Veterinary Dermatology 2002, 13, 63 76

Blackwell Original Artical Science, Ltd

Review Cutaneous lesions of the canine scrotum

ROSARIO CERUNDOLO* and PAOLA MAIOLINO *Dermatology Unit, The Royal Veterinary College, Hawkshead Lane, North Mymms, Hateld AL9 7TA, UK, Dipartimento di Scienze Cliniche Veterinarie, Sezione di Clinica Medica, Facoltadi Medicina Veterinaria, Universita degli Studi di Napoli Federico II, Napoli, Italy; Dipartimento di Patologia, Prolassi and Ispezione Degli Alimenti, Sezione di Anatomia Patologica, Facolta di Medicina Veterinaria Universita Degli Studi di Napoli Federico II, Napoli, Italy
(Received 15 December 2000; accepted 29 March 2001)

Abstract Scrotal lesions are uncommon and often present a diagnostic challenge. In the veterinary literature there are no texts devoted to this subject. This study reviews and illustrates canine scrotal lesions following an aetiological layout with the aim of facilitating clinical identication and diagnosis. Infectious, immune-mediated, endocrinological and neoplastic conditions are the most commonly reported causes of scrotal lesions in the dog. They may affect the scrotum only or other parts of the body as well. The clinical presentation of the lesions, the presence of primary or secondary lesions and the presence of clinical signs of systemic disease may help in obtaining a diagnosis. In some cases further investigations are necessary to reach a denitive diagnosis. Histopathology aids in understanding pathological reactions of the scrotal skin but unfortunately this is not commonly carried out and few reports in the literature include histopathology. The list of conditions given in this review is not exhaustive and other, more rare, diseases may be encountered. Keywords: dermatosis, dog, scrotum, skin.

I N T RO D U C T I O N In small animal practice scrotal skin lesions are uncommon. When they occur, understanding their cause is sometimes a challenge for the clinician. Little information specic to the scrotum is available in the veterinary literature. The aim of this review is to provide a guide that will be of value in clinical diagnosis; therapy of these conditions and diseases of the testes are not considered. Many dermatological diseases and systemic disorders may present only scrotal lesions and determining their aetiology is the best way of achieving a rational therapeutic plan. A thorough history, general physical examination to identify abnormalities elsewhere in the body, and a proper examination of the scrotum by inspection and palpation are fundamental. Appropriate complementary tests, including a biopsy of the scrotum, should be carried out. Histopathology of the scrotal skin has been reported infrequently in the literature, and thus the histopathological descriptions of many of the conditions considered in this review refer to the skin of the general body surface.

two layers: the skin and the dartos. The skin is wrinkled, pigmented, covered with a ne and variable density of hairs, and richly supplied with sweat glands. The epidermis is thick, with marked rete ridges and the dermis contains numerous large smooth muscle bundles.1 The dartos forms a common lining for both halves of the scrotum and contributes to the scrotal septum. The scrotum contains the testes, the epididymides, the distal part of the spermatic cord with its associated spermatic fascia and vaginal tunics, and the distal cremaster muscle (Fig. 1). The external pudendal artery is the main blood vessel to the scrotum and the veins parallel the arteries. Lymphatic vessels drain to the supercial inguinal lymph nodes.2 The scrotum is involved in the thermoregulation of the testes. The temperature in the scrotum is lower than that of the body core to prevent degeneration of the seminiferous tubules of the testes. Two mechanisms are involved. The rst is the cooling of the arterial blood by heat exchange with the adjacent veins. The second is due to the activity of the external cremaster and tunica dartos muscles that allow the testis to be moved away from or closer to the body depending on the external temperature.3

A NATO M Y A N D H I S TO LO G Y S C RO TA L D I S E A S E S The canine scrotum is a membranous pouch divided into two cavities by a median septum and consisting of
Correspondence: Rosario Cerundolo, Department of Clinical Studies, School of Veterinary Medicine, University of Pennsylvania; 3900 Delancey Street, Philadelphia, PA19104, USA. 2002 Blackwell Science Ltd

Careful clinical examination of scrotal skin lesions is important to achieve a correct diagnosis. Many diseases may show only scrotal lesions ( Table 1). Skin diseases affecting the scrotum can present a multifocal or diffuse pattern of lesions (Table 2) which may be helpful in
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Figure 1. Structure of the scrotum and testicle. Table 1. Conditions that may affect only the scrotal skin Babesiosis Brucellosis Contact dermatitis Cuterebra emasculator infestation Erysipelothrix rhusiopathiae infection Fixed drug eruption Frostbite Hyperandrogenism Incorrect castration Neoplasia Protothecosis Rocky Mountain spotted fever Sunburn Trauma

BAC T E R I A L I N F E C T I O N S Supercial pyoderma involves the epidermis and follicular epithelium, whereas deep pyoderma involves the dermis and often the subcutaneous tissues. These infections are usually caused by Staphylococcus intermedius, but other bacteria may be involved. Microorganisms may be introduced by local trauma, by bruising or scratching. Often deep infection follows inappropriate or inadequate antibiotic treatment of a supercial infection or if underlying diseases are still present. The primary presenting lesions are papules and pustules but later secondary lesions may occur at many sites including the scrotum (Fig. 2). In deep infections, the lesions vary both in depth and severity.4 Constant licking of the scrotum may extend bacterial infection to the underlying testicle.6 Cytology of pustules shows the presence of neutrophils and bacteria. Histopathology of supercial pyoderma shows a neutrophilic intraepidermal pustular dermatitis and/or a supercial folliculitis,

establishing a correct differential diagnosis (Table 3). In this review, a brief description of each disease and its effects on the scrotum is given, based on aetiological causes. Full descriptions and therapeutic management of the diseases are given elsewhere.1,4,5

Table 2. Differential diagnosis of multifocal and diffuse scrotal lesions Multifocal lesions Blastomycoses Candidiasis Cuterebra emasculator infestation Dermatophytosis Discoid lupus erythematosus Ectoparasites Ehrlichiosis Erysipelotrix rhusiopathiae infection Erythema multiforme Fixed drug eruption Hyperandrogenism Ischaemic dermatopathy Malassezia pachydermatis dermatitis Neoplasia Pemphigus complex Pyoderma Sporotrichosis Sterile pyogranuloma Metabolic epidermal necrosis Systemic histiocytosis Systemic lupus erythematosus Toxic epidermal necrolysis Trauma Uveodermatological syndrome Vitiligo Zinc-responsive dermatosis Diffuse lesions Atopy Babesiosis Brucellosis Contact dermatitis Food hypersensitivity Frostbite Keratinization defects Incorrect castration Leishmaniosis Lethal acrodermatitis Lupoid dermatosis Protothecosis Rocky Mountain spotted fever Sunburn Thallium toxicosis

