Missing Diamond Ring Leads to an Early Cancer Catch

A series of fortunate events and the collaboration among several services at Henry and Lois Foster Hospital for Small Animals (FHSA) at Cummings School of Veterinary Medicine at Tufts University may have saved the life of an English Springer Spaniel named Jill. It all started when Jill's owner, John Goulet, worried she may have swallowed his wife's diamond ring.

Goulet describes Jill as intelligent, affectionate, and somewhat of a diva, with a mischievous habit of chewing up and eating things she shouldn't, such as credit cards, a compact disc, and even a set of Rosary beads. After a couple of days searching for the lost ring, Goulet and his wife began suspecting Jill as the possible culprit. The last place they remembered seeing the ring was on the kitchen counter.

"We started to think that Jill got on the counter and ingested the ring. It didn't seem likely, but I couldn't rule it out. We were going to Tufts [Cummings School] for an annual check-up two days later, so I asked if we could get an X-ray of her stomach while we were there," says Goulet, in what turned out to be a serendipitous request.

Jill and her twin sister Lily are patients of Dr. Ekaterina Mendoza-Kuznetsova, associate clinical professor in the Department of Clinical Sciences at Cummings School and in the Dermatology Service at FHSA. Five years ago, blisters formed on Jill's nose that spread to her face. Mendoza-Kuznetsova successfully treated Jill for atopic dermatitis and later both she and her sister for ear issues. Jill and Lily continue to see Mendoza-Kuznetsova for yearly skin checks. After their appointment, Jill's abdomen was X-rayed.

Dr. Nathan Biedak, diagnostic imaging resident in the Department of Clinical Sciences at Cummings School, reviewed the initial set of radiographs. He did not find the ring, but in the small portion of the lungs visible on the edge of the film, he noticed soft tissue opacity in the right lung that concerned him. Mendoza-Kuznetsova asked Goulet if Jill was having breathing issues.

"I was surprised to hear that the dog had no respiratory-related clinical signs, as I would've expected the patient to be quite clinical given the severity of the radiographic pulmonary pattern," Biedak says.

Biedak and Dr. Agustina Anson (she/her), assistant professor in the Department of Clinical Sciences at Cummings School in the Diagnostic Imaging service, recommended additional X-rays of the lungs for a fuller view. These radiographs indicated pulmonary pathology and a pulmonary mass.

"This case is a good example of how an important finding can be overlooked if one focuses only on the primary concern—in this case, looking for the ring—without assessing the entire radiograph systematically. It was an incidental but critical finding during imaging for another issue," says Anson of Biedak's catch.

"Edge of film lesions are oftentimes totally incidental, but occasionally they change the course of therapy, so it is important to look at everything provided to us," says Biedak.

In consultation with the Internal Medicine team, Mendoza-Kuznetsova prescribed an anti-inflammatory medication for Jill and scheduled a re-check of the lungs two weeks out, hoping the issues might resolve, particularly since she had no clinical symptoms. The subsequent X-rays showed no changes, so a CT scan was performed for a more precise view. From these images, Anson and Biedak suspected the mass was neoplasia, or a tumor, and saw that the tissues around the mass were diffusely affected. A fine needle aspirate sample taken from the mass was suggestive of pulmonary carcinoma.

Mendoza-Kuznetsova checked in with FHSA's Surgery team on next steps. They initially considered removing the entire right lung, but worried about the potential complications of such an invasive surgery. Over the next two weeks, the diffuse tissues spread to the left lung. Anson and Biedak agreed that they were spreading quickly in the lungs, but the process did not look cancerous, as cancer typically does not appear so diffuse.

With this guidance, the clinicians and surgeons opted to biopsy the diffused area in both lungs instead of removing the lung. The histopathology service found the lung tissue inflamed, but not cancerous, suggesting that Jill's cancer had not spread to the tissues, as the radiologists suspected.

The Oncology team suggested that the diffused tissue was most likely a paraneoplastic reaction, or immunological response, to the tumor. Jill started on a course of high-dose steroids and aggressive anti-inflammatory immunotherapy to treat the paraneoplastic reaction. After her lungs showed improvement on another CT scan, instead of the entire right lung, the Surgical team removed just the lobe of the lung containing the tumor. Histopathological investigation of the removed mass confirmed that the mass was a pulmonary cancer, but the least aggressive type.

"This was quite an unusual case," says Anson. "Thanks to a collaborative approach among several teams—Dermatology, Radiology, Oncology, Internal Medicine, Pathology, and Surgery—and the owners' willingness to proceed, we were able to remove the affected lung lobes. This confirmed that, aside from the mass, Jill did not have cancer in the other lung tissue. As a result, instead of removing multiple lung lobes—which would have significantly compromised Jill's respiratory capacity—only the lobe containing the mass was removed. This allowed for a much less invasive surgery with a smoother recovery."

Jill will return to FHSA periodically for follow-up X-rays to monitor her lungs, but Mendoza-Kuznetsova is hopeful that with the surgical removal of the tumor, the likelihood of relapse is low and that the residual effects of the diffused changes will resolve.

"Jill had no symptoms, no clinical signs. That's why this story is so fascinating for me," says Mendoza-Kuznetsova. "She is lucky that her owner suspected that she ate the ring; otherwise, we never would have discovered the tumor, and it may have been too late once she showed clinical signs."

Mendoza-Kuznetsova also credits FHSA's university setting, with so many seasoned specialists. "During the whole process, I was running among the services. Without input from people knowledgeable in their particular areas, it would not have been possible. Nate first noticed the lesion on the lung. He was carefully looking at the entire slide, not just the belly. Don't ignore what you don't expect."

Anson agrees, "This case highlights the importance of thorough and systematic imaging review, interdisciplinary collaboration, and careful interpretation of findings. It's also a great reminder of how teamwork and thoughtful decision-making can lead to the best possible outcome for the patient."

Regarding all the doctors and services that pitched in to help on Jill's case, Goulet says, "They're amazing people, they do whatever it takes to solve the problem they're presented with. They went above and beyond the call of duty. Every person Jill encountered thoroughly cared about her."

Goulet reports that Jill is in great health and full of energy. They hike up Mount Wachusett together most mornings. And the diamond ring was found in a box—a spot they never expected—a few days after Jill's initial X-ray. He says of the find, "Somehow that ring had a cosmic purpose to it."