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Cutaneous Mast Cell Tumor and Mastocytosis in a Black-masked Lovebird

(Agapornis personata)

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 Cutaneous Mast Cell Tumor and Mastocytosis in a Black-masked Lovebird
(Agapornis personata)
Author(s) :Rebecca K. Dallwig, DVM, Julia K. Whittington, DVM, Karen Terio, DVM, PhD, Dipl
ACVP, and Ann Barger, MS, DVM, Dipl ACVP
Source: Journal of Avian Medicine and Surgery, 26(1):29-35. 2012.
Published By: Association of Avian Veterinarians
DOI: http://dx.doi.org/10.1647/2011-019.1
URL: http://www.bioone.org/doi/full/10.1647/2011-019.1

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 Journal of Avian Medicine and Surgery 26(1):29–35, 2012
’ 2012 by the Association of Avian Veterinarians

Cutaneous Mast Cell Tumor and Mastocytosis in a

Black-masked Lovebird (Agapornis personata)
Rebecca K. Dallwig, DVM, Julia K. Whittington, DVM,
Karen Terio, DVM, PhD, Dipl ACVP, and Ann Barger, MS, DVM, Dipl ACVP

Abstract: A 12-year-old female black-masked lovebird (Agapornis personata) with a cobalt

color mutation was presented for self-mutilation of a mass located on the right lateral neck.
Cytologic evaluation of the soft tissue mass revealed a predominance of poorly stained mast cells
with metachromatic intracytoplasmic granules. The presumptive diagnosis was cutaneous mast
cell tumor. Clinical evaluation, results of a complete blood cell count and biochemical analysis,
and radiographs did not reveal systemic manifestation of mast cell disease. The mass was
surgically resected, but surgical margins were limited because of the location of the mass and the
small size of the patient. The lovebird died the day after surgery. Gross postmortem examination
revealed splenomegaly, multifocal pinpoint white nodules throughout the liver parenchyma,
severe thickening and yellow coloration of the great vessels, and pale pink swelling of the caudal
right kidney. Histopathologic analysis of the resected mass revealed sheets of round cells that
contain metachromatic granules, defined as neoplastic mast cells, within a fine fibrovascular
stroma. Similar neoplastic cells were seen in the right kidney, hepatic sinusoids, splenic pulp,
periovarian connective tissue, and bone marrow. The histopathologic diagnosis was a cutaneous
mast cell tumor and disseminated mast cell disease, or mastocytosis. To the authors’ knowledge,
this is the first reported case of a cutaneous mast cell tumor and mastocytosis in a psittacine bird.
Key words: mast cell, mastocytosis, neoplasia, self-mutilation, avian, psittacine bird, lovebird,
Agapornis personata

Clinical Report score of 2/5. An ulcerated soft tissue mass that

measured 15 mm 3 22 mm and 5 mm in thickness
A 12-year-old female intact black-masked
was visible on the right lateral aspect of the neck
lovebird (Agapornis personata) with a cobalt color
immediately cranial to the thoracic inlet (Fig 1).
mutation was presented to the University of
The mass involved the underlying musculature,
Illinois Veterinary Teaching Hospital because of
but passage of a gavage feeding tube confirmed
a 4-day history of self-mutilation. The lovebird
that it did not communicate with the crop. The
had no history of self-trauma and was reported to
surface of the mass contained a mild serosan-
be otherwise healthy. The bird was housed alone
guineous discharge, and a small amount of dried
in a household with exposure to cigarette smoke
blood was evident on the bird’s beak.
and was fed a diet that consisted of commercial
The owner initially declined extensive diagnos-
psittacine pellets and a cockatiel/parrot seed
tic testing or anesthesia and opted for simple
mix (brands unknown by the owner). No recent
wound management. Butorphanol (2.0 mg/kg
changes to the environment were reported. On
IM; Torbugesic, Fort Dodge Animal Health,
physical examination, the bird weighed 52 g
Fort Dodge, IA, USA) was administered for
and was bright and alert, with a body condition
analgesia, and the ulcerated mass was swabbed
for cytologic evaluation. Feathers on the wound
From the Zoological Medicine Service (Dallwig), Depart- periphery were plucked, and the ulcerated tissue
ment of Veterinary Clinical Medicine (Whittington), Zoolog-
ical Pathology Program (Terio), and Veterinary Diagnostic
was cleansed with sterile saline solution. An aloe
Laboratory (Barger), University of Illinois, College of vera preparation (Soother Plus cream, Harrisons’
Veterinary Medicine, Urbana, IL 61802, USA. Pet Products, Lake Worth, FL, USA) was applied