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Canine scrotal lesions

Table 3. Differential diagnosis of scrotal skin diseases according to pattern of lesions (a) Erythema, macules, papules, crusts and scales Atopy Babesiosis Blastomycoses Brucellosis Candidiasis Contact dermatitis Dermathophytosis Ectoparasites Erysipelothrix rhusiopathiae infection Erythema multiforme Fixed drug eruption (b) Crusts and ulceration Atopy Blastomycoses Brucellosis Candidiasis Cuterebra emasculator infestation Contact dermatitis Discoid lupus erythematosus (c) Hyperpigmentation Atopy Contact dermatitis (d) Oedema and sloughing Cuterebra emasculator infestation Frostbite Food hypersensitivity Frostbite Keratinization defects Leishmaniosis Lethal acrodermatitis Lupoid dermatosis Malassezia pachydermatis dermatitis Neoplasia Pemphigus complex Pyoderma Sunburn Erysipelothrix rhusiopathiae infection Erythema multiforme Fixed drug eruption Food hypersensitivity Ischaemic dermatopathy Neoplasia Pemphigus complex Food hypersensitivity Hyperandrogenism Incorrect castration Rickettiosis

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Sterile pyogranuloma Sporotrichosis Metabolic epidermal necrosis Systemic lupus erythematosus Systemic histiocitosis Thallium toxicosis Toxic epidermal necrolysis Trauma Zinc-responsive dermatosis

Protothecosis Sporotrichosis Metabolic epidermal necrosis Systemic lupus erythematosus Sterile pyogranuloma Systemic histiocitosis Toxic epidermal necrolysis Pyoderma Vascular hamartoma Testicular torsion Trauma

Figure 2. Erythema and pustule formation in supercial staphylococcal infection.

Figure 3. Oedema, erythema and ulceration of the scrotum in Brucella canis infection (reproduced courtesy of C. Tieghi, Varese, Italy).

while in deep pyoderma folliculitis, furunculosis, nodular to diffuse dermatitis, and panniculitis are observed.1,7 Erysipelothrix rhusiopathiae is an uncommon cause of bacteraemia, bacterial endocarditis and septic arthritis in dogs. Crawford & Foil described erythematous and oedematous skin lesions with pinpoint haemorrhagic ulcers on the scrotal skin in a 9-month-old Golden Retriever.8 Blood culture is necessary for diagnosis. Histopathology shows a vasculitis that can be systemic and is characterized by the involvement of arterioles, venules and capillaries.8 Brucellosis in dogs has been reported to be caused by Brucella canis, which is usually transmitted through oronasal, conjunctival or venereal contact with an

infected dog. It usually causes testicular atrophy, epididymitis, prostatitis and sometimes scrotal dermatitis.4,9 The lesions appear 12 weeks after intravenous inoculation or 35 weeks after oral inoculation of B. canis and it is likely that the scrotal dermatitis is caused mainly by staphylococci as a consequence of persistent licking of the scrotum over painful epididymides.10 However, Schoeb & Morton described scrotal lesions, caused by B. canis itself invading the scrotum from within, with several discrete, raw, depressed areas up to 1 cm with subsequent draining of uid from the ulcers (Fig. 3).11 Serological investigations and bacteriological culture are diagnostic. Histopathology shows a nodular to diffuse pyogranulomatous and lymphocytic dermatitis.12,13
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Figure 4. Necrosis and sloughing of the lower part of the scrotum in Rickettsia rickettsii infection.

Figure 5. Erythema and ulceration in protothecosis (reproduced courtesy of P. Ginel, Cordoba, Spain).

RICKETTSIAL INFECTIONS Ehrlichiosis, a tick-borne disease caused by Ehrlichia spp., is characterized by a variety of clinical syndromes. In the subclinical and chronic phases of E. canis infection some dogs may develop scrotal oedema.14 Detection of the morula inside a monocyte in a blood smear and serological investigation are diagnostic. Rocky Mountain spotted fever (RMSF) is a tickborne, zoonotic disease caused by Rickettsia rickettsii. Some dogs may present with scrotal erythema, oedema and ulceration.4 They often have a stiff gait and are reluctant to walk. Necrosis and sloughing of the oedematous scrotum may follow (Fig. 4).15,16 Serological investigations are diagnostic. Histopathology in ehrlichiosis and RMSF shows a vasculitis.1,7,8

FUNGAL INFECTIONS Dermatophytosis is caused by fungi of the genera Microsporum and Trichophyton, which are transmitted by contact with infected hair or scales derived from other animals or their environment. The clinical signs are circular patches of alopecia with variable scaling, or diffuse erythema with ne follicular papules, scales and crusts. The signs are highly variable and may be localized or generalized with associated bacterial infection.4 Diagnosis is based on direct microscopical examination and cultures of plucked hairs and scrapings. Histopathology shows variable acanthosis, ortho- and parakeratotic hyperkeratosis which extend into the follicular infundibula, and neutrophilic folliculitis and furunculosis in more advanced lesions. Dermatophytes may be seen in or around protruding hairs or occasionally free within epidermal keratin.1,5 Candida spp. dermatitis is a rare infection most commonly caused by the yeast C. albicans, which may cause supercial or deep infection. It is usually secondary to trauma, excessive moisture, debilitation, systemic diseases, use of antibiotics and, in immunosuppressed dogs, to prolonged antibacterial, steroid and immuno 2002 Blackwell Science Ltd, Veterinary Dermatology, 13, 63 76

suppressive agents. The supercial infections are often generalized. The scrotal lesions are moist, eroded, ulcerated, crusty and pruritic.17,18 Cytology shows the presence of numerous ovoid yeasts. Histopathology shows a massive parakeratotic hyperkeratosis with a severe neutrophilic intraepidermal pustular dermatitis.1 Malassezia pachydermatis dermatitis is caused by yeasts commonly found on normal skin but predisposing factors, including breed, may cause increased multiplication that leads to disease. Skin lesions are frequently observed in intertriginous areas such as the ventral neck, axilla, inguinal area and the scrotum. Clinical signs include pruritus, erythema and the presence of greasiness, scales and crusts.19 Cytology shows the presence of numerous monopolar budding yeasts. Histopathology reveals a hyperplastic, supercial, perivascular to interstitial dermatitis with diffuse lymphocytic exocytosis and epidermal spongiosis.1 Sporotrichosis is caused by the ubiquitous fungus, Sporothrix schenckii, which exists as a saprophyte in soil and organic debris. Clinical signs are more often localized to the skin including the scrotum, subcutaneous tissues and lymphatics.20 Lesions are multiple rm nodules and ulcerated plaques that may develop draining tracts. Cytological examination of material aspirated from the lesions and fungal culture are not always diagnostic, as the yeasts are rarely found in dogs, and a serological test is more useful. Histopathology shows nodular to diffuse pyogranulomatous dermatitis and panniculitis.1,5,7 Blastomycosis is a chronic granulomatous suppurative systemic mycosis caused by inhalation of the spores of Blastomyces dermatitidis. The cutaneous form is usually a manifestation of the disseminated disease and presents as single or multiple papules, nodules or draining tracts exuding a seropurulent material.4,21 Protothecosis is a systemic mycosis caused by Prototheca wickerhamii a ubiquitous, saprophytic achlorophyllous alga that can cause disseminated infection or skin lesions via wound contamination. The cutaneous lesions are papules, nodules and ulcers. Primary scrotal involvement has been reported in a Collie with scrotal swelling, ulceration (Fig. 5) and secondary generalized lesions.22

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Figure 6. Diffuse exfoliative dermatitis in leishmaniosis. Note the large scales.

