Cutaneous Mass Research Articles

Cytologic features of clear cell adnexal carcinoma in 3 dogs

Clear cell adnexal carcinoma is a rare cutaneous adnexal neoplasm without definitive apocrine, sebaceous, or follicular differentiation. Differential diagnoses include sebaceous carcinoma, liposarcoma, and balloon cell melanoma. Immunohistochemical analysis, with positive immunoreactivity for pancytokeratin and vimentin, aids in the diagnosis. Cytologic features of clear cell adnexal carcinoma have not been described previously. The aim of this study was to describe cytologic features of canine clear cell adnexal carcinoma. Fine-needle aspirates (FNA) obtained prior to biopsy of cutaneous neoplasms with a histologic diagnosis of clear cell adnexal carcinoma confirmed by immunohistochemical analysis were reviewed retrospectively. Slides prepared from FNA had been stained with modified Wright-Giemsa or automated aqueous Romanowsky stain. Of 20 neoplasms diagnosed as clear cell adnexal carcinoma in dogs, FNA of the mass had been performed in 3 cases. Cytologic features were similar and included high cellularity, marked cellular pleomorphism, loose arrangement of neoplastic cells, and a light blue to gray background resulting from streaming of cytoplasm from ruptured cells. Neoplastic cells were oval to polygonal to spindle-shaped with wispy cytoplasmic projections. Cytoplasmic eosinophilic stippling, globular deposits, or pink needle-shaped inclusions were noted. Criteria of malignancy included marked anisocytosis, anisokaryosis and anisonucleoleosis, multinucleation, karyomegaly, macronucleoli, and atypical mitotic figures. Clear cell adnexal carcinoma should be included in the cytologic differential diagnosis for a canine cutaneous mass even if an epithelial origin is not readily identified owing to lack of characteristic epithelial features, such as highly cohesive cell clusters, evident cell-to-cell junctions, and distinct cytoplasmic edges.

Current British veterinary attitudes to the use of perioperative antimicrobials in small animal surgery

A questionnaire was sent to 2951 mixed and small animal veterinary practices to examine the use of perioperative antimicrobials in cats and dogs in the UK. The percentage of respondents...

Primary Dermatofibrosarcoma Protuberans Invading the Orbit

A 38-year-old man presented with a slow-growing, firm cutaneous mass beneath his left eyebrow. Histopathology and immunohistochemistry confirmed the diagnosis of dermatofibrosarcoma protuberans. The mass infiltrated the medial canthal tendon and anterior orbital fat and could not be completely excised with Mohs micrographic surgery. The patient underwent exenteration and dacryocystectomy with margin-controlled excision and remained free of disease 9 months after surgery. To our knowledge, no prior case of primary dermatofibrosarcoma protuberans involving the orbit has been reported.

