J. Modern Sci. Eng. Vol.1, No.4 (2017) 27-29
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A Case of Malignant Trichoepithelioma in Native Sheep: Pathomorphological Findings Abdel-Moneim A.Ali*, Naif A. Al-Gabri*¼. Nora M Elseddawy*, Heba M Abdel-Ghany*, Mohamed Gomaa*. *Department of Pathology, Department of Surgery, Faculty of Veterinary Medicine, Zagazig University, Elzera’a square, 44511 Sharkia, Egypt. ¼* Department of Veterinary Medicine, Faculty of Agriculture and Veterinary Medicine, Thamar University, Yemen. Abstract A ewe of native breed aged 2.5-3 years old was admitted to Vet. Clinic, Faculty of Veterinary Medicine at June 2015 with circumscribed raised large solitary area measuring (5-7cm) in diameter covered by an alopecic, dark-red and ulcerated surface located in a distal portion of the medial aspects of the fatty tail. The sheep was subjected to surgical excisional biopsy under anesthesia. A biopsy was fixed in 10% natural buffered formalin. Paraffin sections were prepared and stained with routine hematoxylin and eosin for microscopic examination. Microscopically, the tumor represented by dermal and subcutaneous multiple circumscribed cystic growths forming lobules composed of pleomorphic basaloid or polyhedral cells arranged in cords and embedded in the distinct stroma. Some of the proliferative cells forming small keratinizing epitheliumlined cysts containing keratin impacted in stromal fibrotic strands infiltrated with leukocytes were prevalent. Malignant cells have large vesicular nuclei and a few have a tendency to form the bizarre giant cell in addition to numerous atypical mitotic figures. It could be concluded that trichoepithelioma is one of the rare encapsulated cutaneous neoplasms of native sheep in Egypt. Keywords Native Sheep, Fatty Tail, Malignant Trichoepithelioma. 1. INTRODUCTION Skin tumors are relatively frequent, especially in dogs, horses, cattle and cats. There is a variable incidence of tumor types among different species of domestic animals. Numerous primary skin neoplasms form ectodermal and mesodermal origins of skin, along with epidermal adnexal structures were described [1]. In animals, early detection of skin tumors is possible when they cause irritation or when they measure more than 1 cm in diameter and the morphological appearance (central ulcer, alopecia) beside localization suggest a diagnosis on clinical examination, but definitive diagnosis requires histological confirmation to exclude other tumour-like or non-neoplastic lesions that frequently occur in the skin [2]. Hair follicle tumors are rare in animals and the classification of these tumors depend upon the structure of hair follicles some of these growths may be differentiated into: trichoepithelioma tricholemmoma
* Corresponding author. (Naif A. Al-Gabri). E-mail address: naifaljabry@yahoo.com
circumscripta [3]. Trichoepithelioma was first described by Brooke in 1892 as epithelioma adenoides cysticum [4]. Malignant trichoepithelioma is an uncommon tumor in sheep, and only one case was reported in Indian udder goat [5]. Trichoepithelioma is a benign follicular appendage tumour with its capability for differentiation to all three segments of the hair follicle, in which incomplete or abortive trichogenesis is present [6]. Trichoepithelioma is a rare benign skin lesion that originates from hair follicles mostly seen in the scalp, nose, forehead, and upper lip of cats, dogs and sheep. It is solitary or multiple, encapsulated, firm, intradermal or subcutaneous covered by alopecic which often ulcerated surface located mainly on back, neck, thorax and tail. Trichoepitheliomas may be divided according to the nature of growth arrangement into the multiple familial trichoepithelioma which include solitary trichoepithelioma and desmoplastic trichoepithelioma [7].
Abdel-Moneim A.Ali et al. Journal of Modern Science & Engineering, vol.1, No. 4, (2017) 27-29
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Desmoplastic trichoepithelioma is one of the rare benign neoplasms, which is considered to have both a follicular and a sebaceous differentiation. It consists of basaloid cells that can differentiate into various parts of the folliculosebaceous apocrine unit. It is also an important disease, because it sometimes clinically and pathologically needs to be differentiated from basal cell carcinoma [8]. This work aimed to diagnose and illustrate pathomorhpological feature of rare cutaneous neoplasm of sheep fatty tail. 2. Case Report A ewe, aged 2.5-3 years, native breed was admitted at Vet. Clinic Faculty of Veterinary Medicine in June 2015 with a complaint of rapid increase skin nodule size with the ulcerated surface during the past weeks with non-response to the treatment by antibiotics. Clinical examination revealed rose large solitary dermal alopecic area measuring (5-7 cm) in diameter and covered by a dark-red ulcerated surface located nearly in a distal portion of the medial aspects of the fatty tail. The animal has good healthy conditions and normal temperature without any clinical signs. Animal subjected to surgical excisional biopsy under anesthesia. A biopsy was taken and fixed in 10% neutral buffered formalin solution, dehydrated in ascending concentrations of ethanol (70-100%), cleared in xylene, and embedded in paraffin. Five-micron thick paraffin sections were prepared and then routinely stained with hematoxylin and eosin and then examined microscopically [9]. Follow-up after surgical removal, no recurrence of the neoplasm could be observed. the final nanoparticles and the (Ag+) of the solution is reached. 3. Results and Discussions Grossly, the skin lesions represented by circumscribed raised large solitary area measuring (5-7 cm) in diameter and
