Epitheliotropic lymphoma

15 Epitheliotropic lymphoma




INITIAL PRESENTATION


Scaling, crusting, hypopigmentation and alopecia.



INTRODUCTION


Cutaneous lymphoma is subdivided histologically into epitheliotropic and non-epitheliotropic forms. Cutaneous epitheliotropic lymphoma is an uncommon condition, characterized by infiltration of neoplastic T lymphocytes into the epidermis and the follicular epithelium. The condition mainly occurs in dogs, but it has also been reported in cats, ferrets, hamsters, rats and mice. In humans, epitheliotropic lymphoma is commonly referred to as mycosis fungoides and this term is often loosely used for the disease in animals. An advanced form of mycosis fungoides in man, the ‘Sezary syndrome’, is characterized by generalized, exfoliating erythroderma, pruritus, peripheral lymphadenopathy and large number of circulating malignant lymphocytes. The d’emblée form of epitheliotropic lymphoma in man refers to a rapidly progressive form of the disease. A subclassification of mycosis fungoides is Pagetoid reticulosis, where histologically there is striking epidermotropism. In dogs these terms are not always useful, as the clinical signs and the progression of the disease vary from that in humans, but are nevertheless used in histological classification. Canine epithelioptropic lymphoma is progressive and often poorly responsive to treatment.




CASE PRESENTING SIGNS


A 10-year-old, neutered male golden retriever presented with generalized truncal scaling and nasal depigmentation.



CASE HISTORY


A common observation in cases of canine epitheliotropic lymphoma is failure to respond to any particular treatment and an associated progression of symptoms, but the deterioration rate varies between individuals. Some dogs may be pruritic. Most do not exhibit signs of systemic disease unless there is internal metastasis but lethargy may be reported. Some dogs may have a history of allergic skin disease that had previously been relatively well managed.


The relevant case history in this dog was:


• The first signs of scaling and nasal depigmentation had started about 9 months prior to presentation and progressively worsened.

• There had been intermittent pruritus.

• Other than a long-standing history of intermittent otitis externa, there had been no history of dermatological disease prior to onset of scaling and nasal depigmentation.

• Concurrent medication included meloxicam for the management of pain, caused by osteoarthritis of the hip joints.

• Previous treatments included cefalexin and prednisolone to which there had been no response.

• The dog had been recently treated with three applications of selamectin at fortnightly intervals.

• The dog was fed a variety of commercial diets and there was a very long-standing history of intermittent diarrhoea, which had been assumed to be a dietary intolerance.

• The animal was exercise intolerant.

• There was no evidence of zoonosis and there were no other pets in the household.


CLINICAL EXAMINATION


There are four clinical presentations of epitheliotropic lymphoma commonly described in the dog:


• Generalized erythema and scaling (exfoliative erythroderma)

• Mucocutaneous erythema, depigmentation, crusting and ulceration

• Solitary or multiple plaques and nodules

• Infiltrative oral mucosal disease.

As the disease progresses all four clinical entities may be present, as demonstrated in this case. The significant findings on examination of this golden retriever were:


• Oral erosions and ulceration were present on the gingival mucosa above the upper molars and the canines.

• Depigmentation of the nasal planum, lip margins, muzzle, eyelids (Figs 15.1 and 15.2) and the margins of the footpads (Fig. 15.3).

• In places, loss of the cobblestone appearance of the nasal planum.

• Generalized scaling affecting the trunk (Fig. 15.4).

• The physical examination was unremarkable with no peripheral lymph node enlargement.

Related posts:

  1. Cheyletiellosis in a rabbit
  2. Metabolic epidermal necrosis
  3. Adverse food reaction
  4. Digital squamous cell carcinoma

Stay updated, free articles. Join our Telegram channel
Tags:
Sep 3, 2016 | Posted by in SMALL ANIMAL | Comments Off on Epitheliotropic lymphoma

Full access? Get Clinical Tree
Get Clinical Tree app for offline access