Pedal ulceration in a long-haired cat Author: Cathy CurtisEditor: David Lloyd © European Society of...

Pedal ulceration in a long-haired cat

Author: Cathy CurtisAuthor: Cathy Curtis Editor: David LloydEditor: David Lloyd

© European Society of Veterinary Dermatology © European Society of Veterinary Dermatology

History | Signs | Differentials | Tests | Therapy | NotesHistory | Signs | Differentials | Tests | Therapy | Notes

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History - 1

• 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

HistoryHistory


History - 2

HistoryHistory

• It was severely lame on the left fore foot

• Therapy with various antibiotics and corticosteroids had not been successful


Typical lesions: swollen & ulcerated digits

Clinical signs - 1

SignsSigns

A firm ulcerated swelling affecting the 4th digit of the left fore foot


Clinical signs - 2

SignsSigns

• The cat was thin

• The popliteal lymph nodes were enlarged

• Pedal lesions were as described

• No other abnormalities detected


How would youapproach this case?

SignsSigns

• 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


Case investigation

DifferentialsDifferentials

• Principle differential diagnoses• Digital lesions

• Neoplasia• Primary cutaneous, or metastatic

• Granulomata: • Bacterial• Mycotic• Foreign body• Sterile (idiopathic)

• Osteomyelitis


Tests - 1

TestsTests

• Initial tests• Blood tests:

• Routine haematology and biochemical screens; total thyroxine, FeLV and FIV assays

• Results:• No abnormalities; FeLV & FIV -ve


Tests - 2

What additional tests should you consider?

• Skin biopsy

• Microbiology of tissue specimens

• Cytology• Aspirates, exudates, impression smears

• Radiography

TestsTests


Tests - 3

TestsTests

Tissue samples from affected digits for histopathology & fungal culture

• Cut surface of digits exuded straw-coloured mucoid fluid

• Cytological examination of fluid unremarkable

• No micro-organisms isolated


Tests - 4

TestsTests

Skin Histopathology (Trevor Whitbread)

• 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


Tests - 5

TestsTests

Histopathologists Comments

• 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


Tests - 6

TestsTests

• Radiographer's diagnosis• Disseminated neoplasia, with osteomyelitis• Granulomata as less likely differential diagnoses

• What do you think now?


What is yourdiagnosis?

• Do the investigations permit a definitive diagnosis?

• Are there any additional investigations which you think may need to be done?

TestsTests


Diagnosis

• Metastatic bronchial carcinoma

TestsTests


How would you deal with this case?

• What is your prognosis?

• How will you advise the owner?

• What treatment would you consider?

TherapyTherapy


Prognosis

• 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

TherapyTherapy


Action

TherapyTherapy

• Euthanasia


Post-mortem examination - 1

NotesNotes

• 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


Post-mortem examination - 2

NotesNotes

Renal (left) & pulmonary (right) lesions


Final diagnosis

NotesNotes

• 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


Review

NotesNotes

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Date post:	25-Dec-2015
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Pedal ulceration in a long-haired cat Author: Cathy CurtisEditor: David Lloyd © European Society of...

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