Cytological examination of material aspirated from the lesions is diagnostic and culture can conrm the diagnosis. Histopathology in blastomycosis and protothecosis shows a supercial and deep pyogranulomatous dermatitis with abundant microorganisms in most cases.1,7,22

the scrotum and the developing larva projects through the puncture while the greater portion is buried and surrounded by a zone of inammatory tissue. The scrotum becomes oedematous and a round rm mass may be palpated. It apparently gives the animal no discomfort unless the parasite causes an abscess with following necrosis of the scrotum, inammation and dislocation of the testes.6,27,28 Parasites such as Sarcoptes spp. and Demodex spp. may also infest the scrotal skin. The presence of pruritus with erythema, papules and crusts also affecting other areas of the body should lead to a suspicion of sarcoptic mange. In demodicosis papules, pustules and comedones with hyperpigmentation commonly affect the face, limbs and inguinal area. Larvae of Pelodera strongyloides or hookworms may also infest the scrotal skin causing erythema. Areas of the body in contact with the ground are more commonly affected. Skin scrapings and hair pluckings are usually diagnostic.4

I M M U N E - M E D I AT E D D I S E A S E S Atopy is a hypersensitivity disease in which the patient becomes sensitized to environmental antigens, with IgE or IgGd production. The age of onset varies from 6 months to 7 years and the clinical signs may be seasonal or nonseasonal depending on the allergens involved. Skin lesions are usually localized on the face, axillae, limbs and ventrum, involving also the scrotum. Initially, there are slightly erythematous macules, usually associated with pruritus, salivary staining and signs of self-trauma, leading to secondary bacterial and yeast infections. Subsequently, alopecia, hyperpigmentation, lichenication and seborrhoea may develop.4 Thickening of the scrotal skin may interfere with the scrotums ability to control testicular temperature and might contribute to thermal testicular degeneration. Diagnosis is based on Willemses criteria and exclusion of other hypersensitivity disorders.29 Intradermal and serological tests may help to understand which antigen may be involved in this condition . Histopathology is not particularly useful in the diagnosis of atopy. However, the most consistent lesion is a supercial perivascular dermatitis with the presence of mononuclear cells, and acanthosis, diffuse supercial dermal oedema and vasodilatation. The follicular epithelium is usually hyperplastic and may be hyperkeratotic.1,7 Food sensitivity is an abnormal clinical response to an ingested food and can be manifested by cutaneous and/or gastrointestinal signs. Skin lesions, primary or secondary, are usually associated with pruritus and may be localized on the face, limbs, axillae and ventrum, including the scrotum. Secondary bacterial and yeast infections usually contribute to the severity of the skin lesions.3 A restriction diet, based on a source of protein and carbohydrate not fed previously, is essential to diagnose this condition. Histopathology is not specic and shows a supercial and deep perivascular dermatitis.7
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P RO TO Z OA L I N F E C T I O N S Leishmaniosis is caused by protozoa of the genus Leishmania that are transmitted by bloodsucking insects of the genus Phlebotomus or Lutzomia. The organism is present in macrophages and the infection causes a chronic systemic disease. Cutaneous lesions with excessive scaling (Fig. 6) and ulcers are commonly seen.23 Cytological examination of aspirates from the lymph nodes or the bone marrow and serological investigations are diagnostic. Histopathology shows orthokeratotic hyperkeratosis and a supercial and deep perivascular dermatitis characterized by histiocytes and small numbers of lymphocytes, plasma cells and neutrophils. Numerous amastigotes are present within the macrophages and some are found free in the tissue.1 Babesiosis is a tick-borne disease caused by Babesia spp., which parasitize red blood cells. The clinical signs vary and are peracute, acute or chronic. In severely affected dogs, thrombocytopenia may produce haemorrhagic macules on the scrotum.24,25 Cytological examination of blood smears and serological investigations are diagnostic. Histopathology shows a neutrophilic vasculitis, mixed perivascular inammatory inltrate and dermal oedema.24,25

PA R A S I T I C I N F E S TAT I O N S Cuterebra spp. are ies that may rarely affect the dog26 but no recent reports of scrotal infestation are available. Cuterebra emasculator may affect the scrotum of wild animals as well as dogs in some regions of the United States. The y deposits its eggs by piercing

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R. Cerundolo and P. Maiolino band of lymphocytes and plasma cells along the dermoepidermal junction, around hair follicles and adnexal glands. Hydropic degeneration of the basal cells and apoptosis of individual keratinocytes during the acute and subacute phase, and marked pigmentary incontinence may also be present.1,7,33 Systemic lupus erythematosus is a rare disorder with a multifactorial aetiology. The clinical signs include polyarthritis, fever, proteinuria and anaemia. Skin lesions may be extremely diverse and multifocal, or generalized, sometimes involving the scrotum and leading to ulceration. The diagnosis in dogs, as well as in humans, should meet four of the criteria established by the American Rheumatism Association.35 Histopathology shows a mild to moderately intense lymphocytic interface dermatitis with hydropic degeneration and necrosis of the basal cell layer of the epidermis with formation of colloid bodies.1,7,33 Fixed drug eruption is a rare reaction potentially caused by any drug administered topically or systemically. Certain drugs (sulphonamides, penicillins and cephalosporins) are more frequently reported to produce hypersensitivity-like reactions.4 Cutaneous drug reactions can mimic virtually any dermatosis, however, the lesions resolve when the drug is withdrawn and return when the drug is reinstated.4 In particular, diethylcarbamazine, 5-uorocytosine and aurothioglucose have been reported to cause scrotal pruritus with subsequent self-trauma and well-demarcated scrotal ulceration.3638 Histopathological ndings are variable but may include an interface dermatitis composed of lymphocytes and plasma cells, with supercial and deep perivascular dermatitis.35 Granulomatous vasculitis has also been reported in the scrotal skin of one dog.1 Erythema multiforme is a condition that has been associated with infections, drugs, neoplasia and connective tissue diseases. The acute skin lesions are variable and include erythematous macules, papules, urticarial plaques and vesicles. Van Hees et al.39 described scrotal lesions in a dog with generalized erythema, macules and wheals following 20 days of levamisole for the treatment of dirolariasis. Histopathology shows a severe reaction in which numerous apoptotic keratinocytes are present at all levels of the epidermis and within the adnexal epithelia. Lymphocytes inltrate into the affected epidermis, and may closely surround the apoptotic keratinocytes, a process known as satellitosis.7 Toxic epidermal necrolysis has been also associated with drug administration, toxins, tumours and other systemic disorders. Skin ndings are characterized by vesiculobullous lesions with necrosis and ulceration. Fever, anorexia and lethargy are common systemic signs. Histopathology shows a cell-poor subepidermal vesicular dermatitis with full thickness coagulative epidermal necrosis that may extend into the external root sheath of the hair follicle. Separation of the necrotic epidermis occurs at the dermoepidermal junction and leads to subepidermal vesiculation. Dermal inammation is minimal or absent.1,7 Ischaemic dermatopathy has been reported following rabies vaccination.40 Various degree of focal or multifocal

Figure 7. Multiple erythematous brown crusted lesions in pemphigus foliaceus.

