Lab Said She Had Cancer, Had An Op

[Mila's Mum]

While my girl was at the chiro several weeks ago having a check-up, he found a lump on her left shoulder - not very big, approx the size of a large pea. He had a good feel of it and said it didn't feel cancerous or anything to worry about at that stage, that it felt like she'd had a reaction to a bite or something - and that it was just enlarged as a result of that.

However, as my girl had a mast cell tumour removed 4 years ago on the same side (back left leg), I thought it best to get checked out. Vet took a sample using a syringe and sent it off for testing. Lab came back and said it was a malignant soft tissue sarcoma (spindle cell tumour). So she had an op on Tuesday to have it removed and vet also removed a small lump nearby - which she thought was a lypoma but removed it just in case.

Both samples went for testing. Turns out the lump orignally advised as a STS was in fact just inflammatory cells - so there's no cancer there at all. The smaller lump was what vet thought - a lypoma.

So now my girl has a big hole in her shoulder which she didn't need to have (and possibly her body would have gotten rid of this inflammation on its own and not required any surgery at all), and I have a big hole in my bank balance.

So my query is - how can a lab mistake inflammatory cells (which I'm assuming are just white cells - I haven't found out yet, but will be trying), with cancerous cells and specifically spindle tumour cells. My vet said if they are not sure what a sample is, they will return an open finding - but they came back with a very specific result. Surely inflammatory (white?) cells look very different to cancerous spindle cells?

Atm I'm feeling very cranky that my girl (who will be 11 in a few days) has had to go through the trauma of an unnecessary operation. Maybe the small inflammation still required surgery (won't ever know now), but if it did, the margin removed would have been a lot less than what was taken bec it was believed the lump was cancerous.

Any thoughts/advice would be appreciated.

[spottychick]

Ahhhh that's so infuriating! I had the opposite situation where my dog was diagnosed with several different things and meanwhile his actual condition - cancer - was rapidly growing inside. By the time it was properly diagnosed it was too late.

Vets - like human doctors - make mistakes. The problem with vets (as someone else is discussing in this forum) is that there is no practical comeback on them because no-one has successfully sued them. However in this case it sounds like it's the lab that was the problem. Ah I dunno. From my experience there are several other tests that you can have done to determine what's going on and ways to treat it - why do they always jump straight to surgery. (I treated tumors on my girl naturally and got them into remission after refusing surgery for her).

Things really need to change anyway.

I'm so sorry this happened to you and your poor girl.

All I can say is that we can only learn from the past and make sure we get a second/third/fourth opinion in future. I wish I'd gone for a second opinion for my boy earlier but at that stage I had no reason to doubt the first vet - it was only a few weeks later when things clearly started deteriorating badly.

[rubiton]

To OP - Is you dog therefore healthy? Why not just be grateful its wasnt anything nasty and your dog shoudl be ok once she is over the op. Yes it would have been nice if the lab results had been correct but sounds like both lumps are gone and tested clear.

Mine had to get her teeth cleaned and she had a couple of lumps taken off the same time (different ones to the first ones that were found as is turns out) - added a few weeks to recovery due to their location but turns out they were apparently fat lumps and I was just relieved to find out that she was OK and the removed ones were not something more sinister. In her case the vet would have recommended just monitoring but since she was being knocked out anyway for the teeth the lumps were added to the surgery in case they had of required removal later and that would have meant a second op (yes it was extra expense).

Edited October 30, 2010 by rubiton

[spottychick]

Surely the point is that it would have been better not to put the dog through risky surgery and for the OP not to have spent all that money on surgery that was actually unnecessary. The dog was healthy and ok before the surgery.

[Rappie]

This is a difficult situation, but unfortunately it happens.

The vet initially has the benefit of seeing the whole dog and then taking what is really, a tiny sample of cells that are spread out on a slide. We then send them to someone who has only the slide and a written history to work off and determine a diagnosis. Cells can be damaged and look like something else, sometimes the cells collected are not really representative of the actual problem. Spindle cell tumours can be difficult to diagnose from cytology and have a recognised higher rate of false positive and false negative results. Spindle cells originate from other cells in the skin, there can be inflammation associated with cancerous growth.

