Scales bulge on garter?

[Boots]

While I have an appointment booked to see a vet next week, I was wondering if anyone had encountered a similar issue to what I have seeing. It is like a tumor is forming under the scales and bulging them out. Any info would be much appreciated.

http://www.thamnophis.com/forum/attachment.php?attachmentid=13639&stc=1

Close up of the area.

http://www.thamnophis.com/forum/attachment.php?attachmentid=13640&stc=1

Jason

[guidofatherof5]

Maybe an abscess. I don't think it's a subcutaneous worm as the usually don't affect the scales like that. Has there been any discharge form this area? Is it painful to the touch? I don't think that bedding is prone to produce slivers and the location of the injury is too high. Does anything wipe off if try? When was this snakes last shed? I would caution a biopsy being done as that can sometimes "wake the sleeping giant" if you know what I mean. It will be interesting to see what the Vet. thinks.

[Boots]

Hi Steve,

The garter shed last week and while it mostly came off in one piece, the part from the bulge back did not. It does not seem to be painful to the touch as he slithers though a towel I am holding no problem, and I did not notice any discharge from the area. I will try using a wet towel on the area and see if it helps. Seems to be a little bigger after the last shed as well.

Jason

[guidofatherof5]

Great info. I wondered what the white stuff was, now I know it is retained shed. I would say it is an abscess or more likely a subcutaneous worm. That is a typical location for one. Feeding any feeder fish?

[Boots]

Not so sure about the "subcutaneous worm", and have to thank you for making me look it up. I really could have live without seeing the pictures of them on google. The though of them is disturbing.

Funny that you ask about feeding the garter fish has I have been thinking of trying to see if she would take a filet. I am not sure if she was ever given fish, but I know that for at least the last two years she has only been feed thawed mice.

Jason

[guidofatherof5]

At this point I will stay with subcutaneous worm. Please let us know what the vet. finds.

[joeysgreen]

Hi Jason, how have you been? If this is an older snake, neoplasia certainly could be on the list. Removal of the mass and having it sent for histopath would probably be ideal, but it depends on what the physical exam tells the vet; they'll decide if it is feasible or too invasive (if it invades the body wall past the ribs, entering the coelom). Imaging could be helpful in a treatment plan as well; CT would be ideal and is what we use here; ultrasound might be helpful but there's a lot of ribs that might get in the way. Radiographs will always be available and may at least see if there are other masses that may have metastasized. Unfortunately they can be hard to interpret in snakes. Bloodwork can also be helpful in assessing overall body response (immune system) and health (organ function and homeostasis) prior to making any treatment plans.
Other differential diagnostics are fungal dermatitis, abscess, and parasitic cyst; probably in that order, but diagnostics could sort it out.

Ian

[Boots]

Hi Ian,

Hope all is well. The garter is about 5 years old now if memory is correct so it is possible. Hopefully the vet will be able to figure it out without having to run the more evasive tests. I will post what we find out when we see the vet. Thanks for you thoughts and concerns.

Jason

[Albert Clark]

Wow! Sorry for the dilemma. I would want to know the temperatures and humidity percentages in the enclosure firstly. Also what type of substrate is the animal on? My first suspicion was a resolving blister but then again it looks more suspicious on closeup. I would certainly try neosporin on it to try and see if it has a effect on specifically the dryness and somewhat infectious appearance. But yeah, purely speculation on my part and I would only be grabbing at straws with my suspicions. Let's leave it to the higher minds of science and go with that. As long as she is acting normally and feeding and urinating and defecating let's put her on paper towels and quarantine her for now. Hope this helps. Good luck and I'm hoping she gets a clean bill of health.

[Boots]

Well the garter, who the wife has now named boots against my recommendation as my first garter was already names Boots, has seen the doctor. It was actually a while back, but I was hoping to post the full results, but they are not in. I have the x-rays and will post them tomorrow once I am able to grab a screen shot of them.


Your San Francisco Garter Snake presented to the clinic today for evaluation of 2 masses - one slightly to the left of the spine about 3" cranial to her vent, and one under her tail immediately behind the vent. She is a little limp and weak in clinic.

Xrays were taken of your snake. They thankfully show no invasion of the masses into the spine, and no evidence of calcification of the masses, which is good. They were both soft tissue/fluid density.

Fine needle aspirations were performed of both masses. The mass behind her vent is an abscess. I suspect that it is the musk gland that is abscessed, given the location and the slightly musky smell that released as I was aspirating. Slides were made from the mass over her spine for pathological evaluation. Results are pending. We will contact you...

