PCR for antigen receptor rearrangement (PARR) clonality testing in a horse with a solitary retropharyngeal lymphoma

A 19-year-old Quarter Horse gelding was evaluated for respiratory distress and a rapidly enlarging retropharyngeal mass. Initial evaluation revealed severe respiratory distress, and a large, firm mass, visibly appreciable as 12 x 12 cm, in the left retropharyngeal and perilaryngeal region, with surrounding left and right retropharyngeal swelling. No significant abnormalities were present on complete blood count and serum biochemistry analyses. Endoscopy revealed severe pharyngeal collapse restricting airflow without gross abnormalities of the pharyngeal mucosa other than inflammation and irritation. A multilobular retropharyngeal mass, diffusely heterogeneous in echogenicity, was present adjacent to, but not occluding, the carotid artery as assessed by ultrasonography. Initial needle aspirate suggested lymphoma. Tissue biopsy and histopathology confirmed a round cell tumour. A temporary tracheotomy was performed to provide respiratory relief, and the horse was managed on oral antibiotics and anti-inflammatory medications while awaiting histopathological results. The decision was made to humanely euthanise the horse after biopsy results indicated lymphoma. Definitive diagnosis of T cell rich, large B cell lymphoma was made by combination of cytology, immunohistochemistry and molecular clonality PCR (PARR) testing. Lymphoma should be considered in horses with focal masses of the retropharyngeal region. Although treatment was not pursued, PARR testing was successful in this case and may be helpful for accurate characterisation of lymphoma in horses to more precisely determine prognosis and the most effective treatment plans, as it has been in human patients and small animals.