@article{marin_ferris_gruber_2023, title={What is your diagnosis? Perineal swelling in a dog}, volume={1}, ISSN={["1939-165X"]}, url={https://doi.org/10.1111/vcp.13172}, DOI={10.1111/vcp.13172}, abstractNote={A 2-year-old male intact Terrier mix presented to the North Carolina State Veterinary Teaching Hospital (NCSU-VTH) for evaluation of an ill-defined, soft, fluctuant mass in the right dorsal perineal area that had been present for approximately 1 week. The subcutaneous lesion was approximately 10 by 8 centimeters, fluid-filled, non-painful, and initially reported to be non-reducible. The owner reported no abnormalities in behavior, urination, or defecation, and there was no known physical trauma. Other relevant history included a prior diagnosis of congenital renal dysplasia with stable proteinuria and azotemia. Targeted ultrasonography confirmed that the mass was fluid-filled, but did not identify communication with the abdominal cavity. Approximately 20 ml of fluid was removed from the perineal swelling via fine-needle aspiration, and submitted for cytologic evaluation (Figures 1 and 2). Atypical epithelial cells, concerning for carcinoma. The direct smears were of moderate cellularity consisting of mixed leukocytes and large atypical cells present individually and in small clusters on a light pink background with a moderate amount of blood. Atypical cells were round to polygonal with distinct cellular borders, round to oval nuclei, fine chromatin, and a moderate amount of mid to deep blue cytoplasm. Occasionally, these cells contained variably-sized bright pink round to oval inclusions that displaced the nucleus (Figures 2A-C). Cells displayed moderate anisocytosis and anisokaryosis. Occasional bi- and multi-nucleated and rare karyorrhectic cells were observed. Rarely, cells displayed cannibalistic phagocytosis. Leukocytes consisted mostly of macrophages, which occasionally contained non-specific phagocytic debris and/or clear vacuoles, along with low numbers of non-degenerate neutrophils and small lymphocytes. The large atypical cohesive cells were consistent with either epithelial or mesothelial cells, although the large eosinophilic cytoplasmic inclusions were unusual for mesothelial cells. Given the location and initial description of a non-reducible lesion, the atypical cells were interpreted to be concerning for carcinoma. Differential diagnoses included a congenital cyst or perineal hernia, although the latter was considered unlikely given that communication with the abdominal cavity had not been identified. Full abdominal ultrasonography revealed chronic nephropathy and cystic prostatomegaly, but no connection between the abdomen and the fluid-filled mass. No cytologic abnormalities or BRAF mutation (CADET BRAF) were detected on the prostatic wash sample. Further discussion with the primary clinician revealed that the lesion was, in fact reducible, and the clinical diagnosis was a perineal hernia. The NCSU-VTH Soft Tissue Surgery Service explored the lesion and identified a defect in the abdominal wall that communicated with the perineal swelling. The defect was repaired with a classic herniorrhaphy supplemented with an internal obturator muscle transposition. Excised tissue was examined by histopathology, which revealed adipose tissue with marked fibroplasia, mild mesothelial hypertrophy, and multifocal de novo lymphoid follicle formation. Findings were consistent with entrapped peritoneal adipose tissue that had undergone fibrosis, and the final diagnosis was a perineal hernia (Figure 3). The intracytoplasmic inclusions, observed only in the cytologic specimens, were Periodic acid-Schiff (PAS) negative. Here, we report cytologic findings from entrapped fluid collected from a perineal hernia in a dog, which to our knowledge, have not been previously described. Reflecting its connection to the abdominal cavity, cytologic findings are similar to peritoneal transudative effusions: primarily mixed leukocytes with fewer reactive mesothelial cells. At the time of cytologic evaluation, the connection between the perineal swelling and abdominal cavity had not been identified; thus, the large atypical cells with cytoplasmic inclusions were concerning for carcinoma. After further discussion with the primary veterinarian, the lesion was described as reducible, and the perineal hernia was prioritized. The diagnosis was confirmed by surgery and histopathology. Two years