AFIP SYSTEMIC PATHOLOGY

JPC SYSTEMIC PATHOLOGY

INTEGUMENTARY SYSTEM

September 2019

I-M32

 

Signalment (JPC 2614951): Nine-year-old domestic shorthair cat

 

HISTORY: This cat had a swollen, soft, discolored footpad.

 

HISTOPATHOLOGIC DESCRIPTION: Skin, footpad: Infiltrating the dermis, separating and surrounding footpad adipose tissue and collagen bundles, and surrounding adjacent adnexa are multifocal to coalescing aggregates of numerous plasma cells and fewer lymphocytes and neutrophils. Frequently, plasma cells are packed with globular, eosinophilic, intracytoplasmic vacuoles (Russell bodies within Mott cells). There is increased dermal clear space separating collagen fibers as well as ectatic lymphatics (edema) that occasionally contain aggregates of lymphocytes. There is mild multifocal increased intercellular clear space and accentuation of intercellular bridges (spongiosis).

 

MORPHOLOGIC DIAGNOSIS: Skin, footpad: Pododermatitis, plasmacytic, multifocal to coalescing, marked, domestic shorthair, feline.

 

CAUSE: Unknown

 

CONDITION: Feline plasma cell pododermatitis

 

GENERAL DISCUSSION:

·      Rare skin disease of cats; rarer in dogs

·      No breed predilection, typically affects cats 6-months to 12-years of age, neutered males are possibly predisposed

·      A minority of affected cats also have plasma cell stomatitis, immune-mediated glomerulonephritis, or renal amyloidosis; may have concurrent indolent ulcers or eosinophilic granulomas

·      Both medical and surgical treatment is curative

·      Recent reports document a concurrent FIV infection in 50% of cases

 

PATHOGENESIS:

·      Pathogenesis is unknown

·      Possibly immune-mediated because there is:

·      Persistent hypergammaglobulinemia

·      Plasma cell infiltrate

·      Beneficial response to glucocorticoid and immunomodulatory (i.e. doxycycline) treatment

·      Recurrence in warm weather supports an allergenic origin

·      Immunohistochemistry and PCR studies have not revealed any infectious agents, though some cases are responsive to doxycycline treatment

 

TYPICAL CLINICAL FINDINGS:

·      Non-painful unless there is ulceration

 

TYPICAL GROSS FINDINGS:

·      Gross appearance is diagnostic

·      Commonly affects multiple pads on multiple feet; larger metacarpal and metatarsal pads are most commonly affected

·      Uniform swelling that does not disturb normal pad architecture with web-like, cross-hatched appearance to the pad surface

·      Ulceration is common

 

TYPICAL LIGHT MICROSCOPIC FINDINGS:

Cutaneous lesions:

·      Histologic features are diagnostic

·      Early, superficial and deep plasmacytic vasculitis that progresses to diffuse dermal plasma cell infiltrate that obscures normal architecture

·      Plasma cells containing Russell bodies (Mott cells) can be frequent

·      Leukocytoclastic vasculitis is rare

·      Epidermal acanthosis, erosion, or ulceration

·      Variable number of neutrophils independent of ulceration

·      Suppurative to pyogranulomatous inflammation secondary to ulceration/proliferation

Other lesions:

·      +/- Renal lesions:

·      Renal amyloidosis

·      Immune complex glomerulonephritis with positive direct immunofluorescence indicating immunoglobulin deposits within the basement membrane zone

·      +/- Oral lesions: Plasma cell stomatitis

 

ADDITIONAL DIAGNOSTIC TESTS:

·      Cytology: Aspiration cytology reveals predominately plasma cells; in combination with classic clinical appearance, biopsy may not be necessary

·      Serum immunoelectrophoresis: hypergammaglobulinemia

·      Some cases also have: positive antinuclear antibody tests, Coombs-positive anemia, polyclonal gammopathy

 

DIFFERENTIAL DIAGNOSIS:

·      Eosinophilic granuloma: Features eosinophils and collagen degradation; will not usually involve multiple foot pads

·      Nocardiosis: Swelling of foot pads with pyogranulomatous inflammation

·      Neoplasia: Eccrine carcinoma, metastatic pulmonary bronchioloalveolar carcinoma (multiple feet), plasmacytoma (typically only one foot)

·      Infectious or sterile granuloma

·      Foreign body

·      Insect bites

 

REFERENCES:

1.    Bettenay SV, Lappin MR, Meuller. An immunohistochemical and polymerase chain reaction evaluation of feline plasmacytic pododermatitis. Vet Pathol. 2007;44(1):80-83

2.    Breathnach, R.M., Baker, K.P., Quinn, P.J., McGeady, T.A., Aherne, C.M., and Jones, B.R. Clinical, immunological and histopathological findings in a subpopulation of dogs with pododermatitis. Veterinary Dermatology. 2005;16: 364–372.

3.    Guaguere E, Hubert B, Delabre C. Feline pododermatoses. Vet Dermatol. 1992;3(1): 1-12.

4.    Hargis AM, Myers S. The Integument. In: Pathologic Basis of Veterinary Disease. 6th ed. St. Louis, MO: Elsevier. 2017: 1145.

5.    Mauldin EA, Peters-Kennedy J. Integumentary system. In: Maxie MG ed. Jubb, Kennedy, and Palmer’s Pathology of Domestic Animals. Vol 1. 6th ed. Philadelphia, PA: Elsevier Ltd. 2016: 613-614.

6.    Scott DW, Miller WH, Griffin CE. Miscellaneous skin diseases. In: Small Animal Dermatology.7th ed. Philadelphia, PA: WB Saunders Co; 2013: 718-719.


Click the slide to view.



Click on image for diagnostic series.



Back | Home | Contact Us | Links | Help |