11/10/16
All# you#need#to#know# about# hematology# and#cytology*
Tracy#Stokol,#BVSc,#PhD,#DACVP Ashleigh# Newman,#VMD,#DACVP *Well,¬&everything,&but&as&much&as&we&can&teach&you&in&2&hours!&
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142 Railroad Drive Ivyland, PA 1-215-364-5582 www.safe-tecllc.com 142 Railroad Drive Ivyland, PA 1-215-364-5582 www.safe-tecllc.com
1 11/10/16
Introduction Introduction
Garret# Pachtinger,# VMD,# Justine-A.-Lee,- DVM, DACVECC DACVECC,- DABT CEO,-VETgirl COO,# VETgirl
VETgirl…OnFTheFRun VETgirl#ELITE
• The#techFsavvy# way#to#get#online#veterinary# CE! • A#subscriptionFbased# podcast# and#webinar# service# offering# veterinary# RACEFapproved# CE
50F60# podcasts/year# plus&24+#hours#of#webinars! • $199/year • 40+#hours#of#RACEFCE
New#and#improved#video! Up$to$5$members:$ $599/year
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2 11/10/16
New#and#improved#video! Download#our#iTunes#podcasts#free!
Social#media#and#our#blog!
Introduction Logistics:#CE#Certificates
! Type-in-questions Dr.-Tr ac y - Stokol BVSc,- PhD,-DACVP ! Emailed- to-you 48-hours after-the-webinar ! Active-participation-=-no-quiz Professor-Department-of- ! Watching- video-later,-must- complete- quiz Population-Medicine-and- ! ELITE- members- only Diagnostic-Sciences-College- ! Email-/-contact- with-ANY-questions of-Veterinary-Medicine- Cornell-University ! [email protected] ! [email protected]
3 11/10/16
Introduction www.eclinpath.com
Dr.-Ashleigh- Newman,- VMD,-DACVP
Instructor-in-Clinical- Pathology-at-Cornell- University
Outline Make#a#fresh#blood#smear!
• Hematology • Crucial! • Tips# on# smear#preparation • ASAP,#ideally#<#4#hours • How# to# examine#a#blood# smear • Fact#or#fiction? • Delays#can#result#in: • Why# look# at#a#blood# smear? • WBC: • Cases:# Approach# to#anemia,# diagnostic# conundrums • Nuclear#swelling#and#smoothing:##PseudoFleft#shift • Prominent#Dohle • Cytology bodies:#PseudoFtoxic# • Tips# on# smear#preparation change • How# to# examine#a#cytologic# smear • Apoptosis:#Mimic#nRBC • Fact#or#fiction? • Cases:# Skin#lumps# and# bumps# (the#tip# of#the#iceberg) fresh stored
Make#a#fresh#blood#smear! Making#a#smear
• Delays#can#result#in: • RBC: • Crenation#and#lysis • Detachment#Mycoplasma&(c ats)
• Platelets: • Clumping#and#degranulation
Image:& Orsini &&Divers.& Equine& Emergencies:& Treatment& and&Procedures
4 11/10/16
Blood#smear#examination Blood#smear#examination
• Check#that#feathered#edge#(10x) • Find#and#scan#the#monolayer#(10x)
Blood#smear#examination Blood#smear#examination
• Perform#a#differential#count# • Identify#and#classify#leukocytes#(40x#or#50x) (40x#or#50x) • Note#obvious#abnormalities
Segmented#neutrophils Lymphocyte Monocyte
Blood#smear#examination Blood#smear#examination
• Evaluate#WBC#morphologic#features#(100x) • Evaluate#RBC#morphologic#features#(100x)
Toxic#band Iron#deficiency# anemia# (hypochromic# fragmented#RBCs)# pos t#trans fus ion# (dual# population)
Reactive# lymphocyte
5 11/10/16
Blood#smear#examination Fact#or#fiction?
• Estimate#platelets#(1#per#100x# OIF#=#15,000/μL) • Which#one#is#the#infectious# agent? • Evaluate#morphologic#features#(100x)
Anaplasmaplatys
Stain# precipitate Phagocytized# bacteria
Fact#or#fiction? Fact#or#fiction?