29
30 JOURNAL OF AVIAN MEDICINE AND SURGERY
Figure 1. Raised ulcerated soft-tissue mass, measuring
approximately 15 3 22 3 5 mm, on the right lateral
neck of a 12-year-old female black-masked lovebird.
to the ulcerated area, and the neck was bandaged
with a film dressing (Telfa pad, Tyco Health Care
Group LP, Mansfield, MA, USA), cast padding,
and flexible bandaging material (Vetrap, 3M
Animal Care Products, St Paul, MN, USA).
The bird was discharged with meloxicam (0.5
mg/kg PO q24h; Metacam, Boehringer Ingelheim
Vetmedica Inc, St Joseph, MO, USA) and
enrofloxacin (15 mg/kg PO q12h; Baytril, Bayer
Health Care, Shawnee Mission, KS, USA). A
commercial Romanowsky stain (Diff-Quik, Jor-
gensen Laboratories Inc, Loveland, CO, USA)
applied to the tissue sample revealed a highly
cellular infiltrate composed primarily of presump-
tive mast cells and background erythrocytes
(Fig 2A). The presence of mast cells was con-
firmed by Wright-Giemsa stain (Fig 2B). The
presumptive diagnosis was a cutaneous mast cell
tumor.
Twelve hours later, the lovebird was returned
for a scheduled bandage change. Because of the
presumptive diagnosis, the owner elected to
pursue staging for neoplasia. A complete blood
cell count (CBC), whole blood biochemical analy-
sis, and radiographic evaluation were performed.
Results of the CBC showed a decreased packed
cell volume (26%; reference range, 39%–51%) and
leukopenia (3.5 103/mL; reference range, 4.5–9 3
103/mL), and results of the biochemical analysis
revealed hypoproteinemia (0.9 g/dL [9 g/L];
reference range, 2.8–4.0 g/dL [28–40 g/L]), hypo-
albuminemia (0.7 g/dL [7g/L]; reference range,
2.0–2.8 g/dL [20–28 g/L]), and a high concentra-
tion of creatine kinase (925 U/L; reference range,
52–245 U/L).1 Hematogenous mast cells were not
observed. The anemia and hypoproteinemia in
conjunction with hypoalbuminemia were attrib-
uted to recent blood loss associated with self-
mutilation. Whole-body radiographs demonstrat-
ed the expansile nature of the soft-tissue mass,
which was causing tracheal deviation to the right.
No evidence of gross metastatic disease was seen.
The wound was cleaned and rebandaged as
previously described. Treatment with oral enro-
floxacin and meloxicam was continued, and
diphenhydramine (2 mg/kg PO q12h; Benadryl,
Pfizer Consumer Healthcare, Morris Plains, NJ,
USA) was added.
Three days after staging, the lovebird was
admitted for surgical resection of the mass. The
bird had remained bright and alert, and no
changes were revealed during physical exami-
nation. Before surgery, butorphanol (2.5 mg/kg
IM once) was administered for analgesia. Gen-
eral anesthesia was induced with 5% isoflurane
(Minrad Inc, Orchard Park, NY, USA) delivered
by face mask. The lovebird was intubated with a
modified 8-Fr red rubber tube (Tyco Health Care
Group LP, Mansfield, MA, USA), and anesthesia
was maintained with 1.5%–3% isoflurane.
The soft tissue surrounding the mass was
circumferentially incised with a scalpel blade,
and the tumor was bluntly dissected from the
underlying tissue. The mass did not appear to
extend through the underlying fascial plane.
Because of the location and size of the mass
relative to the size of the bird, minimal margins
(2–3 mm) were obtained. The skin was closed
with 4–0 Vicryl (Ethicon Inc, Somerville, NJ,
USA) in a Ford interlocking pattern. The mass
was submitted for histopathology. The bird had
an uneventful recovery from anesthesia and was
discharged that night.
The following day, the bird was found dead in
its cage at home. A postmortem evaluation was
performed, and tissue samples were submitted for
histopathology. On gross examination, the spleen
was enlarged (5-mm diameter) and dark red, the
liver parenchyma contained multiple pinpoint
white nodules, and the caudal pole of the right
kidney was enlarged and pale pink. The great ves-
sels at the heart base were thickened and yellow.
On histologic examination, the mass excised from
the neck was well demarcated but unencapsulated
and composed of sheets of round cells within a
fine fibrovascular stroma. Neoplastic cells con-
tained a moderate amount of slightly granular
 DALLWIG ET AL—CUTANEOUS MAST CELL TUMOR AND MASTOCYTOSIS IN A BLACK-MASKED LOVEBIRD 31

