Atlas of Canine and Feline Oncocytomorphology

-:....•....

Contributia autorilor la realizarea prezentului ATLAS este:Nicolae Manolescu 40%Emilia Balint 60%

Authors contribution for achievement of this ATLAS is:Nicolae Manolescu 40%Emilia Balint 60%

© Reproducerea interzisa. Toate drepturile apartin autorilor.© Reproduction prohibited. All rights reserved to the autors.

Descrierea CIP a Bibliotecii Nalionale a RomanieiAtlas de oncocitomorfologie la canide ~i feline - Atlas of canine and

feline oncocytomorfology. - Bucure~ti : Curtea Veche, 2009ISBN 978-973-1983-26-4

619

Editura Curtea Veche

Str. Echinoctiului nr. 57, Sector 5, 050206, Bucure~ti

Editura acreditata CNCSIS (Consiliul National al Cercetarii $tiintifice din invatamantul Superior)cod 65/2008

Tipografia CURTEA VECHE TRADING S.R.L.

Responsabilitatea pentru continutull?tiintific al cartiirevine In exclusivitate autorilor

INTRODUCERE

Un atlas despre citopatologia oncologica la caine 9i pisica este rar Intalnit In

literatura de specialitate, Insa acest volum speram sa fie un ghid extrem de util

speciali9tilor medici veterinari oncologi pentru elaborarea unui diagnostic pozitiv 9i

diferentialln oncopatiile maligne, la cele doua specii de animale. Pentru colectivul nostruacest lucru se Inscrie ca 0 veritabila provocare, din care se spera sa ie9im In cele mai

bune conditii, cu sufragiile unei activitati bine facute, Implinite, deoarece, pentru ambii

autori exista 0 imensa motivatie.

Motivatiile noastre sunt legate de necesitatea ca medicii veterinari speciali9ti In

anatomie patologica 9i/sau oncologie, care sunt dedicati citodiagnosticului oncologic, sa

posede un material mai mult sau mai putin complet, care sa-i poata ajuta la elaborarea

diagnosticului de oncologie maligna la animalele de companie.

Lucrari expasate, cu subiecte punctiforme, care trateaza aspecte ale

citodiagnosticului folosit atat In medicina veterinara cat 9i In cea umana au fost publicate

In ultimii 50 de ani 9i Inca se mai publica. Primul tratat care a abordat problematicacitodiagnosticului In oncologia umana a fost publicat In Romania, In 1968, In Editura

Medicala sub semnatura unui eminent colectiv de speciali9ti, In frunte cu marele citolog

oncolog Dr. V. lonescu.

Un astfel de elaborat In tara noastra, pentru oncologia veterinara nu a fost publicat

pana In momentul de fata. Avand 0 experienta care Insumeaza peste jumatate de secol,

fiind In acela9i timp experimentator, anatomo-patolog, oncolog, clinician 9i terapeut, am

putut observa dezvoltarea unor procese canceroase de la 0 unica celula pana la

constituirea unei tumori. Acestea ne permit astazi sa ne exprimam pareri decisive Inaprecierea 9i situarea citodiagnosticului In practica medical-veterinara, ca 0 valoare

intrinseca, cat 9i situarea corecta a acesteia In competitie cu alte mijloace de diagnostic,

de care profesia noastra dispune.

Prin colaborarea mea cu d-na Dr. Emilia Balint, eleva prestigioasa, medic oncolog

specialist, care de peste 15 ani practica zilnic, atat diagnosticul, cat 9i toate elementelespecifice Invatamantului 9i cercetarii 9tiintifice In domeniul oncologiei comparate, am

reu9it printr-o activitate continua 9i asidua sa strangem materialul propriu, din cadrul

cazuisticii noastre, pe care II prezentam sub forma de atlas.

In cele ce urmeaza dorim sa prezentam avantajele, dar 9i Iimitele practicarii

citodiagnosticului In general 9i al animalelor de companie In special.In cadrul avantajelor putem enumera:

1) Punctia aspirativa (biopunctia) este cea mai facila abordare a unei formatiuni

tumorale sau a unui tesut, fara nici un fel de risco

3

~

NiCOLAE MANOLESCU, EMILIA BALINT

2) Frotiurile obtinute din punctii sau amprentele obtinute din tumori excizate, se

coloreaza simplu ~i rapid (MGG sau alte metode) (Intre 5-30 minute).3) Citologul poate stabili un diagnostic diferentiallntre un proces inflamator acut

sau cronic; un proces discrazic; un proces tumoral benign fata de unul malignastfel identificand ~i precizand baza celulara a proliferarii tumorale.

4) Citologic se poate stabili G-ul celular al unei proliferari maligne.

5) Citologul poate dimensiona raportul dintre celulele In diviziune fata de totalulcelulelor tumorale, stabilind astfel gradul de malignitate.

6) Se poate alcatui mitograma, fazele mitozei cat ~i frecventa In populatia celularaa celulelor In amitoza.

7) Citologul stabile~te gradul ~i tipologia celulelor implicate activ In raspunsulimun al macroorganismului.

8) In cazul limfomului malign, citologul stabile~te existenta sau absentafenomenului de descarcare citemica.

9) Citodiagnosticul este metoda de electie pentru studiul morfologic al sangeluiperiferic total ~i alleucoconcitratului, In special.

10) Reprezinta de asemenea metoda de electie utilizata pentru investigareamaduvei hematopoietice, a lichidelor din cavitatile preformate (peritoneu,pleura, pericard ), inclusiv cavitatea articulara.

11) Punctatul permite In mod deosebit completarea investigatiilor citochimice,citoenzimatice ~i de folosire a tehnicilor de fluorescenta.

La toate aceste avantaje deosebite retinem ~i limite/e, acestei tehnici. Acesteasunt:

1) Examenul citologic trebuie completat cu examenul histopatologic, deoarece

acesta din urma precizeaza gradul de infiltrare a procesului tumoral, relatia cu

pachetul vascular existent In parenchimul tumorii (vase limfatice, capilare,vene, artere) ~i eventuala lor trombozare partiala cu embolusuri tumorale.

2) Examenul citologic nu este suficient pentru 0 apreciere a TNM-ului, comparativcu examenul anatomo-histologic.

3) Examenul histopatologic ofera relatii concludente, cu privire la gradul de

evolutie al unei leziuni displazice simple, displazice agravate, carcinomintraepitelial, carcinom microinvaziv, carcinom invaziv, etc.

Desigur ca examenul histopatologic ramane pe soclu, ca metoda de baza la care

se apeleaza constant ~i perfect conclusiv, dar pentru ca examenul citomorfologic neofera un diagnostic rapid, trebuie impus ca metoda de baza, permitand clinicianuluiinstituirea celei mai adecvate terapii anticanceroase.

Trebuie sa ne obi~nuim ~i deci sa introducem In practica dezideratul major pentru

animalele de companie (caine ~i pisica) a termenului de "urgenta. terapeutica.

4

Atlas de oncocitomorfologie la canide $i feline / Atlas of canine and feline oncocytomorphology

oncologica". Acest termen se justifica perfect 1inand cont ca 6-7 ani de via1a la om

reprezinta numai un an de via1a pentru animalele de companie. Daca facem un calculsimplu, 0 zi de via1a la caine ~i pisica reprezinta 0 saptamana din via1a omului. Deci 10zlle in medie, intarziere cauzata de durata examenului histopatologic, reprezinta de fapt,

pentru aceste specii 0 intarziere de circa 2 luni, pana la instituirea terapiei adecvate.Poate fi prea tarziu, in acest rastimp putand sa apara fie recidive locoregionale, cat ~i

metastaze la distan1a. Acestea sunt argumentele ~i motiva1ii1e care ne-au asigurat"combustibilul cel mai nobil", absolut indispensabil propulsiei pentru realizarea

prezentului elaborat. Pentru introducerea in practica larga a dezideratelor de mai sus,este imperios necesar a organiza un judicios inva1amant post universitar de oncologie

comparata, care sa pregateasca adevara1i oncologi medici veterinari, condu~i decadrele didactice care fac parte din ~coala noastra.

Autorii

5

INTRODUCTION

The subject "Cytomorphological aspects in canine and feline oncology" is rarelyencountered in literature; nevertheless we hope that this guide will be extremely useful toall veterinarians who are specialize in oncology and who are supposed to make a positive

and differential diagnosis of the malignant oncopathy to the two species. For our team

this atlas is entered as a true challenge, which is hoped to get out the best conditions, thesatisfaction of a well made, fulfilled, because, for both authors there is a huge motivation.

Our motivations are related to the fact that veterinarians specialize in pathological

anatomy and/or oncology and who are committed to the oncological cytodiagnosis. should have at their disposal a material that is more or less complete and that can help

them to elaborate the diagnosis of malignant oncology in pets.

Over the last 50 years, several papers and books, with punctual topics, dealing withaspects of the cytodiagnosis used both in human and veterinary medicine have been

published. The firs book that approached the problematics of the cytodiagnosis in the

human oncology was published in Romania in 1968 by the Medical Publishing House,

under the signature of a preeminent team of specialists led by the great Romanianoncologist Dr.V.lonescu.

Such a treaty drafted in our country, for veterinary oncology has not been published

until now. With an experience which amount to over half a century, being anexperimenter, a clinician, a therapist and anatomo-pathologist, , we could see thedevelopment of cancerous processes from a single cell up to the formation of tumors.

This allows me now to express my opinion in critical appreciation and location

cytodiagnosis in medical and veterinary practice as an intrinsic value and the correct

location in competition with other means of diagnosis that our profession has.

The same is valid for my collaborator, Dr. Emilia Balint, who was a brilliant student,

and who is at present a veterinarian specialized in oncology. For more than thirteen

years, she has been making diagnoses daily; she has also been making use of all the

elements specific to the scientific research in the domain of comparative oncology.What follows is a list of the advantages and disadvantages of the practice of

cytodiagnosis, in general, with special reference to pets.

The advantages of cytodiagnosis

1) The aspiration punction (biopunction) is the easiest approach to a tumor or to atissue, with no risk whatsoever.

2) The smears obtained from punctions or the tissue prints obtained from theexcised tumors are fast and easy to colorate (MGG or other techniques)

(maxim 30', in case of emergency in 5").

6

Atlas de oncocitomorfologie la can ide $i feline / Atlas of canine and feline oncocytomorphology

3) The cytologist establishes the presence of a chronic, acute inflammatory

process,' a dyscrasic process, the presence of a benign tumoral process by

differentiating it from a tumoral malignant process, by identifying the cellularbase of its proliferation.

4) The cellular G of a malign proliferation can be established.

5) The cytologist can assess the ratio of the cells in division to the total of tumoralcells.

6) It draws up the mitogram, the stages of the mitosis as well as the frequency

within the cellular population of cells in amitosis.

7) The cytologist can assess the degree and the typology of the cells actively

involved in the immune answer of the macro-organism.

8) In the case of the malignant lymphoma the cytologist establishes whether the

phenomenon of citemic discharge is present.9) The cytodiagnosis is the method of election for the study of the peripherical

blood, especially for underlining the leukemia-like reactions and theleucocitoconcentrate .

10) It is also the method of election for the investigation of the hematopoetic spine,

of the liquids within the pre-formed cavities ( peritoneum, pleura, pericardium),

the articulary cavity inclusively.11) Of particular importance is the fact that it allows for necessary cytochemical,

cytoenzymatic investigations and investigations entailing use of fluorescence.

These are special advantages to which we must add the list of limits:

1) The cytological test must be completed by the histopathological test, because

the latter states the degree of infiltration of the process, the relationship with the existent

vascular package within the parenchyma of the tumour ( lymphatic, capillary vessels,veins, arteries) and possible partial thrombosis with tumoral embols

2) The cytological test does not allow for statements related to TNM-in comparison

to the anatomo-histological test which does allow for such statements.

3) The histopathological test offers sure relations relative to the degree of evolutionof a simple dysplasic lesion, of an acute dysplasic lesion, intraepithelial carcinoma,micro-invasive carcinoma, invasive carcinoma etc.

The biopsic histopathologic test remains the best method to be used constantly and

it is perfectly conclusive.

But for a very rapid diagnosis ( less than 112 h as compared to days and weeks

the duration of a histopathogical test) we consider that the cytological test must beimposed as a fundamental test that offers immediately the first diagnosis that allows thechoice of the most appropriate anti-cancer therapy. We must get used to and therefore

7


introduce in practice the major imperative for pets ( cats, dogs) of the term oncologicaltherapeutic emergency. This term has perfect justification if one takes into consideration

the fact that 6-7 man-years are only one dog or cat-year. That is to say, one day in a lifeof a pet amounts to a week in the life of a human. Therefore, an average of 10 days ofdelay caused by the duration of the histopathologic test represents a delay of 2 months

for a pet. During this time, both loco-regional relapses and metastasis can occur.

The only way out is the cytological test, in spite of the disadvantages it has incomparison with the histopahological one. These are the arguments and the motivation

that ensured us "the noblest fuel", which is absolutely indispensable for the propulsionto write the present book.

In order to put into practice the ideas mentioned above, it is crucial for us to havea good post-graduate educational system of comparative oncology that should prepare

genuine veterinarians specialized in oncology, led by the scholars who belong to ourschool.

The authors

8

CAPITOLUL 2/ CHAPTER 2

CLASIFICAREA NEOPLAZIILOR MALIGNE

In cele ce urmeaza vom incerca sa realizam 0 clasificare a neoplaziilor maligne la

canide ~i feline intalnite in practica noastra. Deci nu vom cita toate formele embriomorfologice care pot fi -,ntalnite in practica medicala.

A. Hemopatii maligne

1. Leucemiile

1.1 Acute:

1.1.1 Limfoblastice (LLA):- "T" celulare- ,,8" celulare- leucemia cu celule NK

1.1.2 Nonlimfoblastice:

- leucemia eritroida- leucemia monocitara- leucemia histiomonocitara

- leucemia mieloblastica: - micromieloblastica- macromieloblastica

- megacariocitara

- leucemia promielocitara1.2 Cronice:

1.2.1 Limfocitare (LLC)- "T" celulare- ,,8" celulare

- cu celule paroase (Hairy cell- Leukemia)- leucemia cu celule NK

1.2.2 Mieloida:- neutrofilica- eozinofilica- bazofilica- mastocitara

2. Limfoame maligne2.1 Limfom malign Hodgkinian

9

10


2.2 Limfom malign non- Hodgkinian

a) Limfom malign ,,8" celular:- Centrocitic

- Centroblastic

- Imunoblastic

- Plasmoblastic - plasmocitar

- Tip Waldenstrom

b) Limfom malign "T"celular:

- limfom Sezary

- limfom Mycosis Fongoides

c) Limfom malign histiocitar3. Tezaurismoze

B. Tumori maligne epiteliale

1. Carcinomul pulmonar cu celule mari

2. Carcinomul bazocelular tegumentar

3. Carcinomul nediferential tegumentar4. Carcinomul squamos (epidermoid)4.bis Adamantinomul

5. Seminomul testicular

6. Sertoliomul testicular

7. Luteomul ovarian

8. Carcinomul non invaziv (intraepitelial) al vezicii urinare

9. Carcinomul papilifer vegetant invaziv al vezicii urinare

10. Adenocarcinomul vegetant al prostatei

11. Carcinomul intraepitelial (displazia agravata-intraductala) al glandeimamare

12. Carcinomul vegetant al glandei mamare

13. Carcinomul solid al glandei mamare

14. Adenocarcinomul glandei mamare

15. Carcinomul vegetant al cavitatii nazale

16. Adenocarcinomul cavitatii nazale17. Carcinomul tiroidian.

C. Tumori maligne mezenchimale (sarcoame)

1. Fibrosarcomul

2. Rabdomiosarcom

3. Osteosarcomul:


- osteoblastic

-' osteocitic- osteoclastic

4. Condrosarcom

5. Sinoviomul malign6. Tumora Abricosov

7. Kupffer-cell-sarcoma

8. Sarcomul histiocitar tegumentar9. Mastocitomul mucoaselor

D. Tumori nervoase si ale sistemului APUD:,D.1. Melanomul malign

D.2. Ganglioneuromul

E. Tumori mixte (epitelial - mezenchimale):

E.1. Carcinosarcomul mamarE.2. Mezoteliomul:

- limfocitar-like

- histiocitar-like

- epitelial-like

11


THE CLASSIFICATION OF MALIGNANT NEOPLASIA IN PETS

What follows is a classification of the malignant neoplasia in pets ( only those we have

met in our practice). So we will not mention all embryo-morphological forms that can bemet in the medical practice.

A. Malignant hemopathies

1. Leukemia:

1.1 Acute:

1.1.1 Lymfoblastic (LLA):- "T" cellular- "8" cellular

- N.K. cell

1.1.2 Nonlimfoblastic types of leukemia:

- erythroid leukemia

- monocitary leukemia- histiomonocitary leukemia

- myeloblastic leukemia:

- micromyeloblastic

- macromyleoblastic

- megakaryocitic

- promyelocytary leukemia1.2. Chronic:

1.2.1 Lymfocytary (LLC):- "T" cellular- "8" cellular

- Hairy cell-Leukemia

- N.K. cellular

1.2.2 Myeloid:

- neutrophilic

- eozinophilic

- basophilic

- mastocytary

12


2. Malignant lymphomas

2.1 Malignant Hodgkin's lymphoma

2.2 Malignant non- Hodgkin's lymphoma

a) ,,8" cellular malignant lymphoma:

- Centrocytic- Centroblastic

- Imunoblastic

- Plasmoblastic - plasmocytary

- Type Waldenstrbm

b)"T" cellular malignant lymphoma

- Sezary lymphoma

- Mycosis Fongoides lymphoma

c) Histiocitary malignant lymphoma3. Thesaurismosis

B. Epithelial malignant tumors

1. Pulmonary carcinoma with big cells

2. Tegumentary baso-cellular carcinoma

3. Tegumentary non-differential carcinoma

4. Squamos (epidermoidal )carcinoma4. bis Adamantinoma

5. Testicular seminoma

6. Testicular sertolioma

7. Ovarian luteoma

8. Non-invasive (intraepitelial) carcinoma of the urinary bladder

9. Invasive vegetant papillary carcinoma of the urinary bladder

10. Vegetant adenocarcinoma of the prostate

11. Intraepithelial carcinoma (aggravated-intraductal dysplasia) of the

mammary gland

12. Vegetant carcinoma of the mammary gland

13. The solid carcinoma of the mammary gland

14. The adenocarcinoma of the mammary gland

15. The vegetant carcinoma of the nasal cavity

16. The adenocarcinoma of the nasal cavity17. Tiroidian carcinoma

13

14


c. Mesenchymal malignant tumours (sarcomas)

1. Fibrosarcoma2. Rabdomiosarcoma3. Osteosarcoma

- Osteoblastic -osteosarcoma

- Osteocytic osteosarcom of the bone- Osteoclastic osteosarcoma of the bone

4. Chondrosarcoma of the bone

5. Malignant sinovioma

6. Abricosov tongue tumor7. Kupffer-cell-sarcoma8. Tegumentary histiocitary sarcoma9. Mastocytoma of the mucous membranes

D. Nervous tumors and of the APUD system:

D.1. Malignant melanomaD.2. Ganglioneuroma

E. Mix (epithelial - mesenchymal) tumours:

E.1. Mammary carcinosarcomaE.2. Mesothelioma:

- Iymfocytary-Iike- histiocytary-like

- epithelial-like

CA~ITOLUL3_1 CHAPtER.3

REACTIILE LEUCEMOIDE,

Reactiile leucemoide sunt stari

pasagere (efemeroide) care au 0

etiologie extrem de diversificata 9i de

multe ori neprecizata, care se traduce

printr-o proliferare a unei linii celulare

leucocitare la nivelul sangelui periferic. In

fata acestor cazuri medicul specialist

citomorfolog Intampina mari dificultati destabilire a diagnosticului pozitiv 9i

diferential Intre 0 reactie leucemoida, undebut al unei leucemii vera sau 0

leucemie vera. In cazul reactiilorleucemoide este necesara repetarea

examenului hematologic dupa 14-21 zile

pentru a surprinde fie disparitia celulelor

tinere 9i atipice, fie proliferarea unei liniicelulare, deci debutul unei leucemii vera.

