一例犬乳头状瘤病相关的皮角的冷冻治疗疗效观察

王帆

Efficacy of cryotherapy in the treatment of cutaneous horn associated with papillomatosis in a dog

一例犬乳头状瘤病相关的皮角的冷冻治疗疗效观察

作者：Felipe Noleto de Paiva , Manuela Silva Gomes de Souza, Laercio Correia Fernandes Junior, Thiago Souza Costa, Bruna Sampaio Martins Land Manier, Dayane Caico Collares Araujo , Cristiane Bazaga Botelho and Julio Israel Fernandes

翻译：王帆

Cutaneous horn is a skin disease with low incidence and few citations in the literature. This report describes a dog with multiple cutaneous lesions of papillomatosis and one giant cutaneous horn on the face. Two sessions of cryotherapy achieved complete remission of the lesions.

摘要 – 皮角是一种发病率较低、文献引用较少的皮肤病。本报告描述了一只犬的乳头状瘤病的多发性皮肤病变，同时面部有一个巨大皮角。分2次冷冻治疗达到病变完全缓解。

Introduction

介绍

Cutaneous horns are keratinised acellular formations generally related to other dermatological disorders, such as papillomatosis.Papillomas are benign neoplasms, originating in the squamous epithelium, usually associated with papillomavirus, a non-enveloped DNA virus. This report describes a case of cutaneous horn associated with papillomatosis, which was successfully treated with cryotherapy to obtain complete remission.

皮角是无细胞结构角化形成的，通常与其他皮肤病有关，如乳头状瘤病。乳头状瘤是良性肿瘤，起源于鳞状上皮细胞，通常与乳头状瘤病毒(一种非包膜DNA病毒)有关。这篇报告描述了一例与乳头状瘤病有关的皮角，成功经冷冻治疗达到完全缓解。

Case report

病例报告

A 5-year-old male, mixed breed dog was referred for evaluation of multiple skin lesions on the face, which had evolved over a six-month period. The lesions were pedunculated, irregular, verrucous and sessile nodules, ranging from 0.5 to 1.0 cm in diameter, on the face and oral cavity, muzzle, lips and tongue. A single larger lesion (3.0 x 4.0 cm diameter) arose from the left side of the muzzle, and was keratinised. (Figure 1). It was reported that the papillary lesions had remained stable, but that the large keratinized lesion exhibited continuous growth.

一只5岁雄性杂交犬，因6个月内面部逐渐出现多处皮肤病变被转诊。病变带蒂、不规则、疣状、硬质结节，直径范围从0.5 至1.0 cm，分布于面部、口腔、口周、唇部和舌部。单发较大病变(直径3.0 × 4.0 cm)位于左侧口周，角化表现(图1)。据报道，乳头状病变持续稳定，但大的角化病变持续增长。

Cytological examination was performed, and a presumptive diagnosis of mucocutaneous papillomatosis and cutaneous horn was assigned. Results of a complete blood count and serum biochemical profile were compatible with hematological infection, which was later confirmed to be associated with both ehrlichiosis and babesiosis. Treatment of the tick-borne pathogens was initiated and only after these were fully resolved was treatment for the cutaneous lesions considered.

进行细胞学检查，并推测诊断为皮肤粘膜处乳头状瘤病和皮角。全血细胞计数和血清生化分析结果提示存在血液感染，后证实同时有埃里希体病和巴贝斯虫病。患犬初期进行蜱传播病原治疗，只有在这些病完全恢复后，才考虑治疗皮肤病变。

For the treatment intervention, the dog underwent general anaesthesia. First, an excisional biopsy of the verrucous nodules and the keratinised lesion was taken for histopathological analysis. Next, cryotherapy was performed to freeze the lesions, focusing on those located on the muzzle and lip region. The keratinised nodule was sectioned at its base, followed by freezing applied directly to the remaining lesion (Figure 2).

在治疗时，犬进行全身麻醉。首先，对疣状结节及角化病变进行切除活检，进行组织病理学分析。接下来，进行冷冻治疗以冻结病变，重点在口周和唇部区域。在角化结节基底切除，然后直接冰冻剩余病变(图2)。

Two freeze/thaw cycles were performed on each of the minor lesions and three cycles were used for the larger mass. The cycles consisted of applying a quick freeze, reaching freezing halo in ≤10 s with a continuous cryogen jet, and then maintaining the freeze for 1 min, with an intermittent cryogenic jet; followed by a slow, natural thaw. The fraction removed from the keratinised lesion was submitted for histopathological analysis.

对每个小病变进行两次冻融循环，对较大病变进行3次冻融循环。循环过程包括快速冷冻，连续冷冻喷射在≤10 s内达到冰冻，然后间歇冷冻喷射维持冰冻1 min;随后缓慢自然的解冻。从角化病变中取出的部分进行组织病理学分析。

Histopathological results supported a diagnosis of papillomatosis in the smaller lesions. Findings in the large keratinised lesion described juxtaposed linear areas containing a large amount of keratin with no changes in the areas of the epidermis, being compatible with the diagnosis of cutaneous horn.

组织病理学结果支持小病变是乳头状瘤病的诊断。在大的角化病变中发现切面线性区域含有大量角蛋白，表皮层无变化，符合皮角的诊断。

The dog was returned after 14 days for a second cryotherapy session, at which time approximately 80% remission of the papilloma lesions had occurred. Remaining papillomas measured less than 0.5 cm in diameter. The keratinised lesion was healing appropriately and was covered by a large crust. When the crust was removed, it was noted that the lesion had decreased in volume by about 90%. (Figure 3). Two additional freeze/thaw cycles were performed (using the technique described for the initial session) on the papillomas and the remaining surface area of cutaneous horn.