* Corresponding author. (Naif A. Al-Gabri). E-mail address: naifaljabry@yahoo.com
covered by alopecic dark-red, ulcerated surface seen mainly on the distal portion of the medial aspects of the fatty tail (Fig 1), a similar result was reported by [10]. Although medial aspects of fatty tail devoid of wool the probabilities of neoplastic growths from hair follicles were predictable [13]. Moreover, another malignant neoplasm as squamous cell carcinoma was reported in the skin of fatty tail of Awassi sheep [12] and trichoepithelioma was reported in Indian udder goat [5]. Microscopically, the cutaneous neoplasm represented by interlacing lobules of variable sizes invading deep dermis and subcutes (Fig 2). Clusters of large polymorphic cells with foamy cytoplasm contain large vesicular hyperchromatic nuclei and numerous atypical mitotic figures were predominant (Fig 3). The majorities of cells invade the stroma forming masses or lobules of large basaloid cells or poorly differentiated cells (Fig 4). Large bizarre giant cell beside mitotic figures and a few cells have the tendency of cornification together with intense stromal fibrous tissue containing inflammatory cells were observed (Figs. 5and 6). Some keratinized immature hair follicles formed cornified cysts which were characteristic features of trichoepithelioma. Other cells appeared poorly differentiated cell with less keratinized centers. The previous results were partial agreed with [11] which described trichoepithelioma as superficial dermal symmetric and well-delineated proliferation of basaloid cells growing in narrow strands of one to three cells thick and embedded in compact desmoplastic stroma and associated with small keratinizing epithelium-lined cysts containing keratin. Other common cutaneous lesions include foreign body-type granulomatous reaction, calcification and focal acanthosis must be considered during differential diagnosis [10]. Moreover, the differential diagnosis includes basal cell carcinoma and other adnexal tumorous. Our study concluded that the malignant trichoepithelioma was considered one neoplasm of the fatty tail in native breed sheep in Egypt and it first case recorded in the Arab World and Egypt.
Abdel-Moneim A.Ali et al. Journal of Modern Science & Engineering, vol.1, No. 4, (2017) 27-29
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Fig 1: Ewe fatty tail with circumscribed raised large solitary area covered by a dark red ulcerated surface. (2) Photomicrograph of the cutaneous neoplasm showing interlacing lobules of variable sizes invading deep dermis and subcutis, H&E X 200. (3) Clusters of large polymorphic cells with foamy cytoplasm contain large vesicular hyperchromatic nuclei and numerous atypical mitotic figures (arrow), H&E X400. (4) The majority of cells invade the stroma (star) with a presence of bundles large basaloid neoplastic cells or polygonal poorly differentiated cells (arrow). H&E X400. (5) Large bizarre giant cell (arrow) beside mitotic figures with the tendency of cornification of some individualized neoplastic cells (thick arrow) together with intense stromal inflammatory cells. H&E X400. (6) High power of neoplastic lobule showing cornified center (green arrow) with numerous typical and atypical mitotic figure (black arrow), polygonal cells (short-thick arrow) H&E X1000. 5. References 1- Magnol JP. Tumeurs cutannées du Chien et du Chat. Rec. Méd Vét. 1990, 166:1061–1074. 2- Abramo F. Pratesic F, Cantile C, Sozzl S and Pol A. Survey of canine and feline follicular tumours and tumourlikelesions in central Italy. Journal of Small Animal Practice, 1999, (40): 479-481. 3- Baba AI and Câtoi C. Epithelial and melanocytic tumors of the skin. Comparative Oncology, 2007, pp 53-54. 4- Anderson DE, Howell JB. Epithelioma adenoides cysticum: Genetic update. Br J Dermatol; 1976, 95:225-32. 5- Raval SH, Patel AM, Patel JG, Charavala AH, Patel BJ, Joshi DV. Trichoepithelioma in goat: A case report. Indian Journal of Veterinary Pathology: 2016, 40: 354-355. 6- Elder D, Elenitsas RE and Ragdale BD. Tumors of the epidermal appendages. In: Lever’s Histopathology of the Skin. 8th ed. Philadelphia: Lippincott-Raven, 1997, 761–2 7- James WD, Berger T and Elston D. Andrew’s diseases of the skin: clinical dermatology: Elsevier Health Sciences. 2011, UK. 8- YamamotoO, HamadaT, DoiY, SasaguriY and Hashimoto H. Immunohistochemical and ultrastructual observations of
* Corresponding author. (Naif A. Al-Gabri). E-mail address: naifaljabry@yahoo.com
desmoplastic trichoepithelioma with a special reference to a morphological comparison with normal apocrine acrosyringium, J Cutan Pathol, 2002, 29: 15–26. 9- Suvarna SK, Layton C and Bancroft JD. Bancroft's theory and practice of Histological techniques. 7th ed., Churchill Livingstone. Elsevier, England. 10- Meuten, DJ. Tumors in Domestic Animals, 2013, 4th ed., pp. 55 63. Iowa State Press, Ames, IA. 11- Jaroslaw J, David L and Jennifer MM. Desmoplastic trichoepithelioma with perineural involvement: a series of seven cases. J Cutan Pathol: 2012, 39: 317–323. 12- Wael Hananeh M., Nabil Q. Hailat and Abdel rahman Al-Saleh. An unusual presentation of localy invasive squamous cell carcinoma in the fatty tail of Awassi sheep. Mirror of Research in Veterinary Sciences and Animals, 2012, 1(1), 13-16. 13- Tmumen S.K., Al-Azreg S.A., Abushhiwa M.H., Alkoly M.A., Bennour E.M. and Al-Attar S.R. Cutaneous squamous cell carcinoma in the lateral abdominal wall of local Libyan ewes. Open Veterinary Journal, 2016, Vol. 6(2): 139-142.