De multe ori In absenta unor tablouri

clinice, specifice unor boli, reactialeucemoida este surprinsa In urma unui

examen hematologic de rutina.Examenul citomorfologic (fig. 1-8).

Din punct de vedere citomorfologic

reactiile leucemoide se prezinta In 3forme:

Forma granulocitara (fig. 1-2) In

frotiul de sange identificam prezentagranulocitelor neutrofile adulte, alaturi de

elemente celulare tinere (metamielocite

9i rare mielocite), una dintre etiologiipoate fi Babesioza pentru specia canina.

LEUKEMOID REACTIONS

Leukemoid reactions are passing

(ephemeral) states that have a very

diversified etiology, which is impossible to

define most of the time, translated into the

proliferation of a leucocitary cellular line

(cell lines) at the level of the peripheral

blood. When confronted with such a case,

the specialist in ctytomorphology finds it

difficult to establish the positive and

differential diagnosis (In front of these

cases the specialist in ctytomorphology

experiencing great difficulty in establishing

a positive and differential diagnosis

reaction), whether this is a leukemia vera,

a leukemoid reaction or the beginning of aleukemia vera. In the case of leukemoid

reactions it is necessary to repeat the

hematological test after 14-21 days to

capture the disappearance of the young

and atypical cells, or the proliferation of acellular line.

Often, due to the lack of a clinical

picture, the leukemoid reaction is

discovered during a routine hematologicaltest.

Cytomorphological test (fig. 1-8)

From a cytomorphological point ofview the leukemoid reactions are

classified in 3 forms:

15


Forma Iimfocitara (fig. 3-5)In aceasta forma In afara de

modificarea cantitativa a leucocitelor

Iimfocitare se remarca, indiferent de

specie 0 pregnanta modificare calitativa,

exprimata prin prezen1a de prolimfocite,~i

limfobla~ti. La specia canina (fig. 12)modificarea are originea In infestarea cuparazitul Babesia Canis, iar In fig. 14 la

aceea~i specie reac1ia leucemoida a fostprovocata de Haemobartonella sp.

Forma monocitara (fig. 6-8)In aceasta forma elementele mono

citare sunt crescute cantitativ, prezentand

modificari calitative In acela~i timp. Seobserva atat caracterul "atipic", cat ~icaracterul de "blast". Se constata lipsa

nucleoli lor ~i celulelor In diviziune.La specia canina ~i aceasta forma

celulara poate fi datorata agentuluipatologic Haemobartonella.

16

Granulocyte-like form (fig.1-2) In the

blood smear we identify the presence ofthe adult neutrophilic granulocytes, nextto young cellular elements (metamyelocytes and rare myelocytes ). In ourcase, the etiology was Babesiosis for thecanine species.

Lymphocyte form (fig. 3-5)In this form apart from the quantitative

modification of Iymphocitary leucocytes,

there is also, regardless of species, agreat qualitative modification, expressed

though the presence of pro-lymphocytesand Iymphoblasts. In the canine species

(fig.12), the modification has its origin inthe infestation with the parasite Babesia

Canis, and in fig.14, in the same species

the leukemoid reaction was caused byHemobartonella.

Monocitary form (fig. 6-8)In this form the monocitary elements

are raised quantitative a lot and there arequalitative modifications in the same

time. It can be observed the "atypical'feature as well as the "blast" feature. It is

important that the nucleolis are missing,as well as the cells during division.

In the canine species this cellular form

can be due also to the pathologic agentHemobartonella.


Fig. 1

r

Fig. 2

17

Dc

.LN17V8V17lw3'n:JS370NVW3V70:J/N

LlMFORETICULOZELEREACTIVE

Pentru 0 mai buna Intelegere acapitolelor de limfoame maligne non hod

gkiniene ~i leucemii, este necesar ca

medicii veterinari speciali~ti, sa cunoascarelatiile dintre cele doua capitole, cel allimfo-reticulozelor reactive, cel al

reactiilor leucemoide ~i leucemic-like.Pentru a diagnostica din punct de vedere

cito-morfologic 0 limfadenopatie externa,trebuie sa se cunoasca cu exactitate

tabloul citomorfologic al leucemiilor ~ilimfoamelor maligne pentru un diagnosticpozitiv, precum ~i statusurile reactive dela acest nivel.

Examenul citomorfologic (fig. 1-7)se releva existenta a 4 structuri care,

anatomo-clinic se exprima quasi identicprin aparitia adenopatiei.

Acestea se caracterizeaza astfel:

a) Statusul de Iimforeticulita acuta

purulenta sau nonpurulenta nespecifica.Clinic: limfonodul tumefiat este

dureros, putand fi dur sau fluctuent,

aderent sau nu de tegument ~i de planul

anatomic profund. Se pune In evidentacoarda limfatica. Sa pot vizualiza traiectefistulare active.

Citologic: dominanta celulara este un

amestec de neutrofile ~i macrofage(fig. 1) cu prezenta corpilor bacterieni sau

REACTIVELYMPHORETICULOSES

For a better understanding of the

chapters on malignant non-Hodgkin'slymphomas and leukemias, should be

brought into question for the experts

veterinarians, two correlative chapters,namely the reactive lymphoreticuloses,the leukemoid and leukemic-like

reactions. The person who must

diagnose an external lymphadenopathy

in a pet should know exactly thecytomorphological table of leukemias and

malignant lymphomas for a positivediagnosis, as well as the information

offered by the reactive states at this level

of the lymph node whose volume hasincreased.

The cytomorphological examination (fig.1-7) reveals the existence of 4structures which, from an anatomo

clinical point of view, are expressedquasi-identically through the occurrence

of adenopathy.These structures may be characterized

as follows:

a) the status of non-specific nonsuppurative or suppurative acuteIymphoreticulitis

Clinically: the tumefied lymph node is

painful and it can be hard or fluctuant,

adherent or non-adherent to the tegu-

21

NICOLAE MANOLESCU, EMILIA BALINT

a hifelor micotice care a declan~atprocesul. Imaginea normala a Iimfonodului, dominata de elementele limfocitoreticulare este Tnlocuita cu celule

specifice tesutului de granulatie.b) Statusul de Iim fore ticulita

cronica nespecifica (fig. 2)Clinic: limfonodul tumefiat nu este

dureros, este dur ~i aderent de tegument,nu e prezenta coarda limfatica.

Citologic: Structura citomorfologicalimfonodala este remaniata profund Tnsensul unei hiperplazii reticulare, pefondul celular limfocitar adult alaturi de

celule fibrocitare ~i mastocitare cuabsenta elementelor blastice.

c) Statusul de Iimforeticulitacronica specifica. In aceasta categorie

vom descrie numai granulomul TBC.Clinic: aspectul este de limfonod

boselat, nedureros ~i aderent de planul

profund, rar se poate observa 0 aderentala planul superficial tegumentar.

Citologic: apare exprimarea clasica a

granulomului TBC - cu prezenta decelule epitelioide (ovoidale sub aspect denuclei liberi, fara citoplasma

identificabila). Nucleii sunt oligocromi cucromatina laxa, fara exprimare anucleoli lor. Din loc Tnloc se gasesc celule

gigante de tip Langhans - adica celule de

50-6011 cu citoplasma larga, acidofila ~icu 0 coroana periferica de nuclei.Numarul acestora variaza de la 3-4 la 10

15 nuclei. Nucleii prezinta 0 importantatachicromazie fara a exprima prezenta

nucleolilor. In - frotiu, pe langa celulele

Langhas se identifica limfocite adulte,

22

ment and to the deep anatomical plane.The lymphatic chord is made evident.

You can view active fistular trajectories.Cytologically: the cellular dominant is

a mixture of neutrophiles and macro

phages (fig. 1), with the presence ofbacterial bodies or of the mycotic hyphaethat triggered the process.

The normal image of the lymph node,

dominated by reticulare cells is replaced

with specific cells of the granulationtissue.

b) The status of non-specificchronic Iymphoreticulitis (fig. 2)

Clinically: the tumefied lymph node is-not painful, it is hard and adherent the

tegument. There is no lymphatic chord.

Cytologically: the Iymphonodal cytomorphological structure is deeplyreshuffle- in the sense of a reticular

hyperplasia on the adult Iymphocitarycellular background -the lack of blastic

elements next to fibrocitary andmastocitary cells.

c) The status of specific chronicIymphoreticulitis. In this category wewill describe only the TB granuloma.

Clinically: bosselated lymph node, not

painful, adherent to the deep plan, onlyvery rarely can one notice adherence to

the shallow tegumentary plan.Cytologically: the classical expression

occurrence of TB granuloma-with

epitheloid cells (ovoid aspects as the

form of free nuclei, yvith no identifiablecytoplasm). The nuclei are oligo-chrome

with lax chromatin, without an expressionof nucleoli. From place to place there are


plasmocite, macrofage 9i fibroblaste.

d) Statusul, de Iimforeticulozacronica imunoreactiva (fig. 3 - 7).

Clinic:se manifesta ca orice limfo

reticuloza cronica nespecifica, anteriordescrisa.

Citologic: Pe fondul celular limfocitaradult specific structurii limfonodale, se

constata aparitia unei populatii rare deimunobla9ti, a unei intense prezente decelule proplasmocitare 9i plasmocitare.Acest aspect trebuie corect interpretat 9i

diferentiat de proliferarile plasmocitare 9ilimfoplasmocitare maligne. In cazuldescris nu se identifica nici mitoze 9i niciatipii celulare.

giant cells of the Langhans type- that iscells- of 50-60 I-l with a large, acidophilic

cytoplasm and with a peripherical crown

aspect of nuclei. The number varies fromseveral to 10-15. The nuclei represent an

important tahicromasia withoutexpressing the presence of nucleoli. Inthe smear there are many adult

lymphocytes, plasmocytes, macrophagesand fibroblasts which identify with the

Longhas cells.d) The status of immuno-reactive

chronic lymph ore tic ulitis (fig.3 - 7)Clinically: it manifests itself like any

non-specific chronic Iymphoreticulitis,described previously.

Cytologically: the image is of a lymphnode greatly changed in the sense of the

emergence of a rare population ofimmunoblasts, of an intense presence of

plasmocitary cells and plasomocitary onthe adult cellular Iymphocitary

background specific to the Iymphonodalstructure. This aspect should be correctly

interpreted and differentiated from

malignant plasmocitary and Iympoplasmocitary proliferations. In the casedescribed are not identified mitoses orcellular abnormalities.

23

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GRANULOMUL EOZINOFILIC

In aceasta forma tumorala nu este

obligatorie prezenta in sangele periferic agranulocitelor eozinofilice, diagnosticul

pozitiv se poate pune pe baza

examenului citomorfologic al neoforma

tiunii solide sau ulcerate.Aceasta forma de neoplazie cu malig

nitate medie face parte din cadruldezordinilor maligne ale sistemului

celular hematopoietic.

Se poate identifica sub trei forme

topografice- forma tisulara tegumentara sau

mucotegumentara;- forma sangvina in cadrul

reactiilor leucemoide;- forma mixta - tegumentara ~i

sangvina.

Forma tegumentara sau mucotegumentara este u~or de diagnosticat

macroscopic deoarece leziunea prezinta

un aspect ulcerativ caracteristic. Cito

morfologic granulomul eozinofilic se

exprima prin prezenta unui infiltratunicelular compus din granulocite

eozinofile atat adulte cat ~i tinere.

Diagnosticul diferential prin examencitomorfologic trebuie sa se faca cucarcinomul bazocelular, care evolueazaanatomoclinic sub forma ulcerativa.

Forma sangvina care apare ca 0 reactie

THE EOSINOPHILICGRANULOMA

In this tumor form is not mandatory

presence in granulocytes of peripheralblood eosimophilia, positive diagnosis

can be put on the examination, ofcitomorphologic solid or ulceratedneoformations.

This form of neoplasia of medium

malignity belongs to the class ofmalignant disorders of the hematopoietic

cellular system.We can identify three topog(aphical

forms:

- mucotegumentary or tegumen

tary tissular form- leukemoide sanguine form

mix form - tegumentary and

sanguineThe tegumentary or mucotegumen

tary form is easily to diagnose from

macroscopic perspective because of thelesion has a characteristic appearance

ulcerative. From the cytomorphological

point of view granuloma eosinophilia is

expressed by the presence of unicellularinfiltrate composed of granulocytes

eosinophilic both adult and young.

Differential diagnosis by cytomorpho

logical examination must be made withbazocelular carcinoma, which develops

29

-


leucemoida ~i care la examenul frotiului

de sange periferic total sau a LCT-Iuiprezinta un numar mare de granulocite

eozinofile circulante, adulte ~i tinere

(metamielocite ~i mielocite eozinofile),iar In formula leucocitara granulociteleeozinofile reprezinta un procent depeste 40%.

Diagnosticul diferential se face cu:1) Leucemia vera eozinofilica In

care, pe langa celulele descrise mai sus

In circulatie se gasesc blaste eozinofiliceInalte de tipul promielocitului eozinofilic,iar procentul granulocitelor eozinofilice

ajunge Intre 50 - 80%

2) Reaclia eozinofilica consecutivunei stari alergice sau parazitar active.In aceasta situatie eozinofilele sunt celuleadulte ~i nu depa~esc 20-30% (fig. 1 - 4).

30

as ulcerative anatomoclinic. The

sanguine leukemiode form, presents in

the total peripheral blood smear or in theLCT a large number of circulating.eosinophilic granulocytes and they areboth young and adult (eozinophilicmetamyelocytes and myelocytes). In the

hemogram the eosinophilic granulocytesrepresent a percent of more than 40%.

The differential diagnosis of this formis made in comparison with :

1) Eosinophilic leukemia vera. In this

case, apart from the cells describedabove, there are high eosinophilic blasts

of the eosinophilic promyelocyte type incirculation, and the percentage ofeosinophilic granulocytes is between 5080%.

2) with the eosinophilic reaction after

an allergic or parasitary-active state. Inthis situation the eosinophilicgranulocytes are adult cells and do notexceed 20-30% (fig. 1 - 4).


Fig. 1

Fig. 2

31

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CA~IIOLUL.6J CHA~IER 6

LEUCEMIILE

Fig. 1 - 50. Acestui capitol am acordat

o iconografie de 50 de imagini pentru caleucemiile la animalele de companie

(caine ~i pisica) ocupa cel de-al doilea loc

In ceea ce prive~te incidenta In cadrul

hemopatiilor maligne, primul loc fiind

ocupat de limfoamele maligne. Compa

rativ cu limfoamele maligne, diagnosticulleucemiilor este mult facil, datorita

exprimarii In sangele periferic a celulelor

proliferate malign, provenind din teritoriul

maduvei hematopoetice. Examenul

hematologic cantitativ ~i calitativ este

concludent ~i hotarator pentru sustinerea

unui diagnostic de leucemie, de cele mai

multe ori constituind 0 veritabila surprizala un control de rutina.

Examenul citomorfologic Prin

aceasta investigatie se stabile~te atat

baza celulara proliferata cat ~i forma

clinic evolutiva. Nu vom intra In polemici

privind clasificarea, deoarece vom

prezenta In acest atlas cazuistica proprie

Insotita de un scurt comentariu pentru

interpretarea imagisticii.

Astfel prezentam:

1) Leucemia limfocitara acuta "T"

celulara (LLA "T") - fig. 1.

2) Leucemia Iimfocitara acuta ,,8"

celulara (LLA ,,8" ) - fig. 2 - 4.

LEUKEMIAS

Fig.1 - 50. For this chapter we

provided an iconography consisting in 50

images for Leukemia pets (dog and cat);

leukemias occupies the second place as

regards the incidence of malignant

homeopathies, the first place is occupies

by malignant lymphomas. If compared to

malignant lymphomas, leukemias

diagnose is easy, because expression of

malignantly proliferated cells in the

peripheral blood is coming from the

territory of the hematopoietic marrow.

The quantitative and qualitative

hematological examination is conclusive

and decisive to support a diagnosis of

leukemia, many times being a real

surprise in a routine inspection.

Cytomorphological examination

establishes the proliferate cellular baseas well as the clinical form of

manifestation. We will not enter into

classification disputes, as we will present"as such" our own cases with a brief

comment necessary in order to interpret

the images.

Thus we present the following:

1) T-cell acute lymphocytic leukemia

(LLA "T") - fig. 1.

2) 8-cell acute lymphocytic leukemia

(LLA "8" ) - fig. 2 - 4.

33

-"••••


3) Leucemia limfocitara cronica "B"

celulara (LLC"B") - fig. 5 -6.

4) Leucemia mieloida acuta (LMA) - fig.7 -12.

5) Leucemia mieloida cronica (LMC)

fig. 13 - 18.

6) Leucemia monocitara acuta (LMoA)

fig. 19 - 20.

7) Leucemia histio-monocitara acuta

(LHMoAc) - fig. 21 - 22.

8) Leucemia eritroida acuta (LEA) - fig.23 - 31

9) Leucemia acuta cu celule NK (LANK)

- fig. 32 -35.10) Leucemia cronica cu celule NK

(LcrNK) - fig. 36 - 40.

