Path Lab - Part 3 Flashcards
Case 1
Bear is a 2-year-old, castrated male Maltipoo who is presented to
you. The owner said the patient started to chew his feet when he
was 7 months old, and it was more intense in the spring. He also
had some rashes on the armpit and belly that he frequently licks.
He sometimes shake and scratch the ears. He regularly receives
pills for preventing parasites. He has been prescribed steroids by
a vet and the rash sometimes get better and sometimes get
worse. He is not taking any drugs currently.
* What do you want to ask the owner?
Case 1
* Describe the clinical presentation?
Bear is a 2 year old male castrated maltipoo who presented for pruritis with partial response to steroids which has been ongoing for about a year and a half with seasonal worsening.
Describe what can be seen?
Erythematous papules in the inguinal region, pinnae, and paw pads. The lesion on the palmar aspect of the paw is diffuse erythematous, alopecic.
Inside the ear canal is diffusely red (erythema) with crusts and mild yellow-brown exudate.
Summarize the clinical lesions
Inguinal region: Multifocal to diffuse erythematous, alopecia papules
Paw pad: diffuse erythematous alopecia papules
Pinnae/Ear: diffuse erythematous alopecic papules with crusts and mild yelow-brown exudate
Tests to perform?
Skin scrape - not significant
- What is the name of clinical
disease caused by this
organism? - What is the typical type of
clinical lesion caused by this
organism?
Neutrophils phagocytizing cocci
Most likely organism? Staph. pseudointermedius
Typically see epidermal collarattes.
Describe your findings
footprint - malastesia
Yeast is secondary here.
What are your clinical differential diagnosis?
- Canine pyoderma
- Ectoparasites
- Seasonal allergies - Canine atopic dermatitis
- Yeast Otitis externa
- Food Allergy
Case 1
1. You decided to submit a biopsy to rule out other diseases. What
type of lesion are you going to sample for biopsy?
2. Any other test you want to perform?
- Primary lesions - the macules and papules on the abdomen.
- Culture for aerobic and anaerobic bacteria
Granulomatous, nodule lesions is when you submit for mycobacterium culture
- In the biopsy submission form, you need to put in Bear’s clinical
history. Please summarize Bear’s clinical history. - Signalment
- Age of disease onset
- Are lesions pruritic or painful?
- Lesion type, distribution, size, growth rate
- Diagnostic findings (cytology, scrapings, blood work, culture, imaging etc.)
- Medication history & response to treatment
- Other clinical signs & diseases
- Differential diagnosis
- Bear is a 2 year old male castrated (canine) maltipoo who presented for skin lesions for a year and five months.
- Age of onset: around 7 months
- Lesions are pruritic, seasonal.
- Lesions can be found in the inguinal region: Multifocal to diffuse erythematous, alopecia papules
Paw pad: diffuse erythematous alopecia papules
Pinnae/Ear: diffuse erythematous alopecic papules with crusts and mild yelow-brown exudate. - On cytology we found malastesia, culture pending. No imaging. ??
- Previously on steroids, but exhibited partial response. Patient was also on antiparasitic, unknown.
7.Canine pyoderma, Ectoparasites, Seasonal allergies - Canine atopic dermatitis, Yeast Otitis externa , Food Allergy
What are features of chronic
perivascular dermatitis?
- The crusts contain degenerate neutrophils, keratin, serum, and
few colonies of cocci - Diffusely moderately hyperplastic and mildly spongiotic with lymphocytic
exocytosis. - Superficial dermis is infiltrated by a moderate number of perivascular mast cells, lymphocytes, plasma cells, neutrophils, and eosinophil (mast cells).
- Thickening of skin (acantosis)
5.
Acantosis - thickening of the epidermis
Case 1
* Based on the morphologic diagnosis and description. What do you think the diagnosis is?
Allergic skin disease
Case 1
You want to explain the biopsy report to the owner.
