What is your diagnosis? Fine-needle aspirate from a subcutaneous preputial mass in a ferret

IF 1.1 4区 农林科学 Q3 VETERINARY SCIENCES
Caitlyn F. Connor, Jesse Riker, Laura K. Burns, Jörg Mayer, Jesse M. Hostetter, Katie Metcalf
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Additionally, there was an inflammatory leukogram with a stress component characterized by a moderate leukocytosis (WBC 31.4 × 10<sup>3</sup>/μL, RI: 2.7–11.2 × 10<sup>3</sup>/μL) with a moderate, mature neutrophilia (29.516 × 10<sup>3</sup>/μL, RI: 1.0–8.0 × 10<sup>3</sup>/μL), mild monocytosis (1.256 × 10<sup>3</sup>/μL, RI: 0.0–0.9 × 10<sup>3</sup>/μL), and a mild lymphopenia (0.628 × 10<sup>3</sup>/μL, RI: 1.0–6.3 × 10<sup>3</sup>/μL).<span><sup>1</sup></span> A blood gas analysis (Nova) revealed no significant abnormalities. Prior to referral, an adrenal panel revealed moderate elevations in progesterone (1.24 nmol/L, RI: &lt;0.1–0.80) and estradiol concentrations within the reference interval, supportive of adrenal disease.</p><p>Abdominal ultrasound revealed several abnormalities, including a heterogeneous, cavitated gastric mass, abdominal lymphadenopathy, diffuse splenomegaly with splenic nodules, a right adrenal nodule, and scant peritoneal effusion. Aspirates of the preputial mass (Figure 1), as well as ultrasound-guided fine-needle aspirates of the spleen and gastric mass, were submitted for cytologic evaluation. Splenic aspirates revealed a heterogeneous lymphoid population with many erythroid and myeloid precursors, consistent with a reactive spleen with marked extramedullary hematopoiesis. The gastric mass aspirate smears revealed marked, septic, neutrophilic inflammation with moderate lymphocytic infiltrate.</p><p>Malignant neoplasm, consistent with apocrine gland adenocarcinoma with moderate neutrophilic inflammation and hemorrhage.</p><p>Smears exhibited excellent cellularity with abundant individualized to clustered pleomorphic cells found in palisading, acinar, or crowded arrangements (Figure 1A,B). These cells were variably shaped (polygonal, cuboidal, columnar, to rarely spindled) with moderate amounts of pale basophilic cytoplasm that often contained few dark blue-green secretory granules or eosinophilic globules (Figure 1C,D). Nuclei were round to ovoid and centrally placed, with coarsely stippled chromatin and 1–3 distinct round nucleoli. Cells demonstrated moderate anisocytosis and anisokaryosis, frequent binucleation, and rare multinucleation (up to 4 nuclei) with nuclear molding. Small amounts of extracellular, pale eosinophilic material were seen associated with these cell clusters. Moderate numbers of variably degenerate neutrophils and few vacuolated macrophages exhibiting erythrophagia were also present.</p><p>Given the concerning ultrasound and cytology findings, exploratory laparotomy was pursued. During surgery, three nodules were also observed on the pancreas. A splenectomy, partial pancreatectomy, partial gastrectomy, and preputial mass excision were performed. Histopathology revealed an unencapsulated, well-defined, highly cellular preputial mass that expanded and replaced the deep dermis (Figure 2A). Neoplastic cells were arranged in tubuloacini and cords amidst a thin fibrovascular stroma (Figure 2B). The tubuloacini occasionally contained varying amounts of brightly eosinophilic, homogenous, acellular material and/or neutrophils. The neoplastic cells were polygonal to cuboidal with well-defined cell borders, moderate amounts of eosinophilic cytoplasm, and a primarily basilar, round to ovoid nucleus with sparse chromatin and 1–2 small, basophilic nucleoli. Within acini, cells had apical cytoplasmic blebbing (Figure 2C). There was mild anisocytosis and anisokaryosis, and the mitotic count was 4 per 2.37 mm<sup>2</sup> (equivalent to 10 FN22/40X fields). Neoplastic cells abutted the deep margins. 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引用次数: 0

Abstract

A 3-year-old castrated male ferret was evaluated for several months' history of alopecia and a more recent history of lethargy, inappetence, and stranguria. Physical examination revealed splenomegaly and an approximately 1 cm freely movable, firm, raised, purple, subcutaneous mass on the prepuce.