Figure 8. Erythema and erosion in cutaneous lupus erythematosus (reproduced courtesy of C. Curtis, London, UK).

Pemphigus foliaceus30 (Fig. 7) and pemphigus erythematosus31,32 are characterized by gradual onset of a vesiculobullous or pustular dermatitis. They usually affect the bridge of the nose, ears, footpads and less frequently the scrotum, which may show erosive and ulcerative lesions. Generalized lesions sometimes occur in pemphigus foliaceus. Cytological examination of the pustule contents shows neutrophils and acanthocytes. Histopathology shows a subcorneal or intragranular vesiculopustular dermatitis with acantholytic keratinocytes. An important nding is hair follicle involvement.1,33 Pemphigus vulgaris is a rare disease characterized by an acute onset in association with systemic signs. The disease presents as vesiculobullous, erosive, ulcerative lesions affecting the oral cavity, the mucocutaneous junctions, the skin and the scrotum. Histopathology shows a suprabasilar acantholysis with resultant clefting, and the formation of vesicles or bullae. The basal cells of the epidermis, although separated from each other by loss of their intercellular bridges, remain anchored to the basement membrane zone like a row of tombstones. The process may extend into the hair follicle epithelium.1,6,33 Cutaneous lupus erythematosus is a disease characterized by depigmentation and ulceration with crusts affecting the planum nasale and lips, and less commonly the periocular area, pinnae, distal limbs and the scrotum (Fig. 8).34 Histopathology shows a heavy
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Canine scrotal lesions alopecia, erosions, ulcers, crusts and hyperpigmentation may affect the face pinnae, foot pads, tail, the skin overlying the bony prominences and the scrotum.40 Histopathology of alopecic areas shows follicular atrophy; lymphocitic perivascular inammation and vasculitis are present in deep dermis and panniculus.40

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C O N TAC T D E R M AT I T I S This disease is conventionally divided into irritant and hypersensitivity reactions although both conditions are likely to be involved to some extent in every instance.41 Irritant contact dermatitis is a reaction due specically to the irritating effects of a substance with no immune basis. It may be caused by many strong irritants (such as acids and alkalis) or other substances, including selenium and povidone iodine,42 that injure the scrotal skin following a single exposure. Other substances, such as soap, detergents and medicated shampoos require repeated contact to cause injury. In both cases, a secondary bacterial infection may follow.4,43 Contact hypersensitivity is a type IV reaction and only a few dogs in an exposed population may develop clinical signs of the disease. Repeated or continuous challenge is necessary for sensitization to occur and for the signs to develop. The lesions may be common in dogs kennelled on concrete oors. Sometimes the lesions may be seasonal if plant allergens are involved. Numerous substances have been incriminated including cement, synthetic textiles, soil cleaning products and topical drugs.44 The clinical signs of the two syndromes are similar and differentiation between them is not always easy. If multiple dogs in a kennel are affected, primary irritant contact dermatitis is much more likely than contact hypersensitivity. Lesions are observed not only on the scrotum but at all potential contact sites especially if the animal lies on or walks over the responsible substance. The primary lesions are patches of erythema, macules and papules with serous exudation followed by formation of crusts, excoriation and hyperpigmentation. Intense pruritus may promote severe self-trauma. A detailed history and avoidance of contact with the suspected agents will help to identify the cause of the condition. In contact hypersensitivity, patch tests may be used. Histologically, it may not be possible to distinguish between irritant contact dermatitis and contact hypersensitivity, particularly in more advanced lesions. A supercial perivascular dermatitis, spongiotic in the acute phase and hyperplastic in the chronic phase, is evident.1,4

Figure 9. Erythema, crusts and ulceration in supercial necrolytic dermatitis (reproduced courtesy of E. Ferguson, London, UK).

idiopathic hyperandrogenism, the macular melanosis fades slowly over a 6-month period.45 An enlarged testis or high level of blood testosterone is diagnostic. Sertolis cell tumour is the most common of the testicular tumours. Symmetrical alopecia, gynecomastia, pendulus prepuce and inguinal and scrotal hyperpigmentation are common clinical ndings. An enlarged or retained testicle is suggestive of this condition. Blood oestrogen may be elevated. Metabolic epidermal necrosis (supercial necrolytic dermatitis, hepatocutaneous syndrome) has been associated with hepatic or pancreatic disease in old dogs. The pathogenesis of this disease is undetermined. The presence of a high glucagon concentration due to a glucagonoma may be the cause of the decrease in the plasma amino acid levels which can occur prior to the appearance of skin lesions.46,47 Scrotal lesions may sometimes be the rst sign noted.48 Erythema and scaling followed by erosion or ulceration and crusting with sticky exudate are observed (Fig. 9).49,50 Little et al.49 described a case in which scrotal lesions developed following hepatic injury owing to the ingestion of mouldy biscuits containing a mycotoxin. Histopathology shows a perivascular dermatitis with diffuse parakeratotic hyperkeratosis and a band of hydropic, pale-staining keratinocytes in the upper half of a usually acanthotic stratum spinosum. Both intra- and intercellular oedema contribute to epidermal pallor. As these cells degenerate, clefts and vesicles may form in the outer stratum spinosum.1,7

H E R E D I TA RY D I S E A S E S Lethal acrodermatitis of the Bull Terrier is a rare, familial disease in which a defect in zinc metabolism at the cellular level has been suspected. Affected animals develop, early in life, crusted and ulcerated skin lesions on the face, limbs and scrotum with cracking of the footpads and paronychia. Breed predisposition and the clinical ndings are suggestive of this condition. Histopathology shows diffuse, parakeratotic hyperkeratosis and folliculitis.4,51 Lupoid dermatosis of the German Short-Haired Pointer is presumed to be a hereditary disease. Scales
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ENDOCRINE DISEASES Hyperandrogenism, is a rare disease which may be caused by an interstitial cell tumour of the testis. It is associated with perianal gland and tail gland hyperplasia and macular pigmentation of the scrotal skin. In

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and crusts are initially localized on the face and ears, and then become generalized. Pyrexia is present and the hocks and the scrotum are markedly pruritic.52,53 Breed predisposition and clinical ndings may be indicative of this condition. Histopathology shows an inammatory interface dermatitis, orthokeratotic hyperkeratosis and acanthosis with hyperpigmentation of the epithelium; similar ndings are present in some follicles.1,52 Keratinization defects can be congenital (primary seborrhoea, ichthyosis) or acquired (vitamin A-responsive dermatosis, sebaceous adenitis). The cutaneous lesions (seborrhoea, scales) are usually generalized involving also the scrotal skin.4 Sebaceous adenitis is an idiopathic, probably hereditary, disease commonly seen in Standard Poodles but reported also in other breeds.54 The cutaneous changes are somewhat dependent on haircoat type and breed. In short-haired breeds the lesions are circular with alopecia and scaling. In longhaired breeds alopecia may be patchy but is usually more generalized and the degree of scaling is very pronounced.4 Breed predisposition, clinical signs and the presence of follicular casts are indicative of this condition. Histopathological ndings are variable depending on the severity of the lesions. Early lesions show granulomatous to pyogranulomatous dermatitis, whereas chronic lesions show a supercial perivascular dermatitis with prominent orthokeratotic or parakeratotic hyperkeratosis of epidermis and hair follicles. The sebaceous glands are progressively destroyed by a granulomatous reaction and are completely absent in the nal stages of the disease.7,54

Figure 10. Oedema and erosion with diffuse erythema and a large bruise of the inguinal area following a road trafc accident.