* What are clinical differential diagnoses for perivascular dermatitis?
* What immune mechanism is likely involved?
* What’s your treatment plan?
Type 1 hypersensitivity; perivascular eosinophillic dermatitis.
Treatment plan: Foodtrial, apoquel for the itching and inflammation, cytopoint injection: attacks IL- 33
If don’t work = steroid
Antibiotic = wait for culture to come back, get antimicrobial testing and pick from that
Claro for ear
Case 2
* Lucy is a 6-year-old, spayed female Labrador retriever who is
presented to you. The owner said about 5 month ago the
patient went potty more frequently than she used to be. She also continued to loss hair on the sides and belly. She has also had some skin issue on the belly which she has seen a vet for.
She was given some steroid injections but the skin is not getting
better.
- Scar from the spay
- Thinning of the epidermis
- Diffuse Alopecia
On right = blackheads
Case 2
* Describe the clinical presentation.
* Lucy is a (signalment) who presented for (chief complaint)
* Describe the clinical lesions.
* On physical examination of Lucy’s skin, there is (lesion distribution and
type)
* What diagnostic test would you like to do?
Endocrine Dermatosis
Anytime see blackheads - test for demodex.
Hyperadrenocortism –> ACTH stim test
Hypothyroidism
Hyperestrogenism
Case 2
* You did a surface cytology and it is negative. You decided to do
a deep skin scrape. What are you looking for? Why is it
important to do this test?
Case 2
* The owner asked what if the skin issue is related to her frequent
potty behavior. What will you tell the owner?
* What are your clinical differential diagnoses for Lucy?
Case 2
* Can you explain the cause for each of your differential
diagnoses?
* Name the typical clinical findings for your top differential
diagnosis.
Hyperestrogenism: sertoli tumor, ovarian tumor, exposure to estrogen gel
Hypothyroidism: inflammation of thyroid gland and atrophy
Case 2
* Which histologic pattern will you expect on histopathology
* What features will you expect to see on histopathology?
Missing telogen
Hyperkeratosis
Crusting
?
Pink area = hypopigmentatiion/depigmentatio
Pemphigus fallaceious
Zinc responsive dermatosis
Huskies
Desmocolin -1
Type 2
Condition: Indolent ulcer
Usually caused by allergies
Histiocytoma
Nodule or neoplasia rather than cyst because a cyst would be filled with fluid.
Boxer
* Lesion type:
* Which type of neoplasm is it
(epithelial, mesenchymal, or
round)?
* What is your diagnosis?
Mast cell
Lesional description: Focal tumor/nodule
Round (mesenchymal are spindle shaped).
What can be seen here?
- Dog
- Describe the lesion: depigmentation (loss of pigment), ulcerated on lunar fold; lip: depigmentation, swelling = edema, cells infiltrating (neoplastic), or inflammatory
- DDx: epithelialtropic lymphoma b/c of depigmentaiton on nasal planum also affects the oral cavity as well?
Papilloma
Bilateral symmetrical alopecia on the dorsal aspect
Endocrine dermathopathy.
Vasculitis
Sloughing of the ear tip
Scalloped and notched ear margin with ulcer, scales, and crusts
Scaling
Exofilative dermatitis is paraneoplastic syndrome in cats; some cases are associated with thymoma. other causes: nonthymic neoplasms, immune mediated?
Generalized scaling, nonpruritic
Issue with collagen so skin easily tears
Feline skin fragility syndrome.
Associated condition: hyperglucocoritcoidims, diabetes mellitus
Bilateral alopecia with crusting
Ventral aspect
Usually associated with carcinoma of the bile duct
Cutaneous tag
Focal areas of alopecia? Raised lesions that push the hairs up
Folliculitis
differentials for folliculitis: dermatophyte, bacteria, demodex
Multifocal nodules
apocrine cysts
Plaque
Calcinosis cutis
Hypercortisolemia
