Sterile Panniculitis In Dogs: New Diagnostic Findings And .
DOI: 10.1111/j.1365-3164.2011.00957.xSterile panniculitis in dogs: new diagnostic findings andalternative treatmentsHa-Jung Kim*, Min-Hee Kang*, Jung-HyunKim*, DaeYoung Kim† and Hee-Myung Park**Department of Veterinary Internal Medicine, College of VeterinaryMedicine, Konkuk University, Seoul, South Korea†Veterinary Medical Diagnostic Laboratory, College of VeterinaryMedicine, University of Missouri, MO, USACorrespondene: Dr Hee-Myung Park, Department of VeterinaryInternal Medicine, College of Veterinary Medicine, KonkukUniversity, #1 Hwayang-dong, Gwang-jin-gu, Seoul 143-701, SouthKorea. E-mail: parkhee@konkuk.ac.krSources of FundingThis study is self-funded.Conflict of InterestNo conflicts of interest have been declared.AbstractThe objective of this study was to analyse the underlying diseases, diagnostic findings and treatmentoutcomes in 10 dogs with sterile panniculitis. Therewas no significant breed association in this study(P 0.86).The median age of the dogs was 7.4 years.Concurrent diseases included atopic dermatitis (fourdogs), acute pancreatitis (two dogs) and primaryhypoadrenocorticism (one dog), with no concurrentconditions detected in three dogs. There was no significant association with the sterile panniculitis(P 0.57). Well-circumscribed firm nodules werenoted in seven dogs, and ill-defined soft noduleswere observed in three dogs. Bacterial and fungalcultures of biopsy samples were negative in all cases.Fine-needle aspiration cytology of the nodulesrevealed pleomorphic mesenchymal cells in all of thewell-circumscribed firm nodules, whereas numerousinflammatory cells and adipose cells were evident insoft nodules. These results indicate that firm nodulesin panniculitis could be misdiagnosed as tumours.Immunosuppressive therapy was used in eight cases.Topical dexamethasone was used in four dogs,intralesional dexamethasone in one dog, oral prednisolone plus ciclosporin in two dogs and oral prednisolone only in one dog. The remaining treatmentswere surgical excision and systemic cefalexin in onedog each. The lesions regressed within 1 week in allcases, with more rapid remission following systemicimmunosuppressive therapy. This study suggeststhat cytology may be misinterpreted as neoplastic,especially with firm lesions. In addition, topicalglucocorticoid therapy should be further evaluated asa potential treatment for canine sterile panniculitis.Accepted 8 December 2010352IntroductionPanniculitis results from various pathological processesthat damage components of the subcutaneous adiposetissue. There are many causes, including infectiousagents, vasculopathies, pancreatic disorders, neoplasiaand a variety of other immunological, nutritional andphysicochemical abnormalities or drug-related factors.1,2Canine sterile panniculitis refers to inflammation of thesubcutaneous fat in the absence of microbial infection,but the pathogenesis is not well understood.2 In mostcases, identifying the exact aetiology can be difficult,because affected dogs present with similar clinical signsand histopathological features.3Sterile nodular panniculitis is most commonly misdiagnosed as deep pyoderma, a cutaneous cyst or cutaneousneoplasia.2 Tissue cultures for aerobic, anaerobic andmycobacterial cultures are needed to diagnose sterilepanniculitis.2 Fine-needle aspiration (FNA) of intactlesions of panniculitis usually reveals numerous neutrophils, foamy macrophages and no micro-organisms.4 However, panniculitis can be diagnosed only by biopsy,because FNA cytology is often inconsistent with thehistopathology.2,5Pseudotumours, including inflammatory, hamartomatous, regenerative and iatrogenic lesions, have beendescribed in humans.5 Idiopathic inflammatory andreactive conditions in soft tissue and skin can inducepseudotumours.5,6 Traumatic panniculitis and nodularfasciitis have also been reported as pseudotumours.6Pseudotumours consistent with inflammatory nodulescomposed of various inflammatory cells have beenreported in the veterinary literature.7–9 As panniculitis isassociated with inflammatory nodular lesions on theskin, it can be classified as a pseudotumour. Benignmesenchymal lesions that are considered pseudotumours can demonstrate marked cytological anaplasia oratypia, leading to a misdiagnosis of neoplasia.5 The aimof this study was to evaluate the cytological findings incanine sterile panniculitis.Sterile panniculitis with multiple lesions usuallyresponds well to systemic glucocorticoids.2 However,most cases require long-term (occasionally life-long)treatment, and adverse effects are therefore a concern.3 Surgical excision of solitary lesions is usuallycurative,10 although this technique is more invasive.Oral vitamin E has been used to manage sterile panniculitis in dogs11, but not in severe cases. Another aimof this study was to assess alternative treatments thatmay have fewer adverse effects than systemic glucocorticoids that could be used to treat severe lesions.This study, therefore, retrospectively summarized thediagnostic findings and treatment outcomes in 10 dogswith sterile panniculitis.ª 2011 The Authors. Veterinary Dermatologyª 2011 ESVD and ACVD, Veterinary Dermatology, 22, 352–359.