E N V I RO N M E N TA L D I S E A S E S Traumatic lesions are uncommon despite the exposed location of the scrotum. Clinical signs depend on the severity of the injury. Minor abrasions and lacerations such as those which occur in hunting dogs owing to thick vegetation, are initially undetected because of the paucity of clinical signs.55 Severe lesions such as urine scalding may occur following burns or trauma which lead the dog to a sedentary position or to incontinence. Inammation with or without infection may be seen (Fig. 10) and the scrotum is sensitive to palpation. The affected animal frequently licks at scrotal wounds, causing further inammation and possible infection. A stiff gait may be noted and the dog prefers to sit. Trauma to the parietal vaginal tunic of the testis can result in orchitis with subsequent oedema and sloughing of the ventral scrotal skin. Incorrect castration, carried out illegally by members of the public by applying a rubber band to the base of the scrotum, may lead to ischaemia, necrosis and subsequent infection of the wound (K. V. Mason, personal communication). Sunburn is caused by chronic exposure to strong sunlight and may occur commonly during the summer in dogs such as Dalmatians and white Bull Terriers.
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Predisposed areas are the unpigmented, sparsely haired skin of the ank, ventral abdomen and the scrotum (K. V. Mason, personal communication). Frequently, the caudal aspect of the scrotum is affected and in the early stages there is erythema and scaling. Crusts and eventually ulceration may be seen as the lesion progress. Palpation of the area may reveal an uneven surface owing to the thickening of the skin. Continued exposure to sunlight may predispose to squamous cell carcinoma.5 Frostbite affecting the ears, tail tip and scrotum, may occur during cold weather particularly in those breeds in which the scrotal skin is sparsely covered by hair. In mild cases only hyperaemia and oedema are observed, but in severe cases the skin may become pale owing to vasoconstriction and subsequent ischaemia. In severe cases, the skin becomes necrotic and sloughs.56 Thallium toxicosis is a cumulative, general cell poisoning normally caused by a rodenticide which was used frequently in the past. Thallium may produce systemic toxicity and in the chronic form there is a generalized alopecia with erythema and necrosis of the skin. The scrotal skin becomes erythematous,57 thickened and slightly oedematous with subsequent alopecia and scale formation.58 Histopathology shows massive and diffuse parakeratotic hyperkeratosis that extends into follicular infundibula. Marked spongiosis and/or intracellular oedema are evident at the surface and in the external root sheath epithelium. The supercial dermis shows oedema. Hair follicles are mostly in catagen or telogen.1

N U T R I T I O NA L D I S E A S E S Zinc-responsive dermatosis has been reported most frequently in Siberian Huskies and Alaskan Malamutes in which a poor or defective absorption of zinc has been suspected.59 The onset of skin lesions frequently occurs during puberty, although old dogs may also be affected. They show erythema followed by alopecia, crusting and scaling around the mouth, chin, ears, eyes and, less frequently, the scrotum and the prepuce.4 Clinical signs may be suggestive of this condition but skin biopsy helps to conrm the diagnosis.

Canine scrotal lesions Histopathology shows a supercial perivascular dermatitis with diffuse parakeratotic hyperkeratosis, acanthosis and dyskeratosis.1,5

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P I G M E N TA RY D I S O R D E R S Hypopigmentation is a decreased amount of melanin in the epidermis and is associated with congenital or acquired defects in melanization such as occurs following trauma or chemical injuries. It may be also caused by an immune-mediated destruction of the melanocytes. Uveodermatological syndrome ( Vogt-Koyanagi-Haradalike syndrome) is a rare, possibly autoimmune, disease characterized by a concurrent granulomatous uveitis and progressive depigmentation with dermatitis of the head and scrotum.60,61 Clinical ndings are suggestive of this condition. Histopathology shows a lymphohistiocytic interface dermatitis with parakeratotic hyperkeratosis, acanthosis and marked pigmentary incontinence.1,5 Vitiligo has been described in Belgian Tervurens in which a familial predisposition was reported, however, it may also affect other breeds causing progressive cutaneous depigmentation including of the scrotum (Fig. 11).4,62 Other clinical signs, as in uveodermatological syndrome, are absent in vitiligo. Histopathology of depigmented skin reveals a mild interface accumulation of lymphocytes and macrophages in early lesions and absence of melanocytes and melanin-containing keratinocytes.5 Sites of dihidroxyphenylalanine oxidase (Dopa-oxidase) activity are absent. In vitiligo, the cutaneous depigmentation is not only an aesthetic problem but may also predispose to sunburn. Occasionally, spontaneous repigmentation may be observed without any treatment. Hyperpigmentation is an excessive amount of melanin deposited within the epidermis and may be either

macular as in hyperandrogenism owing to testicular neoplasia (see above) and in vascular hamartoma (see later), or diffuse as in chronic inammatory diseases (hypersensitivity disorders) and hormonal dermatoses (Sertolis cell tumour). However, hyperpigmented macules must be differentiated from the normal patchy appearance of the scrotum in some dogs.

MISCELLANEOUS DISORDERS Sterile pyogranuloma is a disease in which the aetiology and pathogenesis are unknown, but an immune-mediated pathogenesis is suspected.4 There are rm, nonpruritic papules, plaques and nodules that may ulcerate on the head, pinna, paws and scrotum.63 Histopathology shows normal to moderately acanthotic epidermis with large perifollicular granulomas or pyogranulomas, which are elongated and vertically orientated. They track hair follicles but do not invade them.4

S C RO TA L N E O P L A S M S Many cutaneous neoplasms may affect the scrotum either as primary localization or following metastasis.6466 Fineneedle aspiration biopsies and impression smears are useful techniques to reach the diagnosis. Careful examination and ne-needle aspiration of supercial lymph nodes, bone marrow biopsy, buffy coat examination and diagnostic imaging investigations are necessary in some cases to rule out tumour metastases. Cutaneous neoplasms are of epithelial, mesenchymal or melanocytic origin. Epithelial tumours such as squamous cell carcinoma (SCC) (Fig. 12) and sweat gland adenocarcinoma (SGA) are usually solitary and circumscribed nodules. SCC may be more common in dogs with unpigmented scrotal skin.64,6670 Histopathology of SCC shows a neoplastic proliferation composed of irregular cords and clumps of epidermal cells inltrating the underlying tissues. Large numbers of horn pearls and numerous mitotic gures, sometimes atypical, are frequently found.64 Histopathology of SGA shows neoplastic tissue, extending throughout the thickness of the skin with some invasion of the dartos, composed of an irregular proliferation of epithelial cells usually arranged in thin

Figure 11. Patchy depigmentation of the lower part of the scrotum and prepuce in idiopathic vitiligo-like depigmentation.

