Dixon, J J

Jeckel, S J

McSloy, A

Pool, R

Weller, R

English

RVC Research Online

  RVC OPEN ACCESS REPOSITORY – COPYRIGHT NOTICE  This is the peer reviewed version of the following article: Dixon, J., Weller, R., Jeckel, S., Pool, R. and Mcsloy, A. (2015), IMAGING DIAGNOSIS–THE COMPUTED TOMOGRAPHIC APPEARANCE OF A GIANT CELL TUMOR AFFECTING THE MANDIBLE IN A PYGMY GOAT. Veterinary Radiology & Ultrasound. doi: 10.1111/vru.12319 which has been published in final form at http://dx.doi.org/10.1111/vru.12319.  This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Self-Archiving. The full details of the published version of the article are as follows:  TITLE: Imaging Diagnosis – The Computed Tomographic Appearance of a Giant Cell Tumor affecting the mandible in a pygmy goat AUTHORS: Dixon, J., Smith, K., Perkins, J., Sherlock, C., Mair, T. and Weller, R. JOURNAL TITLE: Veterinary Radiology & Ultrasound PUBLISHER: Wiley PUBLICATION DATE: 17 December 2016 (online) DOI: 10.1111/vru.12319  1 THE COMPUTED TOMOGRAPHIC APPEARANCE OF A GIANT CELL TUMOR 1 AFFECTING THE MANDIBLE IN A PYGMY GOAT 2  3 Jonathon Dixon, Renate Weller, Sonja Jeckel, Roy Pool, Alex McSloy 4  5 Department of Clinical Sciences and Services, Royal Veterinary College, 6 Hawkshead Lane, Hatfield, Hertfordshire, AL9 7TA 7  8 Department of Veterinary Pathobiology, College of Veterinary Medicine and 9 Biomedical Sciences, Texas A&M University, College Station, Texas, USA 10  11 Keywords: CT, pygmy goat, giant cell tumour 12  13  14  15  16  17  18  19  20  21  22  23  24  25  2 Abstract 26 A 3-year old male neutered pygmy goat presented for evaluation of a progressive 27 mandibular swelling and inappetence. A computed tomographic (CT) scan of the 28 head and thorax was performed under general anaesthesia. CT revealed an 29 extensive multiloculated, markedly expansile lesion within the right 30 hemimandible, which involved the articular surface of the temporomandibular 31 joint. The goat was euthanased due to a poor prognosis and postmortem 32 examination confirmed the diagnostic imaging findings. Histopathology was 33 strongly suggestive of a multinucleated giant cell tumor, therefore this condition 34 should be considered in goats presenting with expansile mandibular mass 35 lesions.  36  37 38  3 Signalment, history and clinical findings 39 A 19.7 kg, three year old, male neutered pygmy goat presented to the Farm 40 Animal Clinical Centre at the Royal Veterinary College (UK) for evaluation of a 41 bilateral mandibular swelling which had been present since the owner 42 purchased the animal 7 months prior to presentation. At the time of purchase the 43 goat was seen to have a mild visible swelling to the rostral aspect of the right 44 mandible. This swelling progressively enlarged, this being most evident in the 4 45 weeks prior to presentation. Episodes of oral haemorrhage were reported in 46 addition to a malodorous smell and superficial skin sores, and the animal became 47 progressively inappetent with slight weight loss (body condition score 4/9), 48 Antimicrobial therapy (Ceftiofur sodium, 2.2 mg/kg bwt i.m. BID, Excenel, Zoetis 49 UK Limited, London, UK), resulted in no change in the rate of mass enlargement 50 or improvement in appetite. 51  52 On oral examination a malodorous and well defined soft tissue mass, 53 approximately 3cm x 4cm was present at the right rostral aspect of the mandible, 54 and showed cutaneous erythema and crusting. Palpation of the vertical and 55 horizontal rami of the mandibles revealed enlargement, and the goat resented 56 palpation. There was slight right mandibular and retropharyngeal 57 lymphadenomegaly. 58  59 Imaging, diagnosis and outcome 60 The patient was anaesthetised and placed in sternal recumbency on the patient 61 table of a 16 slice multidetector CT scanner (GE Healthcare, Lightspeed Pro 16, 62 GE Medical Systems, Berkshire, UK) using the following technical parameters; 80 63  4 kV, 160 mAs, 1.25 mm slices with an interslice gap of 1.25 mm, tube rotation of 64 0.8 seconds, pitch of 0.56 and a helical acquisition. The field of view was set using 65 a scout scan at 25 cm. Images were obtained and reconstructed using a bone and 66 soft tissue algorithm and a matrix size of 512 x 512. Intravenous contrast media 67 was not administered in this case. 68  69 CT images identified an extensive, multiloculated and multifocal expansile soft 70 tissue mass lesion located within the right hemimandible mandible both rostral 71 and caudal to the cheek teeth. The right first incisor was absent and the 72 remaining incisors were misaligned, with the mass causing destruction of the 73 alveolus and periapical bone surrounding the right incisor teeth, though 74 remaining teeth retained