Cytopathology of cutaneous tumors Flashcards

1
Q

Skin is a complex tissue
- cytologic assessment can be useful for what type of tumors?

A
  • homogeneous tumors with distinct cellular changes.
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2
Q

Interpretation of cytology for a mass is only possible:

A
  • if the sample reflects the tumor
  • if the cytologic appearance of the tumor cells is different from that of normal cells
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3
Q

Skin tumors that can be diagnosed by cytopathology:

A
  1. Mast cell tumors (MCT) - Dogs
  2. Mast cell tumors - Cats
  3. Histiocytoma
  4. Skin lymphoma
    a. Epitheliotropic form of lymphoma
    b. Non-epitheliotropic lymphoma
  5. Plasmacytoma
  6. Transmissible Venereal Tumor (TVT)
  7. Melanoma
  8. Lipoma
  9. Soft tissue stromal (spindle) cell tumors
  10. Epithelial tumors
  11. Cysts and hair follicle masses
  12. Mammary tumors
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4
Q

Mast cell tumors (MCT) - Dogs
- cytologic appearance
- distribution
- breeds
- progression
- grading schemes

A
  • typical cytologic appearance
  • solitary or multiple; cutaneous, subcutaneous or internal organs
  • certain breeds at higher risk (short haired)
  • vary from non-progressive to rapidly metastatic
  • Cytopathology grading scheme for cutaneous MCT
  • Histopathology for MCT in other locations or metastatic MCT
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  • The degree and type of granulation can vary
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5
Q

Mast cell tumors - dogs
- clinical presentation
- what cells do we see?
- cure?
- use of histo assessment
- spread?

A
  • Clinical presentation: edematous mass, ”shrinks and swells”
  • Eosinophils among mast cells
  • Majority of cutaneous MCTs are cured with surgical excision (~90%)
  • Histological assessment is essential to identify those that may recur, spread or distantly metastasize (~10%)
  • MCT have a propensity to spread to lymph nodes and spleen
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6
Q
  1. Mast cell tumors - Cats
    - where do we find them?
    - disease course
    - cytologic appearance
    - what other cells?
A
  • skin, spleen, other sites
  • most MCT in cats have an ‘indolent’ course of disease
  • pleiomorphic cytologic appearance
  • also often contain eosinophils
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7
Q
  1. Histiocytoma
    - who gets them?
    - appearance?
    - progression
    - what is it??
A
  • mostly in young dogs; ~20% in older dogs
  • non-haired raised lesion
  • tumor of tissue histiocytes
  • regression without treatment is common
  • immune dysregulated proliferation rather than neoplasm?
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8
Q
  1. Skin lymphoma
    - types we see?
A

a. Epitheliotropic form of lymphoma
b. Non-epitheliotropic lymphoma

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9
Q

a. Epitheliotropic form of lymphoma
- where do we see this?
- what cells?
- who gets this? progression?
- what do we need for diagnosis?

A
  • Oral mucosa, paws, skin
  • T-lymphocytes, localized or widespread
  • older animal, slowly progressive, but often diagnosed late in disease course
  • Needs histopathology for diagnosis
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10
Q

b. Non-epitheliotropic lymphoma
- anatomic location
- appearance
- disease course / progression
- cells

A
  • Below the epidermis
  • discrete “lumps”
  • may have an indolent disease course
  • waxing and waning tumors in horses
  • most often B cell type
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11
Q
  1. Plasmacytoma
    - what is this?
    - sites?
    - presentation
    - Dx?
    - nature of the tumour / progression?
A
  • tumors of mature plasma cells
  • Sites: skin, oral mucosa (larynx, trachea), rectum
  • may manifest with multiple concurrent masses
  • amenable to cytologic diagnosis
  • mostly non-progressive tumor in dogs
  • more often locally invasive in cats
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12
Q
  1. Transmissible Venereal Tumor (TVT)
    - cell origin
    - anatomic locations
    - geographic locations
    - canada?
    - similar diseases?
A
  • transmissible (parasitic?) tumor, histiocytic cell origin
  • face and genitalia of dogs
  • mostly Southern hemisphere, extra chromosomes
  • diagnosed in Canada in imported dogs
  • Other transmissible tumor described in Tasmanian devils
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13
Q
  1. Melanoma
    - Dogs: types, behaviour
    - horses: who gets it, behaviour
    - cats: anatomic location, behaviour
A

Dogs: Cutaneous = relatively indolent; muco- cutaneous or interdigital area = likely to metastasize
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Horses: mostly indolent tumor of older grey horses
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Cats: iris melanoma; locally infiltrative and sometimes metastatic
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- variable number and size of melanin granules

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14
Q

Mesenchymal subcutaneous tumors
8. Lipoma
- aspirate
- staining
- Dx ease
- variants? behaviour?

