小型贵宾犬的多灶性顶浆腺囊腺瘤

王帆

Multifocal giant apocrine cystadenomas in a miniature poodle

小型贵宾犬的多灶性顶浆腺囊腺瘤

翻译：周莲

Apocrine cystadenomas have rarely been reported in dogs. Herein, a dog with multiple, large (1.0–7.0 cm) fluctuant and cystic skin masses on the right pelvic limb and chest is described. Histopathological evaluation revealed cystic cavities lined by single to multiple layers of apocrine epithelium with papillary projections, consistent with apocrine cystadenoma.

顶浆腺囊腺瘤在犬中罕有报道。在此，我们描述了一只犬在右后肢和胸侧的多灶性大的波动和囊性皮肤肿块(1.0-7.0厘米)。组织病理学评估显示囊腔由单层到多层的顶浆腺上皮伴乳头状突起组成，与顶浆腺囊腺瘤一致。

Introduction

介绍

Multiple apocrine cystadenomas are benign tumours that have been described in cats and people,yet rarely reported in dogs. In cats and people, these present as periocular masses and are invariably reported as apocrine hidrocystomas.To the best of the authors’ knowledge, there is only one case report of multiple apocrine cystadenomas in a dog.In this case report, we describe multifocal apocrine cystadenomas in an adult miniature poodle with giant cyst formation.

多灶性顶浆腺囊腺瘤是一种良性肿瘤，已在猫和人中描述过，但在犬中罕有报道。在猫和人中，这些表现为眼周肿块，总是报告为顶浆腺汗腺囊瘤。据作者所知，本文是仅有的1例犬多灶性顶浆腺囊腺瘤的病例报告。在本病例报告中，我们描述了1例伴有巨大囊肿形成的成年小型贵宾犬的多灶性顶浆腺囊腺瘤。

Case Report

病例报告

A 7-year-old, female spayed miniature poodle was presented with multiple soft, fluid-filled cysts clustered in the skin of the right pelvic limb and thorax. A total of 16 large, occasionally coalescing, pedunculated cysts, measuring 1–7 cm in diameter with a translucent, light blue hue, were observed incompletely encircling the right thigh, extending distally to the stifle and hock along the cranial border (Figure 1a). Another collection of 10 single or coalescing broad-based cysts, ranging from 1 to 9 cm in diameter, were present on the right lateral and ventral chest (Figure 1b). The dog did not appear to be disturbed by the skin lesions. Except from a slightly thin body condition (body condition score: three of nine) the remainder of the physical examination was unremarkable. There were no significant findings from a complete blood count (CBC) and serum biochemical analysis. Fine needle aspiration produced hypocellular, colourless, thin, clear fluid with few foamy macrophages evident on cytological examination.

一例7岁，已绝育雌性小型贵宾犬，因右后肢及胸廓皮肤聚集多个柔软、充满液体的囊肿就诊。共观察到16个大的、偶尔融合的、有蒂的囊肿，直径1-7 cm，呈半透明、淡蓝色，不完全环绕右大腿，沿前缘向远端延伸至后膝关节和飞节（图1a）。另有10个单个或融合的宽基部囊肿，直径1～9 cm，位于右外侧和腹侧胸部，（图1b）。犬似乎未受到皮肤病变的干扰。除略瘦的身体状况（体况评分：3/9）外，其余体格检查无明显异常。全血细胞计数(CBC)和血清生化分析无显著结果。细针穿刺产生细胞量少、无色、稀薄、透明液体，细胞学检查可见少量泡沫状巨噬细胞。

Figure 1. Gross lesions of the skin from a miniature poodle with multiple cystic masses. (a) The cysts on the right pelvic limb are pedunculated, resembling a bunch of grapes. Note the light blue to bluish-black colouration. (b) A series of coalescing masses at the ventral chest. Several smaller isolated masses are present, cranial and caudal to the central cysts.

图1.小型贵宾犬多发囊性肿块的皮肤病变外观。

(a) 右后肢的囊肿有蒂，似一束葡萄。注意淡蓝色至蓝黑色。

(b)腹侧胸部有一系列融合肿块。在中央囊肿的头侧和尾侧存在几个较小的孤立肿块。

Surgical excision of the cysts on the right pelvic limb was performed and the excised specimens were fixed in buffered 10% formalin for histological examination, routinely processed and stained with haematoxylin & eosin (Figure 2). Microscopically, there were variably sized, multilobulated, thin-walled cysts expanding the dermis. Cystlumina were empty or occasionally contained pale pink fluid with few foamy macrophages. Cysts were lined by one-to-two layers of well-differentiated cuboidal (exhibiting decapitation secretion) or attenuated epithelial cells. Cysts were separated by fine fibrovascular stroma. Occasionally, small sprouts of epithelium, arranged in multiple layers projected into the lumen (Figure 3). A diagnosis of multifocal apocrine cystadenomas was made based on the clinical presentation and histopathological findings. A histopathological image including the epidermis is presented in Figure S1.

手术切除右后肢的囊肿，将切除的标本固定在10%福尔马林缓冲液中进行组织学检查，常规处理并用苏木精和伊红染色（图2）。镜下见真皮内有大小不等、多分叶、薄壁的囊肿扩大。囊腔中空或偶尔含有浅粉色液体，伴少量泡沫状巨噬细胞。囊肿内衬1-2层分化良好的立方状（表现出断头分泌）或衰减的上皮细胞。囊肿被细纤维血管间质分隔。偶见小芽状上皮细胞，呈多层排列突入管腔内（图3）。根据临床表现和组织病理学结果诊断为多灶性顶浆腺囊腺瘤。包括表皮在内的组织病理学图像见图S1。

Surgical excision of the remaining masses was performed and the dog was subsequently lost to follow.

