Solutions to "What's Your Diagnosis?"
Radiographic Interpretation: Liver mass. Chronic renal disease. This radiograph interpretation is challenging because the mass does not silhouette with the liver as expected. This is because the mass was on the left medial lobe, which is usually not seen.
Other tests included abdominal ultrasound, CBC, blood chemistry, urinalysis and culture, and FNA of liver mass. Abdominal ultrasound showed a large, complex liver mass. There was ascites surrounding the liver. The kidneys were small and had bilaterally decreased architecture. The urinary bladder was diffusely thickened. CBC showed the WBC = 24,900. Chemistry revealed mild azotemia, hypercalcemia (12.9, reference range 7.8-11.3), an ALT which was too high to read, and a mild hyperglycemia. The urine specific gravity was 1.018. FNA of liver was non-diagnostic and consistent with an inflammatory process with previous moderate hemorrhage. After rehydration, the patient was mildly anemic (28%), and the azotemia and hypercalcemia had resolved.
The owners elected surgical biopsy and a partial liver lobectomy was performed.
Diagnosis:
Histopathology revealed hepatic biliary cystadenoma.
Hepatic biliary cystadenoma: This is a benign, slow-growing, space-occupying tumor that is derived from bile ducts and is not uncommon in the livers of older cats. Occasionally, these tumors can appear in multiple locations on the liver. Clinical signs are usually anorexia, vomiting, and weakness due to its space-occupying nature. Surgical resection is curative if the lesion is unifocal.