A CBC revealed a severe normocytic, normochromic anemia (ADVIA 2120, HCT 17.5%, RI: 40–51%) consistent with anemia of inflammation; however, given the severity, other components such as occult bleeding causing a pre-regenerative anemia were suspected. Additionally, there was an inflammatory leukogram with a stress component characterized by a moderate leukocytosis (WBC 31.4 × 103/μL, RI: 2.7–11.2 × 103/μL) with a moderate, mature neutrophilia (29.516 × 103/μL, RI: 1.0–8.0 × 103/μL), mild monocytosis (1.256 × 103/μL, RI: 0.0–0.9 × 103/μL), and a mild lymphopenia (0.628 × 103/μL, RI: 1.0–6.3 × 103/μL).1 A blood gas analysis (Nova) revealed no significant abnormalities. Prior to referral, an adrenal panel revealed moderate elevations in progesterone (1.24 nmol/L, RI: <0.1–0.80) and estradiol concentrations within the reference interval, supportive of adrenal disease.

Abdominal ultrasound revealed several abnormalities, including a heterogeneous, cavitated gastric mass, abdominal lymphadenopathy, diffuse splenomegaly with splenic nodules, a right adrenal nodule, and scant peritoneal effusion. Aspirates of the preputial mass (Figure 1), as well as ultrasound-guided fine-needle aspirates of the spleen and gastric mass, were submitted for cytologic evaluation. Splenic aspirates revealed a heterogeneous lymphoid population with many erythroid and myeloid precursors, consistent with a reactive spleen with marked extramedullary hematopoiesis. The gastric mass aspirate smears revealed marked, septic, neutrophilic inflammation with moderate lymphocytic infiltrate.

Malignant neoplasm, consistent with apocrine gland adenocarcinoma with moderate neutrophilic inflammation and hemorrhage.

Smears exhibited excellent cellularity with abundant individualized to clustered pleomorphic cells found in palisading, acinar, or crowded arrangements (Figure 1A,B). These cells were variably shaped (polygonal, cuboidal, columnar, to rarely spindled) with moderate amounts of pale basophilic cytoplasm that often contained few dark blue-green secretory granules or eosinophilic globules (Figure 1C,D). Nuclei were round to ovoid and centrally placed, with coarsely stippled chromatin and 1–3 distinct round nucleoli. Cells demonstrated moderate anisocytosis and anisokaryosis, frequent binucleation, and rare multinucleation (up to 4 nuclei) with nuclear molding. Small amounts of extracellular, pale eosinophilic material were seen associated with these cell clusters. Moderate numbers of variably degenerate neutrophils and few vacuolated macrophages exhibiting erythrophagia were also present.

Given the concerning ultrasound and cytology findings, exploratory laparotomy was pursued. During surgery, three nodules were also observed on the pancreas. A splenectomy, partial pancreatectomy, partial gastrectomy, and preputial mass excision were performed. Histopathology revealed an unencapsulated, well-defined, highly cellular preputial mass that expanded and replaced the deep dermis (Figure 2A). Neoplastic cells were arranged in tubuloacini and cords amidst a thin fibrovascular stroma (Figure 2B). The tubuloacini occasionally contained varying amounts of brightly eosinophilic, homogenous, acellular material and/or neutrophils. The neoplastic cells were polygonal to cuboidal with well-defined cell borders, moderate amounts of eosinophilic cytoplasm, and a primarily basilar, round to ovoid nucleus with sparse chromatin and 1–2 small, basophilic nucleoli. Within acini, cells had apical cytoplasmic blebbing (Figure 2C). There was mild anisocytosis and anisokaryosis, and the mitotic count was 4 per 2.37 mm2 (equivalent to 10 FN22/40X fields). Neoplastic cells abutted the deep margins. The final diagnosis for the preputial mass was apocrine gland adenocarcinoma.