post-surgery the patient has no evidence of recurrence or development of urothelial, prostatic, or other epithelial neoplasia, further supporting a non-neoplastic etiology. In this context, the atypical cells were re-assessed to be reactive mesothelial cells, which are notorious for being difficult to distinguish from carcinoma and mesothelioma cells. Reactive mesothelial cells may display increased nuclear to cytoplasmic ratio, large nuclei, prominent nucleoli, increased cytoplasmic basophilia, moderate to marked anisokaryosis and anisocytosis, and/or mitotic figures.1 Although not performed in this case, mesothelial cells are expected to be immunopositive for pan-cytokeratin, vimentin, and desmin.1, 2 The eosinophilic cytoplasmic inclusions in the mesothelial cells resembled Melamed-Wolinska bodies (MWB). MWB are a non-specific degenerative change, most likely composed of mucopolysaccharides or enlarged lysosomes, but unlike the inclusions observed in this case, are PAS-positive.3 MWB are most often associated with cells of urothelial origin, although similar inclusions have been reported in other cell types (eg, mammary, pulmonary carcinoma).3, 4 Cytoplasmic inclusions with a similar appearance to MWB may be observed in normal, degenerating, virus-infected, and neoplastic epithelial cell populations.3, 4 Intracytoplasmic targetoid mucin vacuoles observed in human urothelial cells appear very similar to MWB but differ with mucicarmine staining.5 Anecdotally, cytoplasmic inclusions resembling MWB have been observed in mesothelial cells, but to our knowledge, have not been documented. Here, the PAS-negative staining suggests a non-polysaccharide composition of the inclusions, not consistent with MWB. The origin and composition of these inclusions remain unknown. This case demonstrates the cytologic and histopathologic findings from entrapped fluid and tissue collected from a perineal hernia and documents PAS-negative eosinophilic cytoplasmic inclusions in mesothelial cells. This case also serves as a reminder of the importance of clinical context in the interpretation of atypical cells, which may require additional communication between the cytopathologist and the primary veterinarian. The authors have no affiliations or financial involvement with any organization or entity with a financial interest in, or in financial competition with, the subject matter or materials discussed in this article.}, journal={VETERINARY CLINICAL PATHOLOGY}, author={Marin, Jessica and Ferris, Kelli and Gruber, Erika}, year={2023}, month={Jan} }
 @article{marin_lewbart_stowe_2022, title={What is your diagnosis? Coelomic fluid in an Eastern River Cooter (
            <i>Pseudemys concinna concinna
            )}, volume={8}, ISSN={0275-6382 1939-165X}, url={http://dx.doi.org/10.1111/vcp.13142}, DOI={10.1111/vcp.13142}, abstractNote={An adult male intact Eastern River Cooter (Pseudemys concinna concinna) was presented by a good Samaritan to North Carolina State Veterinary Hospital's Turtle Rescue Team (TRT) after presumably being hit by a motor vehicle. The patient suffered from a carapace fracture of the left bridge (see Figure 2), prefemoral lacerations cranial to the left hind leg, and partial externalization of the intestines. The injuries appeared to be acute in nature. A shell repair was performed, and supportive care was initiated while the patient was dry docked. Blood work was not performed at the time of intake. Approximately 2 months following admittance, the patient was placed in water submersion due to the development of plastron pressure sores secondary to dry-docking. A week later, the patient reportedly had become very lethargic and appreciably edematous. The patient's packed cell volume (PCV) and plasma protein by refractometry at this time were 19% and 8.0 g/dL, respectively (the reference interval [RI] for related species, PCV 14%-26%, total protein 2.3-3.8 g/dL).1 Gross plasma abnormalities, such as hemolysis, were not appreciated. A coelomocentesis was performed, and approximately 35 ml of yellow, slightly cloudy fluid was removed from the coelomic cavity via fine-needle aspiration, which was then submitted for cytologic evaluation only (Figure 1); a total leukocyte count and total protein by refractometry were not performed. Low cellularity fluid with spermatozoa. The cellularity of the effusion was estimated to be low, along with low numbers of erythrocytes and few thrombocytes. Nucleated