FOOD/FARMED ANIMALS Multiple organised haematomas in the presternal region of a cattle A. Alasonyalilar-Demirer, 1 M. M. Kahraman, 1 V. Ipek, 1 B. Yildirim 2 1 Pathology Department, Uludag University Faculty of Veterinary Medicine, Bursa, Turkey 2 Abattoir Veterinarian and Clinician, Bursa, Turkey Correspondence to Dr A. Alasonyalilar-Demirer, e-mail: aalasonya@uludag.edu. tr Received 28 August 2013 Accepted 9 September 2013 To cite: Alasonyalilar- Demirer A, Kahraman MM, Ipek V, et al. Vet Rec Case Rep Published online: [ please include Day Month Year] doi:10.1136/vetreccr- 2013-000011 SUMMARY This is the presentation of a case of numerous elastic masses with subcutaneous and mostly intramuscular localisation in the presternal region of a three-year-old dairy cattle. The masses were accidentally encountered at the meat inspection and submitted for further identification of their nature to the pathology department. Findings are presented here to make a contribution to the differential diagnosis from soft-tissue neoplasms and ectopic trematode parasites when they are encountered at meat inspection or postmortem examination. To the best of the authors’ knowledge, there has been no report on organised haematomas occurring at the presternal region of a cow except a textbook-recorded case, which was reported in the hip muscle of a cattle. BACKGROUND Haematoma is the accumulation of blood in confined tissue spaces, generally as the result of haemorrhage, and resolves either by reabsorption or by organisation (Slauson 2002). Organised haematomas can occur between the muscle fibres, and they generally reduce and resolve over five to six months (Saotome 2003). The word ‘organised’ defines the histological findings, such as fibrous tissue, neovascularisation, and extravasated erythro- cytes. Organised haematomas occur in many loca- tions and they can be mistaken for soft-tissue malignancies (Hsu and others 2009) or ectopic trematode parasite (Chang and others 1991, Madarame and others 2009). Due to its perplexing appearance and unpredictable localisation, com- pared to previously published cases, except of a text book appearance of haematomas in hip muscle of a cattle (Gil and Durao 1990), the presentation of organised haematomas in a cow are made here (Kafle 2011). CASE PRESENTATION The abattoir veterinarian observed numerous elastic masses of sizes from 0.5×1 to 1.8×2.5 cm with subcutaneous and mostly intramuscular localisation in the presternal region of three-year-old dairy cow during meat inspection (Fig 1b,c), and submitted them for further pathological investigation. There was no history of antecedent trauma at the anamnesis; a thorough examination of the carcase revealed dehydration, cachexia and foci of pneu- monia with atelectatic appearance at cranioventral localisation (Fig 1a). At gross examination of the submitted samples, numerous small masses of vari- able size, shape and colour, with elastic fibrous pseudocapsules were noticed (Fig 1b,c). The colour of the cut surfaces of the masses varied from cream to variegated dark red. Touch imprint samples were prepared from the elastic masses collected from the presternal regions and stained with Hemacolor staining kit (Merck). The remaining tissues were fixed in 10 per cent neutral buffered formalin; embedded in paraffin wax, cut at 5 mm in thickness and stained with H & E. The sections were also stained with Mallory’s phosphotungstic acid haematoxylin method (PTAH) for fibrin and Perls’ iron stain. INVESTIGATIONS Cytology depicted numerous erythrocytes and fibrocytes (Fig 2a). Histologically central mass of erythrocytes with necrotic debris and fibrin, and formation of granulation tissue surrounded by a capsule of dense fibrous tissue were seen (Fig 2b). Many haemosiderinophages and capillaries occluded with fibrin were observed as well, and organised haematomas were diagnosed as a result of these findings (Fig 2c). In Perls’ iron and PTAH stained sections, ferric iron and fibrin were observed as blue and dark blue respectively. DIFFERENTIAL DIAGNOSIS Organised haematomas can occur in many loca- tions, and they might be mistaken for soft tissue malignancies (Hsu and others 2009) and sometimes even with ectopic trematode parasites (Chang and others 1991, Madarame and others 2009). At the differential diagnosis of organised haema- toma from sarcoma or trematode parasites which may be encountered at postmortem examination and meat inspection, several features could be con- sidered for macroscopic evaluation. While soft- tissue sarcomas tend to occur in deeper layers and often show invasive features (Cebesoy and others 2008), haematomas do not behave as malignant tumours. Likewise, no invasive feature was observed either macroscopically or microscopically in the presented case. Ectopic parasites, in particu- lar trematode parasites, are located subcutaneously at aberrant sites of the body in human beings (Chang and others 1991) and animals (Madarame and others 2009). Even if an organised haematoma looks like a trematode parasite in form, an orga- nised haematoma has many different dimensions in the accumulated region, whereas a trematode para- site has similar dimensions. Moreover, cut surface of an organised haematoma is a solid structure and has a more rigid consistency. Alasonyalilar-Demirer A, et al. Vet Rec Case Rep 2013;0:1–3. doi:10.1136/vetreccr-2013-000011 1 Veterinary Record Case Reports