Sterile panniculitis in dogsMaterials and methodsfor histopathology and one for aerobic, anaerobic and fungal cultures.The histopathology samples were preserved in 10% formalin, paraffin embedded, sectioned, and stained with haematoxylin and eosin(H&E). Dermal tissue from the biopsies was transported in BBL PortA-Cul! tubes (Becton Dickinson, Franklin Lakes, NJ, USA) to themicrobiology laboratory (Neodin Vetlab, Seoul, Korea) for aerobic andanaerobic bacterial cultures. Macerated tissue was inoculated in Sabouraud dextrose agar (Becton Dickinson) and dermatophyte testmedium (Becton Dickinson) and incubated at room temperature.AnimalsTen dogs with a diagnosis of sterile panniculitis were included in thisstudy (Table 1). All the dogs presented with one or more firm or softcutaneous nodules. The study population comprised six male neutered, two female spayed and two female intact dogs. The ageof onset ranged from 3 to 15 years (mean 7.4; SD 4.1), with fourdogs 3–5 years old. There was no significant breed predisposition(P 0.86).Concurrent systemic diseases were diagnosed on the basis of history, clinical signs and further diagnostic tests, including completeblood counts, serum biochemistry, radiography and ultrasonography.Canine serum pancreatic lipase immunoreactivity (GI Laboratory,Texas A&M University, TX, USA) was measured in acute pancreatitis.Primary hypoadrenocorticism and pituitary-dependent hyperadrenocorticism were diagnosed by using adrenocorticotrophic hormonestimulation tests. A clinical diagnosis of atopic dermatitis (AD) wasmade on the basis of the history, clinical signs and exclusion of othercauses of pruritus.12Two dogs with pancreatitis (cases 2 and 6) were fed a high-fibre,low-fat prescription diet (W d; Hill’s Pet Nutrition Inc., Topeka, KS,USA). Three dogs with AD were maintained on hypoallergenic diets:Ultra z d (Hill’s Pet Nutrition Inc.) for cases 3 and 5, and HA! (PurinaVeterinary Diets, Vevey, Switzerland) for case 10. The remainingdogs were maintained on a variety of standard commercial pet foods.TreatmentDogs with concurrent diseases were treated prior to inclusion in thestudy. Treatments for AD included systemic steroids and medicatedshampoo. None of the dogs was receiving any medication for skinconditions at the time of entry. One dog with pituitary-dependenthyperadrenocorticism (case 9) had been receiving treatment with25 mg kg mitotane (Lysodren!; Bristol-Myers Squibb, New York,NY, USA) once daily, but treatment had finished before the currentstudy. Management in the remaining dogs for pancreatitis and primary hypoadrenocorticism was continued throughout the study.Statistical analysisThe breed predilection and association with underlying diseaseswere assessed using chi-squared tests (Statistical Analysis Software;SAS Corp., Cary, NC, USA). Values of P 0.05 were consideredstatistically significant.Cytological examinationResultsFine-needle aspirations of dermal and subcutaneous masses were performed for cytological examination. The samples were collected with5 mL disposable plastic syringes and 22-gauge needles. Each samplewas placed on a glass slide, air dried and stained with Diff-Quick!