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Possible Epitheliotrophic Lymphoma In A Dog

by lrf9187 - February 17, 2025 View Case Report

Hi Steve,

My own sweet 12yr FS pittie just got a suspected diagnosis of epitheliotrophic lymphoma. It may just be one focal lesion, but we're pending immunohistochem, lymph node FNA, and an abdominal ultrasound.

She's on a 50% gently cooked + 50% dehydrated food diet, Yi Guan Jian, and some general gut/skin/kidney supplements. I recently added Ba Wei Di Huang Wan for some mild renal value elevations (negative UPC).

She went in for a dental and we removed and biopsied a small flat bleeding area on her muzzle. Lo and behold, they suspect cutaneous LSA.

She's always veered towards Blood Deficiency: warm-seeking, seborrhea, dry patchy skin lesions here and there, light pink tongue. For the past year she's had some more Yin Def signs- intermittent PU/PD, mild weight loss that she regained, and polyphagia. I attributed it to the kidneys and added ZBDWH for a bit for oral ulcers and petechhia (both suspected to be dental calculus-related) and cystitis signs, then changed to BWDWH when the oral ulcers and cystitis resolved and her Yin signs improved. Maintained YGJ for Blood/Yin and her skin symptoms.

Currently, she has a pale pink tongue, no coating, still warm-seeking, and her pulsed is a bit weak and thin with some tone.

I'm seeing CHJLGMLT for cutaneous lymphoma + topical XFHMY. Would you do those two blood modified XFZYT for more Blood Deficiency support?

by naturevet

February 24, 2025

Hi there!

Hopefully the lesion is a one-off, or that they even change the diagnosis after further testing. Meanwhile, given the high tolerance of tonics, I'd probably try Modified Xue Fu Zhu Yu Tang. I do find a lot of these dogs are Blood deficient.

If another lesion appears, while waiting to remove it, try topical Xian Fang Huo Ming Yin. You can also use it orally along with the mXFZYT, to guide the Blood moving properties to the Stomach channel, which is where the problem seems to be (given the location of the lesion on the muzzle, and also the oral ulcerations).

Make sure you DO NOT use anything like Wei Qi Booster or any formula containing Astragalus. The latter vigorously stimulates growth of cutaneous lymphoma lesions.

Hopefully this helps you out. It's always tough when it's your own dog!

Steve

by lrf9187

March 21, 2025

Hi Steve,

Sadly when I met checked her a few weeks ago, her spleen already looked very abnormal, and I realized that she had a few small skin lesions, not just the one. So sad.

She's doing well clinically except that she's losing weight despite a STRONG (like, I want to eat everything constantly) appetite and very PU/PD on pred. I'm not sure if this is from the cancer or because I have her on a multimodal protocol with pred and some repurposed drugs including metformin (also mod XFZYT, XFHMY oral & topical, chlorambucil, doxycycline, Vit D, Vit A, mushrooms, and a lymphatic/WBC-supporting Western formula).

I'm going to lower her pred a bit, but debating adding or swapping something for a SP Qi or thirsting/wasting formula. Thoughts?
Her pulse is stronger now, has some tone, maybe a little slippery, & her tongue is much pinker but not red.

by naturevet

March 25, 2025

Hi again,

Given the splenic involvement, I would switch gears and use Xiao Chai Hu Tang as one of your anti-cancer formulas. I would add in Yi Guan Jian, to help address the Stomach Heat driving lesion appearance on the muzzle, appetite and thirst, though the pred is no doubt helping. If you want to continue the others, great, but the spleen suggests a change in strategy is needed.

For some human patients with Shao Yang causes to their tumors, I've been using Qing Ying Tang and adding Qing Hao (Artemisia) to it, which has broad-based anti-cancer effects. I've been using that along with the XCHT approach, so keep that in mind. All three of these address Stomach Heat with wasting and thirsting.

Good luck and keep letting us know how things are going!

Steve

by lrf9187

March 26, 2025

Thank you! She has regained some weight and her PU/PD is better having lowered the pred dose, stopping the metformin, and increasing her calorie intake. Her pulse has also calmed down- it's not as strong as it was the other day. She's also definitely less heat seeking than she's always been, but not exactly cool seeking. More neutral.

If I add XCHT & YGJ, would you stop XFHMY over Mod XFZYT or vice versa?
What would cause you to use QYT + Qing Hao instead of XCHT? Or do you mean you'd use it in addition to XCHT + YGJ? Or with just XCHT?

by naturevet

March 27, 2025

Okay, if you think all those symptoms are pre-induced, and even the red tongue disappears, then maybe for now just add Xiao Chai Hu Tang to what you're already doing. It's synergistic with the other two formulas.

If you decide there is still a lot of lingering Stomach Heat that is not pred-induced, or she remains quite Hot, then add in the QYT + QH and the YGJ. If she partially improves, then you could phase out the other two formulas (XFZYT, XFHMY) if the herbs going in seems too much.

Hopefully that's clear and sounds sensible

Steve

by lrf9187

March 27, 2025

Yes! Thank you for clarifying!

by lrf9187

September 5, 2025

Just an update- she's doing really well! All skin lesions resolved pretty quickly except for the left buccal lip lesion that has been persistent (but has waxed and waned). She's still starving and has some pred head but I do think her appetite was present to some extent pre-pred. She has also had moderately elevated kidney values that seem stable.

I added XCHT with qing hao (I guess I mixed it up in my head as I've used that combo before but hadn't used QYT + QH before). She's also on XFHMY and ZBDWH (the latter really seems to resolve her PU/PD), pred 0.5mg/kg/d, Vitamin A, a blend of calming herbs/mushrooms (ashwagandha, bacopa, reishi, cordyceps, lions mane). On and off Vit D. I think adding peptides actually most recently benefited her oral lesion to the point where her odor and discharge significantly improved. I have not repeated an ultrasound of spleen but I don't feel any abdominal abnormalities.

She seems to be more balanced in temperature but it has been fairly hot here. She'll lie by the fire but she'll also lie on the tile. Her tongue is tending towards more pallor but is sometimes red. Apologies, I'm not home and don't have a recent pulse reading for her. She's definitely SP Qi deficient- she's had some intermittent soft stool, a lot of gas, muscle wasting, tires easily on walks, and sometimes poops in the house while walking around- seemingly without realizing it. She's also gotten ornery in her age- she's feisty and seems angry about not eating enough (she's getting like 1300kcal per day at 45lbs!). I assume I should avoid BZYQT given the astragalus?

by naturevet

September 6, 2025

Hi there!

That's great news! Yes, for lymphoma, I would try to avoid Astragalus. You could always make up a batch of Bu Zhong Yi Qi Tang by hand, but just avoid the adding the Astragalus. I've done that before and it has worked well. It does seem indicated based on your description!

Thank you for letting us know how things are going! It helps others!

Steve

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