PMC5538085_01
Sagittal (A) and transverse (B, C) view of the scapular mass (arrow), histopathologically confirmed to be a metastatic carcinoma.
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F1
CT showed the presence of a destructive bony mass at the level of the left scapular bone (Fig. 1), with associated contrast-enhancing liver nodules.
Cytology of carcinoma metastases identified during the course of the disease: (A): left scapular mass (Wright Giemsa, 50x magnification); (B): liver (Wright Giemsa, 50x magnification); (C): left inguinal lymph node (Wright Giemsa, 50x magnification); (D): right orbital mass (Diff-Quick, 100x magnification). There are high numbers of atypical cells. They are seen in variably sized, apparently cohesive clusters. Occasional acinoid formations are found. The N:C ratio is high and anisokaryosis and anisocytosis are mild. Nuclei are medium sized, round and central to paracentral. Occasional hyperchromatic nuclei are seen. The chromatin is coarsely stippled and occasionally multiple small, round and variably prominent nucleoli are present. The cytoplasm is scant and lightly to moderately basophilic.
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F2
The cytology samples were examined by a board-certified clinical pathologist, showing the same population of atypical epithelial cells, consistent with a metastatic carcinoma (Fig. 2A-C). Seventy-seven days later, the dog's clinical examination revealed the presence of a hard, bony lesion at the level of the right periorbital area, which was confirmed to be a metastatic carcinoma on cytology (Fig. 2D).
Malignant pilomatricoma (left flank mass). Neoplastic lobule composed of epithelial cells with high nuclear/cytoplasmic ratio and occasional intracytoplasmic melanin (thick arrows). Neoplastic cells surround a central area of keratin accumulation with numerous ghost cells with faded nuclei (thin arrows). Haematoxylin and eosin, 10x magnification.
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F3
The keratinization was abrupt with formation of ghost cells (cells with faded nuclei) indicating matrical differentiation (Fig. 3).
Bone metastasis of malignant pilomatricoma (biopsy from left scapula). Epithelial cells (arrows) with high nuclear/cytoplasmic ratio and hyperchromatic nuclei infiltrate the space between trabeculae of remodeled woven bone. Haematoxylin and eosin, 10x magnification.
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F4
The biopsy collected from the left scapular mass mainly consisted of trabeculae of immature bone (remodeled bone), multifocally infiltrated by neoplastic epithelial cells (Fig. 4).
(A): transverse view of the right orbital bone metastasis (arrow); (B): sagittal view of bilateral scapular metastases at the time of the patient's last restaging. Note the arrow indicating the bone metastasis involving the right scapular bone (previously identified on radiographs) and progression of the left scapular mass when compared to the initial CT study (Fig. 1).
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F5
CT of head, thorax and abdomen was performed. CT of the head confirmed an osteolytic lesion at the level of the right maxillary bone (Fig. 5A) and the previously reported metastatic lesion at the level of the right scapular bone (Fig. 5B).