(Baxter Healthcare, Deerfield, IL, USA). The slides were examinedby microscopic examination of at least four high-power (·400) fields.History and clinical signsThe clinical histories are summarized in Table 1. The mostcommon presenting clinical sign was acute onset ofnonulcerated cutaneous nodules. There was a history ofAD in four dogs, acute pancreatitis in two dogs (one withpituitary-dependent hyperadrenocorticism) and primaryhypoadrenocorticism in one dog. The other three dogs hadno history of other diseases. None of the conditions wassignificantly associated with sterile panniculitis (P 0.57).The dogs with pancreatitis also presented with anorexia and vomiting. Fever (39.6 "C) was evident in thedog with primary hypoadrenocorticism. Case 10 had painful lesions and was anorexic, but was otherwise healthy.Samples for tissue culture and histopathologyThe dogs were sedated with 5–8 lg kg intravenous medetomidine(Domitor!; Pfizer Animal Health, New York, NY, USA), which wasreversed with 25 mg kg intramuscular atipamezole (Antisedan!;Pfizer Animal Health). Intravenous propofol was used if medetomidine was contraindicated or in dogs undergoing general anaesthesiafor a separate medical procedure. Local anaesthesia was achievedwith subcutaneous 2% lidocaine (Vedco Inc., Saint Joseph, MO,USA). Surgical biopsy punches (6 mm; Miltex, Rietheim-Weilheim,Germany) were used to obtain two skin samples from each dog, oneTable 1. Signalment and clinical data on 10 dogs with sterile csignsNoneNonePancreatitisAtopic dermatitisAnorexia,vomitingNone10Atopic dermatitisNone5Atopic omitingNoneDepressionCM6PHACM4Atopic dermatitisAnorexia,feverAnorexiaBreedSex1Shih ielChihuahuaSFShih tzuYorkshireterrierMalteseCMFShih tzu678910F14TreatmentIntralesional dexamethasone (3 mg per dog, weekly for2 weeks, then tapered for 2 weeks)Topical dexamethasone (daily for 1 week, then taperedfor 1 week)Oral prednisolone (1 mg kg twice daily) plus oral ciclosporin(5 mg kg twice daily)Topical dexamethasone (daily for 1 week, then taperedfor 1 week)Topical dexamethasone (daily for 1.5 weeks, then taperedfor 2 weeks)Topical dexamethasone (daily for 1 week, then taperedfor 1 week)Surgical excisionTopical flush with warm saline, oral cephalexin(30 mg kg twice daily)Oral prednisolone (0.5 mg kg twice daily)Oral prednisolone (1 mg kg twice daily) plus oral ciclosporin(5 mg kg twice daily)Abbreviations: CM, castrated male; SF, spayed female; PDH, pituitary dependant hyperadrenocorticism; PHA, primary hypoadrenocorticism.ª 2011 The Authors. 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Kim et al.Table 2. Clinical features and cytological findings in 10 dogs with sterile panniculitisCaseno.No. ofnodulesSize of nodule(cm)2144TrunkTrunkTrunk,dorsal neck,shoulderTrunk5Gross findingsCytological findings5 · 1.4, 2 · 7.73.5 · 34 · 3.5, 4.5 · 3.5,2 · 1.5, 2 · 1.5Firm, well circumscribedSoft, fluctuantFirm, well circumscribedSpindle cells exhibiting criteria of malignancy or benignDegenerative neutrophils, adipose cellsSpindle cells exhibiting criteria of malignancy or benign,neutrophils12·3Firm, well circumscribedTrunk24 · 2.5, 3.5 · 2.5Firm, well circumscribed67TrunkTrunk216.8 · 5.5, 3.2 · 2.91.1 · 1.2Soft, fluctuantFirm, well circumscribed89Ventral neckLeft shoulder112.3 · 2.43·2Soft, fluctuantFirm, well circumscribed10Left shoulder14·4Firm, well circumscribedSpindle cells exhibiting criteria of malignancy or