Roxi, a boisterous flatcoat retriever, presented to us for treatment of a cruciate ligament injury.
This was treated with a routine TTA (see seperate article under the orthopaedic section). During consultation the owner mentioned a fatty mass that had been debulked by the referring vet but which had unfortunately regrown. We took an abdominal x-ray for interest and were amazed to see the size of a fatty mass that was pushing the abdominal contents caudally (backwards) and dorsally (upwards). The mass was occupying much of the abdomen and was palpable externally so it was clearly infiltrating the body wall. Most fatty masses are benign lipomas but some are locally infiltrative and recur (considered likely in this case given the history), or even malignant (liposarcomas). It was considered unlikely that this mass was malignant as she was so bright and the mass had grown so big without spread already being evident.
We contacted the referring vets and with their blessing, we addressed this mass. The intent was palliative – to buy her some more time, rather than a curative intent. With the invasion of the body wall and the size of the mass there was no reasonable expectation of achieving any kind of margin around the infiltration. Regrowth was to be expected in the mid-long term.
We performed surgery to remove as much diseased tissue as possible. The excised mass weighed 2.6 kg and was indeed an infiltrative lipoma, infiltrating the diaphragm (the muscle between the chest and the abdomen) and the abdominal wall. We removed all of the abdominal part of the mass including a section of diaphragm, a section of the sternum (breast-bone) and with sections of four of the ribs of the right hand side of the chest wall. The bones were neatly and easily cut with an oscillating air-driven saw. Blood loss was controlled with cautery. The diaphragm was reattached to the remaining ribs. The body was closed and she recovered well from the surgery.
Rest will be enforced for a couple of weeks while wounds heal. There was no point in sending the mass off for histology as this wasn’t going to affect treatment. Regrowth in the body wall is expected in the long run, but at least her abdominal organs have much more room now!
3rd December 2013