Figure 12. Erythema and ulcerated nodules in squamous cell carcinoma (reproduced courtesy of F. Albanese, Naples, Italy) 2002 Blackwell Science Ltd, Veterinary Dermatology, 13, 6376

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irregular cords with frequent formation of glandular spaces resembling sweat glands.64 Mesenchymal tumours characterized by the histological presence of spindle cells (broblast origin) such as brosarcoma, a malignant tumour, and myxoma, a rare benign one, arise from broblasts and occur in adult dogs. The tumours are usually solitary, of variable size, irregular and nodular in shape, poorly demarcated and nonencapsulated.69,70 A scrotal myxoma arising from subcutaneous broblasts has been reported.66 Histopathology shows immature broblasts which are usually fusiform, but they may be ovoid or stellate in shape, and have a variable amount of collagenous bre. In brosarcoma, mitotic gures, sometimes atypical, are common and undifferentiated tumours may have multinucleate giant cells and cells with bizarre shapes.1,4,5 Mesenchymal tumours characterized by the histological presence of spindle cells (from blood vessels endothelium) such as haemangioma, a benign neoplasm, and haemangiosarcoma, a malignant one, occur in adult and old dogs. In the former, the overlying epidermis is usually alopecic and secondary ulceration may occur.5,66,70,71 The latter appears as a plaque or a solitary nodule. Histopathology shows blood-lled vascular spaces lined by single layer of well-differentiated attened endothelial cells.4,5,66,72 In haemagiosarcoma, the neoplastic tissue is composed of immature elongate endothelial cells with round or ovoid nuclei which are very hyperchromatic. Mitotic gures, sometimes atypical, are common.4,5 Vascular hamartoma is believed to be a progressive vascular malformation rather than a true neoplasm. Adult and old dogs of breeds with pigmented scrotal skin are reported to have a higher incidence.69,73 It begins as single or multiple, hyperpigmented macules consisting microscopically of collapsed capillaries that progress to rm plaques as the capillaries become dilated with blood.5,69 The overlying epidermis becomes thickened and is frequently ulcerated because of chronic licking, and there are repeated episodes of profuse bleeding. Histopathology shows acanthosis and increased melanin pigmentation with dermal brosis and a cavernous dilatation of blood vessels.5 Mesenchymal tumours characterized by the histological presence of round cells also occur. Plasmacytoma originates from plasma cells and is found principally in adult dogs. It is usually solitary, circumscribed, raised, smooth, rm to soft, pink to red and dermal in localization, sometimes ulcerating.74 Histopathology shows sheets or large nests of neoplastic cells with oval, round, indented or lobulated nuclei surrounded by a ne brovascular stroma and inltrating the dermis and subcutis.1,74 Epitheliotropic lymphoma is a tumour of T-cell origin and usually affects old dogs. Four different clinical syndromes may be seen: exfoliative erythroderma, mucocutaneous ulceration and depigmentation, solitary or multiple cutaneous plaques or nodules, and inltrative and ulcerative oral mucosal disease.4 The scrotum may be affected in the generalized form characterized by pruritus, erythema and scaling, and the form with cutaneous plaques and/or nodules
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Figure 13. Diffuse erythema and ulceration in a case of nonepitheliotropic lymphoma.

(Fig. 13). Histopathology shows epidermal inltrates of atypical lymphocytes, either single or in clusters, called Pautriers microabscesses. Lymphocytes vary in size and may have a hyperchromatic and convoluted nucleus. Similar inltration of neoplastic lymphocytes is also observed within the supercial dermis and within the epithelia of hair follicles and apocrine sweat glands. The adnexal involvement may precede epidermal involvement.1,5 Histiocytic tumours such as histiocytoma and benign brous histiocytoma are benign tumours originating from Langerhans cells. Young dogs of pure breed are frequently affected. The lesions appear as solitary, round, elevated, rapidly growing, alopecic, erythematous, domeshaped nodules that may ulcerate.4,5,71,75 Histopathology of the former tumour shows uniform sheets of pleomorphic histiocytic cells inltrating the dermis and subcutis, and displacing the collagen bres and adnexae. The neoplastic cells are round to ovoid in shape and have large nuclei. The cytoplasm is pale staining and abundant. Mitotic gures are numerous.4,5 Histopathology of the latter shows a neoplastic proliferation composed of broblasts and histiocytes containing abundant and vacuolated cytoplasm. Lymphocytes and plasma cells are commonly present, especially at the periphery of the masses.1,5 Cutaneous and systemic histiocytosis is an uncommon disease caused by a histiocytic proliferation of Langerhans cells. It has been described in closely related Bernese Mountain Dogs but also other breeds may be affected. Papules, plaques and nodules that may ulcerate and have a crateriform appearance are commonly seen (Fig. 14). Histopathology of the skin shows a nodular to diffuse inltration of cytologically normal histiocytes in the supercial and deep dermis and panniculus adiposus. Histiocytic inltration of the scrotal skin is usually more diffuse and severe and extends beyond the panniculus to involve the common vaginal tunica.76 Mast cell tumour is the most common scrotal neoplasm in the dog.65,66,71,77,78 The scrotum may be hot, swollen and bruised following vasoactive amine release from the mast cells. Usually the tumour occurs as a well-circumscribed solitary cutaneous nodule (Fig. 15) but it may also present as a single or diffuse, poorly delineated oedematous swelling of the skin.69 Histopathology shows considerable variation of the tumour and a classication and grading system has been proposed based on the degree of cellular differentiation.

Canine scrotal lesions

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by pigmentary content and arrangement in clusters or nests rather than by cellular characteristics. Mitotic gures are usually rare in benign melanomas and extremely numerous in malignant melanomas.1,70

A C K N OW L E D G E M E N T S The authors would like to thank Prof. David Lloyd who provided helpful suggestions and critical review of the manuscript and Dr Letizia Davino who drew Fig. 1.

Figure 14. Circular crusts and scales with erythema in a case of systemic histiocytosis.