Figure 2. Photomicrographs of cytologic preparations and histopathologic sections from a soft-tissue mass on the
right lateral neck of a black-masked lovebird; (A) cytologic preparation, showing a predominance of poorly stained
granular mast cells (small arrows) and background erythrocytes (Romanowsky stain, bar 5 10 mm); (B) cytologic
preparation, demonstrating characteristic dark metachromatic intracytoplasmic cell granules (white arrows) (Wright-
Giemsa stain, bar 5 10 mm); (C) section of trachea (lumen denoted by an asterisk), showing neoplastic cells in
syringeal marrow spaces and extending through bone into surrounding tissues (large arrow) (hematoxylin and eosin
stain, bar 5 50 mm); and (D) section of trachea, demonstrating metachromatic granules in neoplastic cells (toluidine
blue stain, bar 5 20 mm).
32 JOURNAL OF AVIAN MEDICINE AND SURGERY
basophilic cytoplasm and a large round-to-oval
nucleus that contained clumped chromatin and a
single prominent nucleolus. Giemsa and toluidine
stains revealed metachromatic granules in neo-
plastic cells (Fig 2D). Mitoses were rare. Small
numbers of eosinophils and fewer heterophils
were scattered throughout the mass. Neoplastic
cells of similar morphology also were found
within the syringeal marrow (Fig 2C), extending
into the adjacent tissue of the neck, and
infiltrating the marrow of the long bones. Similar
neoplastic cells also effaced the right kidney and
infiltrated the hepatic sinusoids, splenic red pulp,
and periovarian connective tissue. Other lesions
included atherosclerosis and retention of the
superficial esophageal mucosa, suggestive of
inanition.
Discussion
This case report describes the presentation of
a cutaneous mast cell tumor with secondary
self-mutilation and disseminated mastocytosis in
an adult female lovebird. Mast cell disease is
uncommon in birds, and, to our knowledge, this
is the first reported case of a cutaneous mast cell
tumor and mastocytosis in a psittacine bird.
Various types of cutaneous and subcutaneous
neoplasia have been reported in psittacine birds,
including basal cell carcinoma,2 lymphosarcoma,3
lipoma,4 malignant melanoma,5–7 metastatic renal
carcinoma,8 sarcoma,9 squamous cell carcino-
ma,10,11 nonepitheliotropic B-cell lymphoma,12
hemangiosarcoma,13 and granular cell tumors.14
Mast cell disease has been documented in
numerous small domestic mammals and occa-
sional reptilian species, including dogs,15–20
cats,15,16,21,22 ferrets,23–26 hedgehogs,27 a snake,28
and a chelonian.29 Mast cell tumors in birds are
rare. Cutaneous mast cell tumors have previously
been documented in owls30,31 and gallinaceous
birds.32,33 Disseminated or metastatic mast cell
disease has very rarely been reported in birds,
with cases documented in 2 chickens.32,33
Mast cells in mammals arise from a heteroge-
nous myelomonocytic cell population originating
in the bone marrow. Mature mast cells are normal
components of the dermis/subdermis, lungs, liver,
and gastrointestinal tract, and have important
roles in the mediation of inflammatory responses,
promoting hypersensitivity reactions, stimulating
T cells in immune responses, and defending the
host against tissue parasites.15,18 Mammalian mast
cells are round with a centrally located round-to-
oval nucleus and contain varying numbers of
intracytoplasmic granules.18,34 Mast cell tumors
can be identified via cytology by using a
commercially available Romanowsky stain; how-
ever, the staining quality is variable, and mast
cells may go unidentified. Mast cells can be
cytologically confirmed by using a Wright-Giem-
sa stain, which demonstrates the characteristic
dark metachromatic intracytoplasmic granules.18
On histologic examination, mast cell granules can
be better identified by using Giemsa or toluidine
blue stains.18 Techniques used to diagnose avian
mast cell tumors have not been well described,
and the methodology used is often extrapolated
from mammals. In this case report, a cutaneous
mast cell tumor was suspected based on a
commercial Romanowsky stain used for cytologic
