From:
"shelbykimura"
Date: 2012-03-14 12:24:26 UTC
Subject: [ferrethealth] Mass Btwn Shoulder Blades Containing Melatonin Implants
To: ferrethealth@yahoogroups.com
Hello,
I have a 0.8kg 8yo FS ferret who was diagnosed w/ adrenal disease at 2yo. She had a left adrenalectomy at that time (and was also dx w/ IBD based on intestinal biopsies). She has been on prednisolone for the IBD since that time and soon after started receiving 100-200mcg IM monthly lupron injections and melatonin implants (q4-6m) for return of clinical signs of adrenal disease.
The owner has been reluctant to take her back to surgery due to concerns that she may have a slight cardiomegaly on radiographs (and has had a few episodes of lethargy/flat-ferreting over the past few mos, of which cardiomegaly on ddx list. Fasting BG declined to r/o insulinoma).
In December, this ferret presented w/ a firm mass between her shoulder blades that the owner states arose rapidly after giving amoxicillin (prescribed for a purulent vulvar discharge). The mass was non-painful. No recent hx of vaccines (for at least 3yrs). A FNA was performed and the results came back as a "probable mesenchymal cell tumor or reactive fibroplasia." A radiograph taken during this visit has been uploaded to the photo album "Mass Btwn Shoulder Blades."
The owner returned in February for an exam as the mass was continuing to grow, and to again discuss surgery. Radiographs were repeated and are included in the abovementioned photo album. The owner booked sx for this past week, but upon examination prior to sx, the mass is even larger (size of a mandarin orange), possibly more firm and more irregular in shape than it was a month ago and can now be palpated past the visible margins of the mass, on the body wall caudal to the right elbow. The mass is now pruritic and there is evidence of excoriation on the mass, but is still non-painful on palpation. The owner also reports that the ferret's gait is slightly affected, but that she doesn't seem painful. Energy/appetite normal. No significant weight changes. Dermacool spray was dispensed to relieve the pruritis.
I discussed the fact that complete surgical excision at this point is not possible and that a good attempt at complete removal would likely have to include amputation of the right forelimb. I also discussed the risk of partial excision, but am a bit worried this may aggravate the tumor to grow more rapidly. Biopsy also provided as an option, but would this change the outcome considering we already know the tumor is growing aggressively. Chemotherapy briefly discussed, but not a likely option. Palliative care offered as the last option.
So, my questions are: Should I de-bulk? Should I only do so w/ biopsy results in hand, or does it matter? And/or for palliative care, is there a drug I should be considering? She is currently on 0.2mg SID prednisolone, which still manages her diarrhea related to IBD (this has been reduced gradually from 0.5mg over the past couple mos). Would azathioprine be a better choice? Both? And lastly, has anyone seen a similar mass containing melatonin implants? Obviously, this could be a coincidence, but must be considered as a possible causative factor.
Thanks for your help!!
Dr. Shelby Kimura BSc BVSc MRCVS
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