benign,neutrophilsSpindle cells exhibiting criteria of malignancy or benign,macrophagesAdipose cells, macrophagesSpindle cells exhibiting criteria of malignancy or benign,neutrophilsSterile pyogranulomatous inflammationSpindle cells exhibiting criteria of malignancy or benign,neutrophilsSpindle cells exhibiting criteria of malignancy or benign,neutrophils123LocationIn addition, none of the cases had a recent history ofinjections or vaccinations at the site(s) of the lesion(s).Four dogs had a leucocytosis (case 2, 19.2 · 103 lL;case 6, 18.4 · 103 lL; case 8, 24.2 · 103 lL; andcase 9, 21.0 · 103 lL; normal range, 6–17 · 103 lL),although it was not clear whether this was related to theunderlying condition, the panniculitis or both.Two dogs had mild nonregenerative anaemia (case 6,5.38 · 106 lL; and case 9, 5.23 · 106 lL; normal range,5.5–8.5 · 106 lL) of unknown cause, and one dog(case 2, 5.41 · 106 lL; normal range, 5.5–8.5 · 106 lL)had a mild regenerative anaemia, thought to be due to itsunderlying condition. Half of the dogs (cases 1, 3, 4, 5and 7) had normal complete blood counts and serumchemistry profiles. The two dogs with pancreatitis hadelevated serum amylase (case 2, 2011 IU L; and case 6,3534 IU L; normal range, 268–1769 IU L) and lipase levels (case 2, 3577 IU L; and case 6, 2560 IU L; normalrange, 269–2299 IU L).Clinical features and cytological findingsSix dogs had solitary lesions on the trunk (n 3), ventralneck (n 1) and shoulder (n 2). The remaining fourdogs had multiple lesions over the trunk (n 4) anddorsal neck (n 1; Table 2 and Figure 1). All of thewell-circumscribed firm nodules (n 7) on FNA cytologyhad pleomorphic spindle cells (Figure 2), but inflammatory cells were rare. In contrast, numerous inflammatorycells and adipose cells were evident in the three dogswith soft and fluctuant nodules in (Table 2). One of thesedogs (case 8) had a ruptured lesion with a purulentdischarge.HistopathologyThe histopathological findings are summarized in Table 3.The epidermis and dermis were normal in seven of 10dogs. Adipose tissue in the panniculus or deep subcutiswas inflamed and in some cases surrounded by fibrousconnective tissue (Figure 3). Inflammatory cells interspersed within and surrounding the devitalized fat consisted mainly of neutrophils and macrophages with apyogranulomatous pattern (seven cases; Figure 3). In all354(a)(b)Figure 1. Clinical features of sterile panniculitis in dogs. (a) Sterilepanniculitis in a Pekingese (case 3). Four subcutaneous nodules(arrows) on the shoulders and trunk. The nodule on the lower trunkwas removed by surgical operation before presentation. (b) Sterilepanniculitis in a Chihuahua (case 6). The dog presented with acutepancreatitis.dogs except case 8, the types of inflammatory cells werenot consistent with the cytological findings. In addition,no criteria indicative of malignant or benign spindle cellswere observed in any of the lesions. Cultures of thebiopsy samples for bacteria and fungi were negative in allcases.Treatment and clinical outcomesThe treatments are summarized in Table 1. One dogreceived intralesional injections of dexamethasone(3–8 mg week of dexamethasone disodium phosphate;ª 2011 The Authors. Veterinary Dermatologyª 2011 ESVD and ACVD, Veterinary Dermatology, 22, 352–359.
