A reference lab revolution - Episode 9
See how a dermatopathologist helped zero in on a diagnosis in this case study
A closer look at how the relationship between GP and dermatopatholgist can enhance patient care
Content sponsored by Zoetis
Adam Christman, DVM, MBA: So you have a case that you're gonna present with us, too. So you could walk us through the journey of that case, right. So tell us about it.
Katherine Gailbreath, DVM, PhD, DACVP: Yeah, so this was a seven year old Golden Retriever named Lily. And she came in to the clinic with a long history of allergic dermatitis. And it had originally responded to some some treatments and then wasn't responding so well. And so that's kind of the time when you start thinking about a biopsy with a derm case. And so they biopsied it and sent it into the lab and probably didn't indicate that they wanted a dramatic pathologist potentially on the on the form. And so it went to a pathologist, and they read it out as this is getting technical superficial perivascular dermatitis, which is a very common reaction pattern that's consistent with allergies, but doesn't give you a whole lot more information. So that's, that's what came out on the report. And then so the clinician saw that and said, "Okay, well, that's kind of what I thought was going on, but it's still not responding clinically. So this isn't making sense." So they refer that case to a dermatologist. And the dermatologist said, "Okay, this isn't making sense. I want somebody who specializes in dermatopathology to look at this case." So they got to re cut and send it to me. And I and I looked at the case and the other thing that that clinician did was gave me a lot more detailed history than the original pathologist probably had on that case, a really good description of all the lesions, a really good description of what drugs were used and whether or not the patient responded. And so I got all that information. And I looked at it, and I, I saw what wasn't there instead of what was there. So it's really easy to look for the inflammation that's there and focus on the things that are that are not supposed to be there that are, but in this case, the interesting key, which is something that a person with a lot of dermatopathology experience picks up on a little bit easier than someone who doesn't look at it a lot was what wasn't there in this case. So there were no sebaceous glands, which is what happens in a condition called sebaceous adenitis. And so that was the key. And so this dog had allergic dermatitis, but it also had sebaceous adenitis. And so sending that sample in with a little bit more history that pointed to some of these things that didn't make sense with allergies, and then also making sure it went to someone with some dermatopathology. Experience and interest really helped.
Adam Christman, DVM, MBA: So my two key takeaways from that history, history, history.
Katherine Gailbreath, DVM, PhD, DACVP: Yes, yes.
Adam Christman, DVM, MBA: And pictures, images, right, too? Is it a requirement to submit pictures to a dramatic pathologist prior to submitting?
Katherine Gailbreath, DVM, PhD, DACVP: So it's not. I mean, we'd like to say, yes, it's a requirement, you absolutely have to Yeah, sure. Yeah. I mean, we're gonna read the case, if we don't get clinical images, for sure. And but I think sometimes the dermatologists and even the dermatopathologist, if it's a case, it's really not making sense, and we really feel like those clinical images would help us, we will call and ask for him, yes, and even even images taken by the owner, because by this time that the patient's not in hospital anymore. So the owner can take some, you know, everybody has a cell phone and send those in those help. So...
Adam Christman, DVM, MBA: Yeah, it's such a great case of just collaboration overall, you know, we were talking just earlier with the panelists, you have the dermatopathologist such as yourself reviewing the case. That dermatologist, the referral veterinarian, you know, so it's just a great, I just love the teamwork approach to veterinary medicine. And that's just such a great example that that shows that.
Katherine Gailbreath, DVM, PhD, DACVP: Yeah, and I think one of the take homes, that I think, kind of how could this case have gone better? And what was in a perfect world? How can this have really worked out not having to send for a second opinion, you know, we prefer not to have to do that, if we can, we'd like to get it. The first time is to make sure that if something doesn't make sense, when you get the result back to call your pathologist and ask. And as pathologists, we're always happy to get a second opinion. You know, I think sometimes people feel like if you ask for a second opinion, that's like, insulting in some way. And it's totally like, we want to we want to talk to people about cases, we want to talk to our colleagues about cases. So I'm always calling talk to your pathologist about things that don't make sense. And so at us, we, I mean, it's great to talk to clinicians, we talk to each other all the time, we like to have new new voices in the fray. So we really like to talk to people about the animals they're touching every day.
Adam Christman, DVM, MBA: So Oh, that's fantastic. Well, thank you so much, Dr. Gailbreath.