Difference between revisions of "Feline Eosinophilic Granuloma"

Revision as of 14:40, 2 August 2010

Description

Feline eosinophilic granuloma complex includes three lesions: 1)Eosinophilic ulcer which present on the lip or oral mucosa of middle-aged cats. 2)Eosinophilic plaque which present on the skin of the medial thighs and abdomen. or 3)Eosinophilic granuloma which present on the posterior aspect of the rear legs of young cats and also found on the tongue, palate and oral mucosa.

Eosinophilic granulomas of the oral cavity appear as yellow/pink raised linear lesions. They can occur on the oral mucosa, hard palate mucosa, soft palate, or the base of the tongue. Cats with eosinophilic lesions of the mouth often have concurrent skin lesions.

The cause of feline eosinophilic granuloma is unknown but it has been associated with food and insect bite allergies, atopy, immunosuppression, bacteral and viral infections.

Signalment

More commonly found in young cats (2-6 years) More common in females than males

Diagnosis

An ulcerated mass may be found at the base of the tongue or on the hard palate, the glossopalatine arches or anywhere else in the mouth.

Clinical Signs

dysphagia
halitosis
+/- anorexia

Laboratory tests

Peripheral blood eosinophilia may be present.

Biopsy

A deep biopsy specimen of the mass is required for a definitive diagnosis
Histology reveals an eosinophilic tissue infiltrate

Treatment

Medical
- Control ectoparasites
- Diet trial and skin testing may be carried out to rule out food allergy and atopy
- Antibiotics if there is evidence of a bacterial infection
- Corticosteroid therapy if the patient is refractory to the above. Treatment should be tapered gradually once a response is seen then discontinued once signs have completely disappeared.
- Chlorambucil may be useful in resistent cases

Surgical
- Surgical excision is required for large lesions that interfere with breathing or swallowing.

Prognosis

Good but the lesion can recur.

References

Tutt, C., Deeprose, J. and Crossley, D. (2007) BSAVA Manual of Canine and Feline Dentistry (3rd Edition) BSAVA

Nelson, R.W. and Couto, C.G. (2009) Small Animal Internal Medicine (Fourth Edition) Mosby Elsevier

From Pathology

This is a complex of diseases affecting skin and oral cavity mainly of cat, which include:

Oral eosinophilic granuloma
Linear granuloma of skin
Eosinophilic plaque of skin

Clinical

Any age, but usually young adults.
Mainly affects lips, may also occasionally affect frenulum of tongue.
Sometimes called "rodent ulcer "
Not neoplastic - it is an inflammatory disease but is progressive and destructive.

May see small plaque or becomes very infiltrative.
In worst cases may erode away whole nose.

Pathogenesis

Histologically lots of eosinophils, polymorphs.
Exaggerated eosinophilic response.

