heckyeahcytos

[heckyeahcytos]

Rib mass from a 6 year-old, male-castrated Golden Retriever.  The owner felt a relatively firm mass along one of the patient’s ribs while petting the dog.  On evaluation the mass was about 2.0 x 2.0cm in size and firmly adhered to the rib.  Additionally the mass appeared non-painful on manipulation and was not warm to the touch.  Here is what we got on needle aspirates!

*

Alright, your eyes are immediately drawn to the gorgeous magenta material!  The slides were just loaded with this beautiful material - which likely represents matrix made by all those spindle-shaped cells.  The matrix could be chondroid from cartilage, bone, or even a mucous-like material (termed myxoid).  My vote was for chondroid.  The spindle cells are easiest to see on the last image - and they did have some criteria for malignancy (variable sizes, rare binucleated cells, etc.)

*

Cytologic diagnosis: Sarcoma.  With follow-up histology we confirmed this bad-boy to be a chondrosarcoma.  Chondrosarcomas arise from chondrocytes, the cells responsible for building cartilage.  Chondrosarcomas are some the most gorgeous appearing tumors cytologically!  Mostly because of all the pink-magenta substance they produce.  Fortunately chrondrosarcomas in dogs rarely spread throughout the body, so surgical excision of the primary tumor is usually curative.  This patient had the tumor (and a whole section of his body wall!) removed and is currently disease free.

[heckyeahcytos]

Draining cutaneous lesion from a 10 year-old, male-castrated, Domestic Medium Hair.  The patient is an indoor/outdoor cat that 'disappears' for days at a time from his house.  The owner noticed the cat limping after returning from a 'disappearance' and on close examination found a pus-draining wound on his left hindlimb.  The patient's primary care veterinarian took some samples of the discharge and sent it our way.

*

As you may expect, the discharge was simply loaded with inflammatory cells.  Most of these inflammatory cells were neutrophils with few really activated macrophages found (the big foamy cells in the top picture!)  Any time you see inflammation, you should start hunting for bacteria.  In one little cluster I thought I saw very thin, filament like bacteria (black arrows)...  

*

...I know, you are probably calling BS, but I swear they are bacteria.  And using an acid fast stain (designed to highlight certain kinds of bacteria), you can see how many organisms there really are!  The bacteria are highlighted in red-pink in the bottom image - and they were EVERYWHERE!  They just did not stain well with our routine cytology stain.

*

Cytologic diagnosis:  Marked pyogranulomatous inflammation with intralesional filamentous bacteria.  This type of inflammation - along with these kinds of bacteria - are often associated with plant foreign material.  Animals can get all kinds of plant material buried in their skin - I've pulled out thorns, grass-awns, whole branches, cactus spines, etc.  Prognosis is great with antibiotics and removal of the foreign material (presuming it's there!)

[heckyeahcytos]

Three skin masses present on a 15 year-old, female-spayed, Domestic Short Hair.  The kitty cat's owner recently felt 3 small, firm masses on the patient's left forelimb.  The masses were about 1cm apart and non-painful on manipulation.  Aspirates from all three lesions showed...

*

Copious amounts of these round cells!  Most of these bad boys contain discrete, purple (or metachromatic!) granules.  Any idea what these cells are.....?  These are mast cells!  Making this a mast cell tumor, sometimes called a mastocytoma.  These cells will often 'pop' when cytology slides are made, releasing the granules into the background (see all the free granules in the bottom picture?)

*

Cytologic diagnosis:  Mast cell tumor.  Feline mast cell tumors are typically low-grade in behavior - meaning they grow locally but rarely spread to other parts of the body.  In this case, the patient could be facing a more high grade tumor as she has multiple skin tumors simultaneously.  The presence of multiple cutaneous mast cell tumors in a cat is no bueno - many of these cats actually have disseminated disease.  In cats, disseminated mast cell disease will often shore up in the spleen.  No word yet on this patient's next move, although I suspect these masses will be removed and a hunt will begin for internal tumors.  

[heckyeahcytos]

Inappropriate Cell of the Week!!!!

*

We found this big ugly in thoracic fluid from a dog with diffuse chest cancer (carcinomatosis to be exact).  Let me state this plainly...a cell like THIS should NEVER be found in the body normally.  Not ever!  This cancer cell is unholy on so many different levels...

[heckyeahcytos]

Cervical mass in a 11 year-old, male-castrated, black Labrador Retriever.  For the past two weeks the patient has been intermittently coughing, especially after voraciously eating his  kibbles.  He is described as healthy otherwise.  On physical examination his primary care veterinarian palpated a very large, 10cm firm mass in his ventral neck.  We got the aspirate samples of the mass and found....

