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How does epitheliotropic lymphoma present in veterinary dermatology
I see this really as a continuum of very severe cases which are referred into my
veterinary
dermatology practice and then quite mild cases that I think are possibly
missed in general practice. So these are possibly the ones that you may be
missing and we?ll talk a little bit more in detail about that. In my veterinary
dermatologypractice,the first type of dog that might come in might be a
chronic atopic dog. It?s had atopic dermatitis for most of its life. It?s limped
along with it. It comes to the vet quite regularly. It may be a case that?s with
the primary vet it?s not with me at this stage and they?ve been treating it with
steroids or cyclosporine, all the various treatments that you can use and the
dog has kind of limped along as they sometimes cannot be greatly controlled but
kind of enough that the dog is under control when suddenly it worsens
dramatically and then they try to increase the steroid dose that doesn?t help.
The dog starts looking more and more scaly, erythematous, then nodules appear
and this is often when you know a case will be referred to me. It?s a chronic
atopic dog and we just don?t seem to be having any success with it. What should
we do?
Another case might be an old dog that?s never really had skin
problems before and then suddenly at the age of 10, 11, 12, it suddenly develops
skin problems. This is very unlikely to be an atopic dog. We all know that atopy
usually happens in the first three years of life. The vet puts these dogs onto
steroids and they?re not really doing that well. And he?s trying various
treatments. He might have tried to start antibiotics. Antibiotics really don?t
work, although, sometimes I use them as an adjunct treatment. At that point,
hopefully, the case is referred across to me and with our work-up we find that
this dog has epitheliotropic lymphoma.
The third type ofdog is an
interesting case because this actually is one of my own dogs that has fallen
into this category. My own dog was a dog that really hadn?t had any skin
problems and at five years old started to developed lip fold pyoderma as I
thought and I tried to treat it with a bit of malaseband so on and antibiotics
and really wasn?t happy with the way it was going. And so I actually cut the lip
folds out as one does but there was a little angel or whatever who reminded me
in the back of my mind that maybe I should send this off because I thought to
myself ?Well, it?s my own dog. I?m sure if I ask LucyOldroyd nicely at Abbey Vet
Services she may not charge me for it.? So I sent it off and sure enough very
surprisingly to me it came back as epitheliotropic lymphoma. I, of course, got
quite upset by this because most dogs that I?d seen with epitheliotropic
lymphoma did not live for very long. I think Lucy was moving around in her chair
then when she realized she gave me a free biopsy but it was well worthwhile
Lucy. We knew we would need to use it at some stage in the future in our
veterinary dermatology practice. So I thought that Change really didn?t have a
lot of time left to live but we?d caught it very early but that things were
going to develop quite quickly. And nine years down the line Chance is still
alive so obviously there are other diseases out there but this is a continuum,
this is a low grade disease and again VerenaAffolter and Peter Moore talked
about this and they called this a cutaneous lymphocytosis. I?m sure Lucy will
perhaps have something to say with the whole argument of when does a reactive
disease become a neoplastic disease and vice versa so we?ll look forward to
hearing Lucy?s thoughts about that.
And this was as I say the study again
at Hong Kong at 2008. Cutaneous lymphocytosis is seen in dogs and cats. Like the
human diseases, very slowly progressive and we actually in the human medicine we
call it indolent lymphoma. Prednisolone as I used in Chance is used to treat and
worked very well. And the lesions can stay stable for long periods. I mean they
said up to six years and Chance is now nine years on from that condition. In
fact, he?s survived so long we couldn?t find his sample to show you a slide of
it. But then it may just suddenly progress into a high grade lymphoma so that is
also possible.
One of the clinical signs that you?re going to see when
you are presented with a case of epitheliotropic lymphoma you?ll quite common
see erythema and scaling. You?ll also see mucocutaneous erythema but also look
out for depigmentation and look out for ulcerations. You?ll also begin to see
the development of cutaneous plaques and nodules. I just think the majority of
these cases that you will see will be mycosis fungoides and they are slow to
develop systemically but they can generalize and they will go into the lymph
nodes and then rarely into the liver and into the spleen.
Anthony Chadwick runs a referral dermatology practice in the North of England. His aim is to provide fantastic value in veterinary CPD
in the comfort of your own homes without the hassle of travel and very
late nights. Please let us know if you have any problems accessing the
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Tags: Pets/Health : Home / Family
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