Sterile panniculitis in dogsTable 3. Histopathological findings in 10 dogs with sterile panniculitisCaseno.12345(a)(b)Figure 2. Fine-needle aspiration cytology of well-circumscribed firmsubcutaneous nodules in canine sterile panniculitis. (a) Fine-needleaspiration cytology revealing pleomorphic spindle cells (thin arrows;case 3; Diff-Quick! ·400 magnification). The inset shows an oval- orspindle-appearing cell with a high nuclear-to-cytoplasmic ratio andprominent nucleoli (Diff-Quick!, ·1000 magnification). (b) Plump andspindle-shaped variably sized cells with large nuclei and prominentnucleoli (case 5; Diff-Quick! ·400 magnification). The inset showslarge nuclei and prominent nucleoli (thick arrow; Diff-Quick!, ·1000magnification).Jeil Pharmaceutical, Seoul, Korea), and four dogs weretreated once daily with a topical dexamethasone ointment(Gentrisone-G!; Shin Poong Pharm, Seoul, Korea). Thelesions were shaved prior to topical therapy. In addition totopical dexamethasone, two dogs (cases 2 and 6)received intravenous antibiotic injections (22 mg kgampicillin sodium three times a day; Dongwon Pharma,Sungnam, Korea) and fluid therapy for acute pancreatitis.Topical and intralesional dexamethasone treatment wastapered as the lesions resolved.Three dogs received systemic immunosuppressivetreatment. Two of three dogs were treated with 1 mg kgtwice daily oral prednisolone (Solondo! tab; Yuhan Corporation, Seoul, Korea) in combination with 5 mg kg twicedaily oral ciclosporin (Neoral!; Novartis Pharma, Basel,Switzerland). One dog (case 9) was receiving 0.5 mg kgtwice daily oral prednisolone for primary hypoadrenocorticism, and the nodule disappeared after 1 week of treatment.A solitary lesion was surgically excised in one dog(case 7). The dog with the ruptured lesion (case 8) wasª 2011 The Authors. Veterinary Dermatologyª 2011 ESVD and ACVD, Veterinary Dermatology, 22, rpanniculitis )))LobularpanniculitisDiffusepanniculitis ) culitisDiffusepanniculitisSeptalpanniculitis))) ) ) ) nulomatousmanaged with topical flushing with warm saline and oralantibiotics (30 mg kg cefalexin twice daily; Falexin!;Dong Wha Pharm, Seoul, Korea) only.In all cases, the initial response to treatment was good,with resolution of clinical lesions within 1 week. The average times to achieve complete remission of clinical signswere 3.6 weeks with topical dexamethasone (cases 1, 2,4, 5 and 6) and 2.3 weeks for systemic immunosuppressive therapy (cases 3, 9 and 10). Two cases (5 and 8)experienced a relapse after 2 months with a mean followup of 5.4 months. The dogs also responded to the sametherapies within 1 week.DiscussionThis study included dogs from a number of breeds, andno significant breed predilections were observed. Thepower of this analysis, however, was limited by the sizeof the study and the low numbers of each breed. In onestudy no age, breed,or sex predilections were reportedfor solitary lesions, but dachshunds and poodles werereported to be predisposed to multiple lesions.2 Eight of10 dogs in our study were neutered and four of 10 were3–5 years of age, which is consistent with a previousreport.13There was no significant association with any oneunderlying disease, although again the small size of thestudy limited the power of the analysis. Four of 10 dogs,however, had AD, and the owners of all of the dogsreported a history of intermittent skin problems. In onehuman study, four of 10 patients with sterile lobularneutrophilic panniculitis had underlying atopic diseases.7The authors speculated that immune dysregulation predisposes to panninculitis.14 The responses of dogs withsterile panniculitis to immunosuppressive therapy sug355