evaluation. However, as depicted in Figure 2A
and B, the avian mast cells were not as readily
apparent with this stain as with a Wright-Giemsa
stain. On histologic examination, granules exhib-
ited a typical, although faint, metachromasia with
toluidine blue and Giemsa stains (Fig 2D).
Scant literature is available that describes the
distribution and function of avian mast cells,
especially with regard to psittacine birds. Mast
cells in domestic chickens have been found in
highest numbers in the connective tissues of the
oviduct, proventriculus, small intestine, peritone-
um, crop, thyroid glands, and peripheral nerves.35
In cockerels, large numbers of mast cells were
reported in the dermis, subcutaneous tissues,
lung, spleen, and thymus. Relative numbers of
mast cells vary among avian species, with larger
counts found in chickens than in turkeys,
pheasants, or Japanese quail.36
Mast cell tumors in domestic mammalian
species are highly variable. In dogs, mast cell
tumors are common, which represents 7%–20%
of all cutaneous tumors,18–20,37 and approximately
50% of these tumors are malignant. Cutaneous
mast cell tumors in dogs are graded on a scale of
1–3 based on the degree of mast cell differentia-
tion. This grading scale in dogs has been
correlated to the biologic behavior of the tumors
and, therefore, the prognosis.15,16,18,38 A grade I
(well differentiated) cutaneous mast cell tumor
is likely to be completely excised by using the
recommended 2- to 3-cm lateral margins and
one fascial plane for a deep margin, whereas a
grade III (poorly differentiated) tumor is more
likely to have metastasized.19,20,39 In addition to
grading, staging of mast cell disease is important
to determine the extent of the neoplasia. The
World Health Organization has established the
Clinical Staging System for canine mast cell
 DALLWIG ET AL—CUTANEOUS MAST CELL TUMOR AND MASTOCYTOSIS IN A BLACK-MASKED LOVEBIRD
tumors: stage I, a single tumor confined to the
dermis; stage II, a single tumor confined to the
dermis with regional lymph node involvement;
stage III, multiple dermal tumors with local
infiltration and regional lymph node involvement;
and stage IV, any tumor with distant metastasis
or recurrence with metastasis.15,18,37,38 In dogs, the
most common sites for cutaneous mast cell tumor
metastasis are the regional lymph nodes, spleen,
and liver.18 As with other neoplastic conditions,
clinical staging is accomplished by evaluating
bloodwork results, bone marrow cytology, radio-
graphs, regional lymph node cytology or histo-
pathology, and advanced diagnostics, for exam-
ple, an abdominal ultrasound.15,18,37,40 Circulating
mast cells are concentrated in the buffy coat,
which should be evaluated when performing a
CBC. However, cytologic evaluation of a bone
marrow aspirate provides a more accurate assess-
ment of possible mastocythemia than does a
CBC.15,18
Although the behavior of mast cell disease and
mastocytosis in avian species is poorly described,
the lovebird in this case report was staged by
extrapolating most of the recommendations used
in dogs. Hematologic analysis and radiographic
examination were performed; however, the lack
of peripheral lymph nodes in birds precluded the
evaluation of lymph tissue. In addition, because
of case constraints, coelomic ultrasound and bone
marrow aspirates were not performed. In this
lovebird, the postmortem discovery of neoplastic
cells in tissues surrounding the mass as well as in
the bone marrow and multiple other sites led to a
presumptive assessment of grade III mast cell
disease with advanced stage III–IV neoplasia.
Cutaneous mast cell tumors are not reported
as frequently in cats as in dogs; however, they
still comprise 12%–20% of all feline skin
tumors.15,21 Cutaneous mast cell tumors in cats
are most often located on the head and neck,15,16
with one paper citing these locations in 43% of
cats with mast cell tumors.21 Currently, the
histologic grading system used to evaluate
canine mast cell tumors is not recommended