Xanthogranuloma in Adolescence

Xanthogranuloma in Adolescence

Solitary Cutaneous Myofibroma on the Sole: An Unusual Localization

Dear Editor: A 61-year-old man presented with several years of history of a solitary cutaneous mass on his left sole. A clinical examination revealed a 26×22 mm sized, skin-colored, firm, asymptomatic subcutaneous nodule (Fig. 1). General laboratory screening, including a complete blood count, renal and liver function tests and lipid levels, were within normal limits. A histopathological examination showed a well-circumscribed mass composed of spindle cells that were arranged in interlacing fascicles or whorls. The spindle cells had elongated nuclei, inconspicuous nucleoli and eosinophilic cytoplasm, resembling smooth muscle cells (Fig. 2). As a result of immunohistochemical staining, these cells were found to be positive for smooth muscle actin, but negative for S-100 protein and desmin. On Masson trichrome staining, many spindle cells with red cytoplasmic stain were found to be dispersed among the blue collagen bundles. Based on both clinical and histological features, a diagnosis of solitary cutaneous myofibroma was made. Fig. 1 26×22 mm sized, skin-colored, firm, asymptomatic subcutaneous nodule on the left sole. Fig. 2 (A) Skin biopsy showed a relatively well-circumscribed tumor in the dermis (H&E, Scanning view). (B) The tumor consists of spindle cells arranged in interlacing fascicles or whorls (H&E, ×100). (C) These spindle cells had pale ... Solitary cutaneous myofibroma is a circumscribed benign neoplasm of superficial soft tissue in adolescents and adults; it represents the adult counterpart of infantile myofibromatosis1. Clinically, it typically presents as a painless, slow-growing, firm cutaneous or subcutaneous nodule with an occasional bluish hue. There is a predilection for it to occur on the head and neck, shoulder girdle, lower extremity and hand2,3. Oral and genital solitary cutaneous myofibromas have also been identified. Plantar involvement is exceptionally rare, and there has been only one case of solitary cutaneous myofibroma affecting the sole in the literature3. Histological findings reveal a distinctive appearance, well recognized in children but much less so in adults. It manifests as a biphasic pattern or a zoning arrangement of two cell types4. Among them, the hemangiopericytomatous components, which are typical of infantile myofibromatosis, may sometimes be inconspicuous or even absent in adult lesions, as in our case3. Spindle cells have eosinophilic cytoplasm arranged in short bundles and fascicles resembling leiomyoma. These cells demonstrate features of both myofibroblasts and fibroblasts. Myofibroblastic differentiation of the tumor cells is supported by their immunophenotype. The spindle cells are desmin negative, but smooth muscle actin positive. The Masson trichrome stain, in which thick fibrous bundles with random, irregularly intersecting angles are prominent, can be used to assist in differentiating myofibromas from smooth muscle lesions5. In contrast, smooth muscle lesions show delicate fibrous tissues surrounding the smooth muscle cells and in the septa between the smooth muscle masses. The limited follow-up of solitary cutaneous myofibromas suggests that they tend to follow a benign clinical course with no evidence of recurrence or metastasis1-3. To our knowledge, our case represents only the second report of a solitary cutaneous myofibroma occurring on the sole. We suggest, even though it is very rare, that solitary cutaneous myofibroma should be considered in the differential diagnosis of solitary lesions involving the sole.

Combined Cutaneous Sarcoma: Pleomorphic Liposarcoma and Conventional Osteosarcoma—The So-Called Malignant Mesenchymoma

Malignant mesenchymoma is combined soft tissue tumors of mesenchymal origin. Cutaneous combined sarcomas are exceedingly rare. We report the case of an 81-year-old woman who presented a left cutaneous mass. She underwent a wide local excision. Histopathological and immunohistochemical studies were consistent with the diagnosis of combined pleomorphic liposarcoma and conventional osteosarcoma (malignant mesenchymoma). Although it is extremely rare, this case suggests that combined sarcoma should be considered in the differential diagnosis of undifferentiated pleomorphic neoplasms.

Gardner's Syndrome

Gardner's syndrome is an autosomal dominant disease and is a subtype of familial adenomatous polyposis. It is characterized by adenomatous intestinal polyps, multiple osteomas in the skull, maxillae, mandible, and multiple cutaneous and subcutaneous masses (epidermoids and desmoid). Intestinal polyps, if not treated, have 100% chance of becoming malignant. We report a case of a 25-year-old female patient with Gardner's syndrome, with clinical manifestations including impacted supernumerary teeth, odontomes, sebaceous cyst on the scalp, and osteomas. It is important for the general dental practitioners to be aware of the clinical and radiological characteristics of Gardner's syndrome.

Feline Papillomavirusinfektion bei einer Katze mit Bowen-like disease und kutanem Plattenepithelkarzinom

A cutaneous mass in the neck was excised in a 13-year-old cat. Histopathological examination of the resected tissue revealed a multicentric squamous cell carcinoma in situ resembling Bowen's disease of man. The tumor showed a multifocal transformation to an infiltrative squamous cell carcinoma. Histological and immunohistological findings excluded actinic keratosis and feline viral plaques and allowed a classification as an irregular non-hyperkeratotic type of multicentric squamous cell carcinoma in situ. As a possible causative agent feline papillomavirus type 2 was detected using nested PCR in formalin-fixed material.