*

...and found numerous apparently cohesive clusters of these mononuclear cells.  Their cohesive nature is typical of an epithelial population.  The cells look relatively bland - that is, they all appear very similar to their neighbor.  Such monomorphism suggests a more benign process...but we'll come back to that interpretation!  Additionally, few clusters were associated with this brilliant magenta extracellular material - could be matrix, secretory product, or colloid.  What tumor type do think this is?!

*

Cytologic diagnosis: Neuroendocrine epithelial tumor.  Based upon the mass location, this is consistent with a Thyroid tumor.  Although the population looks relatively benign cytologically, canine thyroid tumors are usually aggressive adenocarcinomas.  Conversely, kitty thyroid tumors are usually benign and equine tumors a 50-50 shot on benign versus malignant.  No word yet on what therapy the owner has elected to pursue - but the prognosis is sadly grave :-(

On an aside, other neuroendocrine origin tumors (like insulin secreting pancreatic tumors or some adrenal tumors) have a very similar cytologic appearance. 

[heckyeahcytos]

Cutaneous mass on a 5 year-old, Nigerian Dwarf Goat doe.  The owner noticed a small mass growing on the patient's flank over the past few weeks.  The mass appeared firm and non-painful on palpation.  However, the mass eventually begin leaking small amounts of pus - which prompted the owner to immediately contact her veterinarian!

*

So we saw these bad boys on cytology!!!  Any guess what this organism is........

Those little structures are yeast...and their big 'halo' capsule means these are cryptococcal yeast.  We like to term them yeasty beasties!  There were hundreds of these yeast structures throughout the needle aspirates we received - along with many inflammatory cells (like the big vacuolated macrophage in the top picture).  The patient's lesion ended up being excised and submitted for histology.  The bottom image is the histology of the mass....and it makes a gorgeous mosaic of yeast, inflammatory cells, red cells, and fibrin!  Notice how different the Crypto yeast looks between cyto and histo?!

*

Cytologic diagnosis:  Pyogranulomatous inflammation with intralesional cryptococcal yeast.  AKA Cryptococcosis.  This disease is caused by organisms from the genus Cryptococcus.  There are two main species of this yeast, C. neoformans and C. gattii.  C. gattii is considered much more a primary pathogen, while C. neoformans is typically an opportunistic pathogen.  In our area of the world, C. gattii dominates :-S  Cryptococcosis in goats is exceedingly rare, with most reported cases having either mammary or respiratory tissue involvement.  Either way, this organism makes GORGEOUS cytology images!

[heckyeahcytos]

Aspirate of an intermandibular swelling from a 5 year-old, male-castrated, Domestic Shorthair.  The patient present for evaluation of acute onset respiratory distress.  According to the owner the cat was fine the day before, but in the morning was reluctant to eat and then appeared to have breathing difficulties by the afternoon.  On examination a very large swelling was found underneath the tongue and extending into soft tissue region between the mandibles. 

*

Cytology revealed COPIOUS amounts of bacteria along with inflammatory cells.  Almost every type of bacteria under the sun was present...small rods, filamentous rods, cocci, coccobacilli, and (one of my favorites!) spirochetes.  The spirochetes are a bit hard to pick out initially - but once you see one (denoted by the arrow) your eyes will begin to pickout all of them in the background.  All the streaming blue debris is from ruptured neutrophils - there are a few intact neuts dead center in the top picture.

*

Cytologic diagnosis: Marked, septic, suppurative cellulitis.  AKA an abscess.  Given the location, this abscess could have resulted from a bite wound or foreign body.  Many of the bacteria likely originated from the oral cavity.  In particular the mouth has many kinds of spirochete bacteria that can contribute to oral gingivitis and perioral abscesses.  In people, severe gingivitis associated with spirochete infection is termed Trench Mouth.  We see it in pigs too!

[heckyeahcytos]

So very sorry for my protracted absence from the Tumblr community.  Life has been crazy lately…but things are finally settling down. So let the cytology awesomeness begin again!

*

Lymph node aspirate from a 10 year-old, male-castrated, German Shepherd Dog.  The patient had a recent onset of lethargy and anorexia.  On examination the patient had significantly enlarged peripheral lymph nodes.  In addition, spleen and liver enlargement were suspected on abdominal palpation.  Aspirates of the lymph node were acquired and this is what we say…

*

The samples were wall-to-wall lymphoblasts.  In a normal lymph node you should have 90%+ small mature lymphocytes…in this case I only found about a dozen on the entire slide.  Interestingly enough the lymphoblasts also contained these angular, white inclusions.  Any guess what these could be???  Based upon some special stains, we suspect they are accumulations of antibody!  Crazy to see them this angular though!

*

Cytologic diagnosis: Lymphosarcoma.  We even went a little further with this case and found it is a B-lymphocyte tumor.  Which completely fits with the antibody inclusions.  Recall that normal B-cells have the potential to become plasma cells, which make the antibody that so preciously protect us from microbes!  We also found these nasty blasties in the spleen, liver, and circulating in blood.  Thankfully the patient has responded well to chemotherapy thus far.