• Which#one#is#the#infectious# agent? • Which#one#is#the#infectious# agent?
Mycoplasma& haemofelis Water# artifact Birman granules Mast# cell# granules
Fact#or#fiction? Why#look#at#a#blood#smear?
• Is#the#arrowed#cell#a#nucleated#RBC? • Our#eyes#are#better#than#a#machine • Verify#results#(e.g.#platelet#count) • Morphologic#clues#to#underlying# disease • RBC#changes No:# • Left#shift,#toxic#change Pyknotic WB C in# a#dog#with# • Abnormal#cells Acute#leukemia heatstroke • Infectious#agents • Assess# critical#patients#when# analyzer/lab#is# unavailable# (e.g.#after#hours)
6 11/10/16
Case#1:#Taffy Is#Taffy#anemic?
• 4#year#old#MN#Golden#Retriever • One#week#history#of#lethargy • Exposed# to#wasp#insecticide • Drugs • Revolution#2#weeks#prior • Intranasal#Bordetella#and#parainfluenza 3#months#prior • Examination • Quiet,#alert,#responsive • Pallor • Tachycardia,#tachypnea • Grade#II/VI#heart#murmur
How#severe#is#the#anemia? Severity#of#anemia
• Based#on#Hct
Anemia Dog Cat None ≥#41 ≥#31 Mild 30F40 25F30 Moderate 15F30 15F25 Severe <15 <15
Transfusion2 trigger Clinical# and# laboratory# evidence# of# hypoxia# (not# Hct)! Tachypnea,#tachycardia Decreased#percent#oxygen#saturation Hypotension,#etc.
Is#the#anemia#regenerative? Response#to#an#anemia • Erythroid#hyperplasia:#Takes#3F5#days • Release#of#immature#anuc leate RBC • Polychromatophi ls (Wright’s,# DiffFquik) • Reticulocytes# (vital# or# fluorescent# dyes):# Aggregate# in# cats
P
P N
P
A P Has#the#bone#marrow#had#time#to#respond? Polychromatophils (P),#nRBC (N) A:# Aggregate;#P:#Punctate
7 11/10/16
How#good#is#the#regeneration? Test Taffy Reference2interval Hct (%) 13 42F57 • Quantify# via#absolute#reticulocyte#count MCV#(fL) 73 63F74 MCHC#(g/dL) 33 32F37 Degree2of2 Dog2 Cat2 RDW#(%) 16.7 11.3F14.0 regeneration Reticulocyte2 Aggregate2reticulocyte2 Retic (%) 1.0 0.2F1.1 count2(thou/μL) count2(thou/μL) Retic (thou/uL) 19 10F76 None <92 <60 WBC#(thou/uL) 10.3 6.2F14.4 Mild 92F150 60F100 Seg neut (thou/uL) 8.2 3.4F9.7 Moderate 150F300 100F200 Band neut (thou/uL) 0 0F0.1 Severe ≥#300 ≥#200 PLAT#(thou/uL) 189 179F483 Plasma Normal
NonFregenerative#anemia Are#there#clues?
• Problem#with#effective bone#marrow#production • Decreased,#ceased,#or#defective#production • Can#occur#with#hemorrhage#or#hemolysis • Many#mechanisms#and#causes
• Ask#these#questions: • Are#there#any#clues#as#to#the#cause? • Drugs,#toxins,#infectious#agents? • Is#there#a#disease#preventing#the#marrow#from# responding? • Is#the#problem#in#the#marrow? Elliptocyte /#ovalocyte:#Fibrosis
Concept:#RBC#changes Ask#these#questions
• Clinical# relevance#of#RBC#changes? • Drugs,#toxins,#infectious#agents? • Revolution#2#weeks#prior • NumberFdependent • Intranasal#Bordetella and#parainfluenza 3# months# • CONTEXTFdependent prior • Exposed#to#wasp#insecticide • Judgment# call#by#you# • Is#there#a#disease#preventing#the#marrow#from# and#your#clinical# responding? • Anemia#of#inflammatory#disease:#Evidence#of#another# pathologist disease#(chemistry#panel,#examination,#imaging) • Lack#of#erythropoietin:#CKD#(chemistry#panel) • Endocrine#disease:#Hypothyroidism,#Addison’s • CLUE:#Anemia#is#mild#to#moderate Acanthocytes • Taffy’s#anemia# is#SEVERE
8 11/10/16
Taffy:#Chemistry#and#urinalysis Is#the#marrow#the#problem?
