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Lump on dog's lip.

Species: Dog
Breed: Lab Mix
Age: 2-5 years
I have contacted you several times about my dog, Honey. I tend to over think things, and definitely worry too much, so I apologize for this! You have been very helpful in the past and I was hoping for a second opinion on the cytology results of a recent needle aspirate that I had done on Honey.

I noticed a very small growth on the outside of Honey's bottom lip (not on gums/mucous membranes) at the beginning of November. It was whitish-pink and hard/rough. It seemed to grow so I had my vet look at it about 10 days later (11/14). She just looked at it and said it was nothing – probably a wart or cyst, and that it would go away in 6 weeks.

She had a papilloma on the inside of her lip over the summer that looked nothing like this.

By the time I went home for Thanksgiving on 11/17, it seemed to be growing even more. I went to my family’s vet on 11/19 and had it aspirated. The vet used two needles and took two samples.

The following are the results

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Microscopic Description:
The slides are of adequate staining and preservation of cellular detail with moderate hemodilution against a pale basophilic background. Cellularity is low, with a few anucleated squamous epithelial cells noted individually and in groups. Rare macrophages are seen and neutrophils also appear mildly increased reltive to the degree of hemodilution. Rare pleomorphic bacteria are seen.

Microscopic Findings:
Low cellularity specimen with well-differentiated squamous epithelial cells, mixed inflammation and bacteria.

Comment:
Cellularity is low and may not be fully representative. however, the presence of squamous debris with concurrent mixed inflammation could suggest this is a ruptured keratin-filled lesion which has incited a significant inflammatory response with a secondary bacterial infection. However, it is also possible that the squamous epithelial cells are representative of superficial contaminants. Correlation of these findings with the clinical impression of the patient is recommended, with reaspiration and/or tissue biopsy if clinically indicated.
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The vet’s advice was to “watch & wait.” She suspects it is a cyst that has “filled in” and that it is not malignant. She said generally mast cell tumors (her original concern) exfoliate well on aspiration. She also felt she got good samples on her aspiration. The lesion is rough on the outside and is growing out of the skin (it is not below the skin). It has increased in size even more since last week, and does not look like a cyst to me.

Watching and waiting is making me nervous. At the beginning of November the lump was <1mm and now it is probably 4mm. It is still really small, so I know the vets think I'm being silly (crazy). I can't keep paying for office visits just to get "advice". Honey has had two surgeries in the past year (she was spayed at the shelter when I adopted her, and then had to have a surgery to repair an abscess that resulted from that spay), and I would much prefer not to have another surgery because of the risks of anesthesia. However, more than anything I want my dog to be okay and I need more guidance to make the right decision. I don't want to put off removing this if it might be cancer.

I am considering going into my normal vet (not the one who aspirated the growth) this week to show her the pathology report. If there is anything specific you think I should ask her, I would appreciate it.

Thanks for your time.


Online vet, Dr. Marie

Dr. Marie replied:

From what you have described it sounds like you have nothing to worry about so that is good news! I'll see if I can translate the medical speak of the biopsy report for you:

The slides are of adequate staining and preservation of cellular detail with moderate hemodilution against a pale basophilic background.

This basically means that the doctor did a good job and the pathologist has good detail to look at.

Cellularity is low, with a few anucleated squamous epithelial cells noted individually and in groups.

There aren't a lot of cells on the slide. There are a few skin cells that don't have nuclei. This is actually good news...so the pathologist is just seeing skin cells here. That's much better than cancer cells. Cancer cells have very obvious nuclei.

Rare macrophages are seen and neutrophils also appear mildly increased reltive to the degree of hemodilution. Rare pleomorphic bacteria are seen.

Macrophages, neutrophils and bacteria could all possibly be a sign of a mild infection. They could also be normal too.

Cellularity is low and may not be fully representative.

This means that there is a small chance that some important cells were not seen on this biopsy. This is very common with a fine needle aspirate as we don't always get every type of cell in the specimen.

however, the presence of squamous debris with concurrent mixed inflammation could suggest this is a ruptured keratin-filled lesion which has incited a significant inflammatory response with a secondary bacterial infection.

They're basically saying that the type of cells that they did see makes it look like this lump is a cyst that has ruptured and caused some inflammation. The inflammation has possibly lead to a mild infection.

However, it is also possible that the squamous epithelial cells are representative of superficial contaminants. Correlation of these findings with the clinical impression of the patient is recommended, with reaspiration and/or tissue biopsy if clinically indicated.

In my opinion this is the pathologist's way of covering his or her butt. :) They're saying, "This whole thing looks like a ruptured cyst and nothing to worry about, but remember, we don't see the whole picture so there *could* be something else going on." Hence the warning to keep an eye on things and retest if the lump is changing.

The vet is right about mast cell tumors. It is usually super obvious when you have aspirated a mast cell tumor. They have big huge cells with large nuclei and dark purple staining dots all over the place. It is very easy to determine if a lump is a mast cell tumor.

It does sound like the best idea is to just keep an eye on Honey and see how things go. If the lump seems to be getting larger or bothersome then I'd get it checked out again.

I hope that helps ease your mind!

Dr. Marie.






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Disclaimer: Although Dr. Marie is a qualified veterinarian, the information found on this site is not meant to replace the advice of your own veterinarian. AskAVetQuestion.com and Dr. Marie do not accept any responsibility for any loss, damage, injury, death, or disease which may arise from reliance on information contained on this site. Do not use information found on this site for diagnosing or treating your pet. Anything you read here is for information only.

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Dr. MarieDr. Marie is a veterinarian who practices in a busy animal hospital in Ottawa, Ontario. She created Ask A Vet Question as a resource for good, accurate veterinary advice online. Dr. Marie treats dogs, cats, hamsters, guinea pigs, and rats. She has been a vet since 1999.

Is an online vet visit just as good as a trip to your veterinarian? No! But, many times, asking an online veterinarian a question can help save you money. While Dr. Marie can't officially diagnose your pet or prescribe medications, she can often advise you on whether a vet visit is necessary. You can also ask Dr. Marie for a second opinion on your pet's condition.