Oct 19 2016

Swollen Toe – Ingrown Nail or Something More Serious?

Nina is one lucky kitty! Her alert owner brought her to Hawthorne Hills Veterinary Hospital when she noticed a toe that looked abnormal. Nina’s 5th toe on her right front paw was swollen and the nail was crooked. Nina previously had an ingrown nail and the owner was concerned that might be happening again.

Unfortunately, the changes we saw indicated that the swelling was more likely some form of infection or cancer and not because of an overgrown nail. Getting a proper diagnosis is important to know the best treatment plan. Nina was admitted to the hospital for the day and given pain medications to ensure she was comfortable. A short acting sedative was also given so that we could get precise radiographs of the paw and also a sample of the tissue. Nina snoozed through the procedure and woke up comfortable.

Toe pre-surgery

Nina’s toe before surgery

Here are the key components of the diagnostic workup:

  • Radiographs
    • Images of the paw showed destruction of the bones,
      confirming our suspicion of cancer.
    • Radiographs of Nina’s chest were taken to find out if there was evidence that the cancer had spread. Cancers of many types frequently spread to the chest, but Nina’s radiographs did not show any evidence of cancer spread to the lungs. This was a good sign.
  • Fine needle aspirate samples were collected from the toe to clarify what type of cancer was present and ultimately help us determine the long term prognosis.
  • Blood and urine samples were tested to ensure Nina didn’t have any other major health issues and was healthy enough for major surgery.

The laboratory confirmed a type of sarcoma – these are tumors which arise from mesenchymal origin – bone, cartilage, muscle, fat etc. The primary worry was for a Fibrosarcoma or Osteosarcoma arising from the connective tissues of the toe. These tumors can be aggressive and can spread making the long term prognosis guarded. Removing the primary tumor (the toe) might not completely remove all chance of tumor recurrence or spread. In deciding how to proceed, we weigh all of the information including the patient’s overall health and each owner’s situation. These decisions are challenging and there isn’t always a ‘right’ answer.

Nina Post Surgery

Nina happy and healthy!

After considering all of the information, the owners opted to pursue surgery. This would provide Nina the best chance of success and certainly make her more comfortable. One week later, Nina had surgery to excise the affected toe and several other small skin growths. Her toe tumor was confirmed to be a Giant Cell Osteosarcoma. The tumor was well circumscribed and completely excised with margins of healthy tissue. This was the best news. It has been over six months since Nina’s surgery. Her paw has healed well and she shows no signs that she misses her toe. She has remained happy, healthy and active.

Robin E. Riedinger, DVM Hawthorne Hills Veterinary Hospital, Seattle WA | Diagnosis, Lumps and Skin Masses, Surgical Conditions, Toe Amputation, Tumors

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