Rampant cellulits in a 8 year old Labrador

RE: Rampant cellulits in a 8 year old Labrador

Liz Barton — Sat, 07 Jul 2018 23:22:08 GMT

[quote user="Neil Wheadon"]The skin lesions represents a neoplastic epithelial proliferation - adenocarcinoma. The lymphatics are dilated and obliterated by the neoplastic cells and most likely
this represents a metastatic adenocarcinoma. Based on the clinical presentation this could represent originally an apocrine gland carcinoma. As XXX is a female dog a metastatic
mammary carcinoma would be a possible differential. [/quote]

Sorry to hear, but at least biopsy was the right option. In terms of whether this could've been done in house / on more of a budget it would have been interesting to compare the histopath to an impression smear; I know they're often confused by the secondary inflammation/infection. I guess if the pre-scap/axillary lymph nodes were enlarged these could have been FNA'd to see if any neoplastic cells present.

RE: Rampant cellulits in a 8 year old Labrador

Neil Wheadon — Sat, 07 Jul 2018 20:23:17 GMT

RIP, I'm afraid, 1 week after diagnosis

Neil

RE: Rampant cellulits in a 8 year old Labrador

Anthony Todd — Sat, 07 Jul 2018 19:56:44 GMT

What happened?

RE: Rampant cellulits in a 8 year old Labrador

Anthony Todd — Mon, 30 Apr 2018 18:17:40 GMT

[quote user="Thomas Johnson"]Neil's last post has the diagnosis on it, I don't think more pictures are going to help[/quote]

[I would have bet anything on being right too, (missed the diagnosis before I posted again!!)]

Trying to very politely apologise in this new era of sanctity and good will; and so I should!!

RE: Rampant cellulits in a 8 year old Labrador

Thomas Johnson — Mon, 30 Apr 2018 18:10:40 GMT

[quote user="Anthony Todd"]

[quote user="Neil Wheadon"]

It's extending. The newer lesion is dorsally, so the contact theory doesn't apply

However I think there may be a slight improvement

[/quote]

Does that challenge my liquid burn while asleep on it's side theory??

More pics please.

[/quote]

Neil's last post has the diagnosis on it, I don't think more pictures are going to help

RE: Rampant cellulits in a 8 year old Labrador

Anthony Todd — Mon, 30 Apr 2018 18:06:27 GMT

[quote user="Neil Wheadon"]

It's extending. The newer lesion is dorsally, so the contact theory doesn't apply

However I think there may be a slight improvement

[/quote]

Whoops. I'm blown out of the water so retire and learn...

RE: Rampant cellulits in a 8 year old Labrador

Jenny Harris — Mon, 30 Apr 2018 17:44:35 GMT

Oh poor dog. thank you for sharing the results though

RE: Rampant cellulits in a 8 year old Labrador

Neil Wheadon — Mon, 30 Apr 2018 14:41:51 GMT

and the results are as below. Very interesting.

I really enjoy seeing cases like this on here. You have a start, middle and finish and I pick up something every time. Maybe a referral letter with an answer after posting a case, or one worked up yourself. Please don't be afraid, more please?

Neil

The skin lesions represents a neoplastic epithelial proliferation - adenocarcinoma. The lymphatics are dilated and obliterated by the neoplastic cells and most likely
this represents a metastatic adenocarcinoma. Based on the clinical presentation this could represent originally an apocrine gland carcinoma. As XXX is a female dog a metastatic
mammary carcinoma would be a possible differential.

RE: Rampant cellulits in a 8 year old Labrador

Julian Earl — Mon, 30 Apr 2018 10:21:10 GMT

On the lymphoma route.. When I saw this I thought of Mycosis fungoides. So not good news.

RE: Rampant cellulits in a 8 year old Labrador

Anthony Todd — Thu, 26 Apr 2018 11:17:14 GMT

[quote user="Utlendigur"]

Malignant histiocytosis??

