Cutaneous Nodules Research Articles

Multiple Cutaneous Nodules as Clinical Harbinger of Gallbladder Adenocarcinoma: A Case Report

Introduction: Cutaneous metastasis is defined as invasion of the skin by malignant cells originating elsewhere in the body. Cutaneous metastasis of Adenocarcinoma gall bladder is extremely rare. The skin can be involved simultaneously or metachronously with the primary tumour. Cutaneous metastases may present as a clinical harbinger to an otherwise difficult to diagnose primary Adenocarcinoma gallbladder. Case presentation: A young male presented with multiple nodules on scalp, trunk and limbs along with fever, weight loss and lymphadenopathy. Histopathologic examination of the nodule revealed a malignant infiltrating glandular neoplasm in dermis, consistent with metastatic adenocarcinoma with intestinal metaplasia on immunohistochemistry. Radiological investigations further confirmed the primary tumour in gall bladder with metastases in liver and lymph nodes. Unfortunately, the patient succumbed to his disease. Discussion: Gallbladder adenocarcinoma is the most commonly seen tumour of the biliary tract. Skin involvement in malignancy helps determine the treatment course and has inevitable prognostic significance. Conclusion: We herein report multiple cutaneous nodules as a remote manifestation of gallbladder adenocarcinoma. Biopsy of the skin lesion was easy to perform and quite reliably guided us towards the diagnosis of the primary tumour which would have been very difficult to diagnose otherwise.

Pleural lipoma in a horse

Lipoma is a benign neoplasia originating from adipocytes. It is frequently diagnosed in veterinary medicine and usually presents as cutaneous nodules but can also occur inside body cavities in less common cases. There are several reports of abdominal cavity neoplasia in horses, an important cause of colic in these animals. No cases of neoplasia in the thoracic cavity have been reported for this species. Therefore, the aim of this study was to report an intrathoracic lipoma located in the visceral pleura of an American Quarter Horse. The equine was euthanized after relapses of surgically resolved colic and unresponsive visceral pain. At necropsy, we observed fibrinous peritonitis, adherence of intestinal loops in its abdominal cavity, and hemomelasma ilei in several intestine segments. In the thoracic cavity, a whitish, firm, pendulous structure with a regular surface measuring approximately 4.0 cm x 3.0 cm was observed in the pleura of the right caudal lung lobe–and diagnosed by histopathology as lipoma. Due to the rarity of this type of lipoma presentation and considering the absence of reports of its occurrence in horses, this report is essential to list this neoplasia as a differential in pleural masses in the species.

Multiple subcutaneous nodules leading to a diagnosis of metastatic neuroblastoma in an infant: A case report

Neuroblastoma is a childhood malignancy with protean clinical manifestations. One rare presentation is multiple cutaneous nodules, especially in infants. We present a case of multiple cutaneous nodules as the initial presentation in an infant with metastatic neuroblastoma. The patient received chemotherapy with good response and is alive and well 5 years post diagnosis.

Total Knee Arthroplasty Complicated by Diffuse Large B-Cell Lymphoma

A 74-year-old male with a prior left total knee arthroplasty presented with deformity, loosening, pain, and stiffness associated with multiple raised, erythematous, cutaneous nodules about the anterior knee. Workup was concerning for infection, but the skin nodules were atypical. The patient was sent for biopsy which revealed cutaneous diffuse large B-cell lymphoma. The revision surgery was delayed, and the patient underwent chemotherapy/radiation with complete resolution of his lymphoma. He then underwent a successful aseptic revision total knee arthroplasty. Proper identification and treatment of rare cutaneous skin lesions about a prior surgical site can limit morbidity and result in more desirable outcomes.

The immune response to lumpy skin disease virus in cattle is influenced by inoculation route.

