Nodular Dermatofibrosis in a German Shepherd Dog: Case Report
Carlos Eduardo Fonseca Alves,
Aline Goncalves Correa,
Sabrina dos Santos Costa
Sabryna Gouveia Calazans
An 7-year-old male German shepherd dog not neutered was attended
presenting several cutaneous nodules ranging from 0.5-3 cm in diameter at least
a one year history, located mainly in thoracic and pelvic limbs, with progressive
weight loss over two months. Fine needle aspiration biopsy and pelvic and thoracic
limbs nodules excision biopsy were performed. After histopathological diagnosis,
nodular dermatofibrosis diagnosis was determined and abdominal ultrasound was
performed for possible renal cysts evaluation. The animal received treatment
to control secondary bacterial infection. It is necessary to carry out histopathological
examination and ultraosund to identify possible renal cysts and for definitive
diagnosis. There is no specific treatment for nodular dermatofibrosis.
Received: January 07, 2013;
Accepted: March 02, 2013;
Published: May 08, 2013
Nodular dermatofibrosis is a rare paraneoplastic syndrome of multiple collagenous
nerves associated with renal and uterine tumors. It was first reporterd in 1983
in a German shepherd dog (Suter et al., 1983)
but theres a small number of reports in literature since then. Macroscopically,
nodular dermatofibrosis is characterized by multiple dermis and subcutaneous
nodules which in severe cases coalesce (Goldschmidt and Hendrick,
2002). These nodules are firm, well circumscribed, with 0.5-4.0 cm in diameter,
symmetrically distributed around the limbs, neck, back and ventral trunk (Lingaas
et al., 2003). It is necessary to perform an ultrasound examination
to identify renal cystic changes (Suter et al.,
1983). This report aims to describe the clincal, histopathological and ultrasound
findings of a nodular dermatofibrosis in a German shepherd dog case.
A male German shepherd dog, 7 years old, not neutered was attended presenting
several cutaneous nodules ranging from 0.5-3 cm in diameter (Fig.
1) at least a one year history, located mainly in thoracic and pelvic limbs,
with progressive weight loss over two months. Blood samples, to perform blood
counts and serum chemistry profile (creatinine, alanine aminotransferase and
urea) were collected.
||Right pelvic limb tarsal region after shaving. Note nodular
proliferation on different sizes, with ulceration
The blood count reference values, serum activity of ALT enzyme (10-109 UI L-1),
creatinine (0.5-1.7 mg dL-1) and urea (8-28 mg dL-1) were
within the reference range. Fine needle aspiration biopsy, culture, antibiogram
and pelvic and thoracic limbs nodules excision biopsy were performed. The bacterial
culture showed no growth. The nodule microscopic evaluation revealed poorly
demarcated nodular dermis area of mature dermal collagen proliferation.
||Histopathological examination, HE staining, 20x. Hair follicle
surrounded by collagen fibers proliferation. Note that there is no compression,
displacement, or morphologic alteration of the same by collagen fibers
The skin appendages were enveloped by collagen fibers proliferation and non-compressed,
displaced or morphologically altered by them (Fig. 2). Some
hair follicles presented infundibular hyperkeratosis. The lesion epidermis lining
exhibits regular acanthosis and hyperpigmentation. Cellular atypia signs were
not shown. After histopathological diagnosis, nodular dermatofibrosis diagnosis
was determinated and abdominal ultrasound was performed for possible renal cysts
evaluation. The ultrasound exam revealed round structures with definite edges
and anechoic content in both kidneys ( three in the left kidney and one in the
right kidney), the largest one measuring about 2, 5 cm in diameter (in the left
kidney), consistent with renal cysts. The animal received treatment to control
secondary bacterial infection.
The average age of affected dogs is eight years old (Lium
and Moe, 1985). Dermatofibrosis, some authors described as an autosomal
dominant hereditary syndrome with complete penetrance affecting some German
shepherd dogs strains (Goldschmidt and Hendrick,
2002; Lingaas et al., 2003). However,
it has been reported in Golden Retrievers and Boxers (Goldschmidt
and Hendrick, 2002). Some authors report mobile, not itchy
nodules, on the dermis or subcutaneous area and, in the most cases, the epidermis
is intact, although some lesions become inflamed and ulcerated (Suter
et al., 1983; Goldschmidt and Hendrick, 2002).
The histopathological findings associated with clinical signs were consistent
with nodular dermatofibrosis. It is reported that the nodules formation is due
growth factor beta 1 (Transforming growth factor-TGF-beta1) overexpression,
a potent desmoplasia stimulator which was documented in human patients with
cancer and severe nasal carcinoma. A recent study demonstraded an increased
TGF-beta1expression in kidney and skin (hair folicle and kidney tubules, respectively)
of German shepherd dog with nodular dermatofibrosis when compared to the same
breed dogs with no disease (Lium and Moe, 1985). The
literature suggests that in male dogs, the nodular dermatofibrosis is associated
with kidneys cancer (Lingaas et al., 2003).
This disease is a paraneoplastic syndrome that precedes the kidney cancer formation
(Suter et al., 1983; Atlee
et al., 1991). It was recommended to the animals owner animal
ultrasound control every two months and monthly renal function (urea, creatinine
and urinalysis) evaluation. At the diagnosis, the animal was treated with Cephalexin
and Clorexidine 2% bathing to control pyoderma. There is no specific treatment
for this condition, due the bilateral nature of kidney cancer (Suter
et al., 1983; Lium and Moe, 1985). Once
determinate the diagnosis, the animal must be monitored as the cyst renal size
and renal function tests to detect renal failure. The nodular dermatofibrosis
prognosis is unfavorable, once all of the animals develop kidneys cancer.
Recent studies, in which researchers examined several nodular dermatofibrosis
cases associated with kidneys cancer, showed that the average lifetime
after skin changes diagnosis is three years and all of the dogs die due the
uremia (Atlee et al., 1991; Lingaas
et al., 2003). The histopathological diagnosis is essential to differentiate
from keloids fibromas and nodular scars, once these changes have different prognosis
and treatments (Goldschmidt and Hendrick, 2002).
The nodular dermatofibrosis is a rare paraneoplastic syndrome that primarily affects German shepherd dogs. It is necessary to carry out histopathological examination and ultrasound to identify possible renal cysts and for definitive diagnosis. There is no specific treatment for nodular dermatofibrosis.
1: Suter, M., G. Lott-Stolz and P. Wild, 1983. Generalized nodular dermatofibrosis in six Alsatians. Vet. Pathol., 20: 632-634.
2: Goldschmidt, M.H. and M.J. Hendrick, 2002. Tumors of the Skin and Soft Tissues. In: Tumors in Domestic Animals, Meuten, D.J. (Ed.). 4 Edn., Iowa State Press, Ames, USA., pp: 44-117
3: Lium, B. and L. Moe, 1985. Hereditary multifocal renal cystadenocarcinomas and nodular dermatofibrosis in the German shepherd dog: Macroscopic and histopathologic changes. Vet. Pathol., 22: 447-455.
4: Lingaas, F., K.E. Comstock, E.F. Kirkness, A. Sorensen and T. Aarskaug et al., 2003. A mutation in the canine BHD gene is associated with hereditary multifocal renal cystadenocarcinoma and nodular dermatofibrosis in the German Shepherd dog. Human Mol. Genet., 12: 3043-3053.
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5: Atlee, B.A., D.J Deboer, P.J. Ihrke, A.A. Stannard and T. Willemse, 1991. Nodular dermatofibrosis in German shepherd dogs as a marker for renal cystadenocarcinoma. J. Am. Anim. Hosp. Assoc., 27: 481-487.