[heckyeahcytos]

Aspirate from an oral lesion from a 9 year-old, male-castrated Domestic Shorthair.  So no really pathology was evident in this sample....but it did show something super cool!!  Do you notice all those roly polies?!?!?!  Well of course they are not actual roly polies, but instead are stacks of an organism called Simonsiella.  This little bacteria is normal ‘flora’ of the mouth – we all have a TON of it – and likes to live in little colonies resembling our roly poly friends.  In rare cases, they are documented to exacerbate oral ulcers in dogs....in super rare cases...

*

Also, I sincerely apologize for the recent gap in my posts!  I was away last week and SADLY will be away this coming week as well.  However, I will do my best to get some tasty cytos for you from a distance!

[heckyeahcytos]

Lung tissue from a mature Barn Owl.  The history on this animal is pretty minimal: the bird was found dead one morning at someones property.  The fish and wildlife service was called, and upon examining the owl found no gross abnormalities (besides being dead!)  The animal was sent our way for a necropsy - the animal equivalent of an autopsy.  The owl's lungs were found to be very dense on palpation....which is never a good things as they should full of air!  Specimens were collected for histologic evaluation...

*

....and the lungs were found to be completely colonized by fungus!  Hence the firmness.  The above picture shows numerous blue-purple hyphae (easy to see on the bottom left) along with these very large, fruiting body structures!  The fruiting bodies look like the Starship Enterprise :-P These structures are actually termed conidiophores, which are comprised of conidia (the tiny dots).  Conidia are variants of spores.

* 

Diagnosis:  Aspergillosis (presumed).  Many avian species are susceptible to primary and secondary fungal infections....and one of their biggest nemeses are Aspergillus species.  The organism has been responsible for large die-offs of water fowl throughout the Pacific Northwest over the past decade....and was no doubt the cause of this owl's death.

[heckyeahcytos]

CELL OF THE DAY!!!!  Our colorful friend in the middle is a plasma cell...but just not any kind of plasma!  This little guy is the elusive Flame Cell.  So named because of the purple to red hue emanating from the cytoplasm.  This atypical coloration arises due to enlarge endoplasmic reticulum cisterns plugged with antibody (recall plasma cells create immunoglobulin).  This distension alters the normal cytoplasm staining, making it fiery cool!

[heckyeahcytos]

Bronchoalveolar lavage fluid from a 9 year-old, miniature horse mare.  The patient has had a year-long history of recurrent respiratory disease, which has been decently well controlled with steroid therapy.  However, the patient's respiratory distress has become more severe in the recent weeks and completely unresponsive to the steroids.  To better assess the pulmonary pathology, a bronchoalveolar lavage was performed (lungs were flushed with saline and then sucked back out for cytology!)

*

The lavage fluid was quite cellular - recall your airways should be relatively clean!  Most of the cells present were these large mononuclear cells with foamy, basophilic cytoplasm....classic macrophages!  Many contained phagocytized granular debris (bottom picture), which is likely inhaled particular (sand, dust, plant debris, etc.)  In addition, many mast cells were present in the sample.  The mast cells are the cells with purple granules present in the top image.

*

Diagnosis:  Moderate, mixed (macrophagic and mastocytic) bronchoalveolitis.  This type of inflammation, in the airway of a horse, is consistent with Reactive Airway Obstruction...a condition similar to COPD in people.  This is a chronic, inflammatory airway condition which is thought to manifest due to chronic exposure to inhaled allergens. Unfortunately, horses with a mast cell component to inflammation are MUCH less likely to respond to steroid therapy.  Bummers!

[heckyeahcytos]

Ultrasound-guided aspirate of a pulmonary mass in a 10 year-old, female-spayed, Domestic Shorthair. Approximately a year earlier the patient had been diagnosed with a high grade sarcoma on her right hindlimb.  Given the location, the sarcoma was thought to be feline vaccine associated sarcoma.  Her limb was amputated at that time, and she has been doing clinically well until just this past week when she began coughing.  X-rays of her chest showed a very large mass in one of her back lung lobes, and so this sample was taken.

*

If you were to ever sample a normal lung you usually get no cells on the sample...since the lungs are full of air!  However, these slides were chalked full of cells, which is never bueno.  Many aggregates of these loosely arranged, spindle-shaped cells were present. Sometimes these aggregates had a light, pink matrix material within them (bottom picture)  And they are crazy...lots of variation in shapes and size.  Almost all the nuclei have giant nucleoli staring back at you (all the dark dots!).  Anytime you see crazy spindle shaped cells, you should think sarcoma (aka spindle cell tumor!)