Lumpy skin disease virus (LSDV) causes severe disease in cattle and water buffalo and is transmitted by hematophagous arthropod vectors. Detailed information of the adaptive and innate immune response to LSDV is limited, hampering the development of tools to control the disease. This study provides an in-depth analysis of the immune responses of calves experimentally inoculated with LSDV via either needle-inoculation or arthropod-inoculation using virus-positive Stomoxys calcitrans and Aedes aegypti vectors. Seven out of seventeen needle-inoculated calves (41%) developed clinical disease characterised by multifocal necrotic cutaneous nodules. In comparison 8/10 (80%) of the arthropod-inoculated calves developed clinical disease. A variable LSDV-specific IFN-γ immune response was detected in the needle-inoculated calves from 5 days post inoculation (dpi) onwards, with no difference between clinical calves (developed cutaneous lesions) and nonclinical calves (did not develop cutaneous lesions). In contrast a robust and uniform cell-mediated immune response was detected in all eight clinical arthropod-inoculated calves, with little response detected in the two nonclinical arthropod-inoculated calves. Neutralising antibodies against LSDV were detected in all inoculated cattle from 5-7 dpi. Comparison of the production of anti-LSDV IgM and IgG antibodies revealed no difference between clinical and nonclinical needle-inoculated calves, however a strong IgM response was evident in the nonclinical arthropod-inoculated calves but absent in the clinical arthropod-inoculated calves. This suggests that early IgM production is a correlate of protection in LSD. This study presents the first evidence of differences in the immune response between clinical and nonclinical cattle and highlights the importance of using a relevant transmission model when studying LSD.

Comparison of general anesthesia and continuous intravenous sedation for electrochemotherapy of head and neck skin lesions.

Electrochemotherapy of cutaneous tumor nodules requires local or general anesthesia. For multiple and larger nodules, general anesthesia is recommended by standard operating procedures. The choice of general anesthesia is at the discretion of the treating center. Continuous intravenous sedation is also an option. Our study aimed to elucidate the tolerability, safety and possible advantages of continuous intravenous sedation in comparison to general anesthesia in patients undergoing electrochemotherapy. In the prospective study, 27 patients undergoing electrochemotherapy were either under general anesthesia or under continuous intravenous sedation. Evaluated were different endpoints, such as feasibility and safety, duration of anesthesia and compliance with the patients. Ten patients were treated under general anesthesia, and 17 patients were under continuous intravenous sedation. The comparison of the approaches indicated that continuous intravenous sedation required a lower overall dosage of propofol, a shorter duration of anesthesia, a shorter time to reach an Aldrete score >8, and greater satisfaction of the patients with the procedure compared to general anesthesia. The results indicate the feasibility and safety of continuous intravenous sedation for patients undergoing electrochemotherapy of cutaneous tumor nodules. This proved the preferred choice of anesthesia due to its shorter duration and better compliance with the patients compared to general anesthesia.

C1Q labels a highly aggressive macrophage-like leukemia population indicating extramedullary infiltration and relapse

AbstractExtramedullary infiltration (EMI) is a concomitant manifestation that may indicate poor outcome of acute myeloid leukemia (AML). The underlying mechanism remains poorly understood and therapeutic options are limited. Here, we employed single-cell RNA sequencing on bone marrow (BM) and EMI samples from a patient with AML presenting pervasive leukemia cutis. A complement C1Q+ macrophage-like leukemia subset, which was enriched within cutis and existed in BM before EMI manifestations, was identified and further verified in multiple patients with AML. Genomic and transcriptional profiling disclosed mutation and gene expression signatures of patients with EMI that expressed high levels of C1Q. RNA sequencing and quantitative proteomic analysis revealed expression dynamics of C1Q from primary to relapse. Univariate and multivariate analysis demonstrated adverse prognosis significance of C1Q expression. Mechanistically, C1Q expression, which was modulated by transcription factor MAF BZIP transcription factor B, endowed leukemia cells with tissue infiltration ability, which could establish prominent cutaneous or gastrointestinal EMI nodules in patient-derived xenograft and cell line–derived xenograft models. Fibroblasts attracted migration of the C1Q+ leukemia cells through C1Q–globular C1Q receptor recognition and subsequent stimulation of transforming growth factor β1. This cell-to-cell communication also contributed to survival of C1Q+ leukemia cells under chemotherapy stress. Thus, C1Q served as a marker for AML with adverse prognosis, orchestrating cancer infiltration pathways through communicating with fibroblasts and represents a compelling therapeutic target for EMI.

