Pedal ulceration in a long-haired cat

Pedal ulceration in along-haired cat

Author: Cathy Curtis

Editor: David Lloyd

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History - 1

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•12-year-old female, neutered, domestic long-haired cat

•Firm, ulcerated swellings had developed onmultiple digits of both hind legs and the left foreover about 6 weeks

•The cat had recently started biting at the claws ofthe affected feet

History

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History - 2

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History

•It was severely lame on the left fore foot

•Therapy with various antibiotics and corticosteroidshad not been successful

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Typical lesions:swollen & ulcerateddigits

Clinical signs - 1

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Signs

A firm ulceratedswelling affectingthe 4th digit of theleft fore foot

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Clinical signs - 2

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Signs

•The cat was thin

•The popliteal lymph nodes were enlarged

•Pedal lesions were as described

•No other abnormalities detected

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How would youapproach this case?

Signs

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•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 adefinitive diagnosis

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Case investigation

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Differentials

•Principle differential diagnoses

•Digital lesions

•Neoplasia

•Primary cutaneous, or metastatic

•Granulomata:

•Bacterial

•Mycotic

•Foreign body

•Sterile (idiopathic)

•Osteomyelitis

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Tests - 1

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Tests

•Initial tests

•Blood tests:

•Routine haematology and biochemical screens; totalthyroxine, FeLV and FIV assays

•Results:

•No abnormalities; FeLV & FIV -ve

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Tests - 2

What additional tests should you consider?

•Skin biopsy

•Microbiology of tissue specimens

•Cytology

•Aspirates, exudates, impression smears

•Radiography

Tests

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Tests - 3

Tests

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Tissue samples from affected digits for histopathology& fungal culture

•Cut surface of digits exuded straw-colouredmucoid fluid

•Cytological examination of fluid unremarkable

•No micro-organisms isolated

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Tests - 4

Tests

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Skin Histopathology (Trevor Whitbread)

•There is infiltration into the underlying tissue by cellswhich are capable of producing irregular acinar structuresfilled with a mucinous secretion and there are some gobletcells here

•The epithelial cells are slightly variable in size but thereare few mitotic figures here

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Tests - 5

Tests

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Histopathologists Comments

•These biopsies are similar

•These are adenocarcinomas which are producing aciniand mucus and it is this mucus that is exuded from the cutsurface. This is because there are goblet cells here

•These features are typical of those seen before in caseswith bronchial carcinoma

•This would be compatible with a secondary spread fromsuch a tumour

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Tests - 6

Tests

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•Radiographer's diagnosis

•Disseminated neoplasia, with osteomyelitis

•Granulomata as less likely differential diagnoses

•What do you think now?

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What is yourdiagnosis?

•Do the investigations permit a definitive diagnosis?

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

Tests

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Diagnosis

•Metastatic bronchial carcinoma

Tests

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How would you dealwith this case?

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•What is your prognosis?

•How will you advise the owner?

•What treatment would you consider?

Therapy

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Prognosis

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•Prognosis for this type of tumour is poor - it isunlikely to respond to antitumour therapy

•The cat is already in poor condition and would nottolerate aggressive therapy

Therapy

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Action

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Therapy

•Euthanasia

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Post-mortem examination - 1

Notes

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•Adenocarcinoma in the right apical lung lobe

•Solitary adenocarcinomatous mass found affectingthe right renal cortex - presumed vascular spread

•Four swollen digits sampled and shown to havemetastases of the pulmonary adenocarcinoma

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Post-mortem examination - 2

Notes

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Renal (left) & pulmonary (right) lesions

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Final diagnosis

Notes

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•The digital swellings were metastases of a primarybronchial adenocarcinoma

•This has been reported in the cat but is rare

•This type of neoplasm is poorly responsive tosurgery, radiotherapy and chemotherapy and owingto it's aggressive rate of metastasis, euthanasia isoften necessary

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Review

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Notes

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