Profile of Mammary Tumors in Dogs and Cost-Benefit Ratio of ROSE Before Puncture With and Without Aspiration Veterinary Cytology Outpatient Clinic—FMVZ—Botucatu, Brazil |
Animal:..................................................................................................................RG:...................................................................... Age (weeks):.................................... Species: ................................................... Breed:.................................................................... Owner:............................................................................................................................................................................................... Address:.............................................................................................................................................................................................. City:.............................................................................. Phone:......................................................................................................... |
General Condition: ( ) Good ( ) Regular ( ) Weak____________________________________________________________