Preterm Infant with Persistent Hypercalcemia in the Absence of Cutaneous Nodules.

Preterm Infant with Persistent Hypercalcemia in the Absence of Cutaneous Nodules.

Kawasaki Disease can Improve Autism: A Case Report and Literature Review

In this paper, we report a case of autism in a child who was cured of Kawasaki disease and the condition of autism was significantly improved. Kawasaki disease (KD), also known as cutaneous mucosal lymph node syndrome, was first reported by Japanese doctor Tomaku Kawasaki in 1967. In recent years, domestic and foreign studies believe that the pathogenesis of KD is significantly related to infection, genetic susceptibility and immune response, and its pathogenesis and treatment still need to be further studied. The occurrence of autism may be based on genetic predisposition and triggered by environmental factors during the critical period of immune establishment at the age of 1-3 years, which causes immune-mediated inflammation, changes the permeability of gastrointestinal tract and blood-brain barrier, and leads to chronic inflammation in the central nervous system, thereby affecting neurogenesis, migration and synaptic construction.

Neurolymphomatosis as a manifestation of relapsed diffuse large B-cell lymphoma.

A 49-year-old woman presented with right drop foot and desensitization in the peroneal region. She had been diagnosed with stage IE primary cutaneous diffuse large B-cell lymphoma (PCLBCL), leg type, 13 months ago. Five months ago, she had achieved complete remission after receiving six cycles of R-CHOP chemotherapy (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisolone), as determined using 18-F fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG-PET/CT). She consulted an orthopedic physician and was diagnosed with unidentified right peroneal neuropathy. Her symptom neither aggravation nor improved. However, 8 months after onset, she presented with cutaneous nodules on the right foot. Nodule biopsy led to a diagnosis of PCLBCL relapse. 18F-FDG-PET/CT imaging showed increased metabolism in the right inguinal lymph node, right sural nerve, right tibial nerve, right fibula nerve, and right sciatic nerve (Figure 1, left image and upper right image). Contrast-enhanced magnetic resonance imaging (MRI) showed diffuse enlargement with an enhancement of the right sciatic nerve and right tibial nerve on T1-weighted images (Figure 1, bottom right image). Owing to the risk of irreversible neurological deficits, we did not perform a nerve biopsy. Neurolymphomatosis with relapsed PCLBCL appeared highly probable. There was no lymphomatous infiltration of the meninges on cerebrospinal fluid (CSF) cytopathologic evaluation or central neuraxis on MRI. The patient was treated with conventional chemotherapy, CHASER (rituximab, cyclophosphamide, cytarabine, etoposide, and dexamethasone). After two cycles of CHASER, 18F-FDG-PET/CT showed no abnormal uptake; however, there was no clinical improvement with regard to deficits of right peroneal neuropathy because of the prolonged neural damage. Complete remission was achieved with conventional chemotherapy; therefore, the patient planned to receive myeloablative chemotherapy with autologous stem cell transplantation. Neurolymphomatosis is defined as direct endoneurial invasion by lymphoma cells, such as that of the cranial nerves, peripheral nerve roots, plexus, or peripheral nerves [1]. It occurs in approximately 5% of patients with lymphomas, with a strong preponderance of diffuse large B-cell lymphomas [1]. Four clinical patterns have been recognized. Most commonly, neurolymphomatosis presents as painful polyneuropathy or polyradiculopathy, followed by cranial neuropathy, painless polyneuropathy, and peripheral mononeuropathy [2]. Its diagnosis requires the integration of clinical information; imaging findings (MRI and 18F-FDG-PET/CT); and morphologic data obtained from neural tissue, nonneural tissue, and CSF. Especially in the absence of systemic lymphoma, the diagnosis is often delayed, as in our case. As the index manifestation of recurrent lymphoma, neurolymphomatosis should always be considered. Its successful treatment is contingent upon recognition of the condition and its exact neuroanatomic localization without delay. The authors declare no conflict of interest. The authors received no funding for this study. TI monitored the patient. KS performed radiological investigations. IS and TI wrote the report. Written consent to publish this case was obtained from the patient. Data sharing is not applicable to this report as no datasets were generated or analyzed during the current study.