normal internal structure. The right mandible was 75 grossly misshapen rostrally with irregular margins, and the rostral right 76 premolar teeth were slightly displaced. The soft tissue filled cavities located 77 predominantly rostral and caudal to the cheek teeth were homogenously 78 attenuating (average 50HU). Caudal to the mandibular cheek teeth the medullary 79 cavity of the right mandible was widened, with marked expansion, cortical 80 thinning, and irregular outlines to the mandibular condyle. The lateral cortical 81 bone of the right hemimandible was markedly thin caudal to the cheek teeth and 82 there was a focal region of absent bone plate ventral to the right 83 temporomandibular joint. The articular surface and subchondral bone of the 84 right mandibular condyle was poorly defined and irregular in contour, in places 85 appearing incomplete (Fig 1-3). There were ill-defined heterogeneous regions of 86 bone and soft tissue attenuation within the caudal aspect of the left 87 hemimandible, and multiple gas bubbles within this, consistent with impacted 88  5 feed material. There was a cortical bone defect along the lateral aspect of the left 89 hemimandible, caudal to the molar teeth. 90  91 In addition there was a small volume of soft tissue attenuating material in the left 92 tympanic cavity. There was slight symmetric enlargement of the mandibular 93 lymph nodes and retropharyngeal nodes, measuring approximately 10 mm in 94 maximal diameter. The thorax was considered normal. 95  96 The lesions identified fit the criteria to be categorized as an aggressive bone 97 lesion, therefore due to the extensive and progressive nature of the lesions, the 98 most likely differential diagnoses were considered to be neoplastic, with an 99 infectious aetiology less likely. Additionally, due to the extensive nature of the 100 lesions identified, and the involvement of the right temporomandibular 101 articulation, appropriate surgical resection was not considered possible. A 102 wedge biopsy of the lesion in the rostral mandible was obtained under sedation, 103 which was suggestive of a multinucleated giant cell neoplasm. A poor prognosis 104 was conferred and therefore the owners elected that the goat be humanely 105 euthanased. 106  107 At necropsy there was an approximately 3cm x 4cm soft tissue mass located to 108 the right of midline on the rostral aspect of the mandible with haemorrhagic 109 surface ulcerations. On sectioning, the right rostral mandibular bone was 110 disintegrated and replaced by soft cavitative brown tissue. A further 111 approximately 5cm mass was confirmed within the right mandible extending 112 dorsally into the temporomandibular joint. The mid left mandible was thickened, 113  6 firm and had green roughage impacted in a pocket caudal to the last left molar 114 tooth. The right sub-mandibular lymph node was slightly enlarged. Necropsy 115 findings correlated well with CT findings. 116  117 Histopathological examination of samples obtained from the right mandible 118 revealed two predominate populations of cells; dense spindle shaped cells in a 119 streaming pattern and numerous and bizarre multinucleated giant cells (Fig 4). 120 The multinucleated giant cells, contained between 2 and 20 nuclei with varying 121 numbers of nucleoli. There were very few mitoses present. Histological diagnosis 122 was consistent with a giant cell tumour of the mandible. There was no indication 123 of neoplastic spread to lymph node or lungs. Sections obtained from the caudal 124 aspect of the left mandible were interestingly not suggestive of neoplastic 125 aetiology, instead suggestive of inflammatory changes, most likely secondary to 126 an abscess.  127  128 Discussion 129 Multinucleated giant cell tumors affecting the mandible are rare in all domestic 130 species and humans1, and to the authors’ knowledge this is the first reported 131 case of this type of lesion in the goat. The use of CT in this case enabled an 132 accurate depiction of lesion characteristics and lesion extent, this allowing the 133 lesions to be categorized as expansile and aggressive. The ability of CT to rule out 134 more benign conditions for example periapical infection was critical for patient 135 management and establishing decision criteria for euthanasia. In the goat, 136 previously reported mandibular and maxillary neoplasia include 137 adenocarcinoma,2 ossifying fibroma,3 lymphosarcoma,4 osteoma,5 nasal papillary 138  7 adenoma,6 and non-ossifying fibroma,7 conditions which must also be considered 139 as differential diagnoses for potentially neoplastic masses in this location.  