A
  • common, soft consistency, “fatty” aspirates
  • fat may dissolve during staining
  • easy to diagnose
  • rare infiltrative variant
  • rare liposarcoma = infiltrative and progressive, different appearance
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15
Q

Mesenchymal subcutaneous tumors
9. Soft tissue stromal (spindle) cell tumors
- types
- behaviour
- grading
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- how to get samples?
- cell types / matrix?
- tumor classification

A
  • fibroma, soft tissue sarcomas (peripheral nerve sheath tumor, hemangiopericytoma, spindle-cell tumor of soft tissue), leiomyoma
  • typically slow growing tumors
  • rarely metastasize, may get very large
  • histological grading scheme
  • tumor grade based on histological features
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  • usually possible to get adequate samples by fine needle aspiration
  • extracellular matrix may indicate that not a soft tissue cell type – bone, cartilage
  • may not be able to classify the tumor beyond “stromal cell neoplasm”
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16
Q

Mesenchymal subcutaneous tumors
10. Epithelial tumors
- how to Dx
- behaviour?
- subtype classifications?

A
  • readily aspirated and diagnosed
  • behavior usually reasonably predictive from cytology
  • but typically cannot distinguish between subtypes i.e. trichoblastoma, pilomatrixoma, tricholemmoma – all are “low grade epithelial tumor”
17
Q

Squamous cell carcinoma
- behaviour
- Distinct cytological features:

A

High grade tumor of squamous epithelium.
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Distinct cytological features:
* keratin in cytoplasm
* nuclear to cytoplasmic asynchrony
* anisocytosis and anisokaryosis

18
Q

Basal cell tumor (trichoblastoma, if follicular differentiation)
- appearance
- cure

A
  • “palisading” undifferentiated basilar epithelial cells
  • in cats, often pigmented
  • surgical excision is usually curative
19
Q

Sebaceous tumors
- what is this?
- appearance
- behaviour

A
  • tumor of the skin “adnexa”
  • appearance reflects secretory function
  • highly vacuolated cytoplasm
  • mostly benign tumors
  • occasionally criteria of malignancy and invasive/metastatic behavior
20
Q

Tumors of glands – Perianal, dog

A
  • Modified sebaceous gland that may give rise to hyperplasia, adenomas (“hepatoid”) or rarely carcinomas
  • Apocrine gland may give rise to adenocarcinoma = highly metastatic, hypercalcemia
  • Apocrine gland anal sac carcinoma (AGASACA)
21
Q

Tumors of glands – ears, cat

A
  • Apocrine tumors at base of ear: ceruminous gland adenoma and carcinoma in ear canal
22
Q
  1. Cysts and hair follicle masses
    - appearance
    - cells
    - cytological classification?
    - typical findings
A
  • small cystic skin lesions
  • depending on the type of cells lining the cyst, may see epidermal cells, sebaceous cells, or follicular cells
  • cannot classify cysts with cytology
  • typical findings: cholesterol crystals, cell debris, keratin flakes, macrophages +/- neutrophils
23
Q
  1. Mammary tumors in cats
    - behaviour
    - treatment with progestins causes what?
A
  • most are invasive +/- metastatic
  • treatment with progestins can cause severe fibroadenomatous hyperplasia that resembles tumors
24
Q
  1. Mammary tumors in dogs
    - location
    - cytology vs behaviour
A
  • most mammary tumors are localized
  • Cytological appearance is not predictive of canine mammary tumor behaviour
25
Q

Masses that look like tumors …

A
  1. Hematoma – red-yellow fluid, macrophages with phagocytosed RBC, hemosiderin, no platelets
  2. Seroma/hygroma: few cells (macrophages), high protein
  3. Abscess: Neutrophils! Bacteria and/or fungi or yeast
  4. Calcinosis circumscripta: “chalky” fluid, masses on soft tissue or legs of young large breed dogs