[/quote]

Can't see anything that resembles our patient?? Can anyone?

https://www.google.co.uk/search?q=Malignant+histiocytosis%3F%3F&source=lnms&tbm=isch&sa=X&ved=0ahUKEwig-vyj2tfaAhVO3qQKHQfTCHMQ_AUICigB&biw=1680&bih=919

RE: Rampant cellulits in a 8 year old Labrador

David Mills — Wed, 25 Apr 2018 17:57:27 GMT

[quote user="Neil Wheadon"]

[quote user="Utlendigur"]Malignant histiocytosis??[/quote]

We should do this more often, 'guess the lesion', might be as entertaining as watching a full rebuild of a French Bulldog at the O2 featuring various veterinary illuminaries. (see stage show)

Results are in on Monday

Neil

[/quote]

This is telemed in action.

Are the RCVS watching?

RE: Rampant cellulits in a 8 year old Labrador

Neil Wheadon — Wed, 25 Apr 2018 17:44:27 GMT

[quote user="Utlendigur"]Malignant histiocytosis??[/quote]

We should do this more often, 'guess the lesion', might be as entertaining as watching a full rebuild of a French Bulldog at the O2 featuring various veterinary illuminaries. (see stage show)

Results are in on Monday

Neil

RE: Rampant cellulits in a 8 year old Labrador

Anthony Todd — Wed, 25 Apr 2018 16:18:51 GMT

[quote user="Neil Wheadon"]so the contact theory doesn't apply[/quote]

Any other theories then??

A burn, or chemical damage, wouldn't be necessarily all-at-once ie some damage could appear later???? If it was a liquid the damage would extend apparently "dorsally", with gravity, if the dog was in lateral recumb. and the owner, say, spilt a kettle of boiling water ??

Not trying to be obstructive etc., just that it seems likely, when you have primary skin damage over an extensive area, no pointing or local swelling, as with some sort of internal pathology??

Some on here look pretty similar?

https://www.google.co.uk/search?q=skin+scalding+dogs&source=lnms&tbm=isch&sa=X&ved=0ahUKEwjQ7or_29XaAhXoKsAKHfyDB3wQ_AUICigB&biw=1680&bih=919#imgrc=VhWIlW4ULb6cKM:

RE: Rampant cellulits in a 8 year old Labrador

Utlendigur — Wed, 25 Apr 2018 15:58:35 GMT

Malignant histiocytosis??

RE: Rampant cellulits in a 8 year old Labrador

Neil Wheadon — Wed, 25 Apr 2018 15:31:54 GMT

It's extending. The newer lesion is dorsally, so the contact theory doesn't apply

However I think there may be a slight improvement

Neil

RE: Rampant cellulits in a 8 year old Labrador

Anthony Todd — Wed, 25 Apr 2018 15:03:36 GMT

Sorry, I thought, from the earlier picture, the lesion was on and around the withers; this would suggest a lateral contact.

RE: Rampant cellulits in a 8 year old Labrador

Neil Wheadon — Wed, 25 Apr 2018 14:26:35 GMT

Biopsy taken, I'll share the result

RE: Rampant cellulits in a 8 year old Labrador

Anthony Todd — Sat, 21 Apr 2018 00:45:38 GMT

[quote user="Sammy82"] Any new bedding/newly laid concrete in kennel or where the dog lies down often?[/quote]

I was thinking more of a kettle of boiling water or battery acid, even a cup of very hot tea or coffee??

Dog would need to be upright to get that distribution.

Earliest photo of lesion would be helpful to show site of initial damage.

RE: Rampant cellulits in a 8 year old Labrador

Sammy82 — Thu, 19 Apr 2018 20:59:01 GMT

When reading this I was wondering about corrosive/toxic skin damage too. It reminded me of the severe scrotal dermatitis I saw in 2 Labs in the same household (described in detail in another thread) a while ago. Antibiotics/NSAIDs /steroids were useless and only resection of the effected skin resolved it in the end. New bean bags for the dogs were thought to be a he culprit, but never proven. Histo just came back as severe inflammation. Any new bedding/newly laid concrete in kennel or where the dog lies down often?

