signalment :14-year-old spayed mixed breed dog
HISTORY AND CLINICAL FINDINGS: anorexia, lethargy, and a distended abdomen.
Sample: blood smear (lower 100 x) and splenic tissue (touch prep) (upper 100x) - wright Giemsa stain
What is your diagnosis??
ps This is the easiest one : ) and it is my specilty as well.
9 則留言:
MAST CELL TUMOR!!!!!
哈,果然很簡單吧...
那來玩這個: 延伸問題
1)MCT最常發生的地方在哪? 2)怎麼做staging? 3) prognosis要看什麼?? 4)血液中出現Mast cells 的時候有什麼differentials?? 5)貓和狗的MCT有何不同.... 6) DIff-quick stain對於診斷MCT有什麼問題 ？？
1. MCT is the most common skin neoplasm of the dog.
2. Ideally we have to do CBC, biochem, UA, buffy coat, BM aspiration, lymph node FNAB, chest radiography and abdominal ultrasound and/or XR, and of coz biopsy.
Stage o - Single tumour incompletely excised.
Stage I - Single tumour confined to dermis without localised lymph node involvement
Stage II - as stage I plus localised lymph node involvement
Stage III - multiple skin tumours or large infiltrating tumours
Stage IV - any tumour with distant metastases or recurrence with metastases. Any blood or BM involvement should be classified in this stage.
Substage a and b represent the absence and present of systemic disease respectively.
4. Mastocytaemia can be observed in a couple of acute inflammatory diseases like parvoviral infection.
5. Skin MCT are the second most skin neoplasm in cats while it should be most common one in dogs. Systemic MCT and skin MCT tend to be the separate diseases and rarely present at the same time. And most feline skin MCT are clinically and histopathologically benign. Peripheral mast cell counts may be high in cats with mastocytosis.
6. The granules may be poorly stained with Diff-quick.
Prognostic index or factor should be controversial over years. Gender (male got worse), age (>8 yrs old poor px), growth rate (>1cm per week) and poor sx margin carrying poor px are less controversial.
Tumour grading is less useful for predicting the prognostic index. Yes, grade III tumours are more likely to be incompletely excised and more likely to metastasize. Yet in one study, grade II MCT have a much lower rate of local recurrence and longer survival rates than was previously believed. MCT with lymph node involvement should be worse in px. PCNA/Ki67, AgNOR and c-kit IHC expression are the newly found negative prognostic factors. And for general practitioner like me, I have no chance to use those molecular based px factors.
:(
3) 我們現在用mitotic index + Grade system . 所以就是MI >5 and GIII最慘啦. MI的文章去年published, search for Cheryl London. 所以啦,有送病理的話MI是很好取得的 只要算有幾個 mitotic figures every 10 40X HPF4) 其實很多啦, parasite, hypersensitivity, GI inflammation, allergy等等...5)貓貓比較多systemic的 true, 和人一樣,你確定是second most common skin tumor?? 不記得我有看過這個statement.
這個case其實超級rare, 要知道,大部分都是從skin開始然後開始met, 這個case是完全沒有skin leasion,MCT出現在肝臟脾臟還有血液中,如果正確而言應該叫做systemic mastocytosis. MCT是否有BM invovlment就真的沒有人真的好好看過,我非常想研究這部分,不過MCT轉移狗都這麼sick了,實在沒有太大的理由做BM, 不過我是相信, 要有mastocytosis基本上應該都80%都有BM involvment.
"MCT are the second most common cutaneous tumor in the cat, accounting for approximately 20% of cutaneous tumors in this species in the United States"
Withrow SJ & Vail DM. Small Animal Clinical Oncology, 4ed.(2007) p416
ㄟ 大家對cytology討論好像比較不熱烈阿... 是因為太簡單還是不會看阿?? 了解一下.....
我不會
okay. 那我知道了...我們就從最基礎的血球開始好了....
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