Reactive (systemic and cutaneous) histiocytosis

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Sections available in full article Introduction, Presenting signs, Acute presentation, Age predisposition, Breed predisposition, Pathogenesis, Etiology, Pathophysiology, Timecourse (incubation, duration), Diagnosis, Presenting problems, Client history, Clinical signs, Diagnostic investigation, Confirmation of diagnosis, Histopathology findings, Differential diagnosis, Treatment, Initial symptomatic treatment, Sequelae, Prognosis, Expected response to treatment, Reasons for treatment failure, Sources, Publications, Vetstream contributor(s),
Contributors Dr Laura Garrett DVM DACVIM (Oncology)
Dr Susan North BSc PhD DVM DACVIM(Onc)
Ms Verena Affolter DVM PhD DipECVP
Mr Charlie Walker BVetMed CertVD MRCVS

Introduction

  • Systemic (SH) and cutaneous histocytosis (CH) are related conditions.
  • In the cutaneous form all lesions are confined to the skin, with the systemic form the skin and multiple internal organs are involved. The differentiation is purely one of clinical distribution.
  • This disease is a reactive inflammatory process and unlike malignant histiocytosis the cells themselves do not have the characteristics of malignancy. Many cases of systemic histiocytosis present with signs only of the cutaneous form.
  • It is not commonplace for every dog with cutaneous histiocytosis to develop systemic disease.

Diagnosis

Clinical signs

  • Breed.
  • Cutaneous nodular masses of varying size, up to 4 cm, can be:
    • Smooth.
    • Partially alopecic.
    • Ulcerated and crusted.
  • Common distribution is:
    • Eyelids.
    • Nasal apex/planum.
    • Mucous membranes.
    • Trunk, extremities (including footpads), perineum and scrotum.
  • Peripheral lymphadenopathy Lymphadenopathy.
  • Conjunctival hyperemia, chemosis.
  • Nasal discharge/respiratory stertor.
  • Temporal muscle atrophy.
  • 'Depression'.
  • Anorexia.

Diagnosis

Differential diagnosis

  • Round cell neoplasms, eg:
    • Multiple cutaneous histiocytomas Skin: histiocytoma.
    • Cutaneous T cell lymphoma Lymphoma.
    • Malignant histiocytosis Malignant histiocytosis.
  • Foreign body reaction.
  • Sterile granulomatous disease/sterile pyogranulomatous dermatitis.
  • Palisading granuloma.
  • Fungal granulomatous disease.
  • Nodular parasitic diseases including Leishmaniosis.
  • Cutaneous xanthoma.
  • Canine sarcoidosis.
  • Granulomatous drug reaction.

Sequelae

Prognosis

  • CH: variable, may spontaneously regress but usually follow waxing and waning course, can rarely subsequently become systemic.
  • SH: guarded, may wax and wane over a period of years or be rapidly progressive. Survivals range from 2-48 months, averaging ~9-10 months.

Expected response to treatment

  • Improvement of clinical signs.

Reasons for treatment failure

  • May not respond well to any treatment.

Sources

Publications

Refereed papers

  • Recent references from PubMed.
  • Palmeiro B S et al(2007) Cutaneous reactive histiocytosis in dogs: a retrospective evaluation of 32 cases. Vet Derm 18 , 332-340 PubMed.
  • Affolter V K & Moore P F (2000) Canine cutaneous and systemic histiocytosis - reactive histiocytosis of dermal dendritic cells. Am J Dermatopathol 22 (1) 40-48
  • Baines S J et al(2000) Cutaneous T cell lymphoma mimicking cutaneous histiocytosis - differentiation by flow cytometry. Vet Rec 147 (1) 11-16
  • Scherlie P H et al(1992) Ocular manifestation of systemic histiocytosis in a dog. JAVMA 201 , 1229-1231.
  • Mays M B & Bergeron J A (1986) Cutaneous histiocytosis in dogs. J Am Vet Med Assoc 188 (4) 377-381
  • Moore P F (1984) Systemic histiocytosis of Bernese mountain dogs. Vet Pathol 21 , 554-563.

Other sources of information

  • Gaugere E & Prelaud P (eds) (2008) A Practical Guide to Canine Dermatology. Kalianxis. ISBN 9782915758115.
  • Withrow S & Vail D (2007) Small Animal Clinical Oncology (4), Saunders Elsevier. ISBN 0721605583.
  • Bonagura J D (ed) (2000) Kirk's Current Veterinary Therapy XIII Small Animal Practice , Saunders. ISBN 0721655238.

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