presented, in itself, an immediate threat to the animal's life. Immediately prior to surgery, the ferret weighed 1-1/2 pounds. Splenectomy was performed in early February. At the time of surgery, the spleen was so grossly enlarged that it was clearly visible through the animal's skin. A 3 cm incision was made at the cranial abdominal midline and the spleen was eased out, partially rupturing outside the body during the process of ligation of blood vessels due to its friability. A slight enlargement of the incision - about 1/2 cm - was necessary after that. Immediately post-op, another transfusion of 7.5 cc was given and a second dose of vincristine was also administered. Weight immediately following surgery was 1 lb. The spleen had weighed 1/2 lb. - roughly the size of a normal spleen in a 30-35 lb. dog. Biopsy materials of the spleen tissue were taken and sent to the United States Department of Veterinary Pathology, and written report received from US/DVP is attached. One week post-op, a third dose of vincristine was administered intravenously, since no information on further diagnosis was yet available from biopsy; but Dr. Henderson opted to reserve further use of cytoxin unless it was absolutely necessary. It was his opinion, by this time, that the pathology report might indicate a diagnosis other than lymphoma, since exploratory done during surgery had yielded no abnormality of the lymph glands, adrenals, pancreas or liver. Report on the biopsy and telephone conference with Maj. Bruce Williams, DVM proved this hypothesis correct, with a confirmed diagnosis of extramedullary splenetic hematopoiesis. Dr. Williams opinion at this point was that the splenetic enlargement was due to an autoimmune anemia. Treatment protocol indicated for this splenectomy and prednisone given pre- and post-surgery. At 7 days post-op, hematocrit was 31. The course of prednisone begun at 7 days pre-op was continuing, with taper off doses given for 2 months. Last dose was given at the end of the 3rd week of April, and on 12 May, Dr. Henderson examined Patty and another CBC was run. This showed a hematocrit of 37 and normal levels of white cells. Weight on 12 May was 2 lb., a 100% increase from her weight immediately post-op. Her energy and activity level is normal-to-high, and she shows no symptom of illness. Her present prognosis is excellent and she is expected to remain healthy and to have a normal lifespan. Bone marrow biopsy is not deemed necessary, since her hematocrit levels indicate normal bone marrow function. She will, however, be observed at home for any indication of recurrent anemia; i.e. white nose, lethargy, etc., in addition to her regular annual physical exam. Camille Grant 17 May, 1994 ------------------------------- (Excerpt from Pathology Report on Patty, received from US/AFIP - dated 4 March 1994 - Accession number 2440936-9) AFIP DIAGNOSIS: S-0883-445 Spleen, red pulp: Extramedullary hematopoiesis, diffuse, moderate, ferret, mustelid. COMMENT: The cause of the marked anemia in this ferret was not evident in the sections we examined. The splenectomy described in the clinical history is due to moderate extramedullary hematopoiesis. The extramedullary hematopoiesis seen in the spleen suggests a regenerative response to the anemia documented in the clinical history. Submission of bone marrow would have been beneficial in this case to further investigate the cause of the pancytopenia documented in the clinical history. Thank you for submitting this case to the Registry of Veterinary Pathology. RICHARD K. Harris, DVM LtCol. USAF, BSC Chairman, Department of Veterinary Pathology Bruce H. Williams, DVM MAJOR, VC, USA Department of Veterinary Pathology AFIP F/L 61 15 May 87 ------------------------------- The moral of the story is that what looks like lymphoma may not always be lymphoma. Some people hearing the diagnosis of lymphoma and not having the funds to pay for the extended treatment might choose to put the animal down rather than watch her suffer. This shows that there are some cases where this action could, in fact, be a terrible error. The operation and treatment, though not inexpensive, had a finite cost that many vets would likely be willing to finance. In any case, I believe that most ferret owners, when faced with this possibility, would find a way to come up with the money. If the vet finds indications of lymphoma during exploratory, the ferret, at the owner's discression might never wake up. But this way, the ferret at least has a chance. I understand that Dr. K. told Dr. Henderson that as much as 20% of cases that present this way, are actually ESH (extramedullary splenetic hematopoiesis). -- John Gaver ([log in to unmask]) | Action Rubber Stamp Company "Cats may be cool, | Ph:713-668-3557 Fax:713-666-3276 but Carpet Sharks rule." | Custom rubber stamps by phone or fax. ** MENTION THE FERRET LIST FOR 20% DISCOUNT. FERRET RELATED STAMPS 30% OFF. ** [Posted in FML issue 0848]