140  141 Previous reports in the human literature include the case of a giant cell lesion of 142 the jaw in a child.1 It is possible from the histopathological descriptions that the 143 terms “giant cell granuloma” and “giant cell lesion” are synonymous with that 144 described here, and may reflect a similar, if not the same pathological process. It 145 should be noted that in the human field the aetiopathogenesis remains unclear, 146 however it has been established that epithelioid macrophages that define a 147 granuloma are not present in giant cell tumors. This differentiation aided in the 148 classification of the lesion as a giant cell tumor. In people, giant cell granuloma 149 lesions often present as unilocular lesions which subsequently develop into a 150 multilocular structure which thus may appear similar to that described in this 151 goat.8 Conservative and radical surgical techniques have been applied to types of 152 human giant cell granuloma lesions but nonetheless have been associated with 153 recurrence, and serious facial mutilation and loss of dentition.1  154  155 Other conditions that have been documented to manifest within the caprine 156 mandible include primary dental disease, actinomycosis (lumpy jaw) and fibrous 157 osteodystrophy secondary to hyperparathyroidism.9 In our institution, pygmy 158 goats most frequently presenting for conditions of the head are as a result of 159 dental disease with additional secondary pathology. This case report suggests 160 that alternative pathological processes can occur in these species and that an 161 additional differential diagnosis for an expansile lesion such as that depicted 162 here should include a giant cell tumor. Advanced tomographic imaging e.g. CT, 163  8 was found to be an excellent diagnostic tool to evaluate the extent of the lesion 164 depicted here and the authors advocate its use in such cases.  The use of 165 intravenous iodinated contrast media may have facilitated lesion 166 characterization and could be considered in future patients. 167  168  169  170  171  172 Acknowledgments 173 The authors thank the pathology services at the Royal Veterinary College for 174 their assistance.175  9 References 176 1. Gupta MK, Naidu SG, Maheshwari VJ. Giant Cell Lesion of the Jaw: A Case 177 Report in a Child. Peoples Journal of Scientific Research. 2011; 4: 63-67. 178  179 2.  Lane M, Anderson BC. Adenocarinoma of the mouth of a goat. Journal of the 180 American Veterinary Medicine Association. 1983; 10: 1099-1100 181  182 3. Pritchard GC. Ossifying fibroma in an Anglo-Nubian goat. Goat Vet Soc J. 1984; 183 5: 31 184  185 4. Craig DR, Roth L, Smith MC. Lymphosarcoma in goats. Compendium on 186 continuing education for the practicing veterinarian. 1986. 187  188 5. Steinberg H, George C. Fracture-Associated Osteogenic Sarcoma and a 189 Mandibular Osteoma in Two Goats. J Comp Path. 1989; 4: 453-457. 190  191 6. Pringle JK, Wojcinski ZW, Staempfli HR. Nasal Papillary Adenoma in a Goat. 192 Can Vet J. 1989; 12: 964. 193  194 7. Murphy B, Gasper D, Pool R. Nonossifying Fibroma in the Mandible of a Goat. 195 Vet Path. 2011; 6: 1161-1164. 196  197 8. Mullapudi SV, Putcha UK, Boindale S. Odontogenic Tumors and Giant Cell 198 Lesions of Jaws – A Nine Year Study. World Journal of Surgical Oncology. 2011; 9: 199 68. 200  10  201 9. Smith M, Sherman DM. Goat Medicine. 2nd Edition. Iowa: Wiley-Blackwell, 202 2009203  11 Figure Legends 204 Figure 1: Dorsal plane maximum intensity projection (MIP) computed 205 tomographic image depicting the multiloculated, markedly expansile lesion 206 within the right mandible (white arrows). 207  208   209  12 Figure 2: Transverse MIP computed tomographic image at the level of the 210 temporomandibular joints depicting the markedly expansile lesion causing 211 enlargement of the right mandibular ramus and lack of normal contour to the 212 right mandibular condyle at the level of the temporomandibular joint. There is a 213 cortical bone defect located laterally in the vertical ramus. 214  215   216  13 Figure 3: 3D volume rendered computed tomographic image viewed from the 217 right depicting the skull lesions present within the rostral and caudal mandible. 218  219   220  14 Figure 4: Histopathological section of the mandibular mass (H& E stained; x 400 221 magnification): moderately cellular neoplasm consisting of dense spindle shaped 222 cells and numerous and bizarre multinucleated giant cells that are diffusely 223 distributed throughout the mass. 224  225   226 

Imaging Diagnosis – The Computed Tomographic Appearance of a Giant Cell Tumor affecting the mandible in a pygmy goat

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Imaging Diagnosis – The Computed Tomographic Appearance of a Giant Cell Tumor affecting the mandible in a pygmy goat

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