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3. Sys Path 3 > The cytopathology of musculoskeletal and neurologic disease > Flashcards

The cytopathology of musculoskeletal and neurologic disease Flashcards

1
Q

Normal synovial fluid
- consistency, contents
- how to collect and sample
- cells

A
  • Viscous, high mucopolysaccharide content
  • Aspirate fluid slowly, prepare slides slowly!
    > fluid is thick and slow moving
    > just make one slide
  • Cell count <3x109/L, protein <30 g/L
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2
Q

Suppurative inflammation of joint
- most likely dx in small animals? large animals?

A
  • Predominance of neutrophils = most likely immune- mediated polyarthritis in small animals
  • Predominance of neutrophils - likely septic cause in large animals, even if the organism is not apparent
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3
Q

Non-suppurative inflammation of the joint
- when we see this?
- what do we see?

A
  • Degenerative joint diseases manifest mostly with mild increases in mononuclear cells (lymphocytes & macrophages)
  • Occasional osteoclasts if erosive joint disease
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4
Q

canine osteoarthritis - progression of synovial membrane, joint space, cartilage as joint degenerates

A

Normal:
- synovial membrane: mobile and flexible
- joint space: thick and elastic synovial fluid
- healthy cartilage
<><><><>
Beginning of destruction:
- synovial membrane: mobile and flexible
- joint space: narrowing, thin synovial fluid
- thinning cartilage due to wear and tear and destructive enzymes
<><><><>
More progressed osteoarthritis:
- synovial membrane: fibrosed and rigid
- joint space: narrowed, bone on bone, thin and watery synovial fluid
- loss of cartilage

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5
Q

infectious synovitis - is it always bacteria?

A

no it can also be fungal

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6
Q

what can we find in joint fluid in a case of gout?

A

uric acid crystals in joint fluid

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7
Q

Osteosarcoma
- who gets it?
- what bones?
- behaviour?
- dx? considerations?

A
  • Tumor of large breed, middle-age dogs
    > cometimes in young
  • Long bones, flat bones, mandible, maxilla, ribs…
  • Especially: Metaphysis, distal radius & proximal humerus (“away from the elbow”)
  • Mandibular OSA better prognosis?
  • Different histologic subtypes – all behave similar = malignant
  • Metastasis common
  • Metastasis early and subclinical (= not radiographically detectable)
  • Amenable to cytologic diagnosis, but need to select site for aspiration carefully
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8
Q

where to aspirate for in osteosarcoma

A

Aspirate from the center of the lesion!

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9
Q

Chondrosarcoma
- predilection sites
- breed
- behaviour

A
  • more common on flat bones
  • most common nasal cavity?
  • Golden Retrievers predisposed?
  • slow to metastasize > there is time to decide on next steps / tx
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10
Q

Unusual bone tumors:

A

a. Multilobular tumor of bone (osteochondrosarcoma)
* arise on the skull
* discrete masses with bony proliferation
* better prognosis than osteosarcoma
<><><><>
b. Hemangiosarcoma, osteoma, fibrosarcoma, multiple cartilagenous exostosis

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11
Q

Soft tissue sarcomas
- older terms?
- why are they lumped together

A

Older terms:
* Hemangiopericytoma (vascular wall tumor)
* nerve sheath tumor
* fibrosarcoma
* synovial cell sarcoma
* liposarcoma
<><>
Lumped together since have similar grading criteria and prognosis.

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12
Q

Most tumors of the musculo-skeletal system are amenable to cytologic diagnosis if care is taken to:

A
  1. to acquire a good sample, and
  2. to prepare good smears > one layer of cells, not clotted
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13
Q

Histiocytic diseases
- cell lineages from stem cell

A

bone marrow stem cell:
<><>
1. blood monocyte > macrophage > Hemophagocytic histiocytic sarcoma
<><>
2. Interstitial dendritic cell > Histiocytic sarcoma
<><>
3. Langerhans cell (in the skin) > Histiocytoma

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14
Q

Cutaneous histiocytoma appearance, sugnalment, prognosis

A
  • Small, non-haired lump
  • Typically young dog
  • 90% go away by themselves, if not we can cut if off
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15
Q

Histiocytic sarcoma
- sites?
- behaviour?