Kim et al.(a)(b)200 µm(c)100 µm(d)200 µm200 µmFigure 3. Histopathology of well-circumscribed firm subcutaneous nodules in canine sterile panniculitis. (a) Multifocal lobular fat necrosis withnecrotic areas confined to the panniculus (case 5; H&E stain; scale bar represents 200 lm). (b) High-power magnification of (a) (H&E stain; scalebar represents 100 lm). (c) Lobular panniculitis surrounded by fibrous connective tissue (H&E stain; scale bar represents 200 lm). (d) High-powermagnification of (c) (H&E stain; scale bar represents 200 lm).gests that this condition may be immune mediated, andfurther studies are required to confirm this.In our study, two dogs had pancreatitis, and nodulesoccurred acutely during management of the disease. Ithas been suggested that the release of pancreaticenzymes into the systemic circulation via the thoracicor portal circulation plays a role in the pathogenesis ofpanniculitis.15 Recently, three studies reported sterilepanniculitis associated with pancreatic problems indogs.15–17 In humans, panniculitis in association withpancreatitis has been associated with a deficiency ina1-antitrypsin18 and a decrease in a2-macroglobulin concentration.19 However, a1-antitrypsin deficiency is notassociated with the development of the disease indogs.13,20In our study, malignant or benign spindle cells wereobserved following FNA cytology in seven dogs. Interestingly, all of these dogs had well-circumscribed firm nodules. The most common diagnosis prior to histopathologywas cutaneous neoplasia, including fibrosarcoma,fibroma, liposarcoma and lipoma. On the basis of microbial cultures and histopathology, however, sterile panniculitis was diagnosed. The misdiagnosis associated withFNA cytology may have been related to anaplasia or356atypia in the pseudotumours. Inflammatory pseudotumours related to aberrant or exaggerated inflammatoryresponses to tissue injuries in dogs and horses have beenreported.7,8 Cellular atypia may result in misdiagnosis ofbenign inflammatory pseudotumour lesions by FNA cytology. Moreover, lesions in adipose tissue are difficult todiagnose by FNA cytology.21 Cytology in the three dogswith soft and fluctuant nodules, in contrast, revealedinflammatory cells and adipocytes consistent with panniculitis. Firm nodules that exhibit atypia on cytologicalexamination can easily be misdiagnosed as tumoursrather than as canine sterile panniculitis. Therefore, it islikely that the diagnostic accuracy of FNA cytology in firmwell-circumscribed adipose tissue lesions, includingpanniculitis, is limited. This appears to be a novel findingand is worthy of further investigation.Histopathologically, seven of 10 dogs had fibrosis, possibly related to chronic disease. However, the findingswere not consistent with the dogs’ medical histories, allof which had acute disease. Most cases of panniculitis,regardless of cause, appear to have very similar histopathology.2 Histopathological evaluations also showed thatmost of our cases were similar, regardless of the cytological findings or other clinical features. The histopathologiª 2011 The Authors. Veterinary Dermatologyª 2011 ESVD and ACVD, Veterinary Dermatology, 22, 352–359.
Sterile panniculitis in dogscal patterns and cytology reactions therefore appear tohave little therapeutic or prognostic significance.Topical, intralesional or systemic glucocorticoids wereused to treat eight of the dogs. The initial treatment ofdogs with multifocal sterile panniculitis usually involvessystemic glucocorticoids,2 although this can causeunpredictable adverse effects. Topical or intralesionaltherapy was therefore used to manage dogs with mildto-moderate disease in our study. All of the lesions treated with systemic or topical glucocorticoids started toresolve within 1 week, although systemic immunosuppressive therapy resulted in a faster time to completeremission. There are no previous reports of using topicalglucocorticoids to treat deep skin lesions, such as panniculitis, and it has been thought unlikely that the glucocorticoids would be able to penetrate the panniculusand subcutis. However, the anti-inflammatory potency oftopical glucocorticoids can vary between patients,depending on the frequency of administration, the duration of treatment and the site of application.22,23 Morepotent agents have better efficacy in severe diseasesand may penetrate the skin more readily.23 Dexamethasone is a highly potent steroid and may be effective fortreatment of deeper cutaneous inflammatory lesions indogs. This treatment is noninvasive and is associatedwith fewer adverse effects than intralesional or systemictreatment in dogs.Oral ciclosporin was used in combination with oralglucocorticoid therapy when the lesions were scatteredand severe. This was effective and well tolerated. Furthermore, no relapses