Mycobacterial disease in cats in Great Britain: I. Culture results, geographical distribution and clinical presentation of 339 cases

This study investigated 339 cases of feline mycobacterial disease from cats with cutaneous lesions or masses found at exploratory laparotomy. Tissue samples were submitted to the Veterinary Laboratories Agency for mycobacterial culture over a 4-year period to December 2008. The study assessed which species of culturable mycobacteria were involved, where the cats lived, and their clinical presentation (physical findings, serum biochemistry, radiography, feline leukaemia virus and feline immunodeficiency virus status). Mycobacterium microti was cultured from 19%, Mycobacterium bovis 15%, Mycobacterium avium 7%, non-M avium non-tuberculous mycobacteria 6%, with no growth in 53% of samples. M microti, M bovis and M avium were found in almost mutually exclusive clusters within Great Britain (GB) (ie, M bovis in South-West England/Wales/Welsh Border, M avium in eastern England and M microti south of London and in South-West Scotland). While differences were seen in the clinical presentation and distribution of lesions caused by the different infections, these were not sufficiently different to be diagnostic. Cats commonly presented with single or multiple cutaneous lesions (74%), which were sometimes ulcerated or discharging, located most frequently on the head (54%). Lymph nodes were usually involved (47%); typically the submandibular nodes. Systemic or pulmonary signs were rarely seen (10-16%). When a cat is suspected of having mycobacteriosis, accurate identification of the species involved helps to determine appropriate action. Our findings show that knowing the cat's geographic location can be helpful, while the nature of the clinical presentation is less useful. Most cases of feline mycobacterial disease in GB are cutaneous.

Chromatophoroma in a crevice kelpfish (Gibbonsia montereyensis)

A captive adult crevice kelpfish, Gibbonsia montereyensis, developed a cutaneous mass, approximately 9 × 7 mm on the right side of the head in an area of nonscaled skin. Following surgical debulking, examination of both impression smears and histologic sections of the tumor revealed a predominant population of round to spindloid to polygonal cells with a moderate amount of lightly basophilic cytoplasm. The cytoplasm was filled with round, variably-sized reddish-brown granules that often obscured the nucleus. Nuclei were round to ovoid with coarsely granular chromatin. There was minimal anisocytosis and anisokaryosis. The cytoplasmic granules in histologic sections were weakly positive by the Fontana-Masson method, and staining was eliminated with melanin bleach. Immunohistochemical staining was strongly positive with a murine monoclonal antibody for melan A. As the specificity of melan A for melanophores is not clearly defined in nonmammalian species, the tumor was examined by transmission electron microscopy. Melanophores were not detected. Instead, neoplastic cells were filled with numerous intracytoplasmic organelles with triple-limiting membranes composed of concentric lamellae; these structures were most compatible with pterinosomes, which are the pigment-containing organelles of cells called xanthophores and erythrophores. As both of these organelles are ultrastructurally indistinguishable and as kelpfish skin is known to contain both xanthophores and erythrophores, a diagnosis of a mixed pigment cell tumor or chromatophoroma was made. As the tumor was grossly reddish-brown, the possibility of a neoplastic population of only erythrophores could not be excluded. Pigment cell tumors, arising from cells of the embryonic neural crest, are common in reptiles and bony fish.

Diagnosis and treatment of truncal cutaneous pythiosis in a dog

A 4-year-old spayed female Boxer was evaluated for a cutaneous mass located on the dorsum. The mass had been present for 6 weeks and was increasing in size. A mass of approximately 10 cm in diameter was detected on the dorsum cranial to the right ilial wing. Histologic examination of a tissue sample from the mass led to the diagnosis of cutaneous pythiosis. Computed tomography of the abdomen and the mass were performed and revealed a contrast-enhancing soft tissue mass of the dorsum and enlarged intra-abdominal lymph nodes. The dog underwent surgical excision of the cutaneous mass, including 5-cm skin margins and deep margins of 2 fascial planes. The mass was completely excised on the basis of results of histologic examination of surgical margins. The dog received itraconazole and terbinafine by mouth for 3 months following surgery. Recheck examination at 20 months postoperatively showed no signs of recurrence of pythiosis at the surgical site. Aggressive surgical excision in combination with medical treatment resulted in a favorable long-term (> 1 year) outcome in this dog. Thorough workup including diagnostic imaging and lymph node evaluation is recommended. If surgery is to be performed, skin margins of 5 cm and deep margins of 2 fascial planes are recommended.