cells consisted predominantly of variably intact heterophils and macrophages. Outnumbering the leukocytes were several variably intact spermatozoa. Spermatozoa had deeply basophilic staining vermiform-shaped heads, which were elongate and tapered to a point, and variably appreciable, poorly staining midpieces and tails (Figure 2). No intracellular spermatozoa were definitively seen. No infectious agents were identified. Following water submersion and cytologic findings, the patient underwent both a computed tomography (CT) scan and coelomic laparoscopy to re-evaluate the overall extent of injuries due to trauma. The most notable finding on the CT scan included multiple severe comminuted fractures of the pelvis bilaterally, with moderate left sacroiliac subluxation and marked accumulation of coelomic fluid. While there were no obvious abnormalities in the gonads, this region was directly adjacent to the spinal luxation. The CT scan was performed without contrast. Together with the amount of coelomic fluid, any trauma to the gonads may have been inadvertently overlooked. Coelomic laparoscopy revealed a large amount of fluid with free-floating particulate matter, suspected to be plant material. Following the presumptive diagnosis of GI perforation (due to free-floating plant material), euthanasia was elected. On necropsy, a duodenal perforation and ruptured bladder, both with fibrinous adhesions, were discovered. Grossly visible gonadal trauma was not appreciated. Histopathology was not performed. Descriptive texts and images of the cytomorphology of mature turtle spermatozoa are limited.3, 4 Since cytopathology is more commonly used as a diagnostic tool in exotic and wildlife animal medicine; it is advantageous to have accessible resources with both routine and unusual findings that one might encounter as a cytopathologist. Many mammals and birds are seasonal and continuous breeders with synchronous reproductive events. In contrast, turtles located in temperate zones have a unique reproductive cycle in which spermatogenesis in male turtles is asynchronous with ovulation in the female. Spermatogenesis in the male turtle occurs episodically, starting in early summer and ending in autumn, with spermatozoa leaving the testes and entering the epididymis.5 Asynchrony of reproduction events necessitates methods for spermatozoa storage in both male and female turtles.3 In spring-breeding turtles, such as the Eastern River Cooter, spermatozoa are stored in the ductus epididymis of the male. In a study by Gist et al, spermatozoa were found in the ductus epididymis of painted turtles throughout the year, even when the testes were completely regressed in the spring.5 The spermatozoa were observed to be relatively impervious to deterioration over time (as long as 5 months), when evaluated both within and outside of the epididymis. While an official total leukocyte count and protein by refractometry was not performed, a low cellularity fluid suggestive of a transudate was considered most likely. In this case, chief uncertainties included how both the fluid and spermatozoa came to be free within the coelomic cavity. The patient was not hypoproteinemic at the time of water submersion; thus, decreased oncotic pressure was not considered to be a likely cause for the increased presence of coelomic fluid. Given that the fluid accumulation in the coelomic cavity appeared to occur simultaneously with water submersion, a postulation for the coelomic fluid was that water from the patient's enclosure had entered the coelom through the patient's wounds. The testis and epididymis are both located ventral to the kidneys and cranial to the accessory urinary bladder in the male turtle.3 Spermatozoa are a normal finding in the urine of clinically normal male turtles, as well as female turtles that have been in contact with males.6 Therefore, considerations for the presence of spermatozoa in the coelomic fluid include both traumatization to the gonads and/or contamination from the ruptured urinary bladder. An interesting observation made during the cytologic evaluation of the coelomic effusion was the relatively minimal inflammatory response. While heterophils and macrophages were present in low numbers, the spermatozoa appeared practically untouched. In small domesticated animals, the testes are considered an immune-privileged site; if exposed to surrounding tissues, a robust inflammatory response (predominantly macrophages) is anticipated (eg, sperm granuloma).2 Medications administered during the patient's hospitalization at various time points included nonsteroidal anti-inflammatory drugs (ketorolac and ketoprofen), as well as antibiotics (ceftazidime). Postulation for the lack of a significant inflammatory response includes anti-inflammatory and/or immunomodulatory effects of these medications. The timing of duodenal and urinary bladder perforations is not clear; neither plant-like material nor bacteria were observed at the time of cytologic evaluation; however, fibrinous adhesions described during necropsy suggest a degree of chronicity. Given the necessity for spermatozoa storage in both male and female turtles,3 not only traumatic mating but trauma, such as vehicular trauma, to reproductive organs in either sex may lead to spermatozoa leakage into the coelomic cavity year-round. While the presence of spermatozoa in the coelomic fluid was not a primary issue for the patient, this case allowed for the documentation of the cytologic features of spermatozoa from the Eastern River Cooter (Pseudemys concinna concinna). The authors thank Sabrina Kapp for the coordination and supervision of the patient's care. The authors have indicated that they have no affiliations or financial involvement with any organization or entity with a financial interest in, or in financial competition with, the subject matter or materials discussed in this article.}, journal={Veterinary Clinical Pathology}, publisher={Wiley}, author={Marin, Jessica and Lewbart, Gregory A. and Stowe, Devorah}, year={2022}, month={Aug} }
 @article{marin_mochizuki_mastromauro_stowe_2021, title={What is your diagnosis? Dermal mass in a dog}, volume={51}, ISSN={0275-6382 1939-165X}, url={http://dx.doi.org/10.1111/vcp.13015}, DOI={10.1111/vcp.13015}, abstractNote={Veterinary Clinical PathologyEarly View WHAT IS YOUR DIAGNOSIS? What is your diagnosis? Dermal mass in a dog Jessica Marin, Jessica Marin orcid.org/0000-0002-2451-2612 Department of Population Health and Pathobiology, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina, USASearch for more papers by this authorHiroyuki Mochizuki, Hiroyuki Mochizuki orcid.org/0000-0002-1520-0393 Department of Population Health and Pathobiology, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina, USASearch for more papers by this authorMichael Mastromauro, Michael Mastromauro Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina, USASearch for more papers by this authorDevorah M. Stowe, Corresponding Author Devorah M. Stowe damarks@ncsu.edu orcid.org/0000-0002-4058-2995 Department of Population Health and Pathobiology, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina, USA Correspondence Devorah M. Stowe, Department of Population Health and Pathobiology, College of Veterinary Medicine, North Carolina State University, 1060 William Moore Drive, Raleigh, NC 27607, USA. Email: damarks@ncsu.eduSearch for more papers by this author Jessica Marin, Jessica Marin orcid.org/0000-0002-2451-2612 Department of Population Health and Pathobiology, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina, USASearch for more papers by this authorHiroyuki Mochizuki, Hiroyuki Mochizuki orcid.org/0000-0002-1520-0393 Department of Population Health and Pathobiology, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina, USASearch for more papers by this authorMichael Mastromauro, Michael Mastromauro Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina, USASearch for more papers by this authorDevorah M. Stowe, Corresponding Author Devorah M. Stowe damarks@ncsu.edu orcid.org/0000-0002-4058-2995 Department of Population Health and Pathobiology, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina, USA Correspondence Devorah M. Stowe, Department of Population Health and Pathobiology, College of Veterinary Medicine, North Carolina State University, 1060 William Moore Drive, Raleigh, NC 27607, USA. Email: damarks@ncsu.eduSearch for more papers by this author First published: 04 November 2021 https://doi.org/10.1111/vcp.13015Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article. Early ViewOnline Version of Record before inclusion in an issue RelatedInformation}, number={1}, journal={Veterinary Clinical Pathology}, publisher={Wiley}, author={Marin, Jessica and Mochizuki, Hiroyuki and Mastromauro, Michael and Stowe, Devorah M.}, year={2021}, month={Nov}, pages={161–163} }