14天后，犬复诊进行第二次冷冻治疗，在此期间，乳头状瘤病变大约80%得到缓解。剩余的乳头状瘤直径小于0.5 cm。角化病变愈合良好，并覆盖一大块结痂。去除结痂后，发现病变体积减小了约90%。(图3)对乳头状瘤和皮角的剩余表面再次进行了两次冷冻/解冻循环(使用初次描述的技术)。

Ten days after the second session the dog returned for evaluation and showed complete remission of the lesions, with no alternations of facial structures. A complete blood count and serum biochemical profile were repeated and results were within normal reference ranges. The dog underwent periodic reassessment and had remained in complete remission six months after completion of the procedure. (Figure 4)

第二次治疗后10天，犬再次复诊，病变完全缓解，面部未发生结构变化。复查全血细胞计数和血清生化，结果在正常参考范围内。犬进行定期复诊，术后6个月内保持完全缓解。(图4)

Discussion

讨论

Cutaneous horns are considered rare in companion animals with a lower occurrence in dogs compared to cats. In a retrospective study of all skin biopsies assessed, only 0.1% corresponded to this condition. Its origin is not fully elucidated, and cases may be related to solar dermatitis, skin carcinomas, keratinising infundibular acanthoma, intracutaneous epithelioma, keratin cysts and viral papillomatosis . The associated manifestation of papillomatosis observed in the report has been described previously. Papillomas generally are self-limiting, and when persistent, can be treated with a variety of therapeutic modalities that includes surgical excision and several systemic clinical treatments,although lesion recurrence can occur with some treatments. Cryotherapy can be used effectively in cases refractory to other approaches, as demonstrated in the present case.

皮角在伴侣动物中罕见，与猫相比，犬的发生率较低。在所有皮肤活检评估的回顾性研究中，只有0.1%符合此病。其起源尚不完全清楚，病例可能与日光性皮炎、皮肤癌、漏斗部角化棘皮瘤、皮内上皮细胞瘤、角质囊肿和病毒性乳头状瘤病有关。乳头状瘤病的相关表现在以前报告中已有描述。乳头状瘤通常是自限性的，如果疾病持续性，可以通过多种治疗方式进行治疗，包括手术切除和一些全身性的临床治疗，但某些治疗方法可能会出现病变复发。如本病例所示，冷冻治疗对于其他治疗方法无法治愈的病例有疗效。

Cases of cutaneous horns have surgical excision as their main indication,although to the best of the authors’knowledge, only one such case has been reported as being successfully treated with cryosurgery, owing to the low incidence of this condition. In the present case the dimensions of the cutaneous horn were bigger than similar reports.

皮角病例主要是手术切除，但据作者所知，由于此病发病率低，只有本病例报道了经冷冻成功治疗。本病例的皮角直径比类似病例报告的更大。

In human medicine, cryosurgery can be an alternative to conventional surgery, so long as a part of the lesion is sent for histopathological examination, owing to overlap in appearance with other neoplasms, as was done in in the present case. Cryotherapy as used herein, with application in the lesion bed after surgical removal of the apical portion, showed good efficacy without adverse effects. Given the affected anatomical region, cryotherapy was chosen as the modality least likely to cause disfigurement of the nose and face. Complete local control of the disease was achieved with excellent cosmetic effects.

在人医中，只要病变的一部分进行组织病理学检查，因为在外观上与其他肿瘤相似，就像本例中所做的那样，冷冻手术可以替代传统手术。冷冻治疗应用于顶部切除后的病变基部，效果良好，无不良反应。考虑到患病部位解剖区域，选择冷冻治疗对鼻部和面部造成的形变最小。实现了对此病的局部完全控制，并取得了良好的外观效果。

Figure 1. A 5-year-old male, mixed breed dog with cutaneous lesions on the face. Multiple verrucous lesions had diameters ranging from 0.5 to 1.0 cm, and a larger keratinised lesion was c. 3.0*4.0 cm: (a) frontal view and ( b) bottom view.

图1。一只5岁雄性杂交犬的面部皮肤病变。多发性疣状病变直径范围从0.5 -1.0 cm，较大的角化病变约3.0*4.0 cm:(a)正面图，(b)底部图。

Figure 2. A 5-year-old male, mixed breed dog after the first cryotherapeutic intervention on facial skin lesions. a: The cutaneous horn has been sectioned at its base. b: The remaining tissue bed has been frozen with liquid nitrogen.

图2。1只5岁雄性杂交犬，面部皮肤病变进行首次冷冻治疗。a:皮角已从基部切开。b:剩余的组织基部已用液氮冷冻。

Figure 3. A 5-year-old male, mixed breed dog 14 days after an initial cryotherapeutic session. a: Note the marked reduction in size of the papilloma lesions on the muzzle, and a large crust adherent to the tissue bed from which the cutanous horn had been excised. b: Note appearance of the cutaneous horn tissue bed after removal of the crust.

图3。一只5岁雄性杂交犬，首次冷冻治疗14天后。a:注意口周乳头状瘤病变的大小明显缩小，一大块结痂附着在切除皮角的组织基部。b:注意去除结痂后皮角组织的外观。

Figure 4. A 5-year-old male, mixed breed dog showing remission of the skin lesions after two applications of cryotherapy. (a) Macroscopic appearance 10 days after the second application. (b) Macroscopic appearance six months after the second application.

图4。一只5岁雄性杂交犬，经两次冷冻治疗后皮肤病变缓解。(a)第二次手术后10天的外观表现。(b)第二次手术后六个月的外观表现。

如果a

谢谢老师

从前有只猫

bateer578

这个真是吓人了

Ryohei