Diagnostic challenges: Equine thoracic neoplasia

SummaryThe diagnosis of thoracic neoplasia in the horse can be difficult due to the nonspecific nature of the clinical signs and their overlap with other pulmonary diseases. Haematological and serum biochemical evaluation, thoracic ultrasonography, radiography, endoscopic examination, and, where appropriate, thoracocentesis and pleural fluid cytology may all be helpful in reaching a diagnosis. Granular cell tumours are the most frequently reported primary pulmonary tumours of horses. They occur as single or multiple masses adjacent to bronchi and bronchioles, and the mass typically extends into the airway, resulting in partial or complete occlusion of the lumen. Thymic tumours are classified as benign or metastatic, based on evidence of tissue invasiveness, even though they uniformly appear benign histologically. These tumours are derived from epithelial reticular cells of the thymus and are rare in horses. Other primary thoracic neoplasms originate from various pulmonary tissues and are primarily reported as single case reports: pulmonary and bronchial carcinoma and adenocarcinoma, bronchogenic squamous cell carcinoma, bronchial myxoma, pulmonary chondrosarcoma, pulmonary leiomyosarcoma and pleuropulmonary blastoma. Clinical signs of these primary pulmonary neoplasms are dependent on the tumour type and location, but commonly include chronic cough, weight loss, anorexia, fever and respiratory difficulty; ventral oedema, pleural effusion and epistaxis are also frequently observed. Mesothelioma is a rare primary pleural tumour arising from the mesothelium of the pleura, pericardium and peritoneum. The clinical presentation in horses includes weight loss, respiratory difficulty and large volume pleural effusion. The tumour appears ultrasonographically as multiple small nodules on a thick serosal surface and pleural biopsy is diagnostic. Lymphoma is the most common haematopoietic neoplasm in horses, which can present with 4 main manifestations of lesions: mediastinal, multicentric, alimentary and cutaneous. Common clinical features include chronic weight loss, lethargy, anorexia, subcutaneous oedema, lymphadenopathy, colic, bleeding tendency and diarrhoea. Coughing and laboured respiratory effort are often apparent in individuals suffering from mediastinal masses. In such instances, pleural effusion may result in severe pulmonary atelectasis and pulmonary function is significantly compromised. Haemangiosarcoma is the second most common metastatic thoracic neoplasm in horses. Disseminated haemangiosarcoma is aggressive and rapidly progressive. The clinical presentation often includes tachypnoea, pale or icteric mucous membranes, respiratory distress, epistaxis, and subcutaneous, cutaneous or intramuscular masses. Other tumour types that metastasise to the thoracic cavity include adenocarcinoma, squamous cell carcinoma, fibrosarcoma, metastatic melanoma, mastocytoma and undifferentiated sarcoma. The clinical features of these tumours are generally nonspecific and often relate more to the primary site of tumour formation.

Bilateral Cutaneous Diffuse Large B-Cell Lymphoma on FDG PET/CT

Abstract: Primary cutaneous diffuse large B-cell lymphoma is an uncommon type of non-Hodgkin lymphomas. A 51-year-old man had 2 gradually enlarging reddish, firm, and painless cutaneous-subcutaneous masses surrounded with some erythematous patches on his back for 3 years. Skin biopsy result was consistent with diffuse large B-cell lymphoma. FDG PET/CT was performed for staging and demonstrated bilaterally increased FDG uptake in the cutaneous masses with hypermetabolic left axillary lymph nodes. After chemotherapy, FDG PET/CT demonstrated that all FDG-avid lesions resolved, and there is a complete response to therapy.

Waldenström's macroglobulinemia in a dog with a bleeding diathesis

An 11-year-old female spayed Whippet dog was referred to the Veterinary Hospital of the National Veterinary School of Lyon with a 3-month history of chronic bleeding, cutaneous masses suggestive of hematomas, and hemorrhagic diarrhea. Laboratory abnormalities included leukopenia with neutropenia and lymphopenia, rouleaux formation, marked hyperproteinemia with hyperglobulinemia and normoalbuminemia, hypercalcemia, markedly increased serum urea concentration, mildly increased creatinine concentration, and proteinuria. Hemostatic screening tests showed marked prolongation of thrombin time, increased concentrations of fibrin(ogen) degradation products and D-dimers, and slightly prolonged activated partial thromboplastin time. Serum and urine protein electrophoresis revealed a monoclonal peak identified as IgM by immunoelectrophoresis and an M-spike, respectively. Cytologic evaluation of bone marrow revealed a hypocellular sample with lymphoplasmacytic cells comprising approximately 50% of all nucleated cells. These findings were consistent with a diagnosis of Waldenström's macroglobulinemia with secondary bleeding diathesis. Treatment with prednisone and chlorambucil was initiated, and the dog had a good response.

