C10028099 / invoice 10000

Reason: Tumour removal

Physical Exam: See attached "Flowsheet Report"

Laboratory Results: Declined

Patient Assessment:
anxious but do well with premed (meth 0.3mg/kg and mede 10mcg/kg)
current meds:
clonidine
acular 
apoquel
pregabalin
sertraline
trental

Patient Treatments:

Medications - See attached "Flowsheet Report"

IV Fluid Therapy - See attached "Flowsheet Report" 

Anaesthetic Record  -See attached "Smartflow Anaesthetic Sheet"

Surgical Record / Procedure Notes
lump on R lateral cranial abdomen close to spine ~1cm diameter, superficial:
elliptical incision perpendicular to spine and blunt dissected lump off with mayo scissors, lump place in formalin pod for histopath, FNA'd follicular cyst
SC closed with 3/0 mono buried simple continuous
skin closed with 3 cruciate sutures (3/0 mono)

lump on R inguinal area, ~1cm diameter, superficial:
elliptical incision around lump along inguinal area and blunt dissected lump off with may scissors, suture placed on caudal lateral aspect of lump, FNA'd follicular cyst prior
SC closed with 3/0 mono buried simple continuous
skin closed with 3 cruciate sutures (3/0 mono)

lump on L lower eyelid:
wedge resection performed, incision closed with figure 8 suture (5/0 mono)
  
Plan:
Medication to go home with: carprofen 5d
Revisit: 10-14 days suture r/o, no suture removal for eye 
To skip eye drops today, continue tomorrow
high risk of dehiscence on incision site on inguinal area
Discharging Nurse

TTCOLM @ 12:45. O phoned back. Discussed cytology results. 

INTERPRETATION:
Benign keratinizing follicular cyst or tumour (see comment)
COMMENTS:
The presence of abundant keratinocytes is consistent with a benign keratinizing follicular cyst or tumour. Follicular cysts are most common, though infundibular keratinizing acanthomas and trichoepitheliomas can have similar cytologic features. These lesions are common in adult dogs. They are commonly partially or completely alopecic, and ulceration often occurs in larger lesions. In dogs they are most commonly on the dorsal trunk and legs but may also affect other parts of the body. They are typically benign lesions, however rupture of the lesion due to scratching, squeezing, biting etc can lead to release of keratin material into surrounding tissues, eliciting a localised pyo granulomatous cellulitis. Rarely, trichoepitheliomas can have malignant potential or aggressive biologic behaviour, despite their benign appearance. Surgical excision is generally recommended and typically carries an excellent prognosis

Plan:
-O feels mass growing rapidly and keen to get it surgically removed. Opted to remove second mass at the same time. 
GW description of masses: 2x dermal lumps - one 0.5mm on L back just above hip. one 0.75mm round circular dermal mass
-Email estimate for mass removal x2 and histopath. 

Relayed TAHP results - GW 

- CBC: wnl 
- Biochem: wnl 

Still waiting on FNA results