11) Sindrom mieloproliferativ (SMP) - fig.41-50.

Legenda figurilorFig. 1: LLA "T" leucocitoconcentrat,

prezinta un numar mare a limfobla9tilor

atipici 9i a prolimfocitelor "T".

Fig. 2 - 4: LLA "B" leucocitoconcentrat,

cultura quasi pura de limfobla9ti "B",

prolimfocite 9i rare limfocite.

Fig. 5 - 6: LLC - sange periferic.Prezenta limfocitelor adulte si a rare, ,

prolimfocite.

Fig. 7 - 12: LMA - leucocitoconcentrat,

proliferare intensa de mielobla9ti

(macromielobla9ti) .

Fig. 13 - 18: LMC - sange periferic

numeroase metamielocite neutrofile 9irare celule mielocitare alaturi de

granulocite neutrofile segmentate sau

nesegmentate.

34

3) B-cell chronic lymphocytic leukemia

(LLC"B" - fig. 5 -6.4) Acute myeloid leukemia (LMA) - fig.

7 -12.

5) Chronic myeloid leukemia (LMC) fig. 13-18.

6) Monocytic acute leukemia (LMoA)

fig. 19 - 20.7) Acute histio-monocytic leukemia

(LHMoAc) - fig. 21 - 22.8) Acute erythroid leukemia (LEA) - fig.

23 - 31

9) NK-cell acute leukemia (LANK) - fig.32 -35.

10) NK-cell chronic leukemia (LcrNK)

fig. 36 - 40.11) Myeloproliferative syndrome (SMP)

fig. 41-50.

Legend of the figuresFig. 1: LLA "T" leukocyte concentrate,

presents a great number of atypicalIymphoblasts and of IT' prolymphocytes.Fig. 2 - 4: LLA "B" leukocyte

concentrate, quasi pure "B" Iymphoblasts

culture, prolymfocytes and rareIymfocytes.Fig. 5 - 6: LLC - peripheral blood.

Presence of adult Iymfocytes and of rareprolymfocytes.

Fig. 7 - 12: LMA - I leukocyteconcentrate, massive proliferation ofmyeloblasts (macromyeloblasts).Fig. 13 - 18: LMC - peripheral blood,massive presence of neutrophilic

metamyelocytes and rare myelocytary

cells together with segmented ornonsegmented neutrophilic granulocytes.


Fig. 19 - 20: LMoAc - sange periferic.

masiva proliferare de monobla9ti,promonobla9ti ( In diviziune mitotica 9ipromonocite reduse numeric.

Fig. 21 - 22: LHMoAc - sange periferic.Bla9ti Inalti profund atipici 9i anaplazici In

melanj cu monobla9ti 9i celuleprimordiale histiocitare.

Fig. 23 - 31: LEAc. Sange periferic.lntensa proliferare a liniei eritropoietice

Intre proeritroblast 9i diferite tipuricelulare de eritrobla9ti. Un precursor alliniei eritropoietice In diviziune mitoticaatipica.Fig. 32 - 35: Lac NK. Sange periferic.

Masiva prezenta de bla9ti limfocitari cugranulatii acidofile intracitoplasmatice(largi granulatii oxifile intracitoplasmatice= N.K. cells)Fig. 36 - 40: LCr NK. Sange periferic. Inmajoritatea celulelor limfocitare se

remarca limfocite adulte 9i prolimfocitecare intracitoplasmatic contin largigranulatii oxifile = N.K. cells.Fig. 41 - 50: SMP. Splina. In acesteimagini se remarca Inlocuirea populatieicelulare limfocitare dominante a splineicu 0 proliferare de ansamblu atipica, Inmajoritate bla9ti din seria mieloida

eritropoietica 9i monocitara.

Fig. 19 - 20: LMoAc - peripheral blood.

proliferation of monoblasts,promonoblasts ( in mitotic division andfew promonocytes.Fig. 21 - 22: LHMoAc - peripheral

blood. High very atypical and anaplasticblasts mixed with monoblasts and

primordial histiocytary cells.

Fig. 23 - 31: LEAc. peripheral blood.

Intense proliferation of the erythropoieticline between proerythroblast anddifferent cellular types of erythroblasts. A

forerunner of the erythropoietic line in

mitotic atypical division.Fig. 32 - 35: Lac NK. peripheral blood.massive presence of lymphosytic blastswith the presence of acidophil

intracytoplasmatic granulosities (largeoxiphil intracytoplasmatic granulosities =

N.K. cells)Fig. 36 - 40: LCr NK. peripheral blood. Inmost of the lymphocytic cellularpresence, we can identify adult

lymphocytes and prolymphocytes thatcontain oxiphil intracytoplasmatic

granulosities = N.K. cells.Fig. 41 - 50: SMP-spleen. In theseimages, we can see the replacement ofspleen's dominantly cellular lymphocyticpopulation with an atypical overallproliferation, mostly with blast from themyeloid erythropoietic and monocytaryseries.

35

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CA~IIOLUL_llCHABIER]

LlMFOMUL HODGKIN

Aspectele sub care am identificat

limfomul Hodgkin In cadrul cazuisticiinoastre au fost:

- Granulomul Hodgkinian;

~i

- Sarcomul Hodgkinian.

Caracteristicile esentiale ale acestordoua forme sunt determinate de domi

narea tabloului citomorfologic, fie de

catre celula giganta Hodgkin, fie de catrecelula giganta Stenberg-Paltauf-Reed

(fig. 1 - 12).Celula giganta Hodgkin este 0 celula

mononucleara de talie mare, 30/-l.

Cromatina nucleara este de regula

areolata, cu prezenta unui nucleol gigant.

Citoplasma este larga u~or bazofila ("fumde tigara"). Raportul nucleo-citoplasmaticeste In favoarea nucleului. Dominanta

numerica a acestor celule este foarte

mare In cazul sarcomului Hodgkinian ~imai redus In cazul granulomului

Hodgkinian (fig. 1 - 7).Celula giganta Sternberg-Paltanf

Reed este de asemenea de talie mare,

30-40/-l, avand nuclei lobati, multipli.Fiecare nucleu are cromatina densa ~i

lasa sa se observe prezenta unui nucleolgigant. Citoplasma larga, agranulata

este amphofila. Prezenta acestor celule

este ridicata In granulomul Hodgkinian

THE HODGKIN LYMPHOMA

Within our experience, the issues in

which we identified Hodgkin's lymphomain our case were:

Hodgkin's granuloma;and

Hodgkin's sarcoma.The essential characteristics of these

two forms are determined by the

domination of the cytomophological

table either by the Hodgkin giant cell, or

by the Stenberg-Paltauf-Reed giant cell

(fig. 1 - 12).

The Hodgkin giant cell is a mono

nuclear cell of large size, around 30/-l.

The nuclear chromatin is usually haloed,

with a giant nucleolus. The cytoplasm is

wide and slightly basophilic ("cigarette

smoke" form).

The nucleo-cytoplasmatic ratio favorsthe nucleus. The number of these cells is

great in the case of Hodgkin's sarcoma

and smaller in the case of Hodgkin's

granuloma (fig. 1 - 7).

The giant Sternberg-Paltanf-Reed

cell is also of large size, around 30-40/-l,

with multiple lobeate nuclei. Eachnucleus has a thick chromatin and

reveals the presence of a giant nucleolus.

The wide non-grainy cytoplasm is

amphophilic. The presence of this cells

61


~i numeric mai redusa In Sarcomul

Hodgkinian (fig. 8).In ambele cazuri se identifica un Inalt

grad de atipism celular cu prezenta unorveritabile monstruozitati celulare, iar la,nivelul celulei gigante Hodgkin sunt

prezente celule In diviziuni atipice.

Granulomul Hodgkin se carac

terizeaza prin prezenta alaturi de un

melanj celular identic cu cel de granulom

inflamator cronic (granulocite, neutrofileeozinofile, bazofile, limfocite adulte,

macrofage, fibrocite ~i plasmocite), a

celulelor gigante Hodgkin ~i a celulelor

Stenberg-Paltauf-Reed. Diagnosticul

diferential Intre granulomul Hodgkin ~i

granulomul inflamator se realizeaza prin

prezenta celulelor gigante Hodgkin ~i

Stenberg cu grad Inalt de atipie ~i

monstruozitate celulara In granulomul

Hodgkin ~i absenta acestora In

granulomul inflamator. In cazul granulomului inflamator cronic nu exista decat

celule gigante de "corp strain"

inconfundabile cu celulele gigante

Stenberg-Paltauf-Reed (fig. 1)

Sarcomul Hodgkinian este u~or de

identificat In sensu I existentei unei

proliferari quasi omogene de limfocite

tinere (melaj de Iimfobla~ti ~iprolimfocite), iar din loc In loc se

identifica celule gigante Hodgkin ~i mai

rar celule giganteSternberg-~altaufReed. Aceasta forma de sarcom practiceste inconfundabila cu oricare alta forma

celulara de limfom (fig. 9 - 12).

62

is reduced in comparison with the

Hodgkin cell (fig. 8) .

In both cases, you can identify a high

degree of cellular abnormality presenting

of genuine monstrousness specific to real

cancer and the giant cell Hodgkin level

the cells are present in atypical division.

Hodgkin granuloma is characterized

by the presence of a cellular mix identical

to that of chronic inflammatory granuloma

(neutrophilic granulocytes, eosinophilic,

basophilic, adult lymphocyte, macro

phage, fibrocytes and plasmocytes).

Besides those, giant Hodgkin and

Stenberg-Paltauf-Reed cells can be

identified from place to place. Thecharacteristic feature that makes the

difference between Hodgkin granuloma

and the inflammatory granuloma is the

existence of giant Hodgkin and Stenberg

cells with a high degree of cellular

abnormality and monstrousness. In the

case of chronic inflammatory granuloma,

there are only the giant cells of "foreign

body" that can not be mistaken for the

Stenberg-Paltauf-Reed cells (fig. 1)

Hodgkin's sarcoma is easily iden

tifiable within the meaning of the

existence of a quasi homogenous

proliferation of young lymphocytes (mix of

Iymphoblasts and prolymphocytes), giant

Hodgkin cells can be identified from place

to place and more rarely giant SternbergPaltauf-Reed cells. 'This form of sarcoma

can not be mistaken for any other cellular

form of lymphoma (fig. 9 - 12).


Fig. 1

Fig. 2

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Atlas de ancacitamarfalagie la canide $i feline / Atlas of canine and feline ancacytamarphalagy

Fig. 9

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67

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CAPITOLUL 8 '-CHAPTER 8

L1MFOAME MALIGNENONHODGKINIENE

Reprezinta cea mai frecventa forma

e exprimare a bolii canceroase din

adrul hemopatiilor maligne in tara

oastra la animalele de companie, iar

impreuna cu leucemiile detin primul loc

din totalul formelor citomorfologice ale

neoplaziilor maligne. Simptomele clinice

in Iimfoame nu sunt specifice, sus

piciunea pentru un diagnostic de limfom

malign se creeaza in urma examenului

clinic cand la palpatie se constata

prezenta unei mono sau a unei

poliadenopatii. Adenopatia este nedu

reroasa ~i putin aderenta la planurile

profunde ~i superficiale ale limfonodului.

Poliadenopatia extema poate fi insotita

sau nu de hepato ~i/sau splenomegalii.Un criteriu de clasificare a Iimfoamelor

maligne nonhodgkiniene in Iimfoame

acitemice( fara prezenta bla~tilor in

special periferic) sau citemice unde vom

indentifica in plus prezenta eritemiei in

cadrul examinarii frotiului de sange.

Examenul citomorfologic - serealizeaza consecutiv biopunctiei cu ac

fin a Iimfonodului tumorizat, (se prefera

limfonodulul popliteu ~i/sau prescapular

care pot fi mai u~or abordabili). Examenul

microscopic poate pune in evidenta mai

MALIGNANT NONHODGKIN'S LYMPHOMAS

Malignant non-Hodgkin's lymphomas

represent the most frequently encounteredform of cancer to pets in our country (the

most common form) within malignant

homeopathies; next to leukemia, they arethe most frequent in our country out of

the total number of cytomorphological

malignant neoplasms. There are very few

clinical lymphomas specific symptoms,

the only modification that may risesuspicions leading towards the diagnosis

of malignant lymphoma is the presence

of mono-adenopathy or poly-adenopathy. The adenopathy is painless and

less adherence to the deep and

superficial layers of the lymph nodes. Theadenopathy may be accompanied or not

by hepato- and spleeno- megaly.Clinical the animal may present

continuous weight loss, in contrast withthe appetite that remains within normalparameters.

In the case of malignant non

Hodgkin's lymphomas, these may be

classified in acythemic lymphomas

(without the presence of blast cells,

especially periferical) or cythemic wherein addition we will identify the presence of

erythemia within the hematological

general investigation.

69


multe aspecte citomorfologice care vor

conduce la elaborarea unui diagnostic

pozitiv :;;i diferential, necesar stabilirii

prognosticului, evolutiei :;;i terapiei

specifice.

Pe baza proliferarii celulare limfonodale

vom prezenta urmatoarele forme de

limfoame maligne nonhodgkiniene.

Fig. 1 - 2: reprezinta imaginea de

limfom malign "B" celular centrocitic.

Limfonod: Prezenta unei proliferarimonomorfe alcatuita din Iimfocite,

prolimfocite :;;i foarte rare limfoblaste.

Fig. 3 - 4 - 5 $i 5 bis: reprezinta

imaginea unui limfom malign nonhod

gkinian "B" celular cen troblas tic.Limfonod: Imaginea celulara este

relativ polimorfa cu multe elemente

blastice (polimfobla:;;ti :;;i limfobla:;;ti)

atipici - Nucleii contin nucleoli bine

evidentiati :;;iau frecvente mitoze atipice.Dominanta celulara este blastul limfoid

Inalt alaturi de prolimfocite. Limfocitele

adulte adesea lipsesc.

Fig. 6 - 14: sunt imagini de limfom

malign nonhodgkinian "T" celular.

Fig. 6: sunt imagini surprinse Intr-un

limfonod unde distingem modificari In

sensu I aparitiei celulelor limfoproliferate

"T" (Iimfobla:;;ti :;;i prolimfobla:;;ti) au un

grad Inalt anaplazic. Nucleii prezinta 1-2nucleoli. Nucleul nu mai este rotund ca In

cazul celulelor ,,8" deoarece, specific

pentru Iimfocitul "T" este prezenta

multiplelor scizuri :;;i e:;;ancruri alestructurii nucleare.

70

The cytomorphological examination - is carried out after the bio

puncture of the tumor lymph. (It ispreferred to puncture the popliteal lymphnode with a thin needle.) The microscopic examination may reveal several

cytomorphological aspects which wililidein developing a positive and differential

diagnosis because the non-Hodgkinislymphoma evolve differently, they havedifferent reactions to specific therapy,and therefore the prognostication willalso be different.

Fig. 1 - 2: represents the image of a

centrocytic malignant non-Hodgkin'slymphoma of B-cell type.

Lymph node: The presence of

monomorphic proliferation consisting inlymphocytes, prolymphocytes and very

rare Iymphoblasts.Fig. 3 - 4 - 5 and 5 bis: represents the

image of a centro-blast malignant nonHodgkin's lymphoma of B-cell type.

Lymph node: The cell image is

relatively polymorphic with many blastatypical elements (poly-Iymphoblasts andIymphoblasts) - The nuclei contain well

rendered nucleoli and have frequent

atypical mitoses. The dominant cell is thehigh lymphoid blast together with the

polylymphocytes. The adult lymphocytesare often missing.

Fig. 6 - 14: there are images of themalignant non-Hodgkin's lymphomaof T-cell type.

Fig. 6: there are images taken of a

lymph node where we can see changessuch the presence of Iymphoproliferated


In fig. 7 - 10 imaginile au fost

surprinse In sangele periferic ca expresie

a citemiei existente In limfomul "T"

celular. In imaginile 11 - 14 este

prezentata In leucocitoconcentrat celula

Sezary - circulanta care provine dintr-unIimfom "T" celular citemic localizat In

derm (Limfom Sezary).

Fig. 15 - 25 reprezinta imagini care

caracterizeaza limfomul malign

histiocitar. Acest tip de limfom poate

evolua atat acitemic cat 9i citemic.

Imaginile (15 - 23) reprezinta citologialimfomului histiocitar la nivel limfonodal,

iar imaginile 24 - 25 au surprins un

episod citemic. Deci In sangele periferical limfomului histiocitar, indiferent de

tesut limfomul histiocitar, se carac-,terizeaza citomorfologic printr-o proli

ferare In dauna citologiei de bazalimfocitare a liniei histiocitare care se

exprima printr-o Inalta anaplazie celulara

cu frecvente fenomene de gigantism

celular 9i de forme bizare. In rest sunt

celule tipic histio-monocito-macrofagice

caracterizate prin citoplasma de culoarea

tipica a "fumului de tigara", iar nucleul

celular are 0 forma paralelogramica.

Deci, membrana celulara are cel putin Indoua zone contact direct cu membrana

nucleara. Cromatina nucleara are

aspectul tipic "pieptanat". Nucleolii sunt

In cea mai mare parte ecranati. Celulele

In mitoza atipica sunt foarte frecvente.

Fig. 26-31 - ofera aspectele Sarcomului dendritic. Sarcomul dendritic este

"T" cells (Iymphoblasts and prolympho

blasts) _with a high anaplastic degree.The nuclei present 1-2 nucleoli. The

nucleus is no longer round as in the caseof "8" cells because, specific to 'T'lymphocyte is the presence of multiplescissions and chancres of the nuclear

structure.

In fig. 7 - 10 the images were taken

from the peripheral blood as expression ofthe existent cytemia in the "T" cells

lymphoma. In the images 11 - 14 theSezary cell is presented in leukocyte

concentrate- circulating cell that comeform a "T" cell cytemic lymphoma localized

in the skin (Sezary Lymphoma).Fig. 15 - 25 represents images that

characterize the histiocytic malignantlymphoma. This type of lymphoma canhave both a cytemic and a non-cytemic

evolution. Images (15 - 23) represent thecytology of the histiocytic lymphoma at

lymph nodes level, and images 24 - 25show a cytemic episode. So, on all typesof tissues, the peripheral blood of the

histiocytic lymphoma has cytomorpho

logical features through the proliferation

of the histiocytic line expressed by a highcell anaplasia with frequent phenomena

of gigantism strange forms of cells, whichharms the basic Iympho-cytology.Otherwise, there are typically histio

monocytic macrophage cells charac

terized by the cytoplasm of "cigarettesmoke" color and the cell nucleus has a

parallelogram shape. So, the cellmembrane has at least two areas of

direct contact with the nuclear

71

NICOLAE MANOLESCU, EMILIA BALINT

o forma acitemica caracterizata sub doua

aspecte citomorfologice.Fig. 26 - 29 prezinta celule de talie

mare peste 30 /l cu cromatina oligocroma.