Painful lower limb nodules as first symptom of resectable pancreatic acinar cell cancer: a case report

BackgroundPancreatic panniculitis is characterized by subcutaneous fat necrosis and is a rare presentation of an underlying pancreatic disease, appearing in approximately 2–3% of all patients with a pancreatic disease. The nodules usually involve the lower extremities. Pancreatic panniculitis is commonly associated with acute or chronic pancreatitis, and occasionally with pancreatic cancer, especially acinar cell carcinoma.Case presentationA 77-year-old Caucasian woman with no significant medical history was referred to our center with multiple painful, itchy, and warm red/blue cutaneous nodules on the left lower leg. These skin lesions were consistent with the clinical diagnosis of panniculitis. The skin biopsy obtained showed a predominantly lobular panniculitis with fat necrosis of which the aspect was highly suspicious for pancreatic panniculitis. Further analysis revealed high lipase serum of > 3000 U/L (normal range < 60 U/L), and on computed tomography scan a mass located between the stomach and the left pancreas was seen. Endoscopic ultrasonography-guided fine-needle biopsy confirmed the diagnosis of acinar cell carcinoma. After discussing the patient in the pancreatobiliary multidisciplinary team meeting, laparoscopic distal pancreatectomy including splenectomy and en bloc wedge resection of the stomach due to tumor in-growth was performed. The cutaneous nodules on both legs disappeared 1–2 days after surgery. No long-term complications were reported during follow-up. One year after surgery, the patient presented with similar symptoms as preoperatively. Computed tomography scan showed local recurrence and distal metastases, which were subsequently confirmed by biopsy. She started with palliative folinic acid–fluorouracil–irinotecan–oxaliplatin chemotherapy but stopped after two cycles because of disease progression. The patient died 2 months later, 13 months after surgical resection.ConclusionThis case illustrates the importance of clinically recognizing cutaneous nodules and pathological recognizing the specific microscopic changes as sign of a (malignant) pancreatic disease.

S1676 Things Are Not Always What They Seem: A Rare Case of Pancreatic Carcinoma Manifesting Through Cutaneous Metastasis