RE: Rampant cellulits in a 8 year old Labrador

Anthony Todd — Thu, 19 Apr 2018 15:23:55 GMT

With that amount of tissue damage and pathology I'd be very surprised if a biopsy gave you anything apart from a graphic description of tissue damage and destruction.

Seems sensible to me to give an adequate dose of corticosteroid by injection and a third broad spectrum A/B. Oral pred, in my hands never gave a quick nor dramatic improvement when C/F an injection. After then three different potent A/Bs it's pretty unlikely for it to be a primary infection.

Infections go down with gravity so skin damage would be low not on top??

My bet is that the steroid jab will give the usual dramatic improvement and, after three heavy-duty A/Bs you can be pretty sure that infection is not the primary cause so you've pretty well been through all you can do therapeutically.

Can't see the elbow bursitis going up into the shoulder, more likely to go down the radius??

From the damage to the skin I'm wondering if it couldn't be corrosive contact as, usually gravity protects the skin as the damage goes down not up unless the skin was the start of it all??

[All just for discussion, and hopefully helpful. Not being dogmatic or even authorative.....]

RE: Rampant cellulits in a 8 year old Labrador

Neil Wheadon — Thu, 19 Apr 2018 14:50:32 GMT

[quote user="David Mills"] If not, then preds and tmps (if you have it),[/quote]

It's heading this way and yes we do have these. Interestingly the locum last week did have sulphonamides which they had managed to source.

[quote user="David Mills"]If the owner wishes to direct treatment properly then take biopsies and tissue culture. The money spent on this now may prevent frustration and perception of "wasted" treatment/revisits, even though it is unlikely to dramatically change treatment.[/quote]

Yup

[quote user="David Mills"]Flamazine useful topically.[/quote]

Being done

[quote user="David Mills"]Depending on size of dog may have been slightly underdosed for cephalosporins (usually use 25-30mg/kg BID-TID for skin) but not a criticism, just an observation and likely didn't make a jot of difference anyway.[/quote]

Small labrador

Thanks, as always very helpful

Neil

RE: Rampant cellulits in a 8 year old Labrador

David Mills — Thu, 19 Apr 2018 14:42:24 GMT

What's the final common pathway here?

It's infected so needs abx.

There is inflammation so needs anti-inflammatories. I fine melox useless for skin, so it would be a healthy dose of preds. If it's neoplasia its pretty done for so I wouldn't hold off preds for this possibility.

If the owner wishes to direct treatment properly then take biopsies and tissue culture. The money spent on this now may prevent frustration and perception of "wasted" treatment/revisits, even though it is unlikely to dramatically change treatment. If not, then preds and tmps (if you have it), MRSA usually resistant to clindamycin and variable vs cephalosporins. Flamazine useful topically. Depending on size of dog may have been slightly underdosed for cephalosporins (usually use 25-30mg/kg BID-TID for skin) but not a criticism, just an observation and likely didn't make a jot of difference anyway.

RE: Rampant cellulits in a 8 year old Labrador

Richard Carter — Thu, 19 Apr 2018 09:24:24 GMT

the dreaded 'rot'?

think an impression smear/ fna, skin scrape stained would also help rule out lymphoma?

RE: Rampant cellulits in a 8 year old Labrador

Thomas Johnson — Thu, 19 Apr 2018 08:30:21 GMT

[quote user="Neil Wheadon"]Both of us here have the same feeling and this has been discussed with the client that biopsies would be useful. I know we're trying to second guess but a treatment is still required. Does anything touch MRSA? says me hopefully[/quote]

The MRSA that the lab cultured for me last week was sensitive to fluroquinolones and potentiated sulphonamides, but I would be cautious about just trying lots of different antibiotics.

I did wonder as others have done about epitheliotropic lymphoma, but the couple of cases I've seen haven't been pyrexic or had the oedema that your case has.

RE: Rampant cellulits in a 8 year old Labrador

Sarah Keir — Wed, 18 Apr 2018 20:51:10 GMT

Epitheliotropic lymphoma?