occurred, and this combinationregimen appears to hold promise as a treatment forsevere cases of panniculitis.The use of glucocorticoids to treat pancreatitis is controversial, but they may stabilize lysosomal membranesand reduce inflammation.15 However, glucocorticoidsmay also reduce macrophage function and worsen thecondition.24 Topical glucocorticoid treatment was used inthe dogs with pancreatitis to minimize adverse effects.This treatment was effective and well tolerated, andtherefore topical glucocorticoid therapy could be useful indogs where systemic treatment may be contraindicated.In conclusion, nodules from dogs with sterile panniculitis that are firm and well circumscribed can exhibit anaplasia on cytology, which can be misdiagnosed as neoplasia.Therefore, an accurate diagnosis of sterile panniculitis indogs should be made on the basis of microbial culturesand histopathology. Alternative therapies, especiallytopical glucocorticoids, for canine sterile panniculitis couldbe beneficial when adverse effects associated withsystemic steroids are a concern or the clinical signsare severe. Further studies are needed to clarify thesefindings in dogs.References1. German AJ, Foster AP, Holden D et al. Sterile nodular panniculitis and pancreatitis in three Weimaraners. Journal of SmallAnimal Practice 2003; 44: 449–55.2. Scott DW, Miller WH Jr, Griffin CF. Panniculitis. In: Muller andKirk’s Small Animal Dermatology, 6th edn. Philadelphia: W.B.Saunders, 2001: 1156–62.ª 2011 The Authors. Veterinary Dermatologyª 2011 ESVD and ACVD, Veterinary Dermatology, 22, 352–359.3. Torres SM. Sterile nodular dermatitis in dogs. Veterinary Clinicsof North America Small Animal Practice 1999; 29: 1311–23.4. DeManuelle TC, Stannard AA. Difficult dermatologic diagnosis.Journal of American Veterinary Medical Association 1998; 213:356.5. Dodd LG, Martinez S. Fine needle aspiration cytology of pseudosarcomatous lesions of soft tissue. Diagnostic Cytopathology2001; 24: 28–35.6. Weinreb I, Goldblum JR, Rubin BP. Facial soft tissue pseudotumor due to injection of anabolic steroids: a report of 3 cases in 2patients. Human Pathololy 2010; 4: 452–5.7. Knight C, Fan E, Riis R et al. Inflammatory myofibroblastic tumors in two dogs. Veterinary Pathology 2009; 46:273–6.8. Moore CP, Grevan VL, Champagne ES et al. Equine conjunctivalpseudotumors. Veterinary Ophthalmology 2000; 3: 57–63.9. Gärtner F, Santos M, Gillette D et al. Inflammatory pseudotumour of the spleen in a dog. Veterinary Record 2002; 150: 697–8.10. Scott DW, Anderson WI. Panniculitis in dogs and cats: a retrospective analysis of 78 cases. Journal of the American AnimalHospital Association 1988; 24: 551–9.11. Patterson S. Sterile idiopathic pedal panniculitis in the Germanshepherd dog – clinical presentation and response to treatmentof four cases. Journal of Small Animal Practice 1995; 36: 498–501.12. Willemse T. Atopic skin disease: a review and reconsideration ofdiagnostic criteria. Journal of Small Animal Practice 1986; 27:771–8.13. Yamagishi C, Momoi Y, Kobayashi T et al. A retrospective studyand gene analysis of canine sterile panniculitis. The Journal ofVeterinary Medical Science 2007; 69: 915–24.14. Magro CM, Dyrsen ME, Crowson AN. Acute infectious panniculitis panniculitic bacteriaemia: a distinctive form of neutrophiliclobular panniculitis. Journal of Cutaneous Pathology. 2008; 35:941–6.15. Mellanby RJ, Stell A, Baines E et al. Panniculitis associated withpancreatitis in a cocker spaniel. Journal of Small Animal Practice2003; 44: 24–8.16. Fabbrini F, Anfray P, Viacava P et al. Feline cutaneous and visceral necrotizing panniculitis and steatitis associated with a pancreatic tumor. Veterinary Dermatology 2005; 16: 413–9.17. Gear RNA, Bacon NJ, Langley-Hobbs S et al. Panniculitis,polyarthritis and osteomyelitis associated with pancreatic neoplasia in two dogs. Journal of Small Animal Practice 2006; 47:400–4.18. Smith KC, Su WPD, Pittelkow MR et al. Clinical and pathologicalcorrelation in 96 patients with panniculitis, including 15 patientswith deficient levels of a1-antitrypsin. Journal of American Academy of Dermatology 1989; 21: 1192–6.19. Mourad FH, Hannoush HM, Bathlawan M et al. Panniculitisand arthritis as the presenting manifestation of chronic pancreatitis. Journal of Clinical Gastroenterology 2001; 32: 259–61.20. Hughes D, Goldschmidt MH, Washabau RJ et al. Serum a1antitrypsin concentration in dogs with panniculitis. Journal ofthe American Veterinary Medical Association 1996; 209:1582–4.21. Domanski HA, Carlén B, Jonsson K et al. Distinct cytologicfeatures of spindle cell lipoma. A cytologic-histologic study withclinical, radiologic, electron microscopic, and cytogenetic correlations. Cancer 2001; 93: 381–9.22. Goa KL. Clinical pharmacology and pharmacokinetic propertiesof topically applied corticosteroids. A Review. Drugs 1988;36(Suppl. 