• Severity#of#anemia:#SEVERE in#Taffy Test Taffy Reference2interval • Other#cytopenias:#No#in#Taffy ALT#(U/L) 120 25F106 • Normal#neutrophil#and#platelet#count AST#(U/L) 74 16F50 • Abnormal#cells#in#circulation:#No#in#Taffy Total# bilirubin#(mg/dL) 0.3 0F0.3 Iron#(μg/dL) 250 98F220 Saturation#(%) 100 28F62
Urinalysis:##no#abnormalities
What#additional#tests#should#we# Taffy’s#bone#marrow perform#in#Taffy? E
1. Bone#marrow#aspirate" M E E 2. Coombs " Negative 3. 4Dx#plus#SNAP#test " Negative
4. Abdominal#ultrasound" NSF
5. Thoracic#radiographs " NSF M
E:#Early#erythroid,#M:#Myeloid,#arrow:#Late#erythroid
Let’s#recap#Taffy Taffy’s#diagnosis…
• Ill#for#7#days#at# least • Severe#normocytic# normochromic# nonF NonNRegenerative2 ImmuneN regenerative# anemia Mediated2 Anemia2 (NRIMA)2 • Increased# hepatocellular# injury#enzymes# (hypoxia) or2 • No# other# cytopenias PrecursorNdirecte d2 ImmuneN • Bone#marrow:# Ineffective# erythropoiesis Mediated2 Anemia2 (PIMA) • Erythroid# hyperplasia# with# leftFshifted# maturation • Increased# iron# and# %#saturation • No#identifiable# cause# with#diagnostic# testing
9 11/10/16
NRIMA NRIMA
• Any#age#or#breed • Pure# red#cell# aplasia# (most#severe):#Young# FeLVFnegative# cats# (<3# • Coombs# test:# Negative# or#weak#positive years#of#age) • Chemistry • Severe#nonFregenerative#anemia:#Hct <15%# • High# iron# and# %#saturation • Usually# normocytic# normochromic • ± Increases# in#liver#leakage#enzymes#(hypoxic# • No#other# cytopenias injury) • Stable#clinical#signs,#i.e.#chronic • Usually#not#cholestatic,#unless#concurrent#destruction • • Clues#on#blood#smear Normal#total#protein • Dogs:#No#spherocytes or# “partial”# spherocytes,# elliptocytes • Bone# marrow:# Needed#for#diagnosis • Cats :#No#aggregate# and# few#to#no#punctate# reticulocytes • Determine# severity • No#underlying#disease#or#drugs • Caution:# May#not# obtain# in# some# dogs# due# to# fibrosis#(dry#tap)
Bone#marrow#from#cat#with#PRCA The#IMHA#spectrum
No#RBC#precursors,#increased#small#lymphocytes#(arrows)
Smear#comparison Taffy#followFup
Classic2IMHA NRIMA/PIMA • Treatment:#Blood#transfusions,# Spherocytes# (s upport# for# immunosuppressive# drugs,#gastroprotectants extravascular# hemolysis) Elliptocyte (s ugges ti ve# of# fibros is ) • Progress:# Day Hct Retic (%) (thou/μL) 1 13 19 Normal# canine# 5 19* 6 RBC# wi th# c entral# pallor 14 14 30 21 25 176 Polychromatop hil 28 25 320 (support# for# regeneration Ghos t# c el l # (support# for# intravascular# 120 35 40 hemolysis) Ref#interval 42F57 10F76 *Transfusion
10 11/10/16
Case#2:#Madge Case#2:#Madge