*

Cytologic diagnosis:  Sarcoma with moderate criteria of malignancy.  Given the cat's prior diagnosis of a soft tissue sarcoma, this mass likely represents a metastatic lesion from that primary tumor.  Unlike most other species, cats are prone to developing tumors at the site of prior vaccinations.  They seem to develop a hyper-reactive, dysregulated immune response to the materials present in some vaccines...and this dysregulated immune reaction leads to tumor development.  Often these sarcomas are quite large, requiring extreme surgeries (like an amputation) to remove them.  No word yet on the owner's course of action.

[heckyeahcytos]

Tape preparation from the fur of a captive tree vole.  Yeah, I know a bit of an oxymoron....tree vole :-P  In an attempt to establish a breeding colony for research purposes, a number of tree voles have recently been captured.  Most of the voles had tiny, white, moving 'flakes' visible throughout their fur.  After being incredibly creeped out (totally understandable!) the researcher acquired some tape preparations of the skin and sent them our way...

*

...and behold all the little white flakes are mites!!  Mites galore actually, as almost every microscope field you found them.  Two distinct types of mites were present, pictured above and below.  The top critters were more abundant, and moved like racecars.  The mites on the bottom were more scarce, were only associated with hair follicles, and moved like sloths.

*

Cytologic diagnosis: Acariasis.  Acariasis is just the fancy medical term for a mite infestation.  As to which specific mites these are, that is well beyond my personal knowledge.  Thankfully we have a wonderful parasitologist looking at them, and will hopefully get back to us soon on the specific species.  Given these vole are from the wild, the mites are likely commensal organisms instead of true pathogens. Mites are relatively easy to treat, being very susceptible to avermectins along with other 'pour on' acaricides.

[heckyeahcytos]

Blood smear from a 8 year-old Red Tailed Hawk. The patient was recently acquired by a rehabilitation group, after it was found by Fish and Wildlife with a wing fracture.  Except for the wing fracture, the bird appeared to be in relatively good fitness.  As part of a baseline assessment of the patient, bloodwork was taken.

*

Avian blood is very busy to look at, namely from the fact that they contain nucleated red blood cells.  Recall, mammals have anucleate red blood cells.  Distinguishing between the red blood cells and white blood cells can be quite a challenge, so scan carefully!  A small number of leukocytes had this very elongate, spindloid pattern with the nucleus pushed to the side.  These cells are noted by the red arrows in the topic picture, with a magnified image on bottom.  Any guesses what is going on here?!?!  The shape of the cell has been distorted, and the nucleus peripheralized due to an intracellular parasite!!

*

Diagnosis:  Leucocytozoonosis.  The Leucocytozoon parasite is transmitted by the black fly.  In the vast majority of birds, the parasite lives commensally within circulating leukocytes (hence the organism's name!)  As such, these birds do not develop any clinical disease.  That said, certain waterfowl species are extremely susceptible to this disease which can periodically cause wide spread die off of ducks.  For this patient, the organism is likely just along for the ride...or flight :-P

[heckyeahcytos]

Aspirate of a mammary mass in a 10 year-old, female-intact, German Shepherd Dog.  The patient had a year long history of a mass in the right mammary chain, before the mass suddenly grew dramatically in size.  She appears clinically healthy otherwise.  Aspirate samples of the mass were acquired....

*

....and the cytology should a relatively uniform population of cohesive cells, indicating an epithelial population (top picture).  The cells were moderately crazy, varying alot in size and shape.  A few had a large vacuole containing secreting product (bottom right hand side of top picture).  An no inflammation was evident to account for this bizarreness.

*

Cytologic diagnosis:  Adenocarcinoma.  Given the location and intact status of the patient, the tumor is likely a mammary adenocarcinoma.  Mammary tumors are exceedingly common in intact female dogs, and most dogs will develop at least one by the time they get to 'old age.'  About 50% are malignant and 50% are benign.  The patient had the mass excixed and biopsy confirmed a mammary adenocarcinoma.  As a little bit of a bonus, fresh cells were collected and are now being stored in a tumor tissue bank.  These immortalized cells from the patient are present in the bottom picture, and have even taken on more extreme neoplastic characteristics (like the significant multinucleation!!!)  Pretty cool, eh?

[heckyeahcytos]

CRAZY CELL OF THE DAY

*

This gnarly looking cell was found on cytology from an ulcerated mass on the prepuce of a 18 year old quarter horse gelding.  The lesion ended up being a carcinoma, likely squamous cell carcinoma, with secondary inflammation.  This cell in particular represents everything a healthy normal cell should never do!  First off, it has three neutrophils WITHIN its cytoplasm - this is termed emperipolesis.  Additionally, there are actually three concentric neoplastic cells present! The first one is dead middle, the second one has an elongated nucleus inappropriately hugging the first cell, and the third cell is the large one with the peripherally placed nucleus which contains everyone else.  Anytime you see craziness like this, think a tumor!