Dermal Angiokeratoma in a Pet Ferret (Mustela Putorius furo)

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Case Report
Dermal Angiokeratoma in a Pet Ferret (Mustela Putorius furo)
Wolfe, H. A.,1, 2 Eshar, D.,1* Higbie, C.T.1, 3 and Andrews, G.A.1
College of Veterinary Medicine, Kansas State University, 101 Trotter Hall, Manhattan, KS, USA 66505.
Lake Mary Veterinary Clinic, 2889 West Lake Mary Blvd, Lake Mary, FL, USA 32746 (Present address).
School of Veterinary Medicine, Louisiana State University, Skip Bertman Drive, Baton Rouge, LA 70803 (Present address).
* Corresponding author: Dr. David Eshar, College of Veterinary Medicine, Kansas State University, 101 Trotter Hall, Manhattan, KS, USA 66505.
Tel: 785-532-5660. Email:
A 7-year-old female spayed pet ferret (Mustela putoriusfuro) was evaluated for extensive alopecia and pruritus
of a few months’ duration. Physical examination had also revealed a dermal mass on the dorsum of the
head. The cranial lesion was surgically removed and the histopathology was consistent with a diagnosis of
angiokeratoma. To the author’s knowledge, this is the first report to describe the clinical presentation, diagnosis
and treatment for dermal angiokeratoma in a ferret.
Keywords: Ferret; Angiokeratoma; Neoplasia; Skin; Mustela putoriusfuro.
Angiokeratoma is a benign vascular neoplasm that has not
previously been reported in domestic ferrets. It has been
rarely reported in dogs where it is most often seen on the
third eyelid and conjunctiva, but it may also manifest on
the superficial dermis of any other site (1). In humans, these
masses tend to appear as small, bluish to black rough warty
growths, and are mostly located on the lower extremities (2).
A 7-year-old, 984-g female spayed pet ferret (Mustela putoriusfuro) was evaluated by the Exotics and Zoological Medicine
Service at Kansas State University Veterinary Health Center
for chronic skin lesions. The ferret had extensive alopecia
that was first noticed by the owner a few months prior to
the visit, along with what was believed to be an excoriation
on the dorsum of her head. The ferret was housed indoors
and was allowed free roam of the house for a few hours each
day. Her diet consisted of a commercial high protein ferret
kibble. The owner did not report any changes in appetite,
urination or defecation.
Wolfe, H. A.
JUNE 2016.indb 52
On physical exam the alopecia extended from the top of
the ferret’s head and down the spine to the mid-abdomen.
The alopecia was also present dorsally over the feet. The skin
was scaly, dry, thin and reddened. A raised erythematous
dermal mass was present on the head (or top of the head)
(Figure 1). The spleen palpated enlarged with a possible
mass cranial to the right kidney. No other abnormalities
were noted following a complete physical exam. Complete
surgical excision and histopathological examination were
recommended in order to diagnose the dermal mass on the
head. In addition, ferret adrenocortical disease was considered
based on the pattern of alopecia, pruritus, excoriation, and
the presence of a mass cranial to the right kidney. A ferret
adrenal hormone panel and abdominal ultrasonography were
recommended for further testing, but the owner only allowed
the surgical removal and histopathology of the cranial dermal
The ferret was premedicated using a mixture of midazolam (0.25 mg/kg intramuscularly; Akorn Inc., Lake Forest,
IL USA) and butorphanol (0.25 mg/kg intramuscularly;
Torbugesic, Fort Dodge Animal Health, Fort Dodge, IA
USA). General anesthesia was induced using a small face
Israel Journal of Veterinary Medicine  Vol. 71 (2)  June 2016
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Case Report
Figure 1: Image of this ferret at presentation showing the raised
dermal mass on the head.
mask with 5% isoflurane gas (IsoFlo; Abbott Laboratories,
North Chicago, IL USA) in 2L/min oxygen. Following
induction, the ferret was maintained under general anesthesia using a fitted face mask and non-rebreathing circuit
using 2.5% isoflurane delivered via 1.5 L/min of oxygen.
Body temperature was monitored rectally using a handheld
digital thermometer and maintained using a warm water
blanket and heating packs. Vital signs were monitored using a stethoscope, a Doppler (Parks Doppler System Model
811-B; Parks Medical Electronics, Inc., Aloha, OR USA)
and a pulse oximeter (Nellcor Handheld Pulse Oximeter
N20PA, Covidien, Dublin, Ireland). The area around the
mass was aseptically prepared using a standard technique. A
full thickness biopsy of the mass on the head was obtained
using a disposable Baker’s biopsy punch (SklarTru-Punch
disposable biopsy punch, 5 mm; Sklar, West Chester, PA
USA). This also resulted in complete excision of the mass.
The surgical site was closed using 4-0 polydiaxone monofilament absorbablesuture (PDS II ™; Ethicon, Somerville, NJ
USA) in a simple cruciate pattern. Flumazenil (0.05 mg/
kg intramuscularly; Ben Venue Labs, Bedford, OH USA)
was given to assist an uneventful anesthetic recovery. The
tissue was placed in 10% buffered formalin and submitted
for histopathologic examination.
The histopathologic diagnosis of this mass was of an
angiokeratoma (Figure 2). The dermis contained a neoplasm
composed of cavernous vascular spaces filled with blood and
lined by a single layer of well differentiated endothelial cells.
The overlying epidermis was hyperplastic with trabeculae
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JUNE 2016.indb 53
Figure 2: Photomicrograph of ferret cutaneous angiokeratoma
characterized by superficial dermal cavernous vascular spaces filled
with blood and lined by a single layer of well differentiated endothelial
cells. The epidermis is hyperplastic with trabeculae of epithelium that
extend between and partially surround the vascular spaces. H&E stain.