Additional histopathology results included mild neutrophilic pancreatitis with fibrosis as well as multifocal islet cell tumors (presumed insulinomas), chronic gastric abscessation, and splenic reactive lymphoid hyperplasia. Following recovery, the patient arrested, and resuscitation attempts were unsuccessful. A necropsy was not performed.

The most common neoplasms described in ferrets often involve the endocrine (pancreatic islets, adrenal cortex), integumentary, or hemolymphatic systems (ie, lymphoma).2, 3 Regarding cutaneous neoplasms, apocrine gland neoplasms are the third most common, following basal cell tumors and mast cell tumors.3, 4 Apocrine glands are scent glands that are present throughout the haired skin, with the highest concentrations of these glands present at the head, neck, prepuce, and vulva.2 Apocrine glands within these areas share a similar function and do not have specialized forms based on anatomic location, such as those seen in the ear (e.g., ceruminous glands) and mammary glands.2, 5 Given the higher concentrations of these glands, apocrine neoplasms are more commonly found in these locations compared with other areas of the body.6

While benign apocrine neoplasms (adenomas and cystadenomas) are documented, when specifically associated with the prepuce or vulvar regions, apocrine gland neoplasms in the ferret are more frequently malignant (up to 75% of preputial apocrine neoplasms), exhibiting aggressive local tissue invasion, a higher incidence of recurrence following surgical excision, and frequent metastasis to regional lymph nodes.2-4 These tumors are described as large, firm, variably mobile masses that are often pigmented, appearing purple to black.2 Current treatment recommendations include wide surgical excision with palliative radiation therapy; however, given the aggressive behavior, these tumors carry a poor prognosis.3, 6 Without a necropsy, the significance of this patient's apocrine adenocarcinoma and the post-operative arrest cannot be ascertained.

The cytologic features (blue-green globular intracytoplasmic material) of the apocrine adenocarcinoma, in this case, are akin to what has been previously observed.7 However, the presence of eosinophilic granules within the cytoplasm of these cells has not been previously described to the authors' knowledge. Studies of human apocrine cells note two distinct cytoplasmic granules/bodies with transmission electron microscopy.8 The correlation between the presence or absence of these granules observed cytologically and the biological behavior of these tumors has not been evaluated. The described blue-green granules were not observed in the case by Pinches et al, whereas this case contained granules similar to those of Rakich et al with the addition of eosinophilic granular material. It would be interesting to investigate if this cytologic discrepancy provides any further predictive information on tumor behavior. In concordance with other reports, this case also exhibited eosinophilic extracellular material often in the background or adjacent to the clusters of neoplastic cells5, 7 This material may represent basement membrane, collagenous matrix, or, similar to Pinches et al, represent secretory material. These findings support the glandular origin of these neoplasms, given the presence of intracellular material and occasional acinar arrangements of the epithelial cells. Other differentials for neoplasms in this area with similar cytomorphology include mammary epithelial neoplasms or metastatic adenocarcinomas of cutaneous or non-cutaneous origin.

This case demonstrates the cytologic and histologic findings of an apocrine adenocarcinoma on the prepuce of a ferret and highlights the subtle variations in the cytomorphology that exist for these neoplasms, further adding to the case index for this tumor type.

The authors have indicated that they have no affiliations or financial involvement with any organization or entity with a financial interest in, or in financial competition with, the subject matter or materials discussed in this article.

