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“A Skin Scare!”

Maritza Goller, VMD

HISTORY & PHYSICAL EXAM:

“Bonzo” Bowman is a very handsome 2 year old male neutered Golden Retriever that presented for evaluation of a few red, raised, firm, crusted skin masses on his neck. Bonzo has a history of skin infections so he was initially treated with antibiotics. The medication was not working, so Bonzo was re-evaluated. At that point, he had developed more lesions along the left side of his body as pictured below. The largest lesion was on his left chest and none of them were itchy or bothersome to him. Bonzo’s lymph nodes were normal in size during his exams. At this time our list of potential causes for these skin masses included a deep infection, reactive skin disease, insect bite reaction, or even something more sinister like cancer.

DIAGNOSTICS:

• FINE NEEDLE ASPIRATE: A fine needle aspirate (needle inserted into the mass) was done on the largest mass and revealed a large number of 1 type of white blood cell called a lymphocyte. This made us very worried as we were concerned that this could be cutaneous lymphoma (a type of skin cancer)! A biopsy (collection of tissue) was recommended to provide a more definitive answer.

• BIOPSY: Bonzo was sedated and the largest mass was removed completely and sent to the laboratory for further testing. A small sample of two smaller masses was also sent in for evaluation.

RESULTS:

• BIOPSY REPORT: We were very happy to report that Bonzo did not have lymphoma! His biopsy returned as “reactive histiocytosis”.

Reactive Histiocytosis

There are two forms of reactive histiocytosis – cutaneous and systemic.

Cutaneous histiocytosis is a benign accumulation of a type of cell called a histiocyte under the skin. This form is more common in younger dogs and can cause lesions such as those seen in Bonzo. The number of skin lesions can range from 1 to more than 50, but they are not painful or itchy unless they become secondarily infected. Skin masses can be present on head, neck, extremities and scrotum. They can go away on their own and recur in new areas. Work up of these lesions includes a fine needle aspirate or biopsy of the affected tissue. The prognosis of cutaneous histiocytosis is fair as the lesions can actually regress spontaneously or some patients may need long term immunosuppressive drugs for control.

Systemic histiocytosis is seen in middle-aged dogs and is similar to the cutaneous form but spreads to the lymph nodes and internal organs (liver, spleen, bone marrow, nasal cavity). The workup is similar to that for cutaneous histiocytosis but usually includes X-rays or an abdominal ultrasound to evaluate for internal involvement. Treatment for reactive disease typically involves immunosuppressive drugs with or without antibiotics. Prognosis is poor as the disease ultimately progresses.

Bernese mountain dogs are predisposed to histiocytic diseases but other breeds are also overrepresented (Golden retrievers, flat-coated retrievers, Rottweilers and Doberman pinchers).

UPDATE ON BONZO:

• Bonzo is currently doing well and his owners are monitoring his lesions very closely. He is going to be evaluated by a dermatologist to discuss reactive histiocytosis and determine the best treatment for him.

References:

• Côté Etienne. Clinical Veterinary Advisor: Dogs and Cats. Third ed., Elsevier, 2015.

• Hnilica, Keith A., and Adam P. Patterson. Small Animal Dermatology: a Color Atlas and Therapeutic Guide. Fourth ed., Elsevier, 2017.

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Figure 1. Initial Neck Lesions

Figure 2. Largest mass, left chest, removed and sent for biopsy

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