Bar = 200 μm
of epithelial cells that extended between the vascular spaces
and partially surrounded them. The epidermis was focally
ulcerated and covered with clotted blood. Excision of the
mass appeared complete.
Angiokeratoma is a histologically benign tumor that has been
described as an uncommon variant of a dermal hemangioma
(3).While this form of neoplasia has not been reported in
ferrets, it has been seen in domestic dogs. In a total of 8
angiokeratoma cases reported in dogs, each tumor presented
as a single small, red, raised mass (4). Recurrence was only
seen in one of the aforementioned cases, but there was no
evidence of invasiveness or metastasis in that patient (4).
Other vascular tumors such as hemangioma and hemangiosarcoma are occasionally reported in ferrets (5). Similar
to the lesion in this case, they typically have the appearance
of a small, raised, black mass, and are histologically characterized as well circumscribed, blood filled masses lined by
endothelial cells (5, 6, 7). While dermal hemangiomas are
rarely seen in ferrets, they are usually located on the head,
face or feet, although they can occur anywhere on the body
(6). Angiokeratoma grossly appears very similar to dermal
hemangiomas. Although angiokeratoma and hemangioma
share many histologic characteristics, the only way to differDermal Angiokeratoma in a Pet Ferret
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Case Report
entiate these tumors is by histopathology as angiokeratomas
show marked hyperplasia of the overlying epidermis, which
appeared to invade between the vascular spaces of the superficial dermis (3).
Various other skin tumors have more commonly been
reported in ferrets and were considered as differential diagnoses in this case. Two of the most commonly reported
tumors are of basal cell and mast cell origin (6, 8). One retrospective study of fifty-seven cutaneous neoplasms in ferrets
reported 58% basal cell tumors, 16% mast cell tumors, 11%
fibromas, and 4% hemangiomas (7). Another study showed
that among 763 reported cases of ferrets with cutaneous
neoplasia, the vast majority were mast cell tumors at 33%,
nearly equal with basal cell tumors at 30% (6). Hemangiomas
accounted for 8.5% of reported neoplasms. The remaining
masses included preputial gland tumors at 4%, lymphoma at
2.5%, and leiomyosarcoma, squamous cell carcinoma, spindle
cell sarcoma, apocrine gland cystadenoma, mammary gland
adenoma, fibroma, fibrosarcoma, leiomyoma, and epitheliotrophic lymphoma each at roughly 1% occurrence (6). Lastly,
a retrospective study of 574 ferrets reported 83 integumentary
tumors. Of these, 26 were unspecified tumors (9). The majority of the remaining neoplasms included mast cell tumor
(n=17), basal cell tumor (n=6), and squamous cell carcinoma
(n=6), with only one hemangioma reported in that study.
Due to the benign nature of angiokeratomas in dogs,
complete excision of the mass will generally be curative (1,
4). This can be accomplished either by surgical excision or by
using a punch biopsy tool as was performed in this case (6,
10). Histological examination of the excised mass is imperative to obtain a definitive diagnosis and to ensure that the
margins are free of neoplastic cells in cases of a malignant
dermal neoplasia.
This report describes a clinical case of a rare cutaneous
Wolfe, H. A.
JUNE 2016.indb 54
neoplasm in a pet ferret. This neoplasm should be added to
the list of grossly similar dermal masses often observed in
Dr. Andrews served for many years as a diagnostic pathologist
at the College of Veterinary Medicine, Kansas State University.
Exotic animal medicine is extremely challenging given the relative
limited scope of knowledge of their diseases. The authors of this
manuscript feel fortunate to have had the opportunity to learn
from Dr. Andrews and work together with him to promote the
knowledge of non-common species.
1. Vala, H., and Esteves, F.: A Case of Angiokeratoma. Vet. Pathol.
38:324-325, 2001.
2. Imperial, R., and Helwig, E.: Angiokeratoma: A Clinicopathologic
Study. Arch. Dermatol. 95:166-175, 1967.
3. Gross, T.L., Ihrke, P.J., Walder, E.J., and Affolter, V.K: Skin Diseases of the Dog and Cat: Clinical and Histopathologic Diagnosis,
Blackwell Science, Iowa, 2005.
4. George, C., and Summers, B.A.: Angiokeratoma: A benign vascular tumour of the dog. J Small Anim. Pract. 31:390-392, 1990.
5. Fox, J.G, Muthupalani, S, Kiupel, M, and Williams B.: Neoplastic
Diseases. In: Fox, J.G. and Marini, R.P. (Eds.): Biology and Diseases of the Ferret. Wiley, Iowa, p. 601, 2014.
6. Kanfer, S., and Reavill, D.R.: Cutaneous Neoplasia in Ferrets, Rabbits, and Guinea Pigs. Vet. Clin. N. Am-Exotic. 16:579-598, 2013.
7. Parker, G.A., and Picut, C.A.: Histopathologic Features and Postsurgical Sequelae of 57 Cutaneous Neoplasms in Ferrets (Mustela
putoriusfuro). Vet. Pathol. 30:499-504, 1993.
8. Kelleher, S.A.: Skin Diseases of Ferrets. Semin Avian Exot
Pet.11:136-140, 2002.
9. Li, X., Fox, J.G., and Padrid, P.A.: Neoplastic Diseases in Ferrets:
574 cases. J. Am. Vet. Med. Assoc. 212:1402-1406, 1998.
10. Quesenberry, K.E., and Carpenter, J.W.: Ferrets, Rabbits, and
Rodents: Clinical Medicine and Surgery, Elsevier/Saunders,
Missouri, 2012.
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