Sample detailed Report ( 50€)
Case number 456, second opinion. 12 W old dairy Calf ...........................Date 01.1.2011
Macroscopic findings:
6 sections, of haired skin in a glass slides numbered 123 and stained with H&E) were examined.
Microscopic findings:
The sections all show relatively similar changes (comments are made where there are distinct
differences).
There is a marked epidermal hyperplasia with compact, lamellar orthokeratosis. This extends down
into the infundibulae of the majority of the superficial follicles. In some sections this is very
noticeable with many of the follicles dilated and filled with the compact hyperkeratosis. There are
haired and non-haired superficial follicles.
There are multifocal areas of intracorneal blue debris, which has small blue points which could be
cocci. In some sections, there are multifocal, small, intracorneal pustules with degenerate
neutrophils. This blue debris is also seen in some of the follicular lumena.
There is a mild epidermal exocytosis present.
There is a focally pronounced neutrophilic exocytosis almost forming small intraepidermal pustules
and this change is also present in some of the follicular walls.
There is a mild to focally moderate perivascular, superficial and mid-dermal infiltrate which
appears to be more than expected for a cow. In some areas this is noticeably neutrophilic, in
most the inflammatory infiltrate is mixed (neutrophils dominate, with eosinophils, plasma cells and
macrophages with fewer lymphocytes). In one section there are many more eosinophils present
throughout the infiltrate and in one area in the mid dermis there is an almost completely
eosinophilic infiltrate surrounding a large vessel. This section also shows a pronounced superficial
oedema. The apocrine glands are dilated and there is a focal - eosinophilic! - hidradenitis.
Morphologic Diagnosis:
Hyperkeratotic, hyperplastic, perivascular, mixed, (focally eosinophil-rich) Dermatitis. Epidermal
und follicular Exocytosis with intracorneal Debris (epidermis and infundibular). Focal, mild,
intracorneal, neutrophilic pustules
Comments:
The intracorneal blue lines are consistent with a mild form of the so-called "Dunstan/Stannard
blue line" and speak for a possible superficial bacterial infection (as one sees with epidermal
collarettes in dogs). I would recommend a surface bacterial culture on the basis of this change.
Special stains to confirm this (eg Giemsa) cannot be done on the slides at hand, they require
new sections to be cut by the laboratory which processed the slides.
The mild follicular wall exocytosis and the presence of the intracorneal blue debris within a
number of infundibular lumen speaks for a probable bacterial folliculitis and this could be the
cause of the marked perivascular dermatitis reaction. In that case, local/ topical antibacterial
therapy will probably not be sufficient and concurrent systemic therapy will be required.
The presence of a luminal folliculitis also raises a possible dermatophyte infection. Even though
no dermatophytes were identified, a fungal culture should be considered to confirm / rule out this
possibility, or step sections of the original biopsies with special fungal stains could be requested.
The focal eosinophil dominated dermatitis in the mid dermis suggests a possible parasitic
component. Step sections may reveal the parasite and are recommended.
The orthokeratosis is more pronounced than normal and because it is also found within the
infundibulae, a cornification abnormality must be considered. In cows, my first thought would be
to consider a possible nutriotional influence. Although not typical for this, zinc responsive
dermatitis has been reported in cpws to be associated with orthokeratotic hyperkeratosis.
Dr Sonya Bettenay. BVSc (Hons); MACVSc (Feline Medicine); FACVSc (Dermatology); Dip ECVD;
Certified specialist for small animal dermatology (Bavaria)
Sample short Report ( 30€)
Case number 456, second opinion. 12 W old dairy Calf ...........................Date 01.1.2011
Macroscopic findings:
6 sections, of haired skin in a glass slides numbered 123 and stained with H&E) were examined.
Microscopic findings:
The sections all show relatively similar changes.
There is a marked epidermal hyperplasia, exocytosis with epidermal and infundibular
hyperkeratosis. Multifocal areas of intracorneal blue debris and small, intracorneal pustules with
degenerate neutrophils. This blue debris is also seen in some of the follicular lumena.
There is a mild to focally moderate perivascular, superficial and mid-dermal mixed cell infiltrate
-focally neutrophilic, focally eosinophilic with oedema. The apocrine glands are dilated and focal
eosinophilic! - hidradenitis.
Morphologic Diagnosis:
Hyperkeratotic, hyperplastic, perivascular, mixed, (focally eosinophil-rich) Dermatitis. Epidermal
und follicular Exocytosis with intracorneal Debris (epidermis and infundibular). Focal, mild,
intracorneal, neutrophilic pustules
Comments:
The pustule and folliculitis changes suggest a bacterial infection and a possible allergic or
parasitic change. No dermatophytes were identified.
The orthokeratosis and hyperplasia are consistent with chronic inflammation, but may suggest a
cornification abnormality.
Dr Sonya Bettenay. BVSc (Hons); MACVSc (Feline Medicine); FACVSc (Dermatology); Dip ECVD;
Certified specialist for small animal dermatology (Bavaria)