Abstract Image

你的诊断是什么?用细针从雪貂的皮下包皮肿块中抽吸。
我们对一只3岁的雄性阉割雪貂进行了几个月的脱发史和最近的嗜睡、食欲不振和奇异尿症史的评估。体格检查显示脾肿大,包皮上约1厘米可自由移动、坚硬、凸起、紫色皮下肿块。CBC显示严重的正红细胞、正色贫血(ADVIA 2120, HCT 17.5%, RI 40-51%),与炎症性贫血一致;然而,考虑到严重程度,其他因素如隐蔽性出血引起再生前贫血被怀疑。此外,炎症性白细胞图表现为中度白细胞增多(WBC 31.4 × 103/μL, RI: 2.7 ~ 11.2 × 103/μL)、中度成熟中性粒细胞增多(29.516 × 103/μL, RI: 1.0 ~ 8.0 × 103/μL)、轻度单核细胞增多(1.256 × 103/μL, RI: 0.0 ~ 0.9 × 103/μL)和轻度淋巴细胞减少(0.628 × 103/μL, RI: 1.0 ~ 6.3 × 103/μL)血气分析(Nova)未见明显异常。在转诊之前,肾上腺素检查显示黄体酮(1.24 nmol/L, RI: 0.1-0.80)和雌二醇浓度在参考区间内中度升高,支持肾上腺疾病。腹部超声显示几个异常,包括一个不均匀的胃空化肿块,腹部淋巴结病变,弥漫性脾肿大伴脾结节,右侧肾上腺结节和少量腹膜积液。包皮肿块的抽吸(图1),以及超声引导下的脾和胃肿块的细针抽吸,提交细胞学评估。脾穿刺显示淋巴细胞不均匀,有许多红细胞和髓系前体,与反应性脾和明显的髓外造血相一致。胃肿块穿刺涂片显示明显的化脓性中性粒细胞炎症伴中度淋巴细胞浸润。恶性肿瘤,与大汗腺腺癌一致,伴有中度中性粒细胞炎症和出血。涂片显示了良好的细胞结构,在栅栏状、腺泡状或拥挤排列中发现了丰富的个别化到集群的多形性细胞(图1A,B)。这些细胞形状各异(多边形、立方体、柱状,很少呈纺锤形),有适量的淡色嗜碱性细胞质,通常含有少量深蓝绿色分泌颗粒或嗜酸性粒细胞(图1C,D)。细胞核圆形至卵圆形,位于中央,染色质粗点,核仁1-3个明显圆形。细胞表现为中度的异核增生和异核症,常见的双核,罕见的多核(多达4个核)伴核成型。细胞外可见少量苍白的嗜酸性物质与这些细胞团相关。适量变性中性粒细胞和少量空泡化巨噬细胞也表现出红细胞吞噬。考虑到相关的超声和细胞学检查结果,我们进行了探查性剖腹手术。手术中,胰腺也发现了3个结节。行脾切除术、部分胰腺切除术、部分胃切除术和包皮肿块切除术。组织病理学显示一个未包被的、界限分明的、高度细胞包皮肿块,它扩大并取代了真皮深部(图2A)。肿瘤细胞排列在细纤维血管间质中的管泡和索状细胞中(图2B)。小管腺偶尔含有不同数量的亮性嗜酸性、均质、脱细胞物质和/或中性粒细胞。肿瘤细胞呈多角形至立方状,细胞边界清晰,嗜酸性细胞质适量,细胞核呈基底状,圆形至卵形,染色质稀疏,核仁小,嗜碱性。在腺泡中,细胞有顶胞浆泡(图2C)。轻度细胞异位和核异位,有丝分裂计数为每2.37 mm2 4个(相当于10个FN22/40X场)。肿瘤细胞靠近深边缘。包皮肿块的最终诊断是大汗腺腺癌。其他组织病理学结果包括轻度中性粒细胞性胰腺炎伴纤维化、多灶性胰岛细胞肿瘤(推定为胰岛素瘤)、慢性胃脓肿和脾反应性淋巴样增生。恢复后,患者骤停,复苏尝试失败。没有进行尸检。雪貂中最常见的肿瘤通常涉及内分泌系统(胰岛、肾上腺皮质)、表皮或血淋巴系统(即淋巴瘤)。2,3关于皮肤肿瘤,大汗腺肿瘤是继基底细胞瘤和肥大细胞瘤之后第三常见的肿瘤。大汗腺是存在于毛发皮肤各处的气味腺,这些腺体在头部、颈部、包皮和外阴的浓度最高。 这些区域内的顶泌腺具有相似的功能,并且没有基于解剖位置的特殊形式,例如在耳中看到的(例如,耵聍腺)和乳腺。2,5由于这些腺体的浓度较高,与身体其他部位相比,大汗腺肿瘤更常见于这些部位。虽然良性大汗腺肿瘤(腺瘤和囊腺瘤)有文献记载,但当与包皮或外阴区域特异性相关时,雪貂的大汗腺肿瘤更常是恶性的(高达75%的包皮大汗腺肿瘤),表现出侵略性的局部组织浸润,手术切除后复发率更高,并且经常转移到区域淋巴结。