Consequences of intratumoral injection of a herbal preparation containing blood root (Sanguinaria canadensis) extract in two dogs

2 dogs were referred for surgical removal of cutaneous tumors that had previously been treated by intratumoral injection of a herbal preparation containing blood-root (Sanguinaria canadensis) extract. 11 days following injection of bloodroot extract into a small dermal tumor, dog 1 developed a large, soft, fluctuant cutaneous mass at the site of injection. Ultrasonographic evaluation of the mass revealed a fluid-filled central cavity with increased echogenicity of the surrounding subcutaneous tissues. Dog 2 had a small dermal tumor under the left mandible that had been treated in similar fashion. However, an exuberant reaction was not observed following injection of bloodroot extract in this dog. Both dogs underwent surgical excision of the cutaneous tumors. Histologic evaluation revealed severe necrosis and inflammation in the excised tissues from dog 1. This dog experienced postsurgical wound complications and had a prolonged postsurgical recovery. Similar, although less severe, histopathologic findings were apparent in the excised tissues from dog 2; this dog recovered without complications. Various products containing bloodroot are marketed on the Internet for topical and parenteral treatment of cutaneous neoplasms in domestic animals. However, the antineoplastic properties, therapeutic efficacy, and adverse effects of these products are poorly described in the veterinary literature. Clinicians should be aware of the potential for harm caused by the use of these products.

A huge diaphragmatic schwannoma mimicking diaphragm palsy

A 38-year-old nonsmoking woman presented with exertional dyspnea and left chest pain that had persisted for 2 weeks. She had no body weight loss, fever or productive cough. Physical examination revealed decreased breath sounds in the left lower lung field. No skin pigmentation or cutaneous mass was found. A plain chest film showed elevation of the left diaphragm with a shadow that mimicked diaphragm palsy (Figure 1, arrow). A chest sonography revealed a huge isoechoic tumor above the left diaphragm, with thickening of the wall and heterogeneous consistency (Figure 2). Movement of the left diaphragm was adequate in the inspiratory and …

Herpes Simplex Vegetans Presenting as an Eyelid Mass

A 16-year-old girl with congenital T-cell immunodeficiency presented with a 2-month history of an enlarging lower eyelid mass. After complete excision of the mass, the lesion was noted to recur. Histologic and immunohistochemical analysis of the excised mass revealed infection with herpes simplex virus types 1 and 2 with exuberant inflammatory reaction and granulation tissue consistent with the diagnosis of herpes simplex vegetans. Treatment with valacyclovir resulted in complete resolution of the remaining lesions. Herpes simplex vegetans should be included in the clinical and histopathologic differential for rapidly growing cutaneous masses in patients with immunodeficiency.

Beyond the Borders of Keloid Formation: A Case Report

The keloid scar is a cutaneous mass characterized by nodular fibroblastic proliferation of dermis and a predilection for distinctive anatomical locations. However, keloid extension to neighbouring tissue as a nonsyndromic entity has not been described. In the present report, a case involving a 48-year-old woman with extensive bilateral keloids of the ear lobules and neck following ear piercing is presented.

Eccrine spiradenocarcinoma： a case report

A 70-year-old female patient presented with several cutaneous masses on the left neck and trunk for 40 years. Some masses were removed by surgical operation more than 10 years prior to the presentation, but recurred subsequently along with an increase in lesion number. Persistent dull pain emerged at the lesion sites 2 months prior to the presentation and the masses on the left neck ulcerated 10 days prior to the presentation. Histopathology showed tumor cell clumps in the dermis with benign eccrine spiradenoma components in the centre region and carcinomatous components in the periphery. The carcinomatous components included slightly atypical cells and hyaline degeneration. Immunohistochemically, carcinoembryonic antigen and epithelial membrane antigen were observed in the tumor tissues. The case was diagnosed as eccrine spiradenocarcinoma. The masses were surgically removed, but recurred 1 month later, increased in size and number and ulcerated 3 months later, and the patient died 6 months after the surgery. Key words: Sweat gland neoplasms; Pathology, clinical; Eccrine spiradenocarcinoma

What is your diagnosis? Cutaneous mass in the mammary region of a dog

Univ Estadual Paulista, UNESP, Fac Med Vet & Zootecnia, Dept Clin Vet,Serv Patol Vet, BR-18618970 Botucatu, SP, Brazil