A
  • typically around the stifle, also other sites
  • aggressive neoplasm
  • very inflammatory
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16
Q

Histiocytic diseases
* Malignant histiocytic neoplasms sites
* hallmarks of these cancers
* hematology

A
  • Malignant histiocytic neoplasms can occur at any site, although the spleen, bone marrow, lung and stifle are predisposed.
  • The hallmarks of these malignant cancers are multinucleation and variable inflammatory infiltrates.
  • Anemia +/- thrombocytopenia are invariably present if the tumor involves the spleen or bone marrow, and arises from phagocytic macrophages.
17
Q

Breed predisposition to Histiocytic Sarcoma

A
  • flat coated retriever, burnese mountain dog
18
Q

Neoplastic diseases of the musculo-skeletal system - cats
- what are common and uncommon? unique?

A
  1. Vaccine-site associated sarcomas are the most common tumor of the musculo-skeletal system
  2. Osteosarcomas are uncommon
  3. Squamous cell carcinomas that invade bone and/or soft tissue are common
  4. Primary lung carcinoma with digital metastasis – unique in the cat
  5. Cutaneous lymphoma may be more common than in dogs
19
Q

Musculoskeletal tumors in large animals

A
  • fibroma - space occupying
  • sarcoid - papilloma associated, surgery alone will not take them off (radiate)
  • Keloid - exuberant response to injury
20
Q

Cerebrospinal fluid - normal
- cellularity
- protein
- sampling method
- when to take? use?

A
  • very low cellularity (<0.003x109/L)
  • very low protein content (< 0.3 g/L or < 0.8 g/L in horses)
  • need anesthesia to obtain in small animals
    > flows from head to tail, take just downstream, as close to lesion as possible
  • need to process rapidly since cells unstable
  • Therefore: expensive sample to obtain and requires special processing
    <><><><>
  • in health: predominance of mononuclear cells
  • mostly lymphocytes +/- monocytes and macrophages
  • essential component for evaluation of suspect inflammatory diseases of the CNS
  • changes in CSF are common, but rarely diagnostic of a specific disease process
21
Q

Lymphocytic inflammation of CSF
- causes

A
  • viral infections (etiology?)
  • herpesvirus, distemper, feline infectious peritonitis, feline immunodeficiency virus
  • “Shaker” disease of small, often white, dogs
  • Pug encephalitis
22
Q

Suppurative inflammation of CSF causes

A
  • bacterial meningitis
  • steroid-responsive meningitis/arteritis
  • Ehrlichia spp. or Anaplasma spp. infections
  • protozoal infections – Toxoplasma, Neospora, etc.
  • CNS neoplasia
  • Remember: Bacteria are rarely observed in suppurative CSF samples!
23
Q

Mixed inflammation of CSF - when we see it

A
  • increased cell count, different cell types
  • typical for “meningoencephalitis of unknown origin” (MUO); old term “granulomatous meningo- encephalitis” (GME)
  • may be seen in protozoal and listerial meningitis
24
Q

Eosinophilic inflammation - when we see it?

A
  • most commonly idiopathic, Rottweilers appear predisposed
  • may be associated with parasitic infections or unusual responses to protozoal infections
25
Q

CNS neoplasia
- dx
- use of cytology, CSF

A
  • Diagnosing and treating CNS neoplasia requires advanced veterinary facilities and skills.
  • Most CNS neoplasms are diagnosed by imaging techniques.
  • Cytology of tumors is a useful adjunct in the diagnosis of CNS neoplasia due to the rapidity of diagnosis.
  • CSF analysis is rarely useful for definitive diagnosis of CNS neoplasia.
26
Q

Brain tumors:
- what types and who gets them
- growth pattern

A
  • Glial cell & pituitary tumors – more common in brachycephalic dogs?
  • Meningiomas – most common overall, more common in dolichocephalic dogs?
  • Often “benign” growth pattern … but bad location.
27
Q

Spinal cord tumors:
- what types, and who gets them

A
  • Dogs: meningioma, hemangiosarcoma
  • Cats: lymphoma, lymphoma, lymphoma …
28
Q

CNS neoplasia
- CSF abnormalities

A
  • Typical CSF abnormalities with CNS neoplasia are increased protein concentration and no increase or only a very slight increase in the total cell count and proportion of neutrophils.
    > disrupted blood brain barrier > protein leaking in there
29
Q

CNS neoplasia
- what type of tumors can usually be diagnosed by cytology

A
  • Tumors affecting vertebrae and causing neurological signs due to impingement or necrosis on the spinal cord can usually be readily diagnosed by cytology.
30
Q

Vertebral neoplasia
- Vertebral lysis – rule outs?

A

Osteosarcoma
Histiocytic sarcoma
Multiple myeloma
Metastatic carcinoma

3. Sys Path 3 (11 decks)

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