Transcript Case of the Month - Ross Bond

Pedal ulceration in a
long-haired cat
Author: Cathy Curtis
Editor: David Lloyd
© European Society of Veterinary Dermatology
History - 1
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12-year-old female, neutered, domestic
long-haired cat
Firm, ulcerated swellings had developed on
multiple digits of both hind legs and the left fore
over about 6 weeks
The cat had recently started biting at the claws of
the affected feet
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History | Signs | Differentials | Tests | Therapy | Notes
History - 2
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It was severely lame on the left fore foot
Therapy with various antibiotics and corticosteroids
had not been successful
History | Signs | Differentials | Tests | Therapy | Notes
Clinical signs - 1
Typical lesions:
swollen & ulcerated
digits
A firm ulcerated
swelling affecting
the 4th digit of the
left fore foot
History | Signs | Differentials | Tests | Therapy | Notes
Clinical signs - 2
• The cat was thin
• The popliteal lymph nodes were enlarged
• Pedal lesions were as described
• No other abnormalities detected
History | Signs | Differentials | Tests | Therapy | Notes
How would you
approach this case?
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What are the next steps you would take?
Make a list of your principle differential diagnoses
List any samples you would collect
List any tests you would perform to assist in making a
definitive diagnosis
History | Signs | Differentials | Tests | Therapy | Notes
Case investigation
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Principle differential diagnoses
• Digital lesions
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Neoplasia
• Primary cutaneous, or metastatic
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Granulomata:
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Bacterial
Mycotic
Foreign body
Sterile (idiopathic)
Osteomyelitis
History | Signs | Differentials | Tests | Therapy | Notes
Tests - 1
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Initial tests
• Blood tests:
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Routine haematology and biochemical screens; total
thyroxine, FeLV and FIV assays
• Results:
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No abnormalities; FeLV & FIV -ve
History | Signs | Differentials | Tests | Therapy | Notes
Tests - 2
What additional tests should you consider?
• Skin biopsy
• Microbiology of tissue specimens
• Cytology
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• Aspirates, exudates, impression smears
Radiography
History | Signs | Differentials | Tests | Therapy | Notes
Tests - 3
Tissue samples from affected digits for histopathology
& fungal culture
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Cut surface of digits exuded straw-coloured
mucoid fluid
Cytological examination of fluid unremarkable
No micro-organisms isolated
History | Signs | Differentials | Tests | Therapy | Notes
Tests - 4
Skin Histopathology (Trevor Whitbread)
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There is infiltration into the underlying tissue by cells
which are capable of producing irregular acinar structures
filled with a mucinous secretion and there are some goblet
cells here
The epithelial cells are slightly variable in size but there
are few mitotic figures here
History | Signs | Differentials | Tests | Therapy | Notes
Tests - 5
Histopathologists Comments
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These biopsies are similar
These are adenocarcinomas which are producing acini
and mucus and it is this mucus that is exuded from the cut
surface. This is because there are goblet cells here
These features are typical of those seen before in cases
with bronchial carcinoma
This would be compatible with a secondary spread from
such a tumour
History | Signs | Differentials | Tests | Therapy | Notes
Tests - 6
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Radiographer's diagnosis
• Disseminated neoplasia, with osteomyelitis
• Granulomata as less likely differential diagnoses
What do you think now?
History | Signs | Differentials | Tests | Therapy | Notes
What is your
diagnosis?
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Do the investigations permit a definitive diagnosis?
Are there any additional investigations which you think
may need to be done?
History | Signs | Differentials | Tests | Therapy | Notes
Diagnosis
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Metastatic bronchial carcinoma
History | Signs | Differentials | Tests | Therapy | Notes
How would you deal
with this case?
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What is your prognosis?
How will you advise the owner?
What treatment would you consider?
History | Signs | Differentials | Tests | Therapy | Notes
Prognosis
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Prognosis for this type of tumour is poor - it is
unlikely to respond to antitumour therapy
The cat is already in poor condition and would not
tolerate aggressive therapy
History | Signs | Differentials | Tests | Therapy | Notes
Action
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Euthanasia
History | Signs | Differentials | Tests | Therapy | Notes
Post-mortem examination - 1
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Adenocarcinoma in the right apical lung lobe
Solitary adenocarcinomatous mass found affecting
the right renal cortex - presumed vascular spread
Four swollen digits sampled and shown to have
metastases of the pulmonary adenocarcinoma
History | Signs | Differentials | Tests | Therapy | Notes
Post-mortem examination - 2
Renal (left) & pulmonary (right) lesions
History | Signs | Differentials | Tests | Therapy | Notes
Final diagnosis
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The digital swellings were metastases of a primary
bronchial adenocarcinoma
This has been reported in the cat but is rare
This type of neoplasm is poorly responsive to
surgery, radiotherapy and chemotherapy and owing
to it's aggressive rate of metastasis, euthanasia is
often necessary
History | Signs | Differentials | Tests | Therapy | Notes
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History | Signs | Differentials | Tests | Therapy | Notes