• 3#month#old#FS#DSH#cat • • Presented#as#an#emergency#with#progressive#respiratory#disease# Thoracic#radiographs#performed for#1#month • • History:# CBC# submitted • Treated# for# intestinal# parasites • FeLV/FIV#negative Test Result Reference Units • Up# to# date# with# vaccines interval • Physical#examination:# WBC 47.8 5.1#– 16.2 thou/μl • Bright# and# alert,#adequate# hydration • Tachypnea# (60# bpm) Seg neut 24.9 2.3#– 11.6 thou/μl • Increased# respiratory# effort# on#inspiration# and# expiration Mono 1.4 0 – 0.7 thou/μl • Harsh#lung# sounds • Ocular# and# nasal# discharge Lymph 11.0 0.9#– 6 thou/μl • No#murmur TP–ref 9.6 5.9#– 7.5 g/dL
Blood#smear:#Feathered#edge Monolayer
10x 10x DiffFQuik stain DiffFQuik stain
Severe#left#shift Features#of#toxic#change
Meta
B Frothy# vacuolation Myelocyte Dohle body S S:#Seg,#B:#Band,# Meta:# metamyelocyte
Cytoplas mic#bas ophilia S 50x#(left),#100x#(right) 100x DiffFQuik stain DiffFQuik stain
11 11/10/16
Monocytes#versus#neutrophils Monocytes#versus#neutrophils
M M
B M M B
M B
Monocyte#(M) 50x# 100x# DiffFQuik stain DiffFQuik stain
Lymphocytes#vs#platelets#vs#nRBCs Reactive#lymphocytes
L * Macroplatelet * plts *
L n B *
B L:#Lymphocyte,#n:#nRBC 50x#(left) 100x#(left),# 50x#(right) 100x#(right) DiffFQuik stain DiffFQuik stain
Red#blood#cells:#Rouleaux Rouleaux# versus#agglutination
Stacking#of#RBC#like#coins Aggregates#of#RBC
• Increased# globulins • Antibody# bridging# of#RBC • Fibrinogen • ImmuneFmediated • Immunoglobulins • NonFpathologic# antibody# 100x# (EDTAFdependent) DiffFQuik stain
12 11/10/16
Madge#recap Madge#followFup
• Moderate#leukocytosis • Thoracic#radiographs • Neutrophilia#with#a#severe#left#shift#(not# • Bronchiolar# pattern degenerative)#and#marked#toxic#change#and# monocytosis## Inflammatory#leukogram • No#tracheal#wash#done • Marrow#is#responding#to#and#keeping#up#with# • Owner#elected#empiric#treatment demand • Mild#lymphocytosis • Doxycycline • AgeFrelated# and# or# physiologic# (epinephrineFme dia ted) • Fenbendazole • Reactive# lymphocytes# # Antigenic# stimulation • Marked#rouleaux • Hyperproteinemia ( TPFref)#due#to#hyperglobulinemia • Fibrinogen# and/or# immunoglobulins
Case#3:#Sirius Case#3:#Sirius
• 5# year# old# MC# mixed# breed# dog • CBC# submitted • History:# • All#results#within#the#reference#interval • Mild#lethargy • Owner#detected#masses#under# the#dog’s# neck • Primary#veterinarian# diagnosed# peripheral# lymphadenopathy …but&you&should&still&look&at&a&blood&smear!& • Referred# to#CUHA# Oncology# Service#for#further# evaluation • Physical# examination: • Enlarged# mandibular,# superficial# cervical,#inguinal,# and# popliteal# lymph#nodes
Feathered#edge Left#shift
Band# neutrophil
Platelet# clumps
10x#(left),#50x# (right)# 10x DiffFQuik stain DiffFQuik stain
13 11/10/16
Leukocytes More#big#blue#cells
• Are#they#reactive#or#neoplastic?