Nucleii posed a nucleoli giganti. Ceea ceeste caracteristic este citoplasma bazofila

foarte bogata care se anastomozeaza In

"stilul celula cu celula" prin intermediul

multiplelor prelungiri citoplasmatice.Structurile limfonodale normale sunt

complet remaniate.

Fig. 30 - 31 prezinta nuclei liberi de

talie mica sau medie monomorfa, fara

diviziuni celulare ~i lipsiti de monstruozitati

care lasa Impresia ca sunt a~ezati pe 0

citoplasma vacuolara, u~or bazofila quasi

unitara datorita multiplelor prelungiri carese anastomozeaza Intre ele.

Fig. 32 - 39 - reprezinta imagistica

citomorfologica remaniata din limfonoduli

de catre proliferarea celulara specifica

limfomul malign NK. Majoritateacelulelor proliferate indiferent de statutul

de "blaste" sau "cite"contin In citoplasma

u~or bazofila sau acidofila 0 cantitatevariabila de incluzii oxifile de talie diferita.

Nucleul celular este specific liniei

limfocitare. Atipiile celulare cat ~imitozele atipice, sunt moderate.

Fig. 40 - 46 reprezinta imagistica ce

caracterizeaza "limfomul malignimunoblastic". Limfonodul care sufera

procesul de malignizare se prezintamonomorf datorita invaziei structurii cu

celule imunoblastice In cultura quasi

pura. Imunobla~tii sunt celule de talie

mare peste 25/l, cu nucleul relativ plasat

72

membrane. The nuclear chromatin has

the typical "brushed" aspect. Most

nucleoli are shielded. Cells in atypicalmitosis are very frequent.

Fig. 26-31 - shows the aspects of thedendritic sarcoma. The dendritic sarcoma

is a non-cytemic form characterized by twocyto-morphological aspects.

Fig. 26-29 is made up of big sizecells - over 30 /l oligo- chromechromatin. Nuclei possess giant nucleoli,

a very common feature for very reachbasophilic cytoplasm that anastomizes

into "cell with cell style" through themultiple cytoplasm extensions. Normal

_ lymph nodes structures are completelyreshuffled.

Fig. 30 - 31is made up of free nucleiof small or medium monomorphic size,

without cell divisions and lackingmonstrosities, leaving the impression theyare arranged on a vacuolar cytoplasm,slightly basophilic, quasi unitary becauseof the multiple extensions with each other.

Fig. 32 - 39 - represents the

reshuffled cytomorphological image ofthe lymph nodes by the cell proliferation

specific to NK malignant lymphoma.Most proliferated cells, irrespective oftheir "blast" or "cyte" contain in their

slightly basophilic or acidophilic

cytoplasm a variable quantity of oxyphilicinclusions of different size. The cell

nucleus is specific to the lymphocytic line.Cell abnormalities as well as atypicalmitoses are moderate'.

Fig. 40 - 46 are images characteristicto "imunoblastic malignant lymphoma".


semicentral, cu cromatina densificata

de tip limfocitar - cu un nucleol 9i rare demitoze atipice. Citoplasma acestor celule

este intens bazofila Inconjurand nucleul.

Pe ansamblu celulele au un grad ridicat

de atipism. In cazul imunoblastomului

trebuie efectuat un diagnostic diferential,vis-a-vis de 0 alta forma de limfom

malign- plasmocitomul. In aceasta forma,

plasmoblastul seamana foarte mult cu

imunoblastul. Diferenta este ca alaturi de

plasmobla9ti, identificam la examenul

citomorfologic celelalte celule ale liniei

plasmocitare (proplasmocitul, plasmocitul

9i chiar imunoblastul), deci este 0

proliferare polimorfa fata de proliferareamonomorfa din imunoblastom.

Fig. 47 - 63 sunt rezervate

plasmocitomului, un limfom malign cu

plasmocite In cultura pura. Acesta se

poate manifesta rareori 9i "citemic" celmai frecvent este "acitemic". In medicina

veterinara, plasmocitomul evolueaza

extra osos - parenchimatos, inclusiv la

nivel limfonodal, splenic inclusiv In

teritoriul medular al hematopoiezei.

Limfonodul, din punct de vedere

citomorfologic, este complet remaniat, In

locul populatiei polimorfe limfoide, se

identifica tot 0 populatie polimorfa, darapartine subliniei celulare plasmocitare

exclusiv. Aceasta este compusa din rare

imunoblaste, frecvente plasmoblaste,

alaturi de proplasmocite 9i plasmocite.Mitozele sunt foarte frecvente, In schimb

atipiile celulare 9i gigantismul celular suntrare.

The lymph node that undergoes the

malignant process is monomorphicbecause its structure is invaded by

imunoblastic cells in quasi pure culture.The imunoblasts are big size cells of over

25fJ. with a relatively central nucleus, withthickened chromatin- of lymphocyte

type- with a nucleolus and rare atypicalmitosis. These cells' cytoplasm is highly

basophilic, surrounding the nucleus.

Overall the cells have a high degree ofabnormality. In the case of theimunoblastom the differential diagnosis

must be applied, with respect to anotherform of malignant Iymphoma- the

plasmocytom because the plasmoblast is

very similar to the imunoblast. The

difference is that in the cytomorphicculture, we can identify, besidesplasmoblasts, other cells of the

plasmocytary line (the proplasmocyte,

the plasmocyte and even theimunoblast), there is therefore apolymorphic proliferation different from

the monomorphic proliferation within theimunoblastom.

Fig. 47 - 63 are reserved to the

plasmocytom, a malignant lymphomawith plasmocytes in pure culture. It can

rarely evolve in a "cytemic" way, being inmost cases "acytemic". In veterinarianmedicine, the plasmocytom evolvesoutside the osseous system

parenchymatous at lymph nodes' level

included, splenic in the medullary territoryof hematopoiesis.

The lymph node, from a cytomorpho

logical point of view, is completely

73

NlCOLAE MANOLESCU, EMILIA BALINT

Fig. 64 - 71 - sunt rezervate unei

adevarate surprize pentru hemopatiile

maligne din medicina veterinara, aceasta

este legata de aspectul oferit de"TEZAURISMOZE". Acestea se identifica

In exclusivitate la nivel limfonodal 9i/sau

splenic. Proliferarea celulara este alcatuita

din celule de talie mare, peste 3D)..! cu

nucleii excentrici, avand 0 citoplasma

larga acidofila plina de vacuole care

con1in atat lipoproteine cat 9i lipide

complexe. Nucleul are 0 cromatina, fin

reticulata cu prezen1a rara a nucleolilor,

fara mitoze celulare. Popula1ia tipiclimfocitara Intr-o cantitate mai mare sau

mai mica poate lipsi complet In unele

zone In func1ie de gradul de afectare alstructurii normale limfonodale.

Fig. 72 - 80 reprezinta Maladia tipWaldenstrom

Citomorfologic, aspectul este foartecaracteristic, In sensul ca acest Iimfom

malign indiferent daca este dezvoltat la

nivelul structurilor limfonodale sau prinmetastazari de la acest nivel In alte

1esuturi sau viscere se traduce exclusiv

prin proliferarea atat a celulelor limfoide,

cat 9i a celor plasmocitare. Elementul

citomorfologic caracteristic este prezen1ala nivelul liniei limfoide a unor celule

blastice (limfobla9ti 9i prolimfocite In

numar redus) alaturi de celule limfocitare

adulte cat 9i la nivelul liniei plasmocitare

a elementelor blastice (plasmob1a9ti 9i

proplasmocite) alaturi de plasmocitemature.

74

reshuffled and instead of the polymorphlymphoid population, a polymorphpopulation can still be identified, but it

belongs exclusively to the plasmocytarycell sub-line. It is composed of rareimunoblasts, frequent plasmoblasts,

together with proplasmocytes andplasmocytes. Mitoses are very frequent,on the contrary, cell abnormalities and

cell gigantisms are rare.Fig. 64 - 71 - are reserved to a true

surprise for malignant homeopathieswithin veterinarian medicine, related to

the aspect offered by "THESAURISMOSES". They can be identified

exclusively at lymph nodes and/or spleniclevels. The cellular proliferation is made

of big cells, over 3D)..! with eccentricnuclei, having a wide acidophiliccytoplasm full of vacuoles that

contain both lipoproteins and complex

lipids. The nucleus has a finelyreticulated chromatin, with a rare

presence of nucleoli without mitoses .

The typically lymphocytic population in a

greater or smaller quantity may miss

completely in certain areas depending onthe degree to which the normal lymphnode structure is affected.

Fig. 72 - 80 represents Waldenstrom's Disease

From a cytomorphological point of

view, the aspect is very characteristic asthis malignant lymphoma, no matter if it

develops at lymph nodes' structures or bymetastases from thIs level towards other

tissues or viscera, manifests exclusively

through the proliferation of both lymphoid


Diagnosticul diferential se face numaicu proliferarile limfoplasmocitare reactive

sauh;;i inflamatorii. In aceste reactii, lanivelul limfonodal, nu se identificaniciodata elemente celulare blastice din

cadrul celor doua serii celulare.

Studiul citomorfologic minutios al

acestei forme tumorale pune In evidenta

existenta a doua varietati celulare de

maladie tip Waldenstrom:- 0 forma tumorala de maladie tip

Waldenstrom predominant limfocitara

(masiva proliferare limfocitara cu rare

plasmocite);

- 0 forma tumorala de maladie tip

Waldenstrom - predominant plasmo

citara (masiva proliferare plasmocitara

cu rare limfocite).

cells and of plasmocytary ones. The

characteristic cytomorphological elementis the existence at both the lymphoid linelevel of some blast cells (Iymphoblastsand few prolymphocytes) together with

adult. lymphocytic cells and atplasmocytary line level of blast elements

(plasmoblasts and proplasmocytes)

together with mature plasmocytes.Differential diagnosis is established

only with Iymphoplasmocytary reactiveor/and inflammatory proliferations. In

these reactions, at lymph nodes' level,blast cellular elements from the two cell

series can never be identified.

The detailed cytomorphologica studyof this tumor form reveals the existenceof two cellular varieties of Waldenstrom's

disease:

- A mostly lymphocytic tumor form of

Waldenstrom's disease (massivelymphocytic proliferation with rareplasmocytes) ;

- A mostly plasmocytary tumor form of

Waldenstrom's (massive plasmocytaryproliferation with rare lymphocytes).

75

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77

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Fig. 58

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C_A~ITOLUL9~1CHA~TER9 '{

SARCOMUL HISTIOCITAR

Este 0 forma tumorala cu frecventa

medie, la specia canina 9i felina.Sarcomul histiocitar este situat sub

tegumentar, afectand tesutul conjunctiv

subcutan. Tumora are un inalt grad demalignitate datorita prezentei anaplazieicelulare proliferate.

Tabloul citomorfologic (fig. 1 - 8) esterelativ polimorf, dominanta celulara estehistioblastul anaplazic. Celulele au 0 talie

mare > 30 !l cu raportul nucleo-citoplasmatic in favoarea nucleului. Nucleii

sunt de regula rotunzi sau u90r ovalari.

Cromatina este pieptanata 9i lasa sa seidentifice prezenta structurilor nucleolare.Citoplasma este relativ redusa de

culoarea "fumului de tigara". Acest tipcelular nu poate fi confundat cu nici 0 altacelula din cauza elementului dominant

(anaplazia celulara) care se identifica cu

mare u9urinta.

HISTIOCYTAR SARCOMA

It is a skin tumor frequency average atcanine and feline species. The histiocytarsarcoma is situated under the skin and

affects the subcutaneous conjunctivetissue. The tumor has a high degree of

malignancy because of the presence ofcellular proliferated anaplasia.

The cytomorphologic table (fig. 1 - 8)is relatively polymorphic, the cellulardominant is the anaplastic histioblast.The cells have high waist > 30 !l with a

nucleo-cytoplasmic ration favoring thenucleus. The nuclei are usually round orslightly ellipsoidal. The chromatin has a"brushed form" and lets us identify thepresence of nucleoli's structures. The

cytoplasm is relatively reduced and hasthe color of "cigarette smoke". This celltype cannot be confused with any othercell because of the dominant element

that can be easily identified (anaplasiacell).

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:CA~IJ_OLUL_tO_LCHA~TE

MASTOCITOMUL

o

MASTOCYTOMA

Mastocitomul este 0 tumora mezen

chimala a teritoriului hematopoietic cu 0

mare frecventa la specia canina putand

sa Imbrace aspecte extrem de diferite.

Ne vom referi pe de 0 parte la localizarea

acestei forme tumorale, iar pe de alta

parte la aspectul citoproliferativ.

Referitor la localizare se disting 3

forme: una sLibcutano-mucoasa, una

viscera/a, 9i 0 forma /eucemica. Primele

doua forme reprezinta malignizarea post

citoproliferare a mastocitului fix (con

junctival 9i/sau visceral), iar cea de-a

treia forma este datorata citoproliferarii 9i

malignizarii mastocitomului medular, cu

invazie sangvina (Ieucemie), secundara,consecutiv alterarii diabazei medulare.

Referitor la baza celulara a proliferarii

mastocitare distingem trei forme:

- forma predominant mastocitara cucelule adulte,

- forma mastocitara predominanta cucelule blastice

forma mastocitara cu celule primordiale.

Legenda figurilor (fig. 1-15)

In proliferarea mastocitara se iden

tifica un melanj celular format din celuleadulte mastocitare alaturi de 0 celu

laritate blastica mastocitara, cat si rare,

Mastocytoma is a mesenchymaltumour of the hematopoietic territory with

a high frequency in canine species and itcan take very different aspects. We willrefer to the location of this tumoral type,

on one hand, and to the cytoproliferative

aspect on the other hand.

Regarding to location, 3 forms are

to be distinguished: a subcutaneomucous, a visceral form, and a

leukemic form. The first two represent

the transformation of the fix ( conjunctival

and/or visceral) mastocyte into a

malignant one, after cytoproliferation,while the third form is due to the

cytoproliferation and the malignizationof the medullary .mastocytom with

secondary sanguine invasion ( leukemia)after the alteration of the medullar

diabase.With reference to the cellular base

of the mastocytary proliferation we

distinguish three forms: the pre

dominantly mastocytary form with adult

cells, the predominantly mastocytaryform with blastic and the predominantly

mastocytary with primary cells.The legends of figures (fig 1-15)In the mastocytary proliferation a

cellular mixture can be identified; it is

formed of adult mastocytary cells plus

-------------------------- 123


elemente celulare primordiale, de asemenea specifice clasei mastocitare.

Celula mastocitara adulta (fig. 15)

Are 0 talie de circa 18 11 9i esteacoperita cu granule negre, fine, care nu

respecta nici nucleul 9i nici citoplasma.Foarte putine spatii nucleare sunt lasatelibere.

Celula mastocitara blastica (fig. 11)

Celula blastica se diferentiaza printalie mai mare (22-24 11), nucleullasa cu

greutate sa se evidentieze 1-2 nucleoli.Caracteristica este dispunerea quasi

regulata aHH Tn citoplasma, cat 9i Tn

nucleu a unor multiple granule fine deculoare neagra, care nu conflueaza.

Celula mastocitara primordiala(fig. 1 9i 12)

Este 0 celula rara avand 0 talie mare,

circa 28-30 11. Frecvent aceste celule seafla Tn diviziune. Elementul caracteristic

este acela ca poseda un numar mult maimic de granule fine, negre situate atat Tn

citoplasma, cat 9i Tn nucleu.

Diagnosticul diferential trebuie sa sefaca Tntre:

Celula mastocitara unde granulele,de regula, sunt mai fine acoperind

deopotriva nucleul 9i citoplasma. Reactiametacromatica cu albastru de toluidina

este pozitiva.Celula melanica. (cu granulatii de

melanina) are reactie negativametacromatica (cu albastru de toluidina),

granulatiile sunt grosiere, dand un

blastic mastocytary cells plus rareprimordial cellular elements, which are

specific to the mastocytary class as well.

The adult mastocytary cell (fig.15)It has a small size of about 18 11 and it

is covered with black granules that do not

comply with any nucleus or cytoplasm.Some very small nucleic spaces are leftopen.

The blastic mastocytary cell (fig.11)The blastic cell is distinguished by

larger size (22-24 11), and the nucleus

leaves narrowly highlight 1-2 nucleoli.

Characteristic is the quasi-regulararrangement of multiple fine blackgranules, that don't confluate, both in the

cytoplasm and in the nucleus.

The primordial mastocytary cell(fig. 1and 2)

It is a rar cell with a large waist,

around 28-30 11. These cells are frequentlyin the process of division. Thecharacteristic element is the one that it

has a much smaller number of fine black

granules located both in the cytoplasmand in the nucleus.

The differential diagnosis must bemade between:

The mastocytary cell where the

granules are generally finer and theycover both the nucleus and the

cytoplasm. The metachromatic reactionwith toluidin blue is.positive.

The melanic cell (with granulations ofmelanin) has a metachromatic negative

124 --------------------------


aspect de granulatii polimorfe careacopera intreaga celula ca 0 veritabila"pata neagra" sau manta.

Sistemul celular granulocitarbazofil

In acest caz diferentierea fata decelula mastocitara se face foarte greu,putand fi confundata. Important de precizat este ca frecventa legata de speciilecanina ~i felina a proliferarii maligne asistemului celular granulocitar bazofileste quasi inexistenta comparativ cufrecventa de la pasari unde prolifereazaambele tipuri celulare. Daca totu~i seconfunda bazofilul ~i mastocitul, nu estegrav, deoarece aceste tipuri celulare suntstrans inrudite ~i beneficiaza de acelea~iindicatii terapeutice, prognostic, avandaceea~i evolutie ~i tratament.

reaction (with toluidin blue). Thegranulatjons are rough, giving the aspectof polymorphous granulations whichcover the whole cell like a genuine "blackspot" or a cloak.

.The basophilic granulocyte cellularsystemIn this case is very difficult to

differentiate it from the mastocytary cell,easily leading to confusions. It isimportant to mention that the frequencyrelated to the canine and feline species ofthe malignant proliferation of thebasophilic granulocyte cellular system isalmost inexistent in comparison withfrequency in birds where both cellulartypes proliferate. However, if basophilicgranulocyte and mastocyte granulocyteare mistaken for each other, this error isnot serious, because these cellular typesare closely related and they have thesame therapeutic indications, the sameprognostic and the same evolution andtreatment.