Introduction: Pancreatic cancer is an aggressive disease that commonly metastasizes to the liver, lung, and peritoneum. Cutaneous metastasis is a rare occurrence with an incidence of only 2.0%. We present a case of metastatic pancreatic adenocarcinoma primarily presenting as a cutaneous nodule. Case Description/Methods: A 50-year-old male was undergoing outpatient evaluation for a raised, left scalp lesion along with neck nodules. Associated symptoms included an unintentional 30lb weight loss. Outpatient CT soft tissue neck revealed numerous necrotic lateral neck lymph nodes, lytic lesion with epidural soft tissue extension at C2-4, and occlusion/thrombosis of the left subclavian, brachiocephalic, and left internal jugular veins (Figure). Given these findings, the patient was referred to the Emergency Department (ED). At time of ED arrival, vital signs were stable along with initial laboratory values. CTA PE study showed no pulmonary embolism but revealed numerous pulmonary and bilateral adrenal nodules, multifocal liver and osseous lesions, and widespread lymphadenopathy. Additionally, CT head demonstrated a left scalp soft tissue lesion. Follow up CT abdomen/pelvis revealed a 2.8 x 2.2 x 1.8 cm ill-defined pancreatic lesion and confirmed widespread metastasis including to the muscles. Additional testing revealed elevated cancer markers with Cancer antigen 19-9 (CA 19-9) of 5418 U/mL and carcinoembryonic antigen (CEA) of 63.8 ng/mL. Pathology from initial scalp lesion biopsy showed fragments of necrotic dermis with small foci of poorly differentiated carcinoma. Biopsies of the right and left neck masses revealed poorly differentiated adenocarcinoma of uncertain primary. Therefore, liver biopsy was performed and confirmed non-small cell carcinoma of pancreatobiliary origin. Further imaging to determine treatment course discovered intracranial metastasis and cervical spine disease resulting in cord compression. Ultimately, the patient underwent 4 out of 10 fractions of palliative radiation to the cervical spine but passed away after transitioning to comfort care one month after diagnosis. Discussion: There are less than 25 documented cases of pancreatic cancer with cutaneous involvement; however, it is even more rare that cutaneous involvement prompts initial diagnosis. The umbilicus is the most common site of cutaneous involvement and is referred to as the Sister Mary Joseph Nodule. Involvement of the soft tissue of the scalp and neck is much less common and poorly documented making this case extremely unique.Figure 1.: Axial contrast enhanced CT of the abdomen shows a 2.8 cm ill-defined hypoattenuating mass in the pancreatic tail (A) with multifocal metastatic liver lesions and bilateral adrenal metastasis (B). Axial CT image of the pelvis shows a metastatic lesion in the right rectus femoris muscle (C). On liver biopsy, H&E, 40X,(S21-41666) revealed high grade carcinoma with vesiculated nuclei, prominent nucleoli (D), CA 19-9 IHC 20X diffuse positivity in tumor cells (E) and CK AE1/3 IHC, 20X, diffusely positivee for pancytokeratin in tumor cells confirming carcinoma (F). Axial CT of the head shows a 2.4 cm nodular left parietal scalp soft tissue lesion (G) which was also seen on clinical examination (H). Biopsy of the scalp lesion (H&E, 40X) demonstrated high grade carcinoma with vesiculated nuclei, prominent nucleoli and mitoses (I), histologically similar to liver biopsy findings.

P11.71.B Chronic Inflammatory Demyelinating Polyradiculoneuropathy (CIDP) in a patient with blastic plasmacytoid dendritic cell neoplasm: a rare neurologic manifestation in a rare disease

Abstract Background Blastic plasmacytoid dendritic cell neoplasm (BPDCN) is a rare aggressive myeloid hematological malignancy. Skin lesions, bone marrow, lymph nodes or visceral organs can be involved. 30% of patients will have infiltration to the nervous system,occult asymptomatic infiltration is frequent. Immunophenotype express CD4, CD56, and CD123, and flow cytometry is essential. Material and Methods 70-yo Hispanic male with a 1-month history of multiple violaceous cutaneous nodules and adenopathies.Neurological complaints included diplopia, hypoesthesia in the left face, dysphagia, gait difficulties, and generalized weakness with distal hypoesthesia. Examination revealed multiple cranial neuropathy (bilateral VI and VII nerve palsies, left V3 and VIII palsies and IX, X involvement), global areflexia, length-dependent weakness, ataxic gait and cerebellar syndrome. An inguinal ganglionar biopsy retrieved cells positive for CD4, TCL1, CD68 and CD123, whereas CD3, CD20, CD7, CD8, CD30 and myeloperoxidase were negative. PET/CT showed multiple supra and infradiaphragmatic adenopathies, bilateral pleural, pericardial and abdominal implants. Bone marrow biopsy was negative. Brain MRI showed contrast enhancement in the cerebellar folia and in the roots of the cranial nerves clinically involved. Multiple CSFs demonstrated high protein count (281- 310mg/dl), normal glucose and cell count; CSF flow cytometry and cytology reported no blastic infiltration (negative CD4, CD56 and CD123), CSF onconeuronal antibodies were negative. Nerve conduction studies fulfilled definite electrodiagnostic EFNS criteria for CIDP. Sural nerve biopsy reported inflammatory demyelination without infiltration. Systemic chemotherapy (Cyclophosphamide/Vincristine) with intrathecal cytarbine/methotrexate was administered. Results Favorable initial, but brief response was noticed for the cranial nerves and gait. He had neurological relapse with gait impossibility. Neuraxis MRI showed no contrast enhancement in the brain but new contrast enhancement of lumbosacral roots. Nerve conduction studies reported severe worsening criteria of CIDP. The PET/CT demonstrated complete response. Five days of methylprednisolone (1gr IV) followed by oral prednisone were prescribed (50 mg qd). However, two weeks later he suffered clinical neurological worsening with respiratory failure. IVIg was started (.4g/kg/day for 5 days) with no improvement; palliative care decision was consented. Conclusion We report the case of an adult male with multiple cranial nerve palsy, cerebellar syndrome and refractory rapidly progressive asymmetric polyneuropathy with BPDCN. CIDP in the absence of multiple attempts to demonstrate nervous system infiltration led us to consider this as a paraneoplastic phenomenon refractory to treatment. To our knowledge no CIDP has been reported in this rare disease