for cats because the correlation of histologic
findings with prognosis differs in cats.16,21,22
Unlike dogs, cats have a higher propensity to
develop mastocytosis, which is the visceral or
systemic form of the disease.16 Mastocytosis in
domestic mammals has a predilection for the
spleen, liver, and abdominal lymph nodes.16,22 By
using these same criteria in the lovebird, the
discovery of mast cells in the liver and spleen
confirmed the presence of mastocytosis.
33
Previously documented mast cell tumors in
birds have been confined to the head: cutaneous
mast cell tumors in a great horned owl (Bubo
virginianus) were located adjacent to the right
orbit and near the left auditory meatus,30 a mast
cell tumor in a burrowing owl (Athene cunicularia)
involved the oral mucosa,31 a lump on the margin
of the right upper eyelid in Hawaiian owl (Asio
flammeus sandwichensis) was later confirmed to be
a mast cell tumor,31 and a periocular mast cell
tumor was reported in a white leghorn cock.32 The
mast cell tumor found on the neck of the lovebird
described in this case report mirrored the
distribution documented in cats.
Complications of mast cell disease in domestic
animals include gastroduodenal ulceration sec-
ondary to histamine release and subsequent
stimulation of gastric H2 receptors, excessive acid
secretion, and hypermotility. Additional compli-
cations include pruritus, prolonged coagulation
times, and delayed healing of surgical sites.15,18,37,38
The lovebird described here originally presented
for self-mutilation, which may have been induced
by pruritus.
Treatment for mast cell disease in small animals
involves surgical removal of the tumor and/or a
combination of radiation therapy and chemo-
therapy. Surgical margins recommended for mast
cell tumor removal are 3 cm laterally and a deep
margin of one fascial plane.15,16,18 A study in dogs
reported complete excision of grade I and II
cutaneous mast cell tumors by using 2-cm lateral
margins in conjunction with a deep margin of
one fascial plane.20 Adjunct radiation therapy
is recommended if the location of the tumor
prevents complete surgical excision. Radiation
therapy for grade I and II mast cell tumors
reportedly achieves a 1- to 2-year disease-free
interval in 79%–97% and 77%–85% of cases,15
respectively, or 85%–95% of cases with low- or
intermediate-grade mast cell differentiation.16 In
cases of poorly differentiated mast cell disease or
documented dissemination, surgical excision and
radiation therapy may only be palliative, and
additional treatment with chemotherapy may be
warranted. However, the prognosis is poor in
many of these cases, because mast cell disease
appears to be fairly resistant to chemotherapy.15,18
In the case of the lovebird, disseminated disease
was not suspected when the tumor was excised.
Because of the patient’s small size, as well as the
location of the tumor on the lateral aspect of the
neck in close proximity to the trachea, esophagus,
and jugular vein, complete surgical resection
with recommended margins was not possible.
34 JOURNAL OF AVIAN MEDICINE AND SURGERY
Although mastocytosis was not revealed until
postmortem examination, local adjunct radiation
therapy may have been an option. Treatment for
mastocytosis has not been documented in birds.
In spite of radiation therapy and possible
chemotherapy, the extent of disease described in
this lovebird relative to the prognosis for masto-
cytosis in domestic mammals was not likely to
have resulted in a good prognosis.
This case report describes both a cutaneous
mast cell tumor and disseminated mastocytosis in
a lovebird. Because this bird presented for self-
mutilation, a diagnostic workup, including cytol-
ogy, is recommended for all avian patients being
presented for self-trauma, and mast cell disease
should be included in the differential diagnosis.
Acknowledgments: We thank Jodi Matheson, DVM,
Dipl ACVR, Avery Bennett, MS, DVM, Dipl ACVS,
and Kim Byrne, CVT, for their assistance with this
case.
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