Path Lab - Part 3

Question 1

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?

Question 2

Case 1
* Describe the clinical presentation?

Answer 2

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.

Question 3

Describe what can be seen?

Answer 3

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.

Question 4

Summarize the clinical lesions

Answer 4

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

Question 5

Tests to perform?

Answer 5

Skin scrape - not significant

Question 6

• What is the name of clinical
  disease caused by this
  organism?
• What is the typical type of
  clinical lesion caused by this
  organism?

Answer 6

Neutrophils phagocytizing cocci
Most likely organism? Staph. pseudointermedius
Typically see epidermal collarattes.

Question 7

Describe your findings

Answer 7

footprint - malastesia
Yeast is secondary here.

Question 8

What are your clinical differential diagnosis?

Answer 8

1. Canine pyoderma
2. Ectoparasites
3. Seasonal allergies - Canine atopic dermatitis
4. Yeast Otitis externa
5. Food Allergy

Question 9

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?

Answer 9

1. Primary lesions - the macules and papules on the abdomen.
2. Culture for aerobic and anaerobic bacteria

Granulomatous, nodule lesions is when you submit for mycobacterium culture

Question 10

• 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

Answer 10

1. Bear is a 2 year old male castrated (canine) maltipoo who presented for skin lesions for a year and five months.
2. Age of onset: around 7 months
3. Lesions are pruritic, seasonal.
4. 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.
5. On cytology we found malastesia, culture pending. No imaging. ??
6. 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

Question 11

What are features of chronic
perivascular dermatitis?

Answer 11

1. The crusts contain degenerate neutrophils, keratin, serum, and
   few colonies of cocci
2. Diffusely moderately hyperplastic and mildly spongiotic with lymphocytic
   exocytosis.
3. Superficial dermis is infiltrated by a moderate number of perivascular mast cells, lymphocytes, plasma cells, neutrophils, and eosinophil (mast cells).
4. Thickening of skin (acantosis)
   5.

Question 12

Answer 12

Acantosis - thickening of the epidermis

Question 13

Case 1
* Based on the morphologic diagnosis and description. What do you think the diagnosis is?

Answer 13

Allergic skin disease

Question 14

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?

Answer 14

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

Question 15

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.

Answer 15

1. Scar from the spay
2. Thinning of the epidermis
3. Diffuse Alopecia

On right = blackheads

Question 16

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?

Answer 16

Endocrine Dermatosis
Anytime see blackheads - test for demodex.
Hyperadrenocortism –> ACTH stim test

Hypothyroidism

Hyperestrogenism

Question 17

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?

Question 18

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?

Question 19

Case 2
* Can you explain the cause for each of your differential
diagnoses?
* Name the typical clinical findings for your top differential
diagnosis.

Answer 19

Hyperestrogenism: sertoli tumor, ovarian tumor, exposure to estrogen gel

Hypothyroidism: inflammation of thyroid gland and atrophy

Question 20

Case 2
* Which histologic pattern will you expect on histopathology
* What features will you expect to see on histopathology?

Question 21

Answer 21

Missing telogen

Question 22

Answer 22

Hyperkeratosis
Crusting
?
Pink area = hypopigmentatiion/depigmentatio

Pemphigus fallaceious
Zinc responsive dermatosis
Huskies
Desmocolin -1
Type 2

Question 23

Answer 23

Condition: Indolent ulcer
Usually caused by allergies

Question 24

Answer 24

Histiocytoma
Nodule or neoplasia rather than cyst because a cyst would be filled with fluid.

Question 25

Boxer * Lesion type: * Which type of neoplasm is it (epithelial, mesenchymal, or round)? * What is your diagnosis?

Answer 25

Mast cell Lesional description: Focal tumor/nodule Round (mesenchymal are spindle shaped).

Question 26

What can be seen here?

Answer 26

* 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?

Question 27

Answer 27

Papilloma

Question 28

Question 29

Answer 29

Bilateral symmetrical alopecia on the dorsal aspect Endocrine dermathopathy.

Question 30

Question 31

Question 32

Answer 32

Vasculitis Sloughing of the ear tip Scalloped and notched ear margin with ulcer, scales, and crusts

Question 33

Answer 33

Scaling Exofilative dermatitis is paraneoplastic syndrome in cats; some cases are associated with thymoma. other causes: nonthymic neoplasms, immune mediated? Generalized scaling, nonpruritic

Question 34

Answer 34

Issue with collagen so skin easily tears Feline skin fragility syndrome. Associated condition: hyperglucocoritcoidims, diabetes mellitus

Question 35

Answer 35

Bilateral alopecia with crusting Ventral aspect Usually associated with carcinoma of the bile duct

Question 36

Answer 36

Cutaneous tag

Question 37

Answer 37

Focal areas of alopecia? Raised lesions that push the hairs up Folliculitis differentials for folliculitis: dermatophyte, bacteria, demodex

Question 38

Question 39

Answer 39

Multifocal nodules apocrine cysts

Question 40

Answer 40

Plaque Calcinosis cutis Hypercortisolemia