Big##blue#cell M
L
50x 100x DiffFQuik stain DiffFQuik stain
RBC#changes
Acanthocyte
Keratocytes
Schistocyte 100x DiffFQuik stain
More#RBC#changes Acanthocyteversus#echinocyte
Irregularly# spiculated RBC Regularly#spiculated RBC
Eccentrocyte
Echinocytes
• Fragmentation:# DIC,# • Artifact:#Aged# RBC hemangiosarcoma • Other:# Electrolyte# • Altered# RBC#membrane:# Liver# depletion, # renal# dis eas e, # dis eas e drugs # (furos emide# in# horses)
14 11/10/16
Cell#fragments Sirius#recap
platelets • CBC:# • Normal#total#WBC#count • Mild# left# shift • 1,200# thou/μl (11%)# circulating# lymphoma# cells • Evidence#of#RBC#injury • Fragmentation# and# oxidative • Cytoplas mic# Lymph#node#aspirate#and#cytologic#evaluation: fragment • Lymphoma#(large#cell) • Bone#marrow#aspiration#and#cytologic#evaluation: • Lymphoma#infiltrate • Began#treatment#with#CHOP#protocol
Cytologic#smear# preparation
CYTOLOGY
Image:& Orsini &&Divers.& Equine& Emergencies:& Treatment& and&Procedures
Optimal#preparation Causes#of#nonFdiagnostic#samples
• Rapidly#airFdry,#especially#if#viscid#or#thick# • Poor#cellularity (think#tracheal#washes,#joint#fluids,#bile) • Missed#the#lesion • Take#care#of#your#stain! • Accompanying# changes • Necrosis • Know#your#stain • Inflammation • Limitations#of#Quick#stains • Cystic#fluid • Mast#cell#granules • Hemodilution • Granular#lymphocytes • Poor#smearing# technique • “Black#and#white” • • Lose#chromatin#patterns Evaluate# prior#to# submitting
Image:& Cowell& &&Tyler:& Diagnostic& Cytology& of& the& Dog& and& Cat
15 11/10/16
Poor#smearing#technique Evaluate#before#submitting
Splat2smear Excessive2squashing Salivary2gland Adipose2tissue
Low#power#(10x) Low#power#(10x)
• Overall#cellularity • Start#evaluating#cells#FF General&sense&of&the&populations • • Staining# quality Is#there#blood? • Is#there#inflammation? • Is#there#a#cell#population#other# OK#stain than#inflammatory#cells? • Should# they# be#there# or#not? • Take#note# of#their# organization
Understained
Low#power#(10x) The#right#area?
• Are#there#big# objects? • e.g.#infectious# agents * • Take#note#of#the# background# Lungworm other#than#blood • Find#a#well#spread# area#to# go#closer
*:#Well# spread# area;#arrow:#too# thick
16 11/10/16
High#power#(40x,#50x,#100x) High#power#(40x,#50x,#100x)
• Blood • Inflammatory#cells • Is#it#hemorrhage#or# • Which#cell#types?# contamination? • Is#there#a#cause?# • Hemorrhage:# • Depends#on#inflammation Hemosiderophages,# erythrophages in#fresh# • NonFinflammatory#cells smears • What#type? • Contamination/peracute • What#is#their#organization? hemorrhage:#Platelets • Should#they#be#there? Erythrophage in#a#lymph# node • Unique features?# • Criteria#of#malignancy?
Cytologiccriteria#of#maligancy Arrangement#of#tissue#cells • Nuclear#>#
cytoplasmic Cell# organization • Latter# could#be# Packets #or# dysplasia Clus ters #of# Naked#nuclei cells Round#cells# Spindle# • pres ent# cells Abnormal# individually location,#e.g.# Epithelial Endocrine# /# lymph#node Round#/# Mesenchymal neuroendocrine dis crete#cell
Arrangement:#Low#power Fact#or#fiction?