125

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-------------------------- 133

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CA~ITOLULll1CHA~IER 11

MELANOMUL MALIGN

Este una dintre formele de cancer

Intalnite In cazuistica noastra. Melanomul

poate fi localizat la nivelul tegumentului,

indiferent de topografie, inclusiv In

glanda mamara, dar 9i In structurile

corioretiniene ale globului ocular. Cel mai

important lucru pentru medicina vete

rinara este stabilirea diagnosticului

pozitiv de melanom malign 9i diferential

fata de mastocitom. Diagnosticul dife

rential se face prin analiza granulelor

celulare. Astfel granulele din melanom

sunt polimorfe, adica sunt 9i de micidimensiuni, cat si de mari dimensiuni,,putand genera 0 veritabila "pata neagra"

care acopera deopotriva toata celula. In

cazul mastocitomului granulatiile sunt

fine 9i omogene dispuse mult mai

uniform. (vezi fig. A - mastocitom; B, C, D

- melanom)

In fig. 1 - 7 se prezinta un caz In care

se observa placarde de celule tumoralemelanice care infiltreaza teritoriile

epiteliale tegumentare. Cu toate ca

aspectul granulatiilor este relativ uniform

9i dens, apar Insa 9i multiple celule care

contin granulatii melanice extrem de

densificate luand aspectul de "manta"

sau "pata neagra", nerespectandstructura nucleului.

THE MALIGNANT MELANOMA

It is one of the form of cancer that we

have met in our practice. The melanoma

can be located on the tegument,

irrespective of the topography, including

mammary glands, and the corioretinial

structures of the globular eye. The most

important thing for veterinary practice is

to establish the positive diagnosis for

malignant melanoma and to differentiate

it from mastocytoma. The differential

diagnosis can be done by analyzing

cellular granules. So the granules in the

melanoma are polymorphous, that is to

say they are both small and big and they

can generate a genuine" black spot" that

covers the whole cell. In the mastocytom

the granulations are fine and

homogenous having a more uniform

disposition (see fig. A - mastocytom; B,

C,D-melanom ).

In fig.1 - 7 we present a case where

one can notice placards of melanictumoral cells that infiltrate into the

tegumentary epithelial territories. In spite

of the fact that the aspect of the

granulations is relatively uniform and

dense, there are also many cells that

contain melanic granulations that are

extremely densified and that acquire the

aspect of a cloak or of a " black spot",


ln fig. 8 -10 Intr-un alt caz granulatiilepolimorfe sunt prezente In citoplasma de

jur Imprejurul nucleului 1?i Intr-o micamasura pe nucleu.

In fig. 11 - 15 prezentam mai multecelule tumorale melanice In care celula

este acoperita qvuasi total de a1?azisa"pata neagra" sau "manta" alcatuitaexclusiv din confluarea granulelor dincitoplasma.

In fig. 16 - 19 prezentam un caz demelanom malign, 0 forma cu multiple

"celule gigante" care au pe langagranulatiile melanice, 1?i zone deconfluare a acestora sub aspectul de"manta" melanica.

In fig. 20 - 22 se sintetizeaza

imaginea reala inconfundabila a uneicelule tumorale maligne melanice, Incare se distinge polimorfismul granulatmelanic fata de granulatiile mastocitaredin cadrul celulei tumorale maligne de tipmastocitar.

In fig. 23 se identifica prezenta uneimetastaze de melanom malign Intr-un

tesut limfonodal.Fig. A - Celula mastocitara (pentru

comparatie cu celula melanica).

Fig. B, C, 0 - Celule melanice (pentru

comparatie cu celula mastocitara).Apar diferente de morfostructura

granulara net diferite. Celulele nu pot ficonfundate dupa 0 pregatire speciala Indiagnosticul oncocitologic.

without obeying the structure of thenucleus.

In fig. 8-10, in another case, poly

morphous granulations are present in thecytoplasm all around the nucleus and in asmall extent on the nucleus.

In fig. 11-15 we present severalmelanic tumoral cells in which the cell is

. almost totally covered by the so called "

black spot" or" cloak", exclusively madeup of the confluation of the granules inthe cytoplasm.

In fig. 16-19 we present a case of

malignant melanoma, a form withmultiple "giant cells" that have melanicgranulations, as well as areas ofconfluation under the aspect of melanic"cloak ".

In order to make synthesis, fig. 20-22present the real, unmistakable image of a

melanic malignant tumoral cell in whichone can distinguish the polymorphism ofmelanic granulations contrary to themastocytary granulations within themalignant tumoral cell of a mastocytarytype.

In fig. 23 one can identify thepresence of a metastasis of malignant

melanoma in a Iymphonodal tissue.Fig. A - Mastocytary cell (in comparisonwith melanic cell).Fig B, C, 0 - Melanic cells (incomparison with mastocytary cell).There are granular morfostructuredifferences clearly different cells can notbe confused after a specially trained indiagnosis oncologically.

136 --------------------------


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CAPIIOLUL 12/ CHA~TER_12

FIBROSARCOMUL THE PROLIFERATION OF THEMAliGNANT FIBROBLAST

Aceasta forma de cancer face parte

din categoria "sarcoamelor de parti moi".

Forma maligna de fibrosarcom are 0

incidenta foarte ridicata i?i nu prezinta 0

localizare tipica sau specifica, putand

aparea In orice parte a corpului.

In fig. 1 - 3 se prezinta aspectul

citomorfologic al unor celule tumorale

fibroblastice. Imaginile arata ca

fibroblastul tumoral este de talie mare,

atat citoplasma cat i?i prelungirile

acesteia au 0 tendinta neta bazofila.

Nucleul este mare, cu cromatina mult

mai relaxata, lasand sa se distinga In

cele mai bune conditiuni 1 - 2 nucleoli.Multe din aceste celule sunt binucleate.

In fig. 4 - 7 se vizualizeaza aspectulclasic de sarcom fibroblastic moderat

anaplazic. Se prezinta ca 0 masiva

proliferare de celule alungite cu tendintaneta de confluare. Nucleii sunt rotunzi

sau alungiti cu cromatina laxa, ce lasa sa

se observe 1-3 nucleoli. Frecventadiviziunilor celulare este ridicata,

citoplasma i?i prelungirile sunt intensbazofile.

In fig. 8 - 17 se prezinta 0 forma

aparte de fibroblastom - fibroblastomul

Inalt anaplazic giganto-celular. Celulele

This form of cancer belongs to the

category "the soft parts sarcomas". The

malignant form of fibrosarcoma has a

very high incidence and there is no

typical or specific location, which may

occur in any part of the body.

In fig.1-3 is present the cyto

morphological aspects of a fibroblastic

tumoral cell. The images show that thetumoral fibroblast is waist size and that

both the cytoplasm and its prolongation

have an obvious basophilic tendency.

The nucleus is large with a much more

relaxed chromatin, leaving to distinguish

the best condition 1-2 nucleoli. Many ofthese cells are bi-nucleate.

In figA-7 we can see the classical

aspect of moderately anaplastic fibroblastic sarcoma. It looks like a massive

proliferation of elongated cells with an

obvious tendency to confluation. The

nuclei are round or elongated with lax

chromatin, which leaves to observe 1-3

nucleoli. The frequency of cell divisions is

high, the cytoplasm and prolongations

are intensely basophilic.

In fig. 8-17 we present a special form

of fibroblastoma - the giant cell highly

-------------------------- 151


gigante pot fi extrem de polimorfe 9i au 0

talie mare variabila Intre 25-60 !-t.

Celula rotunda sau fuziforma are 0

citoplasma variabila, fie intens bazofilasau acidofila. Nucleii sunt In numar

variabil de la 2 la 10, sunt de regula

oligocromi cu 3-4 nucleoli. Aceasta forma

tumorala are un grad Inalt de malignitate

gratie atipiilor celulare 9i a unei anaplaziimaximale. Este necesar sa se faca un

atent diagnostic diferential fata de un alt·sarcom de tesut moale si anume, ,rabdomiosarcomul.

In final vom adauga 0 imagine tipica

de rabdomiosarcom pe care 0 vom

comenta vis-a-vis de forma gigantocelulara a fibrosarcomului. Daca avem

imaginea clara a sarcomului fibroblastic

forma giganto-celulara este nevoie de 0

scurta prezentare a rabdomiosarcomului.

Imaginea A In rabdomiosarcom se

distinge 0 proliferare masiva _ de

rabdomioblaste care au 0 talie mare 30 !-t

cu un monomorfism elocvent. Celulele,

de regula, sunt rotunde sau trapezoidale

cu citoplasma larga, bazofila 9i

emitatoare a doua prelungiri.Nucleii sunt mari, situati excentric, au,

cromatina In "bulgari" 9i un nucleol

gigant.

Imaginea B, de asemenea, specifica

rabdomiosarcomului, se vizualizeaza 0

celula giganta de talie 100 !-t cu 15-20

nuclei. Citoplasma este bazofila ~i emite

mai multe prelungiri la ambii poli celulari.

Nucleii sunt dispU9i In toata citoplasma,

anaplastic fibroblastoma. The giant cells

can be extremely polymorphous. They

have a big size, varying between 25-60 !-t.

The round or fusiform cell has a

variable cytoplasm, which is either

intensely basophilic or acidophilic. The

number of nuclei vary from 2 to 10. The

nuclei are generally oligochrom with 3-4

nucleoli. This tumoral form has a high

degree of malignancy due to the cellularabnormalities and to a maximal

anaplastia. This tumoral form needs a

very careful diagnosis that should notmistake it for another sarcoma of soft

tissue: rabdomyosarcoma.

Finally, we will add a typical image of

the rabdomyosarcoma which we will

comment in comparison with the giantcell form of the fibrosarcoma. If we have

the clear image of the fibroblastic

sarcoma in its giant cell form, we need a

short presentation of the rabdomysarcoma.

In image A of the rabdomysarcoma

one can distinguish a massive proli

feration of radoblastia with a big size, of

30 !-t, with an eloquent monomorphism.

Cells are usually round or trapezoidal

with a large basophilic cytoplasm with

two prolongations.

The big nuclei are situated

eccentrically, have the chromatin in

"lumps" and a giant nucleolus.

In image B (is .also specified to the

rabdomysarcoma) one can see a giant

cell of size 100 !-t with 15-20 nuclei.

152 --------------------------


prezinta cromatina In "bulgari" cu 0 tenta

oligocroma. Fiecare nucleu lasa sa se

distinga prezenta unui nucleol. In acestfel nu pot exista confuzii Intre cele doua

forme ale sarcoamelor de parti moi.

Fig. 1 $i B - reprezinta imaginea

oferita comparativ a rabdomiosarcomului

cu care, teoretic s-ar putea confunda un

fibrosarcom, dar imaginile care pledeaza

pentru rabdomiosarcom nu lasa nici undubiu de confuzie.

The cytoplasm is basophilic and sends

out- several prolongations to both

cellular poles. The nuclei are disposed

throughout the whole cytoplasm, their

chromatin is in "lumps" with a oligochrom

tendency. Every nucleus leaves us to

distinguish the presence of a nucleolus.Thus, there can be no confusion between

the two forms of soft parts sarcomas.

Fig. 1 and B - represent the image

offered rabdomysarcoma compared to

the theoretically it could confuse a

fibrosarcoma, but the images witch

pleads for rabdomysarcoma leaves no. doubt of confusion.

--------------------------153

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CCAPIIOLUL~'l3cI ~CJ:lAEIER 13,

RABDOMIOSARCOMUL

Rabdomiosarcomul este 0 tumora

maligna a tesutului muscular striat ~i areare 0 frecventa ridicata la caine ~i pisica.Rabdomiosarcomul necesita un atent

diagnostic diferential vis-a-vis de sarcomul fibroblastic, forma gigantocelulara. In ambele forme de evolutie a

acestor neoplasme, mijlocul de

diagnostic pozitiv ~i diferential este

examenul citomorfologic consecutiv

biopunctiei formatiunii tumorale.

Examenul citomorfologic

Releva aspectul celulelor musculare

atipice, alungite cu nucleii fuziformi

plasati la periferia miocitului. Nucleii sunt

oligocromi, de marimi diferite; lasand sase Intrevada un nucleol gigant. 5e

remarca ~i prezenta micronucleilor (fig.6), citoplasma celulara este larga,

bazofila ~i se anastomozeaza In cadrulstructurilor miocitare (fig. 1-6).

in cadrul liniei proliferative In pare'n

chimul tumoral se identifica, $i celulele

globuloase (fig. 7-19) care au numai 0

singura prelungire citoplasmatica. Acestecelule sunt de talie mare, de peste

30-40 /-1, cu citoplasma bazofila sauamphofila. Nucleul celular este excentric,

~i are un nucleol gigant. Cromatinanucleara este dispusa "In gramezi".

RABDOMYOSARCOMA

Rabdomysarcoma is the malignanttumour of the striated muscular tissue.

This on frequently met in the case of

pets. As we have already seen in the

chapter on fibroblastic sarcoma,

rabdomysarcoma needs a very careful

diagnosis which should be different formJhe fibroblastic sarcoma, the giganticcellular form. In both form of evolution of

cancer, the main means of diagnosis is

the cyto-morphologic test made after the

bio-punction of the tumoral formation.The localization is situated wherever

there are striated muscular structures.

The cytomorphological test

It reveals the aspect of the atypical

elongated muscular cells, with fusiform

nuclei placed on the periphery of the

myocyte. The nuclei are oligo-chrom, of

different sizes, revealing a giantnucleolus. There are also micronuclei

(fig. 1-6). The large, basophile, cellular

cytoplasm undergoes anastomosis withinthe myocytary structures (fig. 1-6)

Along the proliferative line in the

tumoral pachyderm globular cells can

be identified ( fig. 7-19); they have only

one cytoplasmatic prolongation. These

cells are waist high, more than 30-40 /-1,

with basophilic or amphophilic cytoplasm.

-------------------------- 163


Fig. 15-16. Sunt prezentate doua

celule bi-nucleate gigante cu citoplasmabazofila sau amphophila. Nucleii sunttachicromi ~i nu lasa sa se vizualizezestructurile nucleolare.

In fine, cel mai important aspect pecare noi I-am vizualizat este celula

gigantii multinucleatii, zisa ~i "Inpaianjen". Aceste celule pot ajunge panala 150 /-!, ~i pot contine pana la 50 de

nuclei, unele dintre ele pot avea multipleprelungiri. Nucleii sunt normocromiavand 1-2 nucleoli de talie mica.

Citoplasma este. bazofila sau acidofila.Numarul de mitoze este procentual marit(fig. 20 - 24).

Tabloul celular al rabdomiosarcomului

este cel mai polimorf din toate formele decancer cunoscute, este cea mai

anaplazica tumora, ceea ce ne face sa

conchidem ca este cea mai maligna, cu

evolutia cea mai scurta ~i cea mairezistenta la terapia cu citostatice.

The cellular nucleus is eccentric and has

a giant nucleolus. Nuclear chromatin isdisposed in piles.

Fig. 15-16: two giant bi-nucleate cellswith basophilic or amphophilic cytoplasm.

The nuclei are tachichrom and preventthe visualization of nucleolar structures.

Finally, the most important aspect thatwe viewed is the giant multi-nucleate cell,also called "the Spider". These cells can

reach up to 150 /-! and may contain up to

50 nuclei, some with multiple prolongations. The nuclei are normochrom, with1-2 small nucleoli. The cytoplasm isbasophilic or acidophilic. The numberof mitoses is increased for 100 cells

(fig. 20-40)

The cellular picture of the rabdomyosarcoma is the most polymorphous of allthe forms of cancer known in pets.

It is also the most anaplastic form ofcancer, which makes us conclude that it

is the most malignant form of cancer, withthe shortest evolution and the most

resistant to the cytostatic therapy.

164 --------------------------

Atlas de oncocitomorfologie la can ide ~i feline / Atlas of canine and feline oncocytomorphology

"

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165

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HEMANGIOSARCOMUL

In oncologia animalelor de companieaceasta forma este foarte rara,

reprezentand malignizarea teritoriului

vascular, care poate avea loc Tn orice

tesut sau Tn orice viscer. Prezentam

cazurile diagnosticate Tn practicanoastra, acestea constituind uneori 0

surpriza de necropsie.

Hemangiosarcomul

Examenul citomorfologicFig. 1-12: Proliferarea maligna a

tesutului vascular se vizualizeaza pentru

specialist sub forma unui melanj celularalcatuit din:

- celule musculare de tip vascular

(miocite) malignizate (fig. 1-3);

- celule endoteliale malignizate (fig.

4-10);

- celule adventiciale malignizate (fig.

11-12);Miocitele vasculare tumorizate (fig.

1-3) sunt celule ovoidale de 20-25 1-1,

avand nucleul situat central. Nucleul este

tachicrom, nucleolii sunt neevidentiati., ,Citoplasma este bazofila prezentand una

sau doua prelungiri situate la capetele

celulei. Unele dintre celulele proliferatesunt Tn mitoza.

Celulele endoteliale proliferate

malign (fig. 4-10) sunt celule volumi-

HEMANGIOSARCOMA

In the oncology of pets this is a very

rare form of cancer representing the

malignization of the vascular territory,which can occur in any tissue or any

viscus. We are presenting these cases

diagnosed in our practice, some of thesebeing identified only in necropsy.

Hemangiosarcoma

Cytomorphological testFig 1-12 Malignant proliferation of the

vascular tissue appears to the specialistunder the form of a cellular mixture made

up of:

- malignized muscular cells of avascular type (miocites) (fig. 1-3)

- malignized endothelial cells (fig.

4-10)

- malignized adventicial cells (fig.11-12)

Tumorized vascular myocytes (fig.

1-3) are ovoid cells of 20-25 1-1, whose

nl}cleus in centrally situated. The nucleusis tachichrom, the nucleoli are not

highlighted. The cytoplasm is basophilic

and it presents one or two prolongationssituated at the end of the cell. Some of

the proliferated cells are in mitosis.

Endothelial cells malignanatly proli

ferated (fig. 4-10) are voluminous cells

over 30 1-1. The cytoplasm presents a

----------------~---------- 177


noase de talie mare, peste 30 Il.Citoplasma prezinta 0 prelungire groasa,care imprima celulei 0 forma racheti

forma, 9i este intens bazofila. Nucleuleste situat excentric, are cromatinadensificata, fiind usor tachicrom. La 0,examinare foarte atenta se deduce

prezenta structurilor nucleolare. Alaturide aceste tipuri celulare se mai identificao forma celulara intens proliferata cu un

aspect limfocitic-Iike.Celulele adventiciale (fig. 11-12)

sunt foarte bine reprezentate. Acestecelule au 0 talie mare de circa 30 Il cu

nucleul plasat strict excentric. Cromatinanucleara este dens structurata lasand sa

se vada 1-2 nucleoli 'In fiecare celula.