5): 51–6.23. Ference JD, Last AR. Choosing topical corticosteroids. AmericanFamily Physician 2009; 79: 135–40.24. Williams DA. Exocrine pancreatic disease. In: Ettinger SJ,Feldman EC eds. Textbook of Veterinary Internal Medicine, 5thedn. Philadelphia: W.B. Saunders, 2000: 1345–67.357
Kim et al.Résumé L’objectif de cette étude était d’analyser les maladies sous-jacentes, les critères diagnostiqueset les effets des traitements chez 10 chiens atteint de panniculite stérile. Il n’y avait pas d’association significative avec la race (P 0.86). L’âge moyen des chiens était de 7.4 ans. Les maladies concourantesincluaient la dermatite atopique (4 chiens), une pancréatite aigue (2 chiens) et un hyperadrénocorticismeprimaire (1 chien) ; trois chiens ne présentaient aucune atteinte concourante. Il n’y avait aucune associationsignificative avec la panniculite stérile (P 0.57). Des nodules
Sterile nodular panniculitis is most commonly misdiag-nosed as deep pyoderma, a cutaneous cyst or cutaneous neoplasia.2 Tissue cultures for aerobic, anaerobic and mycobacterial cultures are needed to diagnose sterile panniculitis.2 Fine-needle aspiration (FNA) of intact lesions of panniculitis usually reveals numerous neutroph-
Cold panniculitis Poststeroid paniculitis Adult-type panniculitis appearing in children Erythema nodosum Enzymatic panniculitis Pancreatic panniculitis Infectious panniculitis Bacterial Mycobacterial Fungal Panniculitis in connective tissue disease lupus panniculitis , Dermatomyositis, Polyarteritis nodosa Granulomatous panniculitis: Sarcoidosis
Dogs on trees. Dogs in cars. Dogs at work. Dogs underwater. Black dogs, white dogs, black and white dogs, red dogs, blue dogs, green dogs and yellow dogs - all together at DOG PARTY! Go, Dog. Go! The 1961 classic children’s story by P.D. Eastman is brought to life onstage. These dogs take the everyday mundane
Panniculitis frequently represents a dermatologic manifestation of a systemic disease and therefore mer-its consideration of a systemic workup. Pancreatic panniculitis can occur in the setting of normal pancreatic enzyme levels. Pathologic features of pancreatic panniculitis include a predominantly lobular panniculitis without vascu-
fluctuant and may evolve into sterile necrotic abscesses which spontaneously ulcerate exuding a thick brown oily material, due to liquefaction fat necrosis. In the very early stage of pancreatic panniculitis [5], a septal pattern of panniculitis is seen characterized by lymphoplasmacytic infiltration along the fibrous septa surrounding the .
represented by sterile pyogranuloma/granuloma syndrome (SPGS), nodular sterile panniculitis (NSP), juvenile sterile granulomatous dermatitis and lymphadenitis, reactive histiocytosis (RI), sterile sarcoidal granulomas and xanthomatosis. In these cases histopathological examination is necessary for the diagnosis. Here, we described
South Korea: Chungbuk (130 ticks from 14 dogs), Chungnam (145 ticks from 15 dogs), and Gyeongbuk (167 ticks from 17 dogs) and southern South Korea: Jeonbuk (165 ticks from 17 dogs), Jeonnam (180 ticks from 19 dogs), and Gyeongnam (193 ticks from 20 dogs). None of the infested dogs showed clinical symptoms of tickborne pathogens (TBPs).
panniculitis”; “ileitis”; “colitis”. Mesenteric panniculitis is a chronic fibrosing inflammation of the mesentery of small and large intestine. It is reported in the literature under several names: mesenteric panniculitis, isolated lipodystrophy of the mesentery, retractile mesenteritis, sclerosing mesenteritis, or mesenteric lipomatosis.
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