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Mass type unknown from biopsy, next steps?
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7 June 2018
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7 June 2018 - 2:37 pm
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My big black Lab, Jake, started limping on May 18th.  My primary vet thought it was probably a sprained wrist from jumping off the couch.  Jake is almost 13 years old, weighs about 90 lbs, he's a round and short English style Lab.  So it kinda made sense. 

He's very active and strong, only started going gray a couple of years ago, lots of playfulness, honestly he's still very much like a puppy, hasn't slowed down a bit.  No signs of arthritis, even.

But then a week later he jumped off the bed and yelped and cried and wouldn't put weight on the leg.  Emergency vet x-rayed and saw a lytic lesion in the middle of his left humerus, not at the ends of the bone, coming from inside (medullary), swelling out the bone.  They sent the x-rays to my primary vet.

My primary vet told me there were some unusual elements to it, he couldn't tell whether it was a cyst or tumor.  The cortex is thinning (like a tumor), but inside it's got a well-defined border (like a cyst). The dark area inside seems to have a faint structure to it, not just a void like a cyst would make. I've looked at a lot of x-rays online at tumors and cysts online since and sure enough it kinda looks like a hybrid of the two.  

Oncologist did a needle biopsy (13 slides).  Results came back inconclusive.  No obvious tumor cells, but did see cartilaginous cells, which is odd.  

They're kinda ruling out osteosarcoma as they normally see tons of cells in the biopsy.  I brought up chondroma or chondrosarcoma and she didn't think it likely due to the location in the leg. The radiologist doesn't think it's a cyst.  No white blood cells so that rules out infection.  

We're kinda in a weird place.  No clear diagnosis.

Oh, and he's been on meloxicam and gabapentin since early on and he's hardly limping and getting around fine.  Eating great, acts just as happy as always.  Pressing on the bone does not elicit a pain response, but he does have trouble putting weight on it, though he will paw at you with the leg.  He has some prior history with benign tumors.  Lots of big lipomas and one lipoma/neurofibroma taken from his rear leg (it was 4 pounds!!).  He's a big, lumpy, lovable boy.

Oncologist has suggested these options and I'm having trouble deciding.

1. Wait a week or two, x-ray again and see how quickly it's growing, if at all.

2. Wait a week or two and do another needle biopsy.

3. Perform a surgical biopsy, though the bone is thin and she thinks its likely to break.

4. Amputate now, surgical biopsy the area and get a clear diagnosis.

5. Do nothing, let whatever it is run its course, though the bone is likely to break.

My big concern is that if it's some aggressive sarcoma type, waiting isn't good.  But with his weight I don't know if he can take an amputation.  And I don't want to amputate if his time is really short anyway, I don't want him to suffer in his last months.

And if I do amputate, there's still a big chance that some other tumor will come along in the next few months anyway (hemangiosarcoma, lymphoma, etc) since he's a Lab and they kinda get that.

Anyone have any suggestions on how to think this through?

Livermore, CA
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7 June 2018 - 3:10 pm
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Hello and welcome, your future posts will not have to wait for approval.

I'm sorry you don't have a clearer diagnosis- very frustrating!

What jumps out at me from what you have written is that the vet thinks the leg is likely to break.  How many opinions have you had?  If the leg is likely to break and there is no way to strengthen it then amputation could be a good option. 

Did anyone bring up treating with bisphosphonates to strengthen the bone?  Here is an older blog post with information:

Bisphosphonates: When Amputation isn’t an Option

We have had many large and giant breed dogs here, much larger than 90 pounds, who do fine with front amputation.  You can read some stories in the Size and Age Matters Forum.  Does the vet think he would do OK as a Tripawd?  He sounds like he is in good physical and mental shape other than the leg.

Karen and the Spirit Pug Girls

Tri-pug Maggie survived a 4.5 year mast cell cancer battle only to be lost to oral melanoma.

1999 to 2010

 

              Maggie's Story                  Amputation and Chemo

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8 June 2018 - 12:42 pm
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Hi Cayenne:  so sorry this is happening to your lovely baby boy & that he’s been through so much and you still don’t have a diagnosis.  With my guy, an almost 100lbs retired greyhound (racing weight 85lbs and 8yr at time of first limp in November 2017), the x-ray was not definitive, but suspicious and I got the same options from my vet, except that she is highly experienced with greyhounds and bone cancer and her gut was saying cancer.  My thoughts were I couldn’t have him living in increasing pain but, like you, was worried that if his time was short I did not want him spending it recovering from such a major operation as amputation.

it is a big decision and only you can know what’s best for your boy, your family and yourself, it it seems from your post that in almost every scenario your vet provided the bone is likely to break and I would imagine then you will be left with only 2 options amputate or let him go.... If it is cancer, getting it out sooner is always (duh) better than later.  If it turns out to be a cyst, could it resolve itself? In which case is the question/concern how much damage to the bone occurs before then? Is it likely that the bone can repair itself if it turns out to be a cyst which stops growing before the bone breaks?

In my case, I decided that I’d rather have my boy feeling a little bit better each day no matter how few he might have.  It was a big surgery and he spent 3 days in the hospital post-amputation but I can honestly say that with proper pain management (there are some VERY helpful posts/topics here covering current pain protocols and info you may need to share with your vet for proper pain management both before and after surgery; I didn’t have that info until about a week/10 days after surgery and we had some significant pain & phantom limb problems which resolved once things were corrected) Buck’s recovery time was surprisingly short; he was up and able to get outside to relieve himself when I brought him home and he’s been happy, hungry and cuddly ever since.  He lost his front left leg which was a concern for me (all that weight now on the 1 front leg) and since he already had pretty significant arthritis in his hips the new balance/walking adjustments did resulted in more joint pain so he has remained on Novox since the surgery and for the most part that seems be working.  

Your guy is a bit older so it might take longer to bounce back and obviously no one can say for sure how he’d do, but I had many of the same concerns that you do and in the end I am (and I am certain Buck is) happy with my decision to amputate.  Now, I should also say that the biopsy came back positive for osteosarcoma so there would have been no coming back for him and getting the tumor out was clearly a ‘right’ choice.  For you I suppose the basic question is how likely is it that your guy can hold on to his leg if the problem is not some cancer.

I hope I’ve been some help. Remember, whatever you decide you will be doing what you think is best for him and that is all a loving pet-parent can do no matter what the future results actual say about the problem.  Even if Buck’s leg didn’t have cancer there was clearly something seriously wrong and I believe I would not now be second guessing my decision. You can only do what you ca with the info currently available.  One last thing, I would say, go with your gut ... you know: 1) what you and your family can and can’t do from a financial and caretaking perspective and 2) your pet-how he’s really feeling, what his general health is like, how he handles stress and stressful situations.

My thoughts and good wishes are with you and you lumpy, lovely boy .... I don’t think you mentioned his name (?) best of luck

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