I am sending her home on a course of inject able antibiotics. Please use as directed.

The antibiotics seem to be working and we are just waiting on the slides. I will post that information once I have it.

Jason

[Boots]

Sorry for the delay. Here are the x-rays of the bulge. Not really easy to see, but it is there.

http://www.thamnophis.com/forum/attachment.php?attachmentid=13699&stc=1
http://www.thamnophis.com/forum/attachment.php?attachmentid=13700&stc=1

[joeysgreen]

Damn, that doesn't look good. Is it affecting mobility at all? I wish I could see the cytology; I'm no clin. path, but I do enjoy looking at that piece of the puzzle.

[guidofatherof5]

Looks deep in the tissue and spread out. I've allowed my Vet. to be aggressive with things like this and in all the few cases it didn't end well. I would tread lightly around this thing. You don't want to wake the sleeping giant.
Has the Vet. given you any treatment options?

[Albert Clark]

Thanks for the insight. Thanks that it's not more ominous and pathological. Try to keep the ambient temperature elevated a few degrees to boost the reptiles immune system and help the antibiotics work more efficiently. Make sure she /he has plenty of water daily also. Good call and hope she /he has a speedy recovery.

[Boots]

Is it affecting mobility at all?

No, mobility is fine, and it does not seem to bother her at all. She has stopped eating once we started the antibiotics though. Which is not great.

All that said, the news is not great. Here is the information I got about the slides that were sent out for analysis. I typed it out as they sent it in jpg. Not sure why.


CYTOLOGY

Cytology

CLINICAL INFORMATION

SOURCE
3 slides prepared from aspiration of a mass on the left dorsal body
wall are examined.

DESCRIPTION/MICROSCOPIC FINDINGS/COMMENTS:

DESCRIPTION:
The aspirates are characterized by variable numbers of mesenchymal
cells on a background of peripheral blood. The mesenchymal cells are
spindle to stellate and arranged individually or in dense clusters.
They have abundant basophillic cytoplasm which frequently forms wispy
tails. The cytoplasm often contains small numbers of punctate clear
vacuoles. The nuclei are rond to oval with coarse chromatin and
frequently display 1 to multiple small nucleoli. Binucleation is
occasionally observed. These cells demonstrate moderate to marked
anisocytosis and anisokaryosis. There is abundant blood.

INTERPRETATION: MESENCHYMALL CELL PROLIFERATION WITH ATYPIA, PROBABLE
SARCOMA

COMMENTS:
Differentials for the population of mesenchymal cells would include a
reactive fibroplasia or a spindle cell neoplasm. Reactive fibroplasia
can result from trauma, inflammation, surgery, vaccination or be
associated with an underlying cyst or neoplasm. Reactive populations
of fibroblasts can display evidence of atypia and mimic a neoplastic
population. The significant number of the mesenchymal cells, almost
monomorphic population and evidence of atypia are most consistent with
a neoplastic population and differentials would include a hemangiopericytoma or
fibrosarcoma. These tumors are locally invasive but slow to
metastasize. This appears to be a soft tissue sarcoma. Histopathology
is necessary to further define the suspected neoplasm and assess its
biological behavior.

In talking with the doctor, she said that while in most cases they go in and scrap out the area and as much as they can around it, in this case it would be tough. Snakes do not have alot of fat or tissue, especially with it being located so close to the spine in this case.

Jason

[guidofatherof5]

Sorry to hear sarcoma. As I said earlier best to not "wake the sleeping giant". Best to let nature takes it's course. I wish you the best in this situation, been there, done that buddy. She will be in my prayers.
Why the course of antibiotics?

[Albert Clark]

Wow. It's very sad to hear this and a tough diagnosis to come to terms with. However I do hope there will be other considerations and options that will come available to help improve the prognosis. The vet sounds like she is a very good one. I know the snake is a special one and has a big place in your heart but just know that I am hoping there will be renewed possibilities for healing. Since the snake is anorexic does the vet recommend tube feedings to support the nutritional status? Stay in peace and not pieces. When there is nothing else there is hope!

[joeysgreen]

Neoplasia was my worry; I don't think there is anything that can be done in this case. Surgical removal doesn't seem plausible. Radiation or chemotherapy are options but the size of the patient are serious limitations to attempting these and it would probably mean several trips to Saskatoon to even get started. Best course of action is probably to monitor quality of life, and euthanize when it has fallen below what seems humane. This may be when it starts to affect mobility or posture. Call your vet about the antibiotics. They may want you to finish the prescription to control what may now be an open wound, or now that we have an answer they may no longer be warranted.
I wish you and your snake all the best.