Mesenchymal Round#cell
Degenerate#neutrophil# Apoptotic#neutrophil# with#phagocytized# with#cellular#debris bugs Endocrine# /#neuroendocrine Epithelial
17 11/10/16
Fact#or#fiction? Case#1:#Danny
• 12#year#old#MC#Golden#Retriever • Site:#Mass#on#right#lateral#carpus • History:# • Owner#noticed#lump#day#before#presentation • Firm,#but#soft,#6.5#x#4.5cm#mass#on#lateral#aspect# of#right#carpus
Starch#crystal Yeast:#Cryptococcus
Danny:#Low#power Danny:#Low#power
10x 10x DiffFQuik stain DiffFQuik stain
Danny:#High#power Danny:#High#power
Anisokaryosis
Anisocytosis
50x 50x DiffFQuik stain DiffFQuik stain
18 11/10/16
Danny:#High#power Danny:#Cytologicinterpretation#
Soft2tissue2 sarcoma
Binucleation
Mitotic# figure# “Crown#cell” Multinucleated# tumor#cell
50x 100x DiffFQuik stain DiffFQuik stain
Soft#tissue#sarcomas Mesenchymal#tumors
• Skin#and#subcutaneous# tissue • Cellular#features • Heterogeneous# category# of#tumors# including:# • Cell#shape:#Spindle(to(stellate • Perivascular# wall#tumor# (hemangiopericytoma) • Exfoliate#individually#or#hang#out# • Nerve# sheath# tumor together,#but#not#cohesive • Less# often:# • Variable#cellularity • Fibrosarcoma (more# i n# t he# cat ) • Benign:##Fibroma,# leiomyoma,# • Myxosarcoma lipoma • Biologic# behavior: • Malignant:##Fibrosarcoma,# • Locally#invasive hemangiosarcoma,# • Low# to#moderate# local#recurrence# rates osteosarcoma • Low# metastasis# rate **#Beware:#Reactive#fibroblasts
Case#2:#Sassy Sassy:#Low#power
• 7#year#old#FS#Shih# tzu • Site:#Small# mass#(~0.5#– 1cm)#firm,# haired# mass#on#the#right#side#of#the#neck • History:# • Dog#seems#bothered#by#it
10x DiffFQuik stain
19 11/10/16
Sassy:#Low#power Sassy
Keratinocyte
Multinucleated# giant# cell#
Neutrophils
Macrophage
10x 20x DiffFQuik stain DiffFQuik stain
Sassy:#High#power Sassy:#Cytologicinterpretation
Presumptive#reactive#fibroblasts Pyogranulatomous inflammation2 due2 to2a2 ruptured2keratinizing2 adnexal2lesion Multinucleated# giant# cell#
vs#intact#lesion Keratinized# 50x squamous# DiffFQuik stain epithelial#cell
Keratinizing#adnexal#lesions Case#3:#Angus
• Most#common# are#follicular# cysts#in#dogs#and# • 12#year#old#MC#West#Highland# White#Terrier cats:# NonFneoplastic# structure# filled#with# • Site:#0.3#x#0.2#x#0.3cm#red,#scabbed#over# anucleate keratinocytes nodule#on#dorsal#aspect#of#calcanean tendon • Further# classified# based# on#involved# area#of# follicle • History:# • Aka:#Sebaceous# or#epidermal# inclusion# cysts • Multicentric#lymphoma,#currently#receiving# • Single#or#multiple CHOP • Head,# neck,#limbs,# dorsum • New#cutaneous#nodule#noticed#today#on# physical#examination • Adnexal#tumors# (e.g.# pilomatricoma,# trichoepithelioma)# can# appear# similar
20 11/10/16
Angus:#The#dreaded#“splat” Angus:#High#power
Small# lymphocytes
?
NonFdegenerate# neutrophil
Nuclear# streaming 4x 50x DiffFQuik stain DiffFQuik stain
Angus:#High#power Angus:#Even#higher#power
Free#nuclei
Free#nuclei * * Free#nuclei *
* * *
Small# Nuclear#streaming lymphocyte
50x 100x DiffFQuik stain DiffFQuik stain
Cytologicinterpretation Histiocytoma
• Benign#tumor#in#dogs Regressing2 histiocytoma • Langerhans#cell#(dendritic#cell)# origin
Lymphocytes • Any#age,# but# more#common# in# young# dogs# (<3#yrs old) • Solitary#lesions • Head,#especially#pinna,#legs • Can# be# multiple## cutaneous# Langerhans# cell#histiocytosis • Spontaneously# regress# within# Histiocyte 3#months • Infiltrate#of#small#lymphocytes • DDx:# Plasma#cell#tumor 50x 10x#(above),#50x#(below)# DiffFQuik stain DiffFQuik stain