2-4这些肿瘤被描述为大、硬、易移动的肿块,通常有色素沉着,呈紫色至黑色目前的治疗建议包括广泛的手术切除和姑息性放射治疗;然而,鉴于其侵袭性行为,这些肿瘤预后较差。没有尸检,不能确定该患者的大汗腺癌和术后骤停的意义。本例大汗腺癌的细胞学特征(蓝绿色球状胞浆内物质)与先前观察到的相似然而,据作者所知,在这些细胞的细胞质中存在嗜酸性颗粒尚未被描述。通过透射电子显微镜对人类大汗液细胞的研究发现两个不同的细胞质颗粒/体细胞学观察到的这些颗粒的存在或缺失与这些肿瘤的生物学行为之间的相关性尚未得到评估。Pinches等人没有观察到所描述的蓝绿色颗粒,而该病例中含有与Rakich等人相似的颗粒,并添加了嗜酸性颗粒物质。研究这种细胞学差异是否能进一步提供肿瘤行为的预测信息将是一件有趣的事情。与其他报道一致,该病例也表现出嗜酸性细胞外物质,通常位于肿瘤细胞群的背景或附近5,7。这种物质可能代表基底膜、胶原基质,或者与Pinches等人类似,代表分泌物质。考虑到细胞内物质的存在和上皮细胞偶尔的腺泡排列,这些发现支持这些肿瘤的腺体起源。该区域细胞形态相似的肿瘤的其他鉴别包括乳腺上皮性肿瘤或皮肤或非皮肤来源的转移性腺癌。本病例展示了雪貂包皮上的大汗腺癌的细胞学和组织学发现,并突出了这些肿瘤存在的细胞形态学的微妙变化,进一步增加了这种肿瘤类型的病例指数。作者已表示,他们与与本文所讨论的主题或材料有经济利益或金融竞争的任何组织或实体没有隶属关系或财务参与。
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来源期刊
Veterinary clinical pathology
Veterinary clinical pathology 农林科学-兽医学
CiteScore
1.70
自引率
16.70%
发文量
133
审稿时长
18-36 weeks
期刊介绍: Veterinary Clinical Pathology is the official journal of the American Society for Veterinary Clinical Pathology (ASVCP) and the European Society of Veterinary Clinical Pathology (ESVCP). The journal''s mission is to provide an international forum for communication and discussion of scientific investigations and new developments that advance the art and science of laboratory diagnosis in animals. Veterinary Clinical Pathology welcomes original experimental research and clinical contributions involving domestic, laboratory, avian, and wildlife species in the areas of hematology, hemostasis, immunopathology, clinical chemistry, cytopathology, surgical pathology, toxicology, endocrinology, laboratory and analytical techniques, instrumentation, quality assurance, and clinical pathology education.
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