Question for vets: standard practice in chemotherapy

[Lindavllzyx]

My dog was misdiagnosed with extranodal lymphoma at a vet school; the pathologist was only guessing at his diagnosis and this was obvious in the pathology report.
It didn't look like lymphoma on the ultrasound, and no lymph nodes were swollen. He got staged for lymphoma metastasis and no lymphoma was found elsewhere.
So he got one session of chemo at the vet school, then I took him to a local vet, who did chemotherapy for lymphoma.
Question - would it have been the normal, sensible thing for the local vet to ask for the pathology report that diagnosed "lymphoma", before doing chemo?
I kind of smelled a rat - I wanted to see the pathology report that came up with such an extraordinary diagnosis. I asked the vet school for it a couple of times without success. After the chemo failed I took my dog to a veterinary internist, who said she wouldn't do chemotherapy without seeing the pathology report. So after bugging the vet school some more, we got it.
I imagine the local vets might say "We just general veterinarians, we were going by the guidance of the oncologist at the vet school and trusted their diagnosis". What do you think? Would a sensible veterinarian have asked to look at the pathology report?
thanks
Linda

 

[esoteric-lizard]

My dog was misdiagnosed with extranodal lymphoma at a vet school; the pathologist was only guessing at his diagnosis and this was obvious in the pathology report.
It didn't look like lymphoma on the ultrasound, and no lymph nodes were swollen. He got staged for lymphoma metastasis and no lymphoma was found elsewhere. So he got one session of chemo at the vet school, then I took him to a local vet, who did chemotherapy for lymphoma.
Question - would it have been the normal, sensible thing for the local vet to ask for the pathology report that diagnosed "lymphoma", before doing chemo?
I kind of smelled a rat - I wanted to see the pathology report that came up with such an extraordinary diagnosis. I asked the vet school for it a couple of times without success. After the chemo failed I took my dog to a veterinary internist, who said she wouldn't do chemotherapy without seeing the pathology report. So after bugging the vet school some more, we got it.
I imagine the local vets might say "We just general veterinarians, we were going by the guidance of the oncologist at the vet school and trusted their diagnosis". What do you think? Would a sensible veterinarian have asked to look at the pathology report?
thanks
Linda

was a biopsy done?

i'm no vet... but i have enough background to know that someone should have looked at a biopsy to confirm the DX.... in other words a histological report.

you cant just look at something and say its cancer... then do chemotherapy, but mabye vets do things differetly?

by the way... i'm sorry to hear about your dog.

 

[Lindavllzyx]

Yes, my dog had a kidney biopsy, the pathology report on that was what I was talking about. The pathologist couldn't be sure what it was from the biopsy slides, and the pathology report, when I got to read it, was obviously just a guess.
Linda

 

[esoteric-lizard]

My dog was misdiagnosed with extranodal lymphoma at a vet school; the pathologist was only guessing at his diagnosis and this was obvious in the pathology report.
It didn't look like lymphoma on the ultrasound, and no lymph nodes were swollen. He got staged for lymphoma metastasis and no lymphoma was found elsewhere.

so cancer was found, or not?

So he got one session of chemo at the vet school, then I took him to a local vet, who did chemotherapy for lymphoma.

your dog was treated for cancer that was found?

Question - would it have been the normal, sensible thing for the local vet to ask for the pathology report that diagnosed "lymphoma", before doing chemo?

it is common knowledge in the medical community that if it isnt documented... it didnt happen!

I kind of smelled a rat - I wanted to see the pathology report that came up with such an extraordinary diagnosis. I asked the vet school for it a couple of times without success. After the chemo failed I took my dog to a veterinary internist, who said she wouldn't do chemotherapy without seeing the pathology report. So after bugging the vet school some more, we got it.

i'm curious, your dog has passed away and you think the vet school is responsable? did the chemo fail, or the cancer was already too progressed? once its gone metastatic it pretty much a done deal.

I imagine the local vets might say "We just general veterinarians, we were going by the guidance of the oncologist at the vet school and trusted their diagnosis". What do you think? Would a sensible veterinarian have asked to look at the pathology report?
thanks
Linda

i think that a DX of lymphoma is very straight forward... any histologist (or vet doctor) can identify lymphatic carcinoma under a microscope from a good biopsy.

also, any procedure that was done on your pet should have been documented in its health chart...

i hope things work out... i feel your pain.

 

[Lindavllzyx]

He was misdiagnosed with lymphoma - no, the diagnosis from a biopsy isn't always right. The pathologist was very unsure of his diagnosis and that was obvious in the pathology report, that more diagnostic work needed to be done. But I wasn't told this, I was told biopsy diagnosis is 99% accurate. I would have gotten more diagnostic work done if I'd known it was needed. My dog was actually beyond help by the time the cancer was found, I spent a huge amount of money trying to cure the supposedly treatable "lymphoma".
Anyway what I'm trying to find out is whether the vet who took over the chemotherapy should have asked for the pathology report - whether that would have been the normal thing to do, especially since it was such a weird diagnosis, it didn't look like lymphoma on the ultrasound.

 

[mrwenninger]

I must first state that I did not see your dog and therefore cannot give a diagnosis but I wanted to share a few points:
1. ultrasound is not a sensitive means to diagnose lymphoma as not all cases show renomegaly, splenomegaly, hepatomegaly, or mesenteric lymphadenopathy.
2. lymphoma can be found in any major organ--lymph nodes, kidneys, liver, spleen, bone marrow, skin, brain, etc.
3. normal lymphocytes (small/mature) can be very similar in appearance to small cell lymphoma so biopsy is not always accurate
4. a complete workup to diagnose lymphoma would likely include bone marrow aspirates, ultrasound, thoracic radiographs, cbc/chem/urinalysis.
5. an oncologist would not begin chemotherapy without a diagosis of lymphoma

I suggest that if you are concerned you discuss the biopsy results with the oncologist/pathologist as they reviewed the samples and performed the workup. I am very sorry for your loss and have been there as both the doctor and the client.
Michael Wenninger DVM