Citoplasma este bazofila 9i ext rem de

bogata 'In granule oxifile prezente 'In

portiunea contranucleara.

thick prolongation that gives the cell arachetiform form. The cytoplasm is

intensely basophilic. The nucleus issituated eccentrically, it has a densified

chromatin, slightly tachichrom. Upon verycareful examination, one can infer the

presence of nucleolar structure. Apartfrom these cellular types, one can identifya cellular form intensely proliferated with

a lymphocyte-like aspect.Advencial cells (fig.11-12) which are

very well represented. These cells have a

big size of about 30 Il with the nucleusplaced strictly eccentrically. The nuclearchromatin is densely structured, allowingfor 1-2 nucleoli to be seen in every

cell. The cytoplasm is basophilic andextremely rich in oxyphilic granules in thecounternuclear area.

178 --------------------------


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Fig. 2

179

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iCA~ITQLllt.-15..LCI:tAeIER~t5

OSTEOSARCOAME

In lumea animala tumorile maligne

osoase au 0 inalta frecventa fiind c1asateaproape In toate datele statistice epidemiologice In primele locuri. In cazuisticanoastra frecventa acestor neoplazii estefoarte ridicata. Diagnosticul acestorforme tumorale beneficiaza de 0 serie de

particularitati comparativ cu alte localizariale neoplaziilor.

Aspectul general anatomo-cliniceste destul de caracteristic, deoarece

deformarea regionala este ul?or de identificat pe un segment osos care are 0serie de aspecte cunoscute, cum ar fi:

- tumefactia de diferite marimi ce se

localizeaza Intr-o zona cu tesutosos;

- zona deformata este nedureroasa;

- aderenta tumorii este localizatastrict la planul profund;

- examenul radiologic releva fieprezenta unei rarefieri de tesut ososrelativ circumscrisa, fie a unei

neoformari deformante de tesutosos;

- la examenul biochimic, fosfataza

alcalina sangvina are valori multcrescute fata de statusul normal;,

Aspectul citomorfologic.Practicareabiopunctiei neoformatiunii duce la un

diagnostic pozitiv l?i diferential Intre uncancer fie primar osos, fie o. stare

OSTEOSARCOMA

In the world of animal, the malignanttumors of the bone have a high rate offrequency, being classified almost in allepidemiological statistics in top positions.In practice, the frequency of theseneoplasias is of course very high. Ifcompared to other locations of thisdisease the diagnosis for those forms ofcancer benefits from a series of

particularities.The general anatomic and clinical

aspect is, generally, a quite typical,because the regional deformation iseasily identified on a bone segment witha series of known issues, such as:

The tumefaction of various sizes

appears in an area with bone tissue;- The distorted area is painless;- The adherence of tumors is located

strictly in deep structure;- The X-ray examination reveals a

well circumscribed rarefaction of the

bone tissue or a distorting neoformation of the bone tissue;

- alkaline phosphatase in blood hasvery high levels in comparison withthe normal status;

The cytomorphological aspect.The execution of the biopuncture of theneoformation makes it possible toestablish a positive and differentialdiagnosis between primary cancer, andan inflammatory osseous state or of a

---------------------------187


inflamatorie osoasa sau periostala juxtaosoasa, cat 9i fata de un cancer primarconjunctival juxta osos sau a unor focarede metastaza neoplazica. Analiza

citomorfologica In cazuistica noastra acuprins urmatoarele aspecte:

- Osteosarcomul osteocitic sau

sarcomul osos cu celule mici (fig.1). Aceasta forma celulara este

alcatuita din osteocite (celule detalie mica cu nucleul excentric

intens colorat cu rari nucleoli,

majoritatea acestora fiind ecranati.Citoplasma este bogata 9i puternicbazofila, prezinta un numar redus

de vacuole 9i de asemenea 0redusa cantitate de hidroxiapatita.

Atat mitozele cat 9i atipiile celulare

sunt putin exprimate, gradul demalignitate este la un nivel inferior,deoarece exista un net caracter de

buna diferentiere celulara;,- Osteosarcomul osteoblastic. pe

la bun Inceput retinem caracterul de

slaba diferentiere a osteobla9tilorcu frecvente mitoze 9i anaplaziicelulare care Ii imprima un net

caracter de Inalta malignitate (fig.

2-6). Citologic aspectul este deproliferare celulara mixta alcatuita

atat din celule rotunde, cat 9i dincelule fuziforme mai mult sau mai

putin bine exprimate. Celulele sunt

de talie mare, depa9ind adesea30 Il, avand nucleul relativ centralsau excentric. Cromatina relativ

densa lasa sa se distinga 1-4

nucleoli de talie mare cu grad ridicat

periostal reaction, but also between aprimary bone cancer or some focuses ofneoplazic metastases. The cytomorphological analysis in our cases has includedthe following aspects:

- Osteolytic osteosarcoma or the

bone small cells sarcoma (fig. 1).This cellular form is made up ofosteocytes (small size cells witheccentric vividly colored nucleus,rarely with nucleoli, most of thembeing shielded. The cytoplasm isrich and strongly basophilic. Itpresents a reduced number of

vacuoles and a reduced quantity ofhydroxyapatites. Both mitoses andcellular abnormalities are very rare.The malignancy degree is at aninferior level, as there is a net

character of good cellular differentiations;Osteoblastic osteosarcoma. We

mention from the very beginning thefeature of poor differentiation of theosteoblasts with frequent mitosisand cellular anaplasias that provides a high level a malignancy (fig.2-6). The cytologic aspect is one ofmixed cellular proliferation of bothround and fusiform cells, more and

less well expressed. The big sizecells, often exceeding 30 Il, have arelatively central or eccentricnucleus. The relatively thickchromatin leaves to distinguish 1-4big size nucleoli with a high degreeof basophilia. The cytoplasm isslightly basophilic, but it is presentin a particularly large quantity, manycells have numerous intracyto-

188 --------------------------


de bazofilie. Citoplasma este slabbazofila, dar este intr-o cantitatedeosebit de mare, multe celuleavand numeroase vacuole intra

citoplasmatice l?i multe incluzii dehidroxiapatita. 0 caracteristica,este identificarea la multe celule

osteoblastice tumorale a unor

prelungiri citoplasmatice mai scurtesau foarte lungi.;

- Osteosarcomul osteoclastic (fig.

7-15). Aceasta forma gigantocelulara este alcatuita din tipuri decelule tumorale extrem de

anaplazice, cu frecvente mitoze l?i

inalte atipii. In aceasta varietatetumorala identificam trei tipuri de

celule proliferate:1. osteoblastul tumoral quasi

clasic, anterior descris, cu sin

gura observatie ca citoplasmaeste intens bazofila l?i Iipsita deincluzii de hidroxiapatita;

2. osteoblastul tumoral atipiccare este fie 0 celula relativrotundo-ovoidala sau 0 celula

fuziforma cu 0 prelungire micagroasa, avand 0 citoplasmaextrem de bazofila cu multiple

vacuole l?i fara prezenta cristalelor de hidroxiapatita. 0 importanta caracteristica este exis

tenta in numar considerabil aacelulelor bi- sau trinucleate.

Nucleii acestor celule continnucleoli multipli l?i atipici.

3. osteoclastul tumoral este 0

celula de talie foarte mare (peste

plasmatic vacuoles and manyhydroxypatite inclusions. Animportant feature, revealed duringthe cytologic examination, is theidentification of many osteoblastictumoral cells of some cytoplasmaticshorter or longer extensions;

- Osteoclastic osteosarcoma (fig.

7-15). This giant cellular form ismade up of different types ofextremely anaplastic cells, withfrequent mitoses and high abnormalities. Within this tumoral

variety we identify three types ofproliferated cells, as follows:1. the tumoral quasi classic osteo

blast, previously described, withonly one observation that thecytoplasm is highly basophilic andmostly devoid of hydroxyapatiteinclusions;

2. the atypical tumoral osteblastwhich is either a relatively roundoval cell or a fusiform one with a

small thick extension, having anextremely basophilic cytoplasmwith multiple vacuoles andwithout hydroxyapatite crystals.An important feature is theexistence of a high number of bior tri- nucleus cells. The nuclei of

these cells contain multiple and

atypical nucleoli.3. the tumoral osteoclast is a very

large size (over 70 Il), giant,multi-nucleus cell with a variable

number of nuclei, from 4-30.

Nuclei have a high level ofabnormality with the presence ofmultiple giant nucleoli. The

--------------------------189


70 Il) giganta, multinucleata, cuun numar variabil de nuclei, intre

4-30). Nucleii au un grad ridicat

de atipism cu prezenta de

multipli nucleoli giganti. Cito

plasma este bazofila, larga, cu 0

cantitate variabila de vacuole ~i

cu incluzii de hidroxiapatita. Este

forma cea mai maligna alaturi

de urmatoarea forma celulara pecare 0 vom descrie.

4. Osteocrondrosarcomul (fig .16

24). Aceasta forma celulara de

inalta malignitate prezinta un

amalgam celular alcatuit dinosteocite clasice, condrocite

tumorale c1asice ~i condroblaste

gigante tumorale. Daca osteocitul tumoral clasic a fost descris

mai sus, vom descrie numaicelulele condrale tumorale.

Condrocitele clasice tumorale

sunt celule de talie mica 12-14 ~avand 0 forma rotunda cu fine

microvilozitati. Citoplasma prezinta vacuole, este larga ~ibazofila. Nucleul este normo

crom, cu pozitionare excentrica

~i posed a un singur nucleol.5. Condroblastele gigante multi

nucleare tumorale sunr celule

de talie mare 30-40 Il avand 0

citoplasma larga bazofila ~i 0structura multinucleara de

regula inmugurita. Nucleii 1asasa se distinga prezenta structurilor nucleolare.

cytoplasm is basophilic, wide,

with a large number of vacuoles

and hydroxyapatite inclusions. It

is the most malignant form next

to the following cellular patternthat we will describe.

4. Osteochondrosarcoma (fig.

16-24). This highly malignant

cellular pattern shows a cellular

mixture composed of classical

osteocytes (os), classical

tumoral chondrocytes (cdr) and

giant tumoral chondroblasts

(cdrbl). Because the classical

tumoral osteocyte has been

described above, we will

describe only the tumoralchondral cells.

Classical tumoral chondrocytes

are small size cells 12-14 Il with

a round shape and fine micro

vilosities. The cytoplasm is wide,

basophilic, with vacuoles. The

nucleus is normochrom, with

eccentric position and posses a

single nucleolus.5. Giant multinuclear tumoral

chondroblasts are large-size

cells (30-40 Il) with a highly

basophilic cytoplasm and a

multinuclear structure usuallyblossomed .. The nuclei allow to

distinguish the presence ofnucleolar structures.

190 --------------------------


Fig. 1

Fig. 2

-------------------------- 191

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SINOVIOMUL MALIGN MALIGNANT SYNOVIOMA

This form of expression of malignant

disease has also quite a reduced

frequency in pets. The location of this

neoplastic form is variable and may be

interested any of the big articulations or allareas where can be found bursale

structures. The diagnosis is supported by

the anatomic clinical, radiological

observations and by the cytomorphological

result of the biopuncture.

Cytomorphologic examination (fig.

1 - 5)

In fig. 1 we present a case of

malignant synovioma - pseudoepithelia/ pattern. We can see the

presence of a cellular monomorphic

conglomerate composed of synovial cells

which takes a pseudoepithelial

appearance. The cells are medium-sized

18!J., with a wide acidophil cytoplasm

issuing a series of extensions. The round

nucleus is hypochrome with a condensedchromatin structure. We cannot reveal

nucleoli. The conglomerate's cells have a

confluent tendency.

In fig. 2 - 5 we present the

pseudofibrob/asticpattern of malignantsynovioma. The synovial cells takes

pseudofibroblastic appearance. The

Aceasta forma de exprimare a bolii

canceroase are 0 incidenta destul de

redusa la animalele de companie.

Localizarea este variabila putand

cointeresa oricare dintre marile articulatii

sau toate zonele unde se gasesc

structuri bursale. Diagnosticul se sustine

pe baza examenului anatomo-clinic,

rezultatele radiologice 9i pe examenul

citomorfologic al biopunctiei.

Examenul citomorfologic (fig. 1 - 5)

In fig. 1 se prezinta un caz de

sinoviom malign forma pseudo-~ epitelia/a unde se distinge prezenta unui

~ conglomerat celular monomorf alcatuit::~.:. din celule sinoviale care Imbraca1\'"

'\ aspectul pseudoepitelial. Celulele sunt

\~:< de talie medie 18!J.,cu 0 citoplasma larga

\\\ acidofila care emite 0 serie de prelungiri.

\-;\\\\ Nucleul rotund este hipocrom cu\'\\\\\ structura cromatiniana condensata. Nu

~\0.~se disting nucleolii. Celulele din

\\\Y::. conglomerat au tendinta de a conflua."'1"'\

\\;~\'.: In fig. 2 - 5 se prezinta aspectul de

\)\~,.:sinoviom malign pseudofibrob/astic.\;\\\\\Celulele sinoviale Imbraca aspectul

\\\\\lseudofibroblastic. Celulele au lungi~',\\\\\relungiricu 0 tenta bazofila neta. Nucleii'. "~1'

(:\\\ynt alungiti, mariti In volum cu aceea9i

\\\\\------------------------- 203;:\~:;\\

. ;~ \1'

NtCOLAE MANOLESCU, EMILIA BALINT

cromatina nucleara densificata 9i fara a

exprima prezenta nucleolilor. Deasemenea, In ambele forme diviziunile

celulare lipsesc. Aspectul general este de

o proliferare celulara cu grad redus de

malignitate.

cells have long extensions with a clear

basophilic tendency. The nuclei are

elongated, increasing in volume with thesame thickened nuclear chromatin

without expressing the presence of

nucleoli. Cell divisions are missing from

both forms. The general appearance is

that of cellular proliferation with a low

grade malignancy.

204 --------------------------


Fig. 1

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Fig. 5

-------------------------- 207

CA~ITOLUL 17 LCHA~IER_1Z

LlPOSARCOMUL

Este una dintre cele mai rare forme

citomorfologice de cancer la speciacanina. EI face parte din categoria deneoplazii maligne mezenchimale aletesutului conjunctiv moale (sarcoame de

parti moi).Proliferarea celulara (fig. 1 - 10) este

polimorfa In sensu I prezentei de celulede la talie mica pfma la foarte mare (de la20 /J. - 60 /J.). Aceste celule au un caractercomun, acela al aspectului citoplasmeicare e alcatuita dupa forma unui veritabil

"fagure de miere". Citoplasma imprima ~iaspectul general al celulei, ce poate fiquasi-rotunda pana la fusiforma, cu una

sau mai multe prelungiri. Desigur ca"ochiurile" din citoplasma sunt actual

mente foarte goale datorita alcooluluimetilic care dizolva depozitele de lipide.

Nucleii celulari sunt plasati diferit, fiecentral fie excentric, cu cromatina

densificata In diferite grade, iar Instructura cromatinei se identifica prezentaunui nucleol. Caracteristic pentru aceasta

forma de cancer este prezenta In numarmare a diviziunilor celulare amitotice (fig.10). Un element constant este acela al

prezentei formelor atipice ~i gigante (fig.5,6, 10).

LYPOSARCOMA

It is one of the most rare

cytomorphological forms of cancer in thecanina species. It belongs to the category

of mesenchymal malignant neoplasias ofthe soft conjunctive (connective) tissue

(soft parts sarcoma ).Cellular proliferation (fig. 1-10) is

polymorphous, namely there are from

small to very large cells (from 20 /J. to60 /J.). These cells have a commoncharacteristic, the aspect of the cytoplasm

is that of a genuine honeycomb. Thecytoplasm gives the general aspect of thecell that which can be quasi-round or

fusiform, with one or sev~ral prolongations.Obviously, the "loops" of the cytoplasm,

at present very empty because of themethylic alcohol which dissolves fat

deposits. Cellular nuclei are placeddifferently, centrally or eccentrically, withchromatin that is densified in various

degrees. The presence of a nucleoluscan be identified in the structure of thechromatin. No cellular mitoses can be

identified, there are only amitoses (fig.10). One constant element is that of the

present of various atypical and giantforms ( fig. 5, 6, 10).

-------------------------- 209

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CA~ITOLUL 18l CHA~IER 18

CANCERULGLANDEI MAMARE

Aceasta localizare a bolii canceroase

la can ide si la feline are 0 frecventa, ,ridicata 9i prezinta 0 serie de dificultati de

diagnostic, de enunt evolutiv 9i de

prognostic cu implicatii Tn zona tera

peutica dintre cele mai marL Prin punctia

neoformatiunii glandei mamare, urmata

de examenul citomorfologic, se urma

re9te Tn primul rand Tncadrarea corecta a

neoformatiunii Tn categoria de tumora

benigna sau maligna. Apoi se urmare9te

definirea bazei celulare a proliferarii

tumorale 9i a G-ului celular.Acesta se refera la stabilirea celor

patru c1ase de Tncadrabilitate a tumorilor

mamare din punct de vedere al gradului

de diferentiere. Acestea sunt:

1. Celule tumorale maligne bine

diferentiate.

2. Celule tumorale maligne slab

diferentiate.

3. Celule tumorale maligne nedi

ferentiate.

4. Celule tumorale maligne anaplazice.

Odata cu aprecierea 9i introduce reaTntr-una din aceste 4 clase a fiecarui caz

Tn parte,se vor face referiri la aspectele

oferite de multiplicarea celulara astfel:

1) Nu se identifica diviziuni celulare.

THE CANCEROF THE MAMMARY GLAND

This localization of the cancer has a

high frequency in dogs and cats and

presents a series of difficulties in

diagnosis, changing the prognostic

implication on its evolution, which has a

very important issues in therapy. The

punction of the neo-formation of the

mammary gland, followed by the

cytomorphological examination, is meant

to help the specialist to identify thedeasise whether the neoformation is

benign or malignant tumor. Then the

cellular base of the tumoral proliferationis identified as well as the cellular G.

This refers to the establishment of the

four classes in which mammary tumors

can be included from the point of view of

the degree of differentiation.

