Transcript Case of the Month

Pedal mass in a
crossbred dog
Author: David Grant
Editor: David Lloyd
© European Society of Veterinary Dermatology
History - 1
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12-year-old entire female crossbred dog
Weight 23 kg
A lump had developed over a period of months on
the right fore foot
The dog was presented when the lesion became
ulcerated and began to bleed
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History | Signs | Differentials | Tests | Therapy | Notes
History - 2
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The dog was lame on the affected foot but otherwise
in good health
History | Signs | Differentials | Tests | Therapy | Notes
Clinical signs - 1
Lateral view of the mass
A mobile, ulcerated mass of 5
cm diameter was present
over the third digit. It was not
painful on palpation. There
were no other lesions; no
lymphadenopathy.
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
• Neoplasia e.g. Schwannoma, haemangiopericytoma,
fibroma, fibrosarcoma
• Bacterial pseudomycetoma
• Actinomycetosis, Nocardiosis, Eumyctic mycetoma
• Foreign body reaction
History | Signs | Differentials | Tests | Therapy | Notes
Tests
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Tests
• Surgical excision and histopathology were logical
diagnostic and therapeutic steps
History | Signs | Differentials | Tests | Therapy | Notes
Results
Histopathology (Joan Rest)
Shows a mass of elongated
cells in onion-skin patterns
with moderate quantities of
intervening collagen.
Some nuclei are pallisaded.
Other areas are looser in
texture. Characteristic of a
schwannoma. Where an edge
is present there is a welldefined border.
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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Schwannoma
History | Signs | Differentials | Tests | Therapy | Notes
Prognosis
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Prognosis is quite good
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Tumour not attached to subjacent tissue
No evidence of local spread
Histology does not suggest malignancy
But little skin available locally to facilitate removal
History | Signs | Differentials | Tests | Therapy | Notes
How would you deal
with this case?
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Should preliminary cytology have been done?
Is surgical excision wise as an initial procedure?
History | Signs | Differentials | Tests | Therapy | Notes
Therapy - 1
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Justification for immediate excision
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Lesion characteristic of neoplasm, clinically
Dog in pain
If an infection, surgery would still be necessary
Good prognosis if complete removal possible
Although schwannomas may recur after excision;
they do not metastasize
• Warning: limb amputation could be necessary
ultimately
History | Signs | Differentials | Tests | Therapy | Notes
Response to surgery
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Complete removal and
coaption was possible giving
a good cosmetic result as
seen here after 10 days
No recurrence after 1 year
History | Signs | Differentials | Tests | Therapy | Notes
Review
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History | Signs | Differentials | Tests | Therapy | Notes