RE F E RE N C E S
1. Yager, J.A., Wilcock, B.P. Color Atlas and Text of Surgical Pathology of the Dog and Cat. Dermatophatology and Skin Tumours. London: Wolfe, 1994. 2. Evans, H.E., Christensen, G.C. The urogenital system. In: Evans, H.E., ed. Millers Anatomy of the Dog, 3rd edn. Philadelphia: W.B. Saunders, 1993: 50458. 3. Stabenfeld, G.H., Edqvist, L.E. In: Swenson, M.J., Reece, W.O., eds. Dukes Physiology of Domestic Animals. Ithaca, NY: Comstock Publishing, 1993: 66577. 4. Scott, D.W., Miller, W.H., Grifn, C.E. Muller and Kirks Small Animal Dermatology, 6th edn. Philadelphia: W.B. Saunders, 2000. 5. Gross, T.L., Ihrke, P.J., Walder, E.J. Veterinary Dermatopathology. A Macroscopic and Microscopic Evaluation of Canine and Feline Skin Disease. St. Louis, MO: Mosby Year Book, 1992. 6. Barton, C.L. Diseases of the testes. In: Morgan, R.V., ed. Handbook of Small Animal Practice. New York: Churchill Livingstone, 1988: 65560. 7. Yager, J.A., Scott, D.W. The skin and appendages. In: Jubb, K.V.F., Kennedy, P.C., Palmer, N., eds. Pathology of Domestic Animals , Vol. 1, 4th edn. San Diego: Academic Press, 1993: 531738. 8. Crawford, M.A., Foil, C.S. Vasculitis: clinical syndromes in small animals. Compendium on Continuing Education for the Practicing Veterinarian 1989; 11: 40015. 9. George, L.W. Semen examination in dogs with canine brucellosis. American Journal of Veterinary Research 1979; 40: 158995. 10. Carmichael, L.E., Kenney, R.M. Canine brucellosis. The clinical disease, pathogenesis and immune response. Journal of the American Veterinary Medical Association 1970; 156: 172634. 11. Schoeb, T.R., Morton, R. Scrotal and testicular changes in canine brucellosis: a case report. Journal of the American Veterinary Medical Association 1978; 172: 598600. 12. Dawkins, B.G., Machotka, S.V., Suchmann, D. et al. Pyogranulomatous dermatitis associated with Brucella canis infection in a dog. Journal of the American Veterinary Medical Association 1982; 181: 14323. 13. Carmichael, L.E., Greene, C.E. Canine brucellosis. In: Greene, C.E., ed. Infectious Diseases of the Dog and Cat. Philadelphia: W.B. Saunders, 1990: 57384. 14. Troy, G.C., Forrester, S.D. Canine ehrlichiosis. In: Greene, C.E., ed. Infectious Diseases of the Dog and Cat. Philadelphia: W.B. Saunders, 1990: 40414. 15. Keenan, K.P., Buhles, W.C., Huxsoll, D.L. et al. Studies on the pathogenesis of Rickettsia rickettsii in the dog; clinical and clinicopathological changes of experimental
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Figure 15. Ulcerated nodules and papules in a dog with a mast cell tumour.

Sheets, cords or small clusters of more or less recognizable mast cells are seen associated with numerous eosinophils. Foci of tumour necrosis and collagenolysis are found.1,5 Transmissible venereal tumour is generally found in sexually intact males affecting the external surface of the penis and the scrotum, which may appear swollen and reddened, with thin and shiny skin or ulcerative lesions. The tumours metastasize especially in immunosuppressed animals.66,79,80 Histopathology shows round, ovoid or polyhedral cells with indistinct boundaries and poorly stained or clear cytoplasm. The nuclei are large, round and hyperchromatic with distinctly marginal chromatin and large central nucleoli. The cells are in compact masses or sheets and sometimes grow in rows, cords or loose in a delicate stroma. The type and number of inltrating lymphocytes depend on whether the tumour is in a progressive, steady, or regressive state.1,4 Melanoma is a neoplasm composed of melaninproducing cells. The incidence is highest in middleaged dogs.69,71 The tumour is usually solitary and often malignant.66,67 The gross appearance ranges from black macules to large, rapidly growing masses with a smooth appearance that may be amelanotic or dark brown to grey or black in colour.69 Histopathology shows intraepidermal and/or dermal tumour cells with considerable variation in appearance (spindle, epithelioid and round cells) that are often recognized

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infection. American Journal of Veterinary Research 1977; 38: 851 6. Greene, C.E., Breitschwerdt, E.B. Rocky Mountain spotted fever and Q fever. In: Greene, C.E., ed. Infectious Diseases of the Dog and Cat. Philadelphia: W.B. Saunders, 1990: 41933. Bourdeau, P., Chermette, R., Fontaine, J.J. Hyperkeratose et candidose cutanee chez un chien. Etude dun cas. Recueil de Medicine Veterinaire 1984; 160: 8039. Pichler, M.E., Gross, T.L., Krool, W.R. Cutaneous and mucocutaneous candidiasis in a dog. Compendium on Continuing Education for the Practicing Veterinarian 1985; 7: 225 30. Mason, K.V. Malassezia dermatitis and otitis. In: Kirk, R.W., Bonagura, J.D., eds. Current Veterinary Therapy XI. Philadelphia: W.B. Saunders, 1992: 5446. Moriello, K.A., Franks, P., Delany-Lewis, D. et al. Cutaneouslymphatic and nasal sporotrichosis in a dog. Journal of the American Animal Hospital Association 1988; 24: 621 6. Legendre, A.M. Blastomycosis. In: Greene, C.E., ed. Infectious Diseases of the Dog and Cat. Philadelphia: W.B. Saunders, 1990: 669 78. Ginel, P.J., Perez, J., Molleda, J.M. et al. Cutaneous protothecosis in a dog. Veterinary Record 1997; 140: 6513. Dereure, J., Espinel, I., Barrera, C. et al. Leishmaniasis in Ecuador. 4. Natural infection of the dog by Leishmania panamensis. Annales de la Societe Belge de Medicine Tropicale 1994; 74: 2933. Carlotti, D.N., Pages, J., Sorlin, M. Skin lesion in canine babesiasis. In: Ihrke, P.J., Mason, I.S., White, S.D., eds. Advances in Veterinary Dermatology, Vol. 2. Oxford: Pergamon Press, 1993: 22938. Capelli, J.L., Ghernati, I., Chabanne, L. et al. La babesiose canine, maladia a complexes immuns: a propos dun cas de vascularite a manifestations cutanees. Pratique Medicale et Chirurgicale de lAnimal de Compagnie 1996; 31: 2319. Roosje, P.J., Hendrix, W.H.L., Wisselink, M.A. et al. A case of Dermatobia hominis infection in a dog in the Netherlands. Veterinary Dermatology 1992; 3: 1835. Bloom, F. Scrotum. In: Pathology of the Dog and Cat. The Genitourinary System, with Clinical Considerations. Evanston, IL: American Veterinary Publications, 1954: 257 61. Muller, G., Glass, A. Diseases of sexual organs. In: Diseases of the Dog and their Treatment. London: Bailliere, 1937: 303 20. Willemse, T. Atopic skin disease. A review and a reconsideration of diagnostic criteria. Journal of Small Animal Practice 1986; 27: 771 8. Grifn, C.E. Diagnosis and management of primary autoimmune skin disease: a review. Seminars in Veterinary Medicine and Surgery (Small Animal) 1987; 2: 17385. Scott, D.W., Walton, D.K., Slater, M.R. et al. Immunomediated dermatosis in domestic animals. Ten years after Part I. Compendium Continuing Education for the Practicing Veterinarian 1987; 9: 42435. Papp, L., Tuboly, S., Vetesi, F. Autoimmune dermatitis in dogs Case report and compilatory account. Mayar Allatorvosok Lapja 1994; 49: 71018. Scott, D.W., Wolfe, M.J., Smith, C.A. et al. The comparative pathology of non-viral bullous skin diseases in domestic animals. Veterinary Pathology 1980; 17: 25781. 34. Rosenkrantz, W.S. Discoid lupus erythematosus. In: Grifn, C.E., Kwochka, K.W., MacDonald, J.M., eds. Current Veterinary Dermatology: The Science and Art of Therapy. St. Louis, MO: Mosby, 1993: 15464. 35. Tan, E.M., Cohen, A.S., Fries, J.F. et al. The 1982 revised criteria for the classication of systemic lupus erythematosus. Arthritis and Rheumatism 1982; 25: 12717. 36. Mason, K.V. Fixed drug eruption in two dogs caused by diethylcarbamazine. Journal of the American Animal Hospital Association 1988; 24: 3013. 37. Rosenkrantz, W.S. Cutaneous drug reactions. In: Grifn, C.E., Kwochka, K.W., MacDonald, J.M., eds. Current Veterinary Dermatology: The Science and Art of Therapy. St. Louis, MO: Mosby, 1993: 15464. 38. Malik, R., Medeiros, C., Wigney, D.I. et al. Suspected drug eruption in seven dogs during administration of ucytosine. Australian Veterinary Journal 1996; 74: 285 8. 39. van Hees, J., Mason, K.V., Gross, T.L. et al. Levamisoleinduced drug eruption in the dog. Journal of the American Animal Hospital Association 1985; 21: 25560. 40. Vitale, C.B., Gross, T.L., Magro, C.M. Vaccine induced ischemic dermatopathy in the dog. Veterinary Dermatology 1999; 10: 13142. 41. Walder, E.J., Conroy, J.D. Contact dermatitis in dogs and cats: pathogenesis, histopathology, experimental induction and case reports. Veterinary Dermatology 1994; 4: 14962. 42. Willemse, T. Clinical Dermatology of Dogs and Cats. A Guide to Diagnosis and Therapy. Philadelphia: Lea & Febiger, 1991: 545. 43. Baker, E. Contact allergy. In: Small Animal Allergy. A Practical Guide. Philadelphia: Lea & Febiger, 1990: 11318. 44. Carlotti, D.N., Pin, D., Bensignor, E. Scrotal contact dermatitis in the dog: 6 cases. Proceedings of the 16th Annual Congress of the ESVD-ECVD Helsinki (Finland). Ooshra Nylands Tryckei Ab, Finland. 1999: 136. 45. Scott, D.W., Reimers, T.J. Tail gland and perianal gland hyperplasia associated with testicular neoplasia and hypertestosteronemia in a dog. Canine Practice 1986; 13: 1517. 46. Gross, T.L., OBrien, T.D., Davies, A.P. et al. Glucagonproducing pancreatic endocrine tumors in two dogs with supercial necrolytic dermatitis. Journal of the American Veterinary Medical Association 1990; 197: 161922. 47. Torres, S.M.F., Caywood, D.D., OBrien, T.D. et al. Resolution of supercial necrolytic dermatitis following excision of a glucagon-secreting pancreatic neoplasm in a dog. Journal of the American Animal Hospital Association 1997; 33: 31319. 48. Walton, D.K., Center, S.A., Scott, D.W. et al. Ulcerative dermatosis associated with diabetes mellitus in the dog. A report of four cases. Journal of the American Animal Hospital Association 1986; 22: 7988. 49. Little, C.J.L., McNeil, P.E., Robb, J. Hepatopathy and dermatitis in a dog associated with the ingestion of mycotoxins. Journal of Small Animal Practice 1991; 32: 23 6. 50. Miller, W.H., Scott, D.W., Buerger, R.G. et al. Necrolytic migratory erythema in dogs: a hepatocutaneous syndrome. Journal of the American Animal Hospital Association 1990; 26: 5738. 51. Smiths, B., Croft, D.L., Abrams-Ogg, A.C.G. Lethal acrodermatitis in Bull Terriers. A problem of defective zinc metabolism. Veterinary Dermatology 1991; 2: 91 6.