Resolution of feline Mycobacterium panniculitis despite protracted treatment with methylprednisolone acetate.

Saprophytic or non-tuberculous mycobacteria are ubiquitous in the environment. They can cause opportunistic infections when the skin is broken and typically manifest with draining sinus tracts or cutaneous nodules. This report details the first confirmed Mycobacterium smegmatis panniculitis in a cat in South Africa. Despite repeated treatment with methylprednisolone acetate for six months prior to diagnosis, the cat made an uneventful recovery once switched to doxycycline and marbofloxacin.

33699 Nodular melanoma of the nipple in a male with in-transit and satellite metastases

An 80-year-old male with medical history of oropharyngeal squamous cell carcinoma treated with chemotherapy presented to the hospital following a fall at home. On physical examination, a 5.5 cm dark brown exophytic hemorrhagic mass was incidentally noted arising from the left nipple with multiple clustered, adjacent dark brown to black irregularly shaped papules. CT of the thorax performed for dyspnea demonstrated a prominent lymphovascular stalk extending from the central mass to the pectoralis musculature and multiple superficial cutaneous nodules.

LEPROMATOUS LEPROSY: A CASE REPORT

Hansen's disease, also known in the past as leprosy, is an infectious disease that remains endemic in >140 countries around the world and it remains a major health care problem in many underdeveloped and developing countries like India and Brazil. The risk of transmission is increased for individuals living in close contact with patients with leprosy, most likely through infectious aerosols but possibly also through direct contact. This study repots a case of a 52-year-old male patient presenting multiple well-defined cutaneous and oral variable-sized nodules and with hypoesthesia. The clinical diagnostic hypotheses were leprosy, Von Recklinghausen's neurofibromate, Kaposi's sarcoma, leishmaniasis, syphilis, paracoccidioidomycosis, lobomycosis, or xanthomatosis. An incisional biopsy was performed from the oral lesion. The histopathologic examination showed chronic inflammatory infiltrate rich in macrophages forming granulomas and neural invasion. Positivity was found for CD68, S100, and Ziehl-Neelsen staining. The diagnosis of lepromatous leprosy was made. The patient is in follow-up. Hansen's disease, also known in the past as leprosy, is an infectious disease that remains endemic in >140 countries around the world and it remains a major health care problem in many underdeveloped and developing countries like India and Brazil. The risk of transmission is increased for individuals living in close contact with patients with leprosy, most likely through infectious aerosols but possibly also through direct contact. This study repots a case of a 52-year-old male patient presenting multiple well-defined cutaneous and oral variable-sized nodules and with hypoesthesia. The clinical diagnostic hypotheses were leprosy, Von Recklinghausen's neurofibromate, Kaposi's sarcoma, leishmaniasis, syphilis, paracoccidioidomycosis, lobomycosis, or xanthomatosis. An incisional biopsy was performed from the oral lesion. The histopathologic examination showed chronic inflammatory infiltrate rich in macrophages forming granulomas and neural invasion. Positivity was found for CD68, S100, and Ziehl-Neelsen staining. The diagnosis of lepromatous leprosy was made. The patient is in follow-up.

