Ginger
Monday, August 3, 2026 at 11:08 PM
Subjective
Chief Complaint
Ginger, a 13-year-old spayed female domestic shorthair cat, presented for evaluation and management of mast cell cancer in the spleen and liver.
History
- Fine-needle aspirates of the spleen and liver confirmed mast cell cancer.
- Ultrasound noted thickening of the small intestinal wall.
- Blood work shows mild anemia.
- X-rays from the primary vet were full-body but lacked detailed chest imaging.
Additional History
- History of vomiting and decreased appetite two weeks ago, resolved after treatment.
- Currently eating and drinking well, urinating and defecating normally, and acting more like herself.
- On medication for hyperthyroidism (methimazole) and steroids (prednisolone).
- Owner reports mild lethargy compared to years ago and occasional heavier breathing.
- Previous history of scratching behavior resolved after moving from Texas to Florida.
Objective
Vital Signs
- Temperature: 101.6°F (38.7°C)
- Weight: 4.1 kg
- Heart Rate: 196 bpm
- Respiratory Rate: 36 breaths/min, mildly increased effort at rest
- Capillary Refill Time: < 2 seconds; mucous membranes pale pink
- Body Condition Score: BCS 4/9
Physical Exam
- Eyes: Clear with no discharge
- Ears: Clean with no discharge or erythema AU.
- Oral: Moderate dental calculus with mild gingivitis.
- Cardiovascular: Normal heart rate, sinus rhythm, no murmurs. Strong and synchronous pulses bilaterally.
- Respiratory: Increased bronchovesicular sounds bilaterally; no crackles or wheezes.
- Abdominal: Mildly distended abdomen; enlarged, non-painful spleen palpable; no fluid wave.
- Lymphatic: No peripheral lymphadenopathy.
- Coat and Skin: Healthy hair coat; no cutaneous masses or ectoparasites.
- Musculoskeletal: Ambulation normal, no lameness observed.
- Neurological: Normal neurologic exam with normal mentation. No proprioceptive deficits or overt ataxia; normal cranial nerve exam.
- Neck and Thyroid: Small left-sided thyroid nodule palpable (positive thyroid slip).
- Reproductive and Urinary: Normal external genitalia, no discharge or inflammation.
- Mammary: No masses palpated.
- Rectal: Not examined
Lymph Nodes
- Mandibular Lymph Node: normal on exam
- Prescapular Lymph Node: normal on exam
- Axillary Lymph Node: normal on exam
- Inguinal: normal on exam
- Popliteal Lymph Node: normal on exam
- Other Lymph Nodes: normal on exam
Assessment
Ginger has confirmed mast cell cancer in the spleen and liver (visceral mast cell disease). Differential diagnoses for the intestinal thickening noted on ultrasound include inflammatory bowel disease, small cell lymphoma, or intestinal involvement by mast cell disease. The increased respiratory rate and lung sounds need investigation for metastasis, heart disease or pleural effusion. Hyperthyroidism appears controlled on methimazole. Ginger is currently stable on steroids but needs further intervention to address the cancer.
Plan
- Perform chest x-rays (three views) to evaluate for metastasis, pleural effusion or signs of heart disease before anesthesia.
- Repeat CBC with a buffy coat smear for circulating mast cells; chemistry panel and total T4.
- Consult with a surgeon regarding splenectomy, with liver biopsy at the time of surgery.
- Evaluate the need for intestinal biopsies during surgery in consultation with an internal medicine specialist.
- Start antihistamines to reduce the effects of histamine released by the tumor: famotidine 0.5 mg/kg PO q12h and cetirizine 5 mg PO q24h.
- Continue the current prednisolone tapering schedule (1.5 mL once daily, reducing to 0.75 mL once daily next week).
- Continue methimazole at the current dose.
- Discuss chemotherapy options after surgery, including lomustine (CCNU) or toceranib (Palladia), depending on histopathology and the owner's ability to give oral medication.
- Schedule splenectomy for late August, aligning with the owner's travel schedule, unless chest x-rays or clinical signs make it more urgent.
Client Discharge Note
Thank you for bringing Ginger in today. We appreciate your commitment to her care and well-being.
Summary
Ginger was seen today to plan treatment for the mast cell cancer found in her spleen and liver. She is eating well and is more like herself since starting prednisolone. On examination, her spleen is enlarged, and her breathing is slightly faster and louder than we would like, so we want to look at her chest more closely before any surgery. Her thyroid gland is mildly enlarged on the left side, which fits with her known hyperthyroidism, and her other findings were stable. The recommended treatment for mast cell cancer of the spleen in cats is removal of the spleen (splenectomy), which often improves quality of life significantly; chemotherapy may be recommended afterwards depending on the biopsy results.
Key Topics We Discussed
- Chest X-rays: We recommend chest x-rays before surgery to check for spread of the cancer, fluid around the lungs, or heart changes that could explain her faster breathing and affect anesthesia.
- Blood Work: We will repeat her blood work, including a test for mast cells in the blood and her thyroid level.
- Surgery: Our surgeon will contact you to discuss removing the spleen and taking a liver biopsy, and possibly intestinal biopsies, during the same anesthesia. We are planning surgery for late August around your travel, unless her x-rays or symptoms suggest it should happen sooner.
- New Medications: Start famotidine twice daily and cetirizine once daily. These antihistamines help protect her stomach and reduce the effects of the substances released by mast cells.
- Prednisolone: Continue 1.5 mL once daily this week, then reduce to 0.75 mL once daily next week.
- Methimazole: Continue her thyroid medication at the current dose.
- Monitoring at Home: Count her breathing rate while she is asleep once a day; a rate consistently above 40 breaths per minute, open-mouth breathing, vomiting, black stools, or loss of appetite should be reported to us right away.
Follow-Up Communication
We will call you with the chest x-ray and blood work results within 48 hours and confirm the surgery date with you. Please contact us sooner if Ginger's breathing, appetite or energy changes.
Thank you for entrusting us with Ginger's care! We're here to support you every step of the way.
— Dr. Lena Morris