对剩余肿块进行了手术切除，随后该犬失访。

Figure 2. Transverse section of a formalin-fixed skin specimen excised from the pelvic limb of a miniature poodle. The cysts are multiloculated and contain watery fluid.

图2：从小型贵宾犬后肢切下的福尔马林固定皮肤标本的横切面。囊肿呈多房状，内含水样液体。

Figure 3. Histological features of a mass from the skin of a miniature poodle. (a) Note the small papillary projections, which distinguish this benign neoplasm from apocrine cysts. Haematoxylin & eosin, x40. (b) Higher magnification of the papillary projections. Fronds are lined by cuboidal to polygonal cells. H&E, x200.

图3：小型贵宾犬皮肤肿块的组织学特征。

(a) 注意小的乳头状突起，可将这种良性肿瘤与顶浆腺囊肿区分开来。苏木精和伊红，40倍。(b)乳头状突起的高倍放大。方框由立方形至多边形单元格排列。H&E，×200。

Discussion

讨论

Multifocal or multicentric apocrine cystadenomas are a rarely reported, neoplastic condition of animals. Clinical differential diagnoses are limited to apocrine cystomatosis, an uncommon non-neoplastic condition characterized by multiple clusters of cystically dilated sweat glands which lack the micropapilllary projections from the cyst wall seen in this case.Differentiation of apocrine cystadenoma from apocrine cysts requires histological evaluation. Cytological evaluation is nondiscriminatory because typically watery fluid with few cells are aspirated. The gross and histological findings in this case supported a diagnosis of benign cystadenoma, based mainly on the large size of the cysts and the micropapillary sprouts seen histologically. The lack of nuclear pleomorphism and mitotic activity of the cyst epithelium and absence of invasion or metastasis distinguished this benign neoplasm from its malignant counterpart, apocrine cystadenocarcinoma.

多灶性或多中心顶浆腺囊腺瘤是一种罕见的动物肿瘤性疾病。临床鉴别诊断仅限于顶浆腺囊瘤病，这是一种不常见的非肿瘤性疾病，其特征为多个囊性扩张的汗腺簇，在该病例中缺乏囊壁的微乳头突起。顶浆腺囊腺瘤与顶浆腺囊肿的鉴别需要组织学评价。细胞学评价是无区分性的，因为通常抽吸细胞很少的水样液体。该病例的大体和组织学结果支持良性囊腺瘤的诊断，主要基于囊肿体积较大和组织学上可见的微乳头芽。囊肿上皮缺乏核多形性和有丝分裂活性，无浸润或转移，将这种良性肿瘤与其恶性对应的顶浆腺囊腺癌区分开来。

Pyrenean mountain dogs, chow chows, Alaskan malamutes, old English sheepdogs (OES) and Persian cats are reported to be predisposed to sweat gland tumours.In dogs, there is a single case report documenting generalized cystomatosis in a 13-year-old, male neutered OES. The masses were found at the dorsal aspect of the body and the face.Although the authors had designated the condition as cystomatosis, we note that the masses did contain features of true neoplasms and resembled human apocrine cystadenomas. Multiple cystadenomas are rarely reported in cats and have been described on the eyelid margins and distal ear canals of Persian and Himalayan breeds, suggesting a hereditary syndrome.

据报道，大白熊犬、松狮犬、阿拉斯加雪橇犬、古代英国牧羊犬(OES)和波斯猫易患汗腺肿瘤。在犬中，有一份病例报告记录了13岁雄性已去势OES中的全身性囊瘤病。在身体背侧和面部发现肿块。尽管作者将该疾病指定为囊瘤病，但我们注意到肿块确实含有真正肿瘤的特征，并类似于人顶浆腺囊腺瘤。多灶性囊腺瘤在猫中罕见，在波斯猫和喜马拉雅猫的睑缘和远端耳道上均有描述，提示为遗传性综合征。

The large size of the cystadenomas in this canine case is unlike most documented reports of hidrocystomas/cystadenomas in cats and people, where cysts are usually ≤1 cm in diameter. Human lesions which are >1–2 cm are rare and are referred to as giant hidrocystoma.The masses described previously in an OES measured between 0.5 and 5 cm, whereas masses ranged from 1 to 7 cm in diameter in the present case. Therefore, cystadenomas in dogs appear to grow larger than in other species. The distribution of the lesions in the current cases varies with that of the OES as there was sparing of the face. Human and feline cysts show a predilection for facial skin; the reason for the different anatomical distribution in dogs is unknown.

该犬病例中的大尺寸囊腺瘤与猫和人中大多数记录的囊肿通常直径≤1 cm的汗腺囊瘤/囊腺瘤报告不同。人类病变罕见> 1-2 cm，被称为巨大汗腺囊瘤。之前在OES中描述的肿块测量值为0.5-5 cm，而在本病例中，肿块直径范围为1-7 cm。因此，犬的囊腺瘤似乎比其他种属生长更大。当前病例中的病变分布与OES不同，因为保留了面部。人和猫囊肿好发于面部皮肤；犬解剖分布不同的原因尚不清楚。

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