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Rsum Les lsions scrotales sont peu frquentes et reprsentent souvent un d diagnostique. Dans la littrature vtrinaire, aucun texte nest dvolu ce sujet. Cet article rapporte et illustre les lsions cutanes scrotales chez le chien, en suivant lorigine tiologique des lsions an de faciliter lidentication clinique et le diagnostic. Les maladies infectieuses, dorigine immunologique, endocriniennes et noplasiques sont les causes les plus frquentes de lesions du scrotum chez le chien. Elles peuvent atteindre seulement le scotum ou tre galement localises dautres zones cutanes. La presentation clinique des lsions, la prsence de lsions primaries ou de lsions secondaires, et la prsence de symptmes en relation avec une maladie systmique peuvent aider au diagnostic. Dans certains cas, des examens complmentaires sont indiqus pour obtenir le diagnostic dnitif. Lexamen histopathologique est une aide prcieuse pour comprendre les ractions pathologiques de la peau du scrotum, mais malheureusement cet examen est rarement realise et peu darticles dans la littrature font tat danalyses histopathologiques. La liste des maladies rapporte dans cet article nest pas exhaustive et dautres maladies, plus rares, peuvent galement tre rencontres dans cette localisation. Resumen Las lesiones escrotales son infrecuentes y presentan a menudo un desafo diagnstico. En la bibliografa veterinaria no existen textos dedicados a este tema. Este estudio revisa e ilustra las lesiones escrotales caninas siguiendo una relacin etiolgica con el objetivo de facilitar la identicacin clnica y el diagnstico. Las causas ms frecuentes de lesiones escrotales caninas son de carcter infeccioso, inmunomediado, endocrinolgico y
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neoplsico. Pueden afectar slo el escroto o tambin otras reas corporales. La presentacin clnica de las lesiones, la presencia de lesiones primarias o secundarias y la presencia de sntomas clnicos de enfermedad sistmica pueden ayudar en el diagnstico. En algunos casos, son necesarias otras pruebas diagnsticas para conseguir un diagnstico denitivo. La histopatologa ayuda a comprender las reacciones patolgicas de la piel escrotal pero desafortunadamente no se realiza normalmente y pocos estudios incluyen histopatologa. La lista de las afecciones de esta revisin no es exhaustiva y es posible la presentacin de otras enfermedades menos frecuentes. Zusammenfassung Skrotale Lsionen sind nicht hug und oft eine diagnostische Herausforderung. In der veterinrmedizinischen Literatur sind diesem Thema keine Verffentlichungen gewidmet. Diese Studie gibt nach einer tiologischen bersicht eine Zusammenfassung und Illustration skrotaler Lsionen beim Hund mit dem Ziel, die klinische Erkennung und Diagnose zu erleichtern. Infektise, immun-bedingte, hormonelle und neoplastische Erkrankungen sind die hugsten verffentlichten Ursachen von skrotalen Lsionen beim Hund. Sie knnen ausschliesslich den Hodensack oder auch andere Teile des Krpers betreffen. Die klinische Prsentation der Lsionen, das Vorhandensein von primren oder sekundren Lsionen und klinische Zeichen systemischer Erkrankungen knnen in der Diagnosendung behilich sein. In einigen Fllen sind weiterfhrende Untersuchungen ntig, um zu einer denitven Diagnose zu gelangen. Histopathologie zielt darauf ab, pathologische Reaktionen der skrotalen Haut zu verstehen, wird aber unglcklicherweise nicht hug duchgefhrt und wenig Berichte in der Literatur schliessen Histopathologie ein. Die Liste der hier aufgefhrten Erkrankungen ist nicht vollstndig und andere seltenere Erkrankungen knnen angetroffen werden.

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