Unfortunately, cytology is not 100% reliable no matter who is doing the sample collecting or the pathology reading. It's a minimally invasive way for us to gather information to make decisions about what to do next. In this case the cytology suggested something sinister, your vet has reacted accordingly and removed the mass with wide margins and then sent the mass, in it's entirety and "in" it's original location to be reviewed as a histopathology sample. I know it's frustrating that the result has now come back as as benign lump, but in a dog with a history of a mast cell tumour this is excellent news. It would be much worse if the cytology said it was nothing (or worse, no cytology was done) and it WAS a soft tissue sarcoma, which wasn't removed, or was removed incompletely.

I have had a similar situation occur, however for some reason we weren't able to go to surgery. I took several needle samples from a particular lump and got a cytological diagnosis that wasn't conclusive but did very much err towards soft tissue sarcoma, with slim possibilities of other things. When I called a while later to check on the patient, the lump had disappeared. The cytology was read by a pathologist who I hold in very high esteem, but making an interpretation and diagnosis from a bunch of spread out cells can be very difficult. That said, this is why we follow the process of cytology - surgical removal - histopathology, so we DO get diagnoses.

[Mila's Mum]

To OP - Is you dog therefore healthy? Why not just be grateful its wasnt anything nasty and your dog shoudl be ok once she is over the op. Yes it would have been nice if the lab results had been correct but sounds like both lumps are gone and tested clear.

Obviously I am grateful that she is healthy - but as I've stated I don't understand how inflammatory cells can be mistaken for cancerous cells. As I'm no expert, that's why I've posted - to try and get some sort of explanation as to why/how this can happen. Maybe if I do get a logical explanation as to how this occurs, then I won't be feeling so annoyed that she's had to have such an invasive procedure she didn't need to have.

[Rappie]

Obviously I am grateful that she is healthy - but as I've stated I don't understand how inflammatory cells can be mistaken for cancerous cells.

There may not have been a large number of inflammatory cells in the initial sample, but other (non blood) cells undergoing an inflammatory response can change their appearance and shape. There are some changes that are common to both inflammatory and neoplastic (cancerous) processes.

[Mila's Mum]

Obviously I am grateful that she is healthy - but as I've stated I don't understand how inflammatory cells can be mistaken for cancerous cells.

There may not have been a large number of inflammatory cells in the initial sample, but other (non blood) cells undergoing an inflammatory response can change their appearance and shape. There are some changes that are common to both inflammatory and neoplastic (cancerous) processes.

Thank you for your replies - this is the sort of stuff I was after - I picked up the lab reports and second test came back with neutrophils, macrophages, plasma cells and lymphocytes - she had an inflammatory response to plant matter.

For future reference, is there any other procedure that could have been done to confirm the first diagnosis before proceeding to invasive surgery ?

[Rappie]

For future reference, is there any other procedure that could have been done to confirm the first diagnosis before proceeding to invasive surgery ?

For a very small mass like you have described, additional testing may not have been practical. If there was some question over the results such as the diagnosis did not fit the clinical picture, vets can take a repeat sample for comparison, or request a review of the initial sample submitted. Beyond that, we're really left with close monitoring of the lump, or excisional biospy and histopathology (which is what has been done with your dog).

In a larger mass where we do have concern over it being a cancer, an incisional biopsy is often done first. This involves a general anaesthetic, removing a small wedge of tissue from the mass, then sending this sample away for histopathology. Once the results of that are known, the mass if removed as indicated (small or large margins if benign or malignant). In the cases of mast cell tumours and soft tissue sarcomas (and some other cancers), the incisional biopsy helps to grade the tumour. It's also the time where additional procedures like chest radiographs or abdominal ultrasounds might be done to search for metastases if a major surgery is being planned.

[spottychick]

Rappie - I'm also very interested in this sort of info for future reference. I'm terrified of it happening to any of my dogs again.

When I finally found a vet who knew what they were doing they x-rayed my dogs shoulder but could only id a mass. They took tissue samples (reluctantly because everytime it was interfered with it grew at an incredible rate) but they also took blood samples and gave me a complete blood work up. This was the first time we were able to get an accurate picture of what was going on inside him and we decided to operate immediately. (too late - he was pts during the op due to extensive spreading etc).