A Primary Extracutaneous Presentation of Merkel Cell Carcinoma

Merkel cell carcinoma (MCC) is a rare aggressive cutaneous neuroendocrine malignancy with a mortality rate of around 33%. The presence of advanced disease at the time of diagnosis is associated with poor prognosis. Twofold etiologies have been described in the pathogenesis of Merkel cell carcinoma: chronic exposure to ultraviolet (UV) light and Merkel cell polyomavirus (MCPvY). MCC usually affects sun-exposed skin areas, and the presence of cutaneous nodules is the hallmark of the disease. However, there have been case reports in the literature where the diagnosis of MCC was made in the absence of any cutaneous findings. We present a case report of Merkel cell carcinoma that is unique in its presentation because of the presence of pulmonary and hepatic nodules and the absence of cutaneous lesions.

Lumpy skin disease in a cow

Clinical History: Five-year-old, spayed, stray brown cow with generalized cutaneous nodules present for a week. Necropsy Findings: The animal is in good nutritional condition. Several ticks are present on the ventrum and withers. Multifocally and widespread, affecting all areas of skin in a random distribution, there are variably sized (1-4 cm in diameter) cutaneous and/or subcutaneous nodules, sometimes with a targetoid appearance. A few nodules are ulcerated, and others have a central dense crust. On cut section, many nodules are well demarcated, with a light pink center delineated by a dark red haemorrhagic/hyperaemicline (acute infarcts). Similar nodules and ulcers are also present over the teats. Skinning reveals extensive subcutaneous thickening with yellowish gelatinous material (oedema) as well as multifocal areas of dark red discoloration (haemorrhages). Multiple superficial lymph nodes are enlarged and haemorrhagic, with the right pre-scapular lymph node most severely affected, measuring 16x7x8 cm.

Rapidly growing cutaneous nodules in a patient with multiple myeloma

Rapidly growing cutaneous nodules in a patient with multiple myeloma

Pathological aspects of cutaneous mast cell tumors with metastases in 49 dogs.

Cutaneous mast cell tumor (MCT) is one of the most frequent cutaneous neoplasms of dogs and may vary from well-differentiated to aggressive tumors with metastasis. The authors retrospectively described the gross and histologic aspects of metastatic MCT in 49 dogs. Primary MCT was most commonly identified in the inguinal region (14/35; 40%), and at necropsy multiple, cutaneous nodules were frequently reported (23/49; 47%). All primary MCT were classified as high-grade neoplasms, and metastases involved the lymph nodes (47/49; 96%), spleen (33/49; 67%), liver (29/49; 59%), bone marrow (20/49; 41%), kidneys (16/49; 33%), and heart (14/49; 29%), while the lungs were less commonly affected (9/49; 18%). The main gross findings included lymphadenomegaly in 47 cases; splenomegaly in 28 cases, with splenic nodules in 13 dogs; hepatomegaly in 28 cases, with white pinpoint foci in 9 cases; nodules on the capsular surface of the kidneys in 9 dogs; and epicardial nodules in 6 cases. Histologically, the lymph nodes were largely obliterated by neoplastic mast cells, while in the spleen, neoplastic cells were multifocally scattered (16/33; 48%), arranged in nodules (10/33; 30%), or obliterated the parenchyma (9/33; 27%). In the liver, the neoplastic cells mainly infiltrated the sinusoids (24/29; 83%), but were also arranged in random nodules (10/29; 34%). Interstitial and nodular metastases were observed in the kidneys and the heart. Grossly unapparent metastases were common in the heart (6/14; 43%), kidneys (4/16; 25%), and lungs (6/9). KIT III and KIT II staining patterns were observed in 29 and 20 cases, respectively.