1. well differentiated malignant tumoralcells

2. poorly differentiated malignanttumoral cells

3. non-differentiated malignant tumoralcells

4. anaplastic malignant tumoral cellsOnce each case has been identified

as belonging to one of these 4 classes,

references will be given to aspects of cell

multiplication as follows:

-------------------------- 215

NlCOLAE MANOLESCU, EMILIA BALINT

2) Multiplicarea celulara se realizeaza

prin amitoza.3) Se remarca prezenta de rare

mitoze tipice 9i atipice.4) Se identifica un numar mare de

celule Tn diviziune atipica.Imagistica noastra prezinta 0 seri.e de

aspecte particulare ale neoplasmuluimamar la canide, Tntre aceste imagini

retinem:Fig. 1 - 5: Carcinom vegetant

papilifer - cu multiple mitoze atipice, cu

grad semnificativ de anaplazie, care Tnfinal conduce la un diagnostic de cancer

de Tnalta malignitate, cu 0 evolutie scurta,

generand metastaze Iimfonodale 9ihepatice Tntr-un termen scurt. Serecomanda ablatia chirurgicala 9iinstituirea chimioterapiei.

Fig. 6 - 7: Carcinom solid. - aceastaforma prezinta un grad Tnalt anaplazic cu

gigantism celular 9i nucleolar. Diviziunilecelulare se realizeaza prin amitoza.

Fig. 8: Adenocarcinom mamar. - se

identifica u90r fata de celelalte formecelulare pe seama prezentei celulelortumorale epiteliale cubice Tntr-o masanecrotica cu infiltrat celular inflamator.

Diviziunile celulare sunt amitotice, fara a

se putea semnala un grad de anaplazie

celulara. Celulele tumorale au un gradmediu de malignitate. Evolutia acesteiforme celulare este de mai lunga durata,iar metastazele sunt rare.

Fig. 9 - 10: Carcinosarcom.- 0 forma.tumorala rara, unde se combina 0

proliferare concomitenta a celulelorductale cubice (fig. 9), omogene cu grad

1) Cells in division cannot beidentified.

2) Cellular multiplication is amitotic.

3) There are rare atypical and typicalmitoses.

4) There are a great number of cells in

atypical division

. Our images shows a series ofparticular aspects of the mammaryneoplasm in dogs, among these we

highlight:Fig 1 - 5: Papillary carcinoma -with

multiple atypical mitoses, with a significant

degree of anaplasia which ultimately leads

to a diagnosis of cancer highly malignancy,with a short evolution, generating

Iymphonodal and hepatic metastases.Surgical ablation is recomanded and

chemotherapy estabilishment.Fig. 6 - 7: Solid carcinoma.This form

shows a high anaplastic degree withcellular and nucleolar gigantism. Cell

divisions are done through amitosis.

Fig 8:. Mammary adenocarcinoma.It is easily identifiable because of thepresence of cubic epithelial tumoral cellsin a necrotic mass with inflammatorycellular infiltration. Cell divisions are

amitotic, without a cellular anaplastic

degree. Tumoral cells have a average

degree of malignity. The evolution ofthese cellular type is longer lasting andmetastases are rare.

Fig. 9 - 10: Carcinosarcoma. A raretumoral which combines a concomitant

proliferation of ductile' cubic cells (fig 9),

homogenous, with a low-grade malignancyand of mioepithelial cells (fig.10) which

216 --------------------------


redus de malignitate l?i a celulelor

mioepiteliale (fig'. 10) care prezinta inschimb un grad inalt de atipism celular.

In fig. 11 - 14 - se prezinta aspectelespeciale ale metastazei carcinomatoase

cu punct de plecare glanda mamara intrun limfonod, unde structura normalalimfocitara este invadata de una sau maimulte celule carcinomatoase metastazante.

presents in exchange a high degree ofcel1ular abnormality.

In fig 11 - 14 - It presents particular

aspects of the metastases of thecarcinoma with a starting point in the

mammary gland in a lymph node thenormal Iymphocitary structure is invaded

by one ore several metastazingcarcinoma cells.

-------------------------- 217

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Fig. 4

-------------------------- 219

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-------------------------- 221

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-------------------------- 223

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CAPITOLUL 19 I CHA.. 1.9

CANCERULVEZICII URINARE

Tumorile maligne ale vezicii urinare

au Tn cazuistica noastra 0 frecventaridicata la animalele de companie (caine

9i pisica).Forma citomorfologica, cea mai

frecventa, este carcinomul tranzitionalsub diferite forme de organizare tisulara.

Bazandu-ne pe faptul ca hematuria

este simptomul eel mai frecvent al uneineoplazii maligne vezicale Tntoate cazurile

obligatoriu se efectueaza examenul

citomorfologic al sedimentului urinar. Invederea coroborarii mijloacelor de inves

tigatie anatomoclinice pentru stabilirea

diagnosticului corect, se examineaza

vezica urinara ecografic pentru a urmariaspectul general morfologic.

Desigur ca acolo unde sunt neclaritatise poate t'ecut'ge ~ila examenul citoscopic

urmat de realizarea biopsiei dirijate pentruinvestigatiile histopatologice.

Examenul citomorfologic releva Tn

cazuistica noastra existenta urmatoareloraspecte:

1) Carcinom tranzilional papilifernon invaziv (fig. 1 - 5). Aspectulcitomorfologic al sedimentului urinar este

relativ caracteristic Tn sensul existentei

unor multiple placarde celulare, lipsite demitoze sau amitoze, fara anaplazie

THE CANCEROF THE URINARY BLADDER

Our experience shows that the

malignant tumors of the urinary bladderare highly frequent in pets.

The most common cytomorphologicalform is transitional carcinoma under

various types of tissular organization.Taking into consideration that

hematuria is the most common symptom

of the bladder malignant neoplasia in all

the cases in which we proceeded to the

compulsory cytomorphologic examinationof the urinary sediment, apart from the

cytomorphological test. In view of thecorroboration of the means of anatomo

clinical investigation for a properly

diagnosis, the specialist must proceed to

the echographic examination of the

urinary bladder to see what the generalmorphologic aspect is.

Of course, whenever there are

uncertainties, one can resort to the

cytoscopic examination, followed of

directed biopsy for histopatological

investigations.

The cytomorphological test reveals in

our case the following aspects:1) Non-invasive papillary transitional

carcinoma (fig 1 - 5) the cytomor

phologic aspect of the urinary sediment is

relatively typical, there are multiple cell

-------------------------- 225

NtCOLAE MANOLESCU, EMILIA BALINT

celulara, imprimand un caracter mono

mort prin formele ~i marimile celulelor

proliferate. Elementele de analiza celulara

necesare elaborarii unui diagnostic

corect pentru a se indica ulterior terapia

sunt reprezentate de:

- citoplasma celulelor proliferate este

acidofila cu palida tenta de bazofilie;- cromatina nucleara este in diferite

grade laxa, buretoasa;nucleolii nu sunt vizibili.

Aceasta forma citomortologica estemai rar intalnita.

2) Carcinomul tranzilional papiliferinvaziv bine diferenliat (fig. 6 - 10).

Este de malignitate redusa ~i secaracterizeaza astfel:

- existenta de placarde vegetante;- anaplazia celulara este prezenta dar

redusa cantitativ;

- lipsa mitozelor atipice;

- apare bazofilia citoplasmatica;- nucleolii Incep sa se vizualizeze;- cromatina nucleara se densifica.

3. Carcinomul tranzilional papiliferinvaziv de inalta malignitate(anaplazic).

(fig. 11 - 19).Este cea mai Intalnita forma In clinica

veterinara.:.

Aceasta se caracterizeaza prin:

- celulare vegetante sunt prezentate In

placarde ~i individual;

- celulele au un grad foarte mare de

anaplazie;celulelesunt de talie mare- cu

citoplasma bazofilica, iar nucleul

prezinta 1-2 nucleoli;

placards, with no mitoses or amitoses,without cellular anaplasia, with a

monomorph character through the formsand sizes of the proliferated cells. The

elements of cellular analysis required to

prepare a correct diagnosis to indicatethe appropriate therapy are:

- the cytoplasm of the proliferated cells is

acidophilic with a slight tendency to

basophilia.- the nuclear chromatin is lax and has a

sponge-like aspect.- the nucleoli are not visible.

This cyto-morphological form is very

rarely in a clinic.2) The well-differentiated invasive

papillary transitional carcinoma (fig. 6- 10)

This cytomorphological form is rather

rarely discovered as well. This ischaracterized as follows:

- the existence of vegetant placards;cellular anaplazia is present but in asmall quantity;

- the lack of atypical mitoses;the presence of cytoplasmatic basophilia;

- the nucleoli can be visualized;- the nuclear chromatin densifies.

All these new cellular aspects (in

comparison with those known as a noninvasive form) still exist to a large extent

together with cytomorphological aspectsoffered by transitional epithelial cells thatstarted to proliferate malignantly, but

stopped in the process.3. Highly mali'gnant invasive

papillary transitional carcinoma(anaplastic) fig. (11 - 19).

226 --------------------------


- cromatina nucleara 19i schimba

aspectul fie din lax-buretos initial fie decompactizare, Intr-o structuralizarelamelar fasciculata;

- multe celule sunt bi- sau trinucleate;- diviziunile celulare se realizeaza nu

numai prin mitoza ci 9i prin amitoza.

It is the most common form to be met

- in the veterinary clinic.This form has the following

characteristics:

- vegetant cellular placards are present:- the cells in the placard or the individual

ones have a very high degree ofanaplasia;

- cells are big and have basophilic

cytoplasm, and the nucleus has 1-2nucleoli.

The nuclear chromatin changes itsinitial aspect which was lax, sponge-like

and of compactisation, into a structurethat is lamella-like and fascicle-like;

- many cells are bi or tri nucleate;

- divisions are no longer carried outpredominately by mitoses but byamitosis.

-------------------------- 227

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Fig. 4

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Fig. 8

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Fig. 12

-------------------------- 233

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Fig. 16

-------------------------- 235

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-------------------------- 237

SEMINOMUL TESTICULAR

Este 0 tumora extrem de maligna,

generand de timpuriu metastaze In

pulmon ~i ficat. Seminomul se realizeazape suportul malignizarii celulelorspermatogonice din testicul. EI are 0

frecven1a sub medie pentru animalele decompanie. In urma examenului anatomo

clinic se poate formula diagnosticul

pozitiv ~i cel diferen1ial pe bazaexamenului citomorfologic consecutiv

biopunc1iei testiculare.Examenul citomorfologic (fig. 1 - 3)Se vizualizeaza diferite plaje celulare

epiteliale formate din celule de talie mare

> 25 f.l. Aceste celule poliedrice pot aveao citoplasma bazofila sau acidofila, relativ

larga ~i agranulata. Nucleul este rotund,mare, avand cromatina reticulata sub

forma de bulgari. Nucleii lasa sa seobserve 1-2 nucleoli de talie relativ mica.

Mitozele sunt frecvent atipice.

TESTICULAR SEMINOMA

It is an highly malignant tumor that

generates early metastases in lungs andliver. The seminoma appears due to the

malignization of the spermatogonic cellsof the testicles. It has a below averagefrequency for pets. Unlike the anatomoclinical test, the cytomorphological test

made after the testicular punction cangive diagnosis.

The cytomorphological test (fig.1 - 3)

Various cellular epithelial ranges

consisting of large cells size(> 25 f.l) canbe seen. These polyedrical cells canhave a basophilic or acidophilic cytoplasm,

which is relatively large and granulated.The nucleus is round, large, withreticulate chromatin having the form of

lumps. The nuclei allow us to see 1-2nucleoli of a relatively small size. Mitosesare frequent atypical. -

-------------------------- 239

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-------------------------- 241

CA~IIOLU.Ll21J CI:U\P-.TER 21

SERTOLIOMUL

Este 0 tumora a tesutului de sustinerea Iiniei seminale a testiculului semi

maligna, care metastazeaza ~i are 0frecventa redusa la canide ~i feline .Tumorile testiculare, de regula, suntsurprize ale interventiei chirurgicalespecifice orhiepididimectomiei practicateIn alte scopuri (castrare).

Dupa sectionarea longitudinala(equatoriala) a testiculului, tumora se

pune u~or In evidenta intraparenchimatos.

Examenul citologic (fig. 1 - 3)Aspectul este destul de caracteristic, de

proliferare celulara monomorfa, cu celule

at~Hrotunde cat ~i u~or ovoidale. Nucleiimari, veziculari, au 0 cromatina finreticulata lasand sa se vada 1-2 nucleolide talie mica.

Celulele au 0 citoplasma redusa,intens bazofila, confluenta, fara a se

putea identifica Iimitele acestora.

Mitozele ~i atipiile celulare sunt rare, dinloc In loc apar celule razlete Leydig(secretorii), acestea fiind de talie mica, cu

nucleul grosolan, pozitionat excentricfara nucleoli. Citoplasma dominacantitativ In structura celulara,avand 0tenta bazofila bine evidentiata. Alaturi deaceste celule pot fi observate celulelespecifice liniei seminale.

SERTOLIOMA

It is a semi-maliganant tumor of thetissue that supports the seminal line ofthe testicle that generate metastases and

. has low frequency in pets.The tumors areusually surprises of the surgical

intervention specific to the orchiectomyapplied for other purposes (castration).

After the longitudinal (equatorial)

cutting of the testicle, the tumor is easilyhighlighted intra-parechymally.

The cytological test (fig. 1 - 3) Theappearance is quite characteristic, that ofmonomorphous cellular proliferation, withboth round and slightly oval cells. The

large, vesicular nuclei have a chromatinwhich is finely reticulated and reveals 1-2small nucleoli.

The cells have a reduced cytoplasm

which is intensely basophilic andconfluent, whose edges cannot be

identified. Mitoses and atypical cells arerare. Some dispersed secretory Leydigcells appear from place to place. Theyare small and their nucleus is rough,eccentrically positioned, with no nucleoli.

Cytoplasms dominate quantitatively inthe cellular structure and have a

basophilic tendency which is wellhighlighted. Besides these cells, can beobserved other cells specific to theseminal line.

-------------------------- 243

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Fig. 3

-------------------------- 245

ADAMANTINOMUL

Este 0 tumora maligna a tesutuluiadamantin de la nivelul gingiilor 9i a

alveolelor dentare care are 0 incidentafoarte rara la animalele de companie, daracest fapt nu trebuie sa-l faca pe

specialist sa 0 ignore prin lipsa decunoa9tere.

Celulele proliferate (fig. 1 - 3) sunt

individualizate sau conglomerate.Acestea au 0 talie relativ mare > 25 f.l,

forma este rotund-ovalara cu 0 largacitoplasma intens bazofila. Nucleul estede talie mare situat excentric. Cromatina

este intens cromofila, lasand sa se

observe un nucleol gigant. Tumoraprezinta un Tnalt grad de atipie

identificandu-se chiar 9i prezenta decelule gigante. Mitozele sunt foarte rare.

ADAMANTINOMA

It is a malignant tumor of theadamantin tissue of the gums and of thedental alveoli, with very rare incidence in

pets, a fact which should not make thespecialist ignore it because of the lack of

knowledge.The proliferated cells (fig.1 - 3) are

either individual or conglomerates. They

have a relatively big size> 25 f.l, the formis round-oval with a large intenselybasophilic cytoplasm. The nucleus is bigsituated eccentrically. The chromatin is

intensely chromophilic and dense and

reveals a gigantic nucleolus. The tumorpresents a high degree of abnormalityand even giant cells. The mitoses arevery rare.

-------------------------- 247

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-------------------------- 249

CA~ITciEIiE~31CH 23

TUMORI MALIGNE EPITELIAlE

In aceasta categorie vom prezenta

cateva cazuri care au 0 incidenta relativ

scazuta In practica noastra, chiar daca

Iiteratura de specialitate indica 0

frecventa ridicata a acestora.

In acest grupaj vom diagnostica

cateva forme ale acestor neoplasme,care au fost realizate fie ca urmare a unor

punctii, fie din sedimentul unui lavaj nazalsau consecutiv unor necropsii.

1. Carcinomul bazocelular de

tegument (fig. 1 - 3) - se identifica un

placard cu multe celule tumorale situat In

regiunea tegumentara a structurii facialea animalului. Celulele sunt identice cu

celulele bazale epidermice, avand un

grad evident de anaplazie celulara, cu

anizocitoza ~i oligocromie nucleara. Se

poate u~or observa un grad foarte mare

de proliferare celulara dezordonata, cublastizare evidenta, fara diviziuni si fara,

caractere anaplazice.

2. Carcinomul squamos (epiteliomul

spino-celular) - este una din formele

morfocitologice cele mai frecvente lacanide In cazul cancerului tegumentar.

Acesta alcatuie~te tripleta neoplasmului

epidermal alcatuit din forma de carcinom

squamos, carcinom nediferential ~icarcinom bazocelular.

EPITHELIAL MALIGNANTTUMOURS

In this category we will present several

cases which have a relatively low

incidence in our medical practice,

although the oncologic literature indicates

a high frequency of these tumors.

Therefore, in this group of pictures,

we will present few diagnoses which

were made either as a result of puncture,

through nose scrub, or during the

necropsy.1. Basal cell carcinoma of the skin

(fig. 1 - 3) We can identify a layer withmore tumor cells located in the region ofthe animal skin facial structure. The cells

are identical to the basal epidemic cells

with an obvious degree of cellular

anaplasia with amiocytosis and nuclear

olygochromia. We can easily identify a

high degree of random cellular

proliferation, with an obvious blastisation,

without divisions or anaplastic features.

2. Squamous carcinoma (spinocel

lular epithelium). It is one of the most

common morphocytological forms incanine in the case of skin cancer. It

makes up the epidermal neoplasm's

triplet composed of the form of squamouscarcinoma, undifferentiated carcinomaand basal cell carcinoma.

--------------------------- 251


In fig. 4 - 10 vom prezenta cele doua

aspecte ale carcinomului squamos. Fig. 4

reprezinta aspectul cu celule mici, plajacelulara este alcatuita din celule de talie

mica, omogene, cu citoplasmele w;;orbazofile, iar nucleii ovoidali au cromatinareticulata lasand sa se vizualizeze un

nucleol. In fig. 5 - 10 se distinge aspectulde carcinom squamos cu celule mari.

Proliferarea celulara este In fond mixta,formata atat din celule de talie mica mai

sus descrise, cat l?i din celule de talie

mare de peste 30 Il, avand citoplasma

larga, ul?or bazofila pana la intens

bazofila l?i un nucleu mare situat fiecentral fie excentric. Cromatina este

densificata In grade diferite, neomogena,

lasand sa se Intrevada prezenta unui

nucleol de talie mare. Din loc In loc apar

celule paracheratozice.

3. Carcinomul nediferentiat (fig. _11)- se prezinta ca 0 proliferare de celule

epiteliale nediferentiate, In placarde,

avand un caracter atipic l?i anaplazic.