I can't remember off-hand what all the different blood work tests were tho. And I don't know how useful they are in all circumstances.

[Mila's Mum]

For future reference, is there any other procedure that could have been done to confirm the first diagnosis before proceeding to invasive surgery ?

For a very small mass like you have described, additional testing may not have been practical. If there was some question over the results such as the diagnosis did not fit the clinical picture, vets can take a repeat sample for comparison, or request a review of the initial sample submitted. Beyond that, we're really left with close monitoring of the lump, or excisional biospy and histopathology (which is what has been done with your dog).

Thanks again for the info - maybe I should have waited a week or so to see if it went on its own. It's distressing putting your dog through such a procedure (especially an older dog), and even more distressing when you find out it was unnecessary. Thankfully this one wasn't as major as the last one, which required skin grafts.

Just needed some answers to try and understand how/why a mis-diagnosis could have occurred.

[cavNrott]

Ahhhh that's so infuriating! I had the opposite situation where my dog was diagnosed with several different things and meanwhile his actual condition - cancer - was rapidly growing inside. By the time it was properly diagnosed it was too late.

I had much the same situation with my 6yo Rottweiler. The first biopsy came back from pathology as inconclusive. 3 months later on second biopsy it was found to be a highly malignant tumour.

From my experience there are several other tests that you can have done to determine what's going on and ways to treat it - why do they always jump straight to surgery. (I treated tumors on my girl naturally and got them into remission after refusing surgery for her).

Can you elaborate please Spottychick. Which tests other than histopathology can be done to determine what the tumours are?

The tumours you treated by natural methods that went into remission. Could you explain the natual methods you used and what type of tumours they were?

If it ever happens again to one of my dogs I want to be fully armed with as much knowledge as possible. I did use alternative treatments as well as allopathic meds for my dog and she happily lived for much longer than expected but eventually the cancer cut her life short.

[Everythings Shiny]

Mila's Mum - I had a similar scare when my boy D got incredibly sick. I rushed him to my work and we ran every test under the sun and two lots of lab tests said he has severe lymphoma and another blood cancer (having a mind blank atm of the name). I then had to make the decision of whether to start treatment, or let him go. My boss was not convinced that was the cause, so he asked for more tests. All came back fine, just mild anemia, we were all stumped, so we sent more bloods, and again came back clear. Do I blame anyone? No, do we know what happened? Another big no.

Either way, everyone in the veterinary industry are human, mistakes will happen and I think people need to remember that.

[Mila's Mum]

Mila's Mum - I had a similar scare when my boy D got incredibly sick. I rushed him to my work and we ran every test under the sun and two lots of lab tests said he has severe lymphoma and another blood cancer (having a mind blank atm of the name). I then had to make the decision of whether to start treatment, or let him go. My boss was not convinced that was the cause, so he asked for more tests. All came back fine, just mild anemia, we were all stumped, so we sent more bloods, and again came back clear. Do I blame anyone? No, do we know what happened? Another big no.

Either way, everyone in the veterinary industry are human, mistakes will happen and I think people need to remember that.

Wasn't it fortunate that your boy only had to undergo blood tests for you to find out the initial diagnosis was incorrect. Maybe if he'd had to undergo something more radical, you might want some answers as well.

[labsrule]

Mila's Mum - I can certainly understand how you are feeling, as apart from unnecessary surgery and associated costs, there is a very high emotional cost involved as well. The emotional rollercoaster would have gone from absolute relief to finding out your dog was OK to downright angry that your poor dog was put through this unnecessary surgery. We all understand that mistakes can happen and no 100% guarantees can be made and there is potential for tests not to return the correct results, but when it is your dog it can be downright distressing and IMHO quite normal wanting to seek answers to what could have potentially caused this misdiagnosis. Situations like this will also make you question any future diagnosis/test results. Best wishes for your dog's recovery

[spottychick]

Ahhhh that's so infuriating! I had the opposite situation where my dog was diagnosed with several different things and meanwhile his actual condition - cancer - was rapidly growing inside. By the time it was properly diagnosed it was too late.

I had much the same situation with my 6yo Rottweiler. The first biopsy came back from pathology as inconclusive. 3 months later on second biopsy it was found to be a highly malignant tumour.