21 11/10/16
Histiocytoma versus#plasmacytoma Round#cell#tumors
Histiocytoma Extramedullary plas macytoma • Examples: • Cellular#features:# 1. Mast# cell# tumor • Cell#shape: Round(to( 2. Histiocytoma/histiocytic sarcoma oval( 3. Extramedullary plas macytoma • Exfoliate#individually 4. Lymphoma • Usually#exfoliate#well 5. Transmissible# venereal# tumor
Lymphoma Mast#cell#tumor
Zoe Zoe:#Low#power
• 12#year#old#female#spayed#Springer#Spaniel# • History:##Mass#noted#on#routine#physical# examination • Site:# • 3cm# leftFsided#perianal#mass,#erythematous • Mass#does#not#appear#associated#with#anal# gland
10x DiffFQuik stain
Zoe:#High#power Zoe:#Cytologicinterpretation
Perianal2gland2adenoma aka#“Hepatoid gland”#adenoma
50x 50x DiffFQuik stain DiffFQuik stain
22 11/10/16
Perianal#gland#adenoma Perianal#gland#adenoma# versus#AASAC
• Older#intact#male#dogs • But#can#occur#in#female#dogs • Rare#in#the#cat • Location:#Perianal • But#also…#tail,#perineum,#prepuce,#thigh,#and#dorsal# lumbosacral#area • Initially#smooth,#round,#raised#lesion • Can#become#multinodular#and#ulcerated#as#they#enlarge • Typically#benign • There#are#malignant#variants • Cannot#differentiate#from#hyperplasia#on#cytology Perianal#gland#adenoma/hyperplasia Apocrine#anal#sac#adenocarcinoma (AASAC) 10x DiffFQuik stain
Perianal#gland#adenoma# versus#AASAC Epithelial#tumors
• Cellular# features : • Cell# s hape: #Round#to#polygonal# to# columnar#to#cuboidal • Exfoliate# in#cohesive(clusters • Usually#exfoliate#fairly# well • Benign:# Trichoblastoma,# perianal# gland# adenoma • Malignant:# Squamous# cell# carcinoma,# transitional# cell# carcinoma
** Beware:#NonFneoplastic# dys plas tic# epithelial# cells
Clus ters , #dis tinct#boundaries Packets,#indistinct#boundaries,# “naked”#nuclei 50x DiffFQuik stain Trichoblastoma Squamous#cell#carcinoma
Endocrine/neuroendocrine#tumors
• Cellular# features : LIKE2/2FOLLOW2 • Cell# s hape: #Round#to#polygonal#with#indistinct#boundaries • Exfoliate# in#packets • Usually#exfoliate#fairly# well CORNELL2CLIN2PATH! • Rupture#easily,#bare#nuclei# • Often#do# not# display#cytologic#criteria#of#malignancy • Usually# malignant:# Thyroid# carcinoma,# ins ulinoma,# AASAC
Insulinomain#liver Thyroid#carcinoma
23 11/10/16
Check#out#our#2016#upcoming#VETgirl appearances!
Dr.#Garret# Pachtinger $ IVS#(Aruba),#Dec#2016 $ NAVC,#Feb#2017 $ WVC,#March#2017
This#material# is#copyrighted#by#VETgirl,#LLC#or#Cornell#University#(images#and#content#via#Dr.#Stokol).#None#of#the#materials#provided#may# be#used,#reproduced# or#transmitted,# in#whole#or#in#part,#in#any#form#or#by#any#means,#electronic#or#otherwise,#including#photocopying,#recording#or#th e#u se # of# any#i n fo rmatio n # storage# and#retrieval#system,# without#the#consent#of# VETgirl,#LLC#or#Cornell#University#(via#Dr.#Stokol).#Unless#expressly#stated#otherwise,#the#findings,# interpretations#and#conclusions#expressed#do#not#necessarily#represent#the#views#of#VETgirl,#LLC.#Medical#information#here#should#be#referenced#by#the# practitioner#prior#to#use.#Under#no#circumstances# shall#VETgirl,#LLC.#or#Cornell#University#(via#Dr.#Stokol)#be#liable#for#any#loss,#damage,#liability#or#expense# incurred#or#suffered#that#is#claimed#to#have#resulted#from#the#use#of#the#information#provided#including,#without#limitation, an y#fault,#error,#omission,# interruption#or#delay#with#respect#thereto.#If#you#have#any#questions#regarding#the#information#provided,#please#contact#[email protected]
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