Celulele sunt surprinse dezordonat, de

marimi diferite l?i cu frecvente mitoze:Citoplasma celulara este bazofila, iarcromatina nucleara densificata lasa sa se

observe In unii nuclei prezenta nucleolului.4. Adenocarcinomul vegetant al

cavibitilor nazale (fig. 12 - 16) - estecea mai frecventa forma de cancer din

aceasta categorie. Diagnosticul s-a

obtinut In urma lavajului cavitatilor

nazale, caredupa centrifugare, s-a etalat

l?i colorarat panoptic concentratul celular

obtinut.

In fig. 4 - 10 we will present the two

aspects of squamous carcinoma. Fig. 4

the srllall cells aspect, the cellular rangeis made up of small size homogenouscells, with slightly basophile cytoplasm,and the ovoid nuclei have a reticulated

chromatin that reveals a nucleolus. In fig.5 - 10 we can distinguish appearance of

large cells aspect of squamouscarcinoma. The cellular proliferation ismixed, made up both of the above

described small size cells, and of large

cells of over 30 Il, with a large, slightly tohighly basophile cytoplasm and a bignucleus situated either in central or

eccentric position. The chromatin has

different degrees of density revealing the-presence of a large nucleolus. There are

parakeratosis cells from place to place.

3. Undifferentiated carcinoma (fig.11). It has the aspect of a proliferation

undifferentiated epithelial cells in layerswith an atypical and anaplastic character.

The cells are in disorder form, they havedifferent sizes and frequent mitoses. Thecellular cytoplasm is basophile, and thethickened nuclear chromatin reveals the

presence of a nucleolus in some nuclei.

4. The vegetant adeno-carcinomaof nasal cavities (fig. 12 - 16).

It is the most common form of cancer

in this category. The diagnosis wasobtained as a result of the nasal cavities

scrub (lavage), after the centrifugation,by making a smear and after the cellularconcentrate was coloured.

The appearance is classical prolif

eration "in glove finger" aspect, meaning

252 --------------------------

-Atlas de oncocitomorfologie la canide $i feline / Atlas of canine and feline oncocytomorphology

Aspectul este c1asic de proliferare "in

deget de manu9a", adica vegetantpapilifer, cu celule tipice ale mucoaseirespiratorii anterioare (aspect de pali

sada). Lipsa mitozelor, atipiilor, ana

plaziilor 9i monstrozitatilor denota ca,respectivul caz este surprins Intr-o faza

initiala, avand un grad de malignitateredus.

5. Adenocarcinomul de tiroida (fig.17 - 19) - celularitatea este specifica

unei proliferari maligne epiteliale, cu vaditcaracter de malignitate celulara (celulegigantoide binucleate). In citoplasma

unor celule se evidentiaza incluziisecretorii cu tenta albastra (Ia coloratiaMGG).

6. Adenocarcinomul vegetant deprostata (fig. 20 - 24) - are aspect de

~. proliferare celulara epiteliala glandulara,specifica structurii tesutului prostatic.Celulele proliferate, fie ca au fost

surprinse solitar, fie In microplacard,prezinta un avansat aspect de anaplaziecelulara, cu atipism 9i gigantism celular.Raportul nucleo-citoplasmatic _este Infavoarea nucleului, acesta prezentand

nucleoli giganti.

papilipheral vegetant with typical cells of

the anterior breathing mucous (palisade).The lack of mitoses, abnormalities,

anaplasias and monstrosities denote thefact that the respective case is in an initial

stage with a low degree of malignancy.5. The thyroid's adeno-carcinoma

(fig. 17-19).The cells' aspect is specific to an

epithelial malignant proliferation with anobvious feature of cellular malignancy

(giant binuclear cells). In the cytoplasm ofsome cells some secretory inclusionswith a blue coloration can be identified

(the MGG coloration).

6. The prostate vegetant adenocarcinoma (fig. 20 - 24)

It has the aspect of an epithelial

glandular cell proliferation, specific to thestructure of the prostate tissue that isattached to the genital masculine system.The proliferated cells, revealed either

individually, or in micro- layer present anadvanced aspect of cell anaplasia,abnormality and gigantism. The nucleocytoplasmatic ratio favors the nucleus,

which presents two huge nucleoli.

-------------------------- 253

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Fig. 15

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Fig. 20

-------------------------- 263

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Fig. 24

-------------------------- 265

CAPIIOLUL 24 I CHAPTER 24

METASTAZEC,ARCINOMATOASE

iN CAVITATILE PERICARDICA,~ ~PLEURALA SI PERITONEALA,

Pentru obtinerea diagnosticuluicitomorfologic de metastaza carcino

matoasa, (fig. 1 - 11) este necesara

obtinerea lichidului prezent Intr-una din

cele trei cavitati enumerate. Dupacentrifugarea lichidului cavitar se va

obtine un bogat sediment, din care se vorrealiza frotiuri In care se vor regasi 0

cantitate mare de celule tumorale cu grad

ridicat de malignitate. Celulele tumorale

pot fi individuale sau In multiple placarde

prezentand un grad Inalt de atipism

celular, cu celule gigante ~i mitozeatipice. Din loc In loc apar celulespecifice neoplasmului metastazat.

Diagnosticul diferential se va fac~ fie fatade mezoteliom, cu una dintre cele trei

forme bine individualizate, fie cu 0

metastaza a limfomului malign sau cuoricare alta forma tumorala maligna care

ar putea metastaza la acest nivel.

In unele cazuri nu se poate indica

topografia viscerala generatoare formeiprimare de cancer, dar prin coroborarea

diagnosticului citomorfologic cu celanatomo-c1inic general ~i cu rezultatele

investigatii10r imagistice, se poate

identifica neoplazia primara.

CARCINOMA METASTASESIN THE PERICARDIAL,

PLEURAL AND PERITONEALCAVITY

Cytomorphological (fig 1 - 11) The

diagnosis of carcinoma metastasis in oneof the three cavities is very simple,

because we identify a rich sediment after

the centrifugation of the cavitary liquid, inwhich we will find a large amount of

tumoral cells with a high degree of

malignity. The tumoral cells can be

individualized or as multiple placards with

a high degree of cellular abnormality, withmany giant cells and atypical mitoses.

From place to place there are also cells

that are specific to the neoplasm causing

the metastasis. The differential diagnosisis made in comparison with themezotelioma, which has three well

individualized forms easy, with the

metastasis of the malignant lymphoma,

or with any other form of malignant tumor

which can give metastasis in this area.In some cases we cannot show the

visceral topography that generates the

primary form of cancer, but throughconjunction the cytomorphological diag

nosis, the anatomo-clinical diagnosis and

with the results from the imagistic

investigations, we can identify the

primary neoplasia.

-------------------------- 267

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-------------------------- 269

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Atlas de oncocitomorfologie la canide $i feline / Atlas of canine and feline oncocytomorpho/l

Fig. 7

Fig. 8

-------------------------- 271

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Fig. 11

-------------------------- 273

TUMORILE MEZOTELIALEMALIGNE SI METASTAZELE,

SARCOMATOASEiN CAVITATILE (PERICARDICA,, ~

PLEURALA

~I PERITONEALA)

A. Tumorile mezoteliale maligne

In acest capitol vom prezenta situatia

proliferarilor maligne ale celulelor

mezoteliale apartinand seroaselor care

captu~esc cele trei importante cavitati:(pericardica, pleurala ~i peritoneala). In

literatura de specialitate incidentaacestor forme de boala canceroasa' la

animale este rara, dar In cazuisticanoastra aceasta manifestare a fost des

Intalnita. Indiferent de forma celulara a

mezoteliomului, acesta are un Inalt grad

demalignitatecuoevolutierapida.lncare anaplazia celulara este prezenta

Impreuna cu multiple mitoze atipice.Formele citologice identificate de noi

sunt diferite fata de formele descrise dealti autori din Iiteratura nationala si, "

internationala.Astfel vom descrie:

- Mezoteliomul epitelial-like (fig. 1

3). Aspectul este de proliferare de tip

epitelial (mimeaza un carcinom) cu o.

a~ezare In placarde, avand un grad Inaltde anaplazie, inclusiv cu celule bi- sau

trinucleate. Raportul nucleo-citoplas-

MALIGNANT MESOTHELIALTUMOURS AND THE

SARCOMATOUS METASTASISIN THE PREFORMED CAVITIES

(PERICARDIAL, PLEURALAND PERITONEAL)

A. Malignant mesothelial tumoursIn this chapter we will present the

situation of malignant proliferations of

mesothelial cells that pad the three major

cavities (serous membranes), the

pericardial, the pleural and the abdominal

(peritoneal) ones. In the literature ofspecialty the incidence of these forms of

cancer is very rare, but in our experiencewe have encountered this form rather

frequently. Irrespective of its cell form, themesothelium has a high degree of

malignancy with a rapidly evolution.Whatever of the cytologic form the

cellular anaplasia is present together with

multiple atypical mitoses.The cytological forms that we have

identified are different from the forms

described by other authors in nationaland international literature.

They are:- The epithelial-like mesothelium

(fig. 1 - 3). The aspect of one of epithelial

proliferation (it simulates an carcinoma)

with layers and a high degree ofanaplasia, including bi- or trinuclear cells.

-------------------------- 275


matic este u90r Tn favoarea nucleului.Acesta prezinta nucleoli multipli, Tnvolume diferite. Mitozele sunt frecvente.

Citoplasma este amphofila, membrana

celulara prezinta 0 coroana de microvili 9istructuri dezmozomiale.

Mezoteliomul Iimfoid-Iike (fig. 4 10). Aceasta forma celulara Tmbraca

aspectul sarcomatos al proliferarii

neoplazice, mimand un limfom malignnonhodgkinian. Elementele caracte

ristice din punct de vedere citologic sunt:- proliferarea masiva monomorfa cu

discreta anaplazie celulara;- raportul nucleo-citoplasmatic este net

Tnfavoarea nucleului;

- atat nucleul cat 9i citoplasma suntintens hipercrome, iar citoplasma esteputernic bazofila;

- citoplasma emite 0 mare cantitate de

structuri microvilare dese 9i lungi lanivelul membranei celulare;

- frecventa mare a diviziunilor celulare

prin amitoza (fig. 4, 5, 7, 8, 9, 10).

Mezoteliomul histiocitic-like (fig. 11

- 17). Este 0 alta forma citologica deexprimare a mezoteliomului mimand un

veritabil sarcom histiocitar. Sunt prezente

absolut toate atributele liniei proliferative

histio-macrofagice. Caracteristicile elocvente liniei histio-macrofagice se potsintetiza astfel:

- raportul celular nucleo-citoplasmaticeste Tnfavoarea nucleului;

- nucleul are 0 cromatina "pieptanata" cu

prezenta a 1-3 nucleoli de talie mare;- forma nucleului este de tip

paralelogram, atingand membrana

The nucleo-cytoplasmatic ration is

. slightly in favor of the nucleus. This one

present$ multiple nucleoli, with extremelydifferent volumes. Mitoses are frequent.The cytoplasm is amphophile, the cell

membrane revealing a crown ofmicrovillus and desmosomial structures.

The lymphoid-like mesothelium (fig.4 - 10). This cellular form has the

sarcomatous aspect of neoplastic

prolifera~ion, simulating a malignant nonHodgkin's lymphoma. The cytologic

features can be found in the followingcharacteristics:

- Monomorph massive proliferation with

discrete cell anaplasia;

- The nucleo-cytoplasmatic ratio definitely·favors the nucleus;

- Both the nucleus and the cytoplasmare highly hyperchrome, and the

cytoplasm is highly basophile;- The cytoplasm emits a great quantity of

microvillar frequent and long structuresat cell membrane level;

- High frequency of cell divisions byamitosis (fig. 4, 5, 7, 8, 9, 10).

The histiocytic-like mesothelium(fig. i1 - 17). It is another cytological formof expression of the mesothelium

simulating a true histiocytic sarcoma.Absolutely all the attributes of the

proliferation histio-macrophag line arepresent with this form of mesothelium.

The specific features of the histio

macrophag line can be synthesized asfollows:

- The nucleo-cytoplasmatic favors thenucleus;

276 --------------------------

Atlas de oncocitomorfofogfe fa canide $i fefine / Atlas of canine and feline oncocytomorphofogy

celulara In cel putin doua puncteopuse;

- citoplasma este slab bazofila, adeseaavand aspectul "fumului de tigara";

- prezinta numeroase vacuole Incitoplasma;

- diviziunile celulare numeroase se

realizeaza prin mitoze atipice.Toate aceste trei forme citologice au

fost frecvent Intalnite In cazuistica

noastra. lncidenta mezotelioamelor esteIn mod egal distribuita In principalelelocalizari (peritoneal, pleural 9ipericardic).

B. Metastazele sarcomatoase (fig.18 - 22) in cavitatile preformate(peritoneala, pericardica ~i pleurala)

In fig. (18 - 19) se observa 0

metastaza pleurala a unui limfom malig~nonhod-gkinian B celular de tipWaldenstr6m, unde apar multiple celuleIimfocitare adulte, alaturi de "blaste"Iimfoide (prolimfobla9ti 9i limfobla9ti)Dease-menea apar alaturi de structuriplasmocitare adulte 9i plasmocitareatipice (fig. 19).

In fig. (20 - 22) apar imagini ale uneimetastaze de plasmocitom In cavitateapericardica. Elementele plasmocitareadulte sunt In parte cu plasmociteleatipice (modificate datorita exudatului dinseroase).

Fig. (23 - 27) Infatigeaza imagini aleprezentei metastazei pericardo-pleuralea unei leucemii acute limfoblastice.

- The nucleus has "brushed" chromatin

with the presence of 1-3 large nucleoli;- The nucleus has a parallelogram

aspect reaching the cell membrane inat least 2 opposite points;

- The slightly basophile cytoplasm hasoften the aspect of "cigarette smoke";

- numerous vacuoles are present in thecytoplasm;

- the numerous cell divisions are done

through atypical mitoses.All of these 3 cytologic forms were

frequently encountered in our medicalpractice. The frequency of mezoteliomalocalization are mostly peritoneal, pleuraland pericardial forms.

B. Sarcomatous metastases in

preformed cavities (peritoneal,pericardial and pleural) (fig. 18 - 22)

In fig. (18 - 19) we can obseNe apleural metastasis of a malignant nonHodgkin's B-cell lymphoma of theWaldenstr6m type where there aremultiple lymphocyte adult cells togetherwith lymphoid "blasts" (prolymphoblastsand Iymphoblasts). Also appear togetheradult plasmocyte structures and atypicalplasmocytes (fig. 19).

In fig. (20 ~ 22) there are images of aplasmocytum metastasis in the pericardialcavity. The adult plasmocytes are equalto the atypical plasmocytes (modifiedbecause of the exudates from the

serous).In fig. (23 - 27) there are images of

the pericardopleural metastasis of anacute lymphoblastic leukemia.

--------------------------- 277

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-------------------------- 291

CAPIJQL!JL26~LCJ:lA~TER26 , . I

GANGLIONEUROMULTESUTULUINERVOS,

VEGETATIV

Este 0 tumorc'i rara la animalele de

companie ~i consideram ca este bine safie prezentata, atata timp cat a fostIntalnita In practica.

Tumora are caractere semimaligne,fiind alcatuita din mai multe tipuri decelule nervoase si neurofibrile, care se,

Intretaie In diferite planuri. Celulisticaeste alcatuita pe fond de celule Schwann

~i de celule nervoase simpatice, uneleavand prelungiri amielinice, iar altele nuposed a prelungiri In preparatele noastre

(fig. 1 - 7). Unele celule au 0 citoplasmabazofila, iar altele acidofila. Nucleul este

mic, situat periferic cu cromatinadensificata. Unele lasa sa se observe

prezenta unui nucleol sau a doi nucleoli.Citoplasma neuronilor este vizibil

strabatuta de 0 retea de filamente, deorigine nervoasa.

THE GANGLIONEUROMAOF THE VEGETATIVE NERVOUS

TISSUE

It is extremely rare in pets, but we

'considered it is better to to be presented,as long as we encountered it in ourmedical practice.

The tumour has semi-malignantcharacters, consisting of several types ofnervous and neurofibril cells that

overlapping in various plans. Themajority of cells are Schwann andsympathetic nervous cells; some of them

have amyelinic prolongations, whileothers do not (fig. 1 - 7). Some cells havea basophilic cytoplasm, while others have

an acidophilic cytoplasm. The nucleus issmale, peripherical located chromatic

densified. Some reveal the presence ofone or two nucleoli. The cytoplasm of the

neurons is clearly crossed by a networkof filaments which are of a nervous origin.

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Fig. 4

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Fig. 7

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TUMORA STICKER

Este 0 tumora relativ frecventa pentru

specia canina, de Inalta malignitatetransmisibila pe cale sexuala. In

momentul de fat a nu este precizataoriginea acestei tumori.

Tumora se identifica u~or anatomo

clinic, iar diagnosticul citomorfologic

pozitiv se precizeaza In urma biopunctiei.Fig. 1 - 4 ne ofera aspectul general al

tumorii cu Inalt grad de monomorfie, curaportul nucleo-citoplasmatic In favoareanucleului. Celulele sunt de talie medie,

circa 20-23 fl cu nucleul perfect rotund,

cromatina este dispusa In bulgari fini ~i Inansamblu este areolata. In nucleu exista

1-2 structuri nucleolare fine. Citoplasma

redusa este slab bazofila, nu de putineori aceasta apare amfophila. Tumora areun numar considerabil de celule In

diviziune mitotica. Cu toata lipsaanaplaziei, tumora este de 0 Inalta

malignitate.

STICKER'S TUMOUR

It is a relatively common tumor in

canine species, of high malignitytransmissible trans-sexually. The origin ofthis tumor it's not specified in thismoment.

The tumor is easily identifiable froman anatomo-clinical point of view, the

cytomorphological diagnosis throughbiopunction gives the positive diagnosis.

Fig. 1-4 shows us the general

appearance of the tumor with a highdegree of monomorphia, with the nucleocytoplasmatic ratio in favor of thenucleus. The cells are medium, about 20

23 fl, with a perfectly round nucleus, the

chromatin is disposed in fine lumps and itis areolate. There are 1-2 nucleolar fine

structures. The reduced cytoplasm isslightly basophilic, and or autophilic. Thetumor has a considerable number of cells

in mitotic division. Despite the lack of

anaplasia, the tumor is highly malignant.

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Fig. 4

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ISBN 978-973-1983-26-4 91178973111983264

Atlas of Canine and Feline Oncocytomorphology

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