From my experience there are several other tests that you can have done to determine what's going on and ways to treat it - why do they always jump straight to surgery. (I treated tumors on my girl naturally and got them into remission after refusing surgery for her).

Can you elaborate please Spottychick. Which tests other than histopathology can be done to determine what the tumours are?

The tumours you treated by natural methods that went into remission. Could you explain the natual methods you used and what type of tumours they were?

If it ever happens again to one of my dogs I want to be fully armed with as much knowledge as possible. I did use alternative treatments as well as allopathic meds for my dog and she happily lived for much longer than expected but eventually the cancer cut her life short.

I'll post or send you something asap. I need a little time to put it together

I keep meaning to write it all up on a website or something. This might be the opportunity.

The blood tests I can't remember off-hand and the paperwork is buried in a box somewhere in the spare room after moving house. But I'll see if I can find it

[Staranais]

Thanks again for the info - maybe I should have waited a week or so to see if it went on its own. It's distressing putting your dog through such a procedure (especially an older dog), and even more distressing when you find out it was unnecessary. Thankfully this one wasn't as major as the last one, which required skin grafts.

Just needed some answers to try and understand how/why a mis-diagnosis could have occurred.

It's easy to second guess yourself after the fact. But if it was a high grade soft tissue sarcoma, then leaving it a week or two could have been long enough for it to grow bigger (making surgery harder on the dog and more expensive for you) or even may have been long enough for it to metastasise (making a cure impossible). It sounds to me like you did exactly the right thing given the information you had, and the vet probably did the right thing given the information that they got from the lab. It's just a huge pity that the lab gave an inaccurate diagnosis, for whatever reason, resulting in the unnecessary surgery.

[Mila's Mum]

Mila's Mum - I can certainly understand how you are feeling, as apart from unnecessary surgery and associated costs, there is a very high emotional cost involved as well. The emotional rollercoaster would have gone from absolute relief to finding out your dog was OK to downright angry that your poor dog was put through this unnecessary surgery. We all understand that mistakes can happen and no 100% guarantees can be made and there is potential for tests not to return the correct results, but when it is your dog it can be downright distressing and IMHO quite normal wanting to seek answers to what could have potentially caused this misdiagnosis. Situations like this will also make you question any future diagnosis/test results. Best wishes for your dog's recovery

Thank you - you summed it up perfectly

[Rileys mum]

If a lab is unable to 100% confirm a diagnosis surely it's more appropriate for the result to be 'inconclusive' than going 'well it kinda could be cancer, and the dogs had a cancer before so let's just say it's cancer'

Dog has now had an unnecessary surgery, which is risky just in itself, and the owner is out of pocket for an unnecessary proceedure. Everyone always pulls the "well just be grateful it wasn't cancer" line, and yes I agree be grateful it isn't, but that shouldn't excuse the fact that a incorrect diagnosis was given by the lab. What if this dog now develops a major infection or complication as a result of that surgery??

I just get so mad that there is a mentality that it's ok after huge Amts of $$$ have been forked out for no reason whatsoever and an animal has been put through pain un necessarily.

***end rant***

[Mila's Mum]

Thanks again for the info - maybe I should have waited a week or so to see if it went on its own. It's distressing putting your dog through such a procedure (especially an older dog), and even more distressing when you find out it was unnecessary. Thankfully this one wasn't as major as the last one, which required skin grafts.

Just needed some answers to try and understand how/why a mis-diagnosis could have occurred.

It's easy to second guess yourself after the fact. But if it was a high grade soft tissue sarcoma, then leaving it a week or two could have been long enough for it to grow bigger (making surgery harder on the dog and more expensive for you) or even may have been long enough for it to metastasise (making a cure impossible). It sounds to me like you did exactly the right thing given the information you had, and the vet probably did the right thing given the information that they got from the lab. It's just a huge pity that the lab gave an inaccurate diagnosis, for whatever reason, resulting in the unnecessary surgery.

Yes hindsight is a wonderful thing as they say - thankfully this thread has given me the answers I was seeking so, while I'm disappointed she had unnecessary surgery, I'm no longer grinding my teeth - I can now understand how the misdiagnosis could have occurred.