@@ Line 1: / Line 1: @@
-{{OpenPagesTop}}
+{{unfinished}}
-Also known as: '''''Rodent ulcer — Eosinophilic ulcer — Eosinophilic plaques — Eosinophilic granuloma'''''
-== Introduction ==
+===Description===
+Feline eosinophilic granuloma complex includes three lesions:
+)Eosinophilic ulcer which present on the lip or oral mucosa of middle-aged cats. 2)Eosinophilic plaque which present on the skin of the medial thighs and abdomen. or 3)Eosinophilic granuloma which present on the posterior aspect of the rear legs of young cats and also found on the tongue, palate and oral mucosa.
-Feline eosinophilic granuloma complex includes three types of lesions:
+Eosinophilic granulomas of the oral cavity appear as yellow/pink raised linear lesions. They can occur on the oral mucosa, hard palate mucosa, soft palate, or the base of the tongue. Cats with eosinophilic lesions of the mouth often have concurrent skin lesions.
-#Eosinophilic or rodent '''ulcers''' which present as a well circumscribed, erythematous ulcer on the lip or oral mucosa of middle-aged cats
+The cause of feline eosinophilic granuloma is unknown but it has been associated with food and insect bite allergies, atopy, immunosuppression, bacteral and viral infections.
-#Eosinophilic '''plaques''' which present as raised erythematous lesions on the skin of the medial thighs and abdomen
-#Eosinophilic or linear '''granuloma''' which present on the posterior aspect of the rear legs of young cats and also found on the [[Tongue - Anatomy & Physiology|tongue]], [[Hard Palate|hard palate]] and oral mucosa.
-Eosinophilic granulomas of the '''oral cavity''' appear as '''yellow/pink raised linear lesions'''. They can also occur on the soft palate, or the base of the tongue. Cats with eosinophilic lesions of the mouth often have concurrent skin lesions.
+=== Signalment===
+More commonly found in young cats (2-6 years)
+More common in females than males
-The cause of feline eosinophilic granuloma is unknown but it has been associated with food and insect bite allergies ([[:Category:Hypersensitivity|hypersensitivity]]), [[atopy]], immunosuppression, bacterial and viral infections.
-== Signalment ==
-More commonly found in young cats (2-6 years) and also more common in females than males. It can also occur in dogs, particularly Siberian Huskies.
+==Diagnosis==
+An ulcerated mass may be found at the base of the tongue or on the hard palate, the glossopalatine arches or anywhere else in the mouth.
-== Clinical Signs ==
+===Clinical Signs===
+*dysphagia
+*halitosis
+*+/- anorexia
-Depending on site of lesion can include dysphagia, halitosis and anorexia. Eosinophilic plaque lesions are intensely pruritic.
+===Laboratory tests===
+*Peripheral blood [[Changes in Inflammatory Cells Circulating in Blood - Pathology#Eosinophilia|eosinophilia]] may be present.
-== Diagnosis ==
+===Biopsy===
-An ulcerated mass may be found at the base of the tongue or on the hard palate, the glossopalatine arches or anywhere else in the mouth as described above. On laboratory tests, a peripheral blood [[Eosinophilia|eosinophilia]] may be present, especially for eosinophilic plaques.
+*A deep biopsy specimen of the mass is required for a definitive diagnosis
+*Histology reveals an eosinophilic tissue infiltrate
-Impression smears: Eosinophilic plaques exfoliate easily and eosinophils predominate the sample.
+==Treatment==
+*'''Medical'''
+**Control ectoparasites
+**Diet trial and skin testing may be carried out to rule out food allergy and atopy
+**[[Antibiotics]] if there is evidence of a bacterial infection
+**[[Steroids|Corticosteroid]] therapy if the patient is refractory to the above. Treatment should be tapered gradually once a response is seen then discontinued once signs have completely disappeared.
+**Chlorambucil may be useful in resistent cases
-A deep biopsy specimen of the mass is required for a definitive diagnosis.
+*'''Surgical'''
+**Surgical excision is required for large lesions that interfere with breathing or swallowing.
+==Prognosis==
+*Good but the lesion can recur.
+==References==
-== Pathology ==
+*Tutt, C., Deeprose, J. and Crossley, D. (2007) '''BSAVA Manual of Canine and Feline Dentistry (3rd Edition)''' ''BSAVA''
-Grossly, there are raised plaques, erythematous, pruritic, erosed or ulcerated areas.
-Microscopically, acanthosis, spongiosis, erosions or ulceration, predominantly eosinophilic dermatitis, possibly areas of collagen degeneration can all be found.
+*Nelson, R.W. and Couto, C.G. (2009) '''Small Animal Internal Medicine (Fourth Edition)''' ''Mosby Elsevier''
-Histology reveals:
+==From Pathology==
-:Eosinophilic ulcers: show hyperplastic, ulcerated, superficial perivascular to interstitial dermatitis. Fibrosis may also be present.
-:Eosinophilic plaques: appear as superficial hyperplasia, deep perivascular dermatitis with eosinophilia. Diffuse spongiosis of the outer root sheaths of hair follicles may also be noted.
-:Eosinophilic granulomas: reveal nodular to diffuse granulomatous dermatitis with flame figures. Eosinophils and multinucleated histiocytic giant cells are commonly found.
-== Treatment ==
+This is a complex of diseases affecting skin and [[Oral Cavity Overview - Anatomy & Physiology|oral cavity]] mainly of cat, which include:
+#Oral eosinophilic granuloma
+#Linear granuloma of skin
+#Eosinophilic plaque of skin
-Initial medical treatment is to control any ectoparasites. Secondly a diet trial and intradermal allergy testing may be carried out to rule out food allergy and atopy. If there is evidence of a bacterial infection [[Antibiotics|antibiotics]] are necessary.
+====Clinical====
+*Any age, but usually young adults.
+*Mainly affects [[Lips - Anatomy & Physiology|lips]], may also occasionally affect '''frenulum of [[Oral Cavity - Tongue - Anatomy & Physiology|tongue]]'''.
+*Sometimes called "rodent ulcer "
+*Not neoplastic - it is an inflammatory disease but is '''progressive and destructive'''.
-If the patient is refractory to the above [[Steroids|Corticosteroid]] should be administered. Treatment should be tapered gradually once a response is seen then discontinued once signs have completely disappeared.
+*May see small plaque or becomes very '''infiltrative'''.
+*In worst cases may erode away whole nose.
-Chlorambucil may also be useful in resistant cases.
+====Pathogenesis====
+*Histologically lots of eosinophils, polymorphs.
+*Exaggerated eosinophilic response.
+[[Category:Oral_Cavity_and_Gingiva_-_Pathology]][[Category:Cat]]
-Surgical excision is required for large lesions that interfere with breathing or swallowing.
+[[Category:To_Do_-_Caz]]
-== Prognosis ==
-Good if the allergy is identified and addressed. Otherwise the lesion can recur and lifelong steroid treatment may be necessary.
-{{Learning
-|flashcards = [[Veterinary Dentistry Q&A 05]]<br>[[Small Animal Dermatology Q&A 05]]
-|literature search = [http://www.cabdirect.org/search.html?q=%28title%3A%28%22Eosinophilic+Granuloma%22%29+OR+title%3A%28%22Rodent+ulcer%22%29+OR+title%3A%28%22Eosinophilic+ulcer%22%29+OR+title%3A%28%22Eosinophilic+plaques%22%29%29+AND+od%3A%28cats%29 Feline Eosinophilic Granuloma publications]
-|Vetstream = [https://www.vetstream.com/felis/Content/Disease/dis60003.asp Eosinophilic Granuloma]
-}}
-== References ==
-Tutt, C., Deeprose, J. and Crossley, D. (2007) '''BSAVA Manual of Canine and Feline Dentistry'''(3rd Edition) ''BSAVA''
-Nelson, R.W. and Couto, C.G. (2009) '''Small Animal Internal Medicine''' (Fourth Edition) Mosby Elsevier.
-Norsworthy, G. (2010) '''The Feline Patient''' ''John Wiley and Sons''
-{{review}}
-{{OpenPages}}
-[[Category:Integumentary_System_-_Pathology]] [[Category:Oral_Cavity_and_Gingiva_-_Pathology]] [[Category:Oral_Diseases_-_Cat]] [[Category:Dermatological_Diseases_-_Cat]] [[Category:Expert_Review - Small Animal]] [[Category:Allergic_Skin_Diseases]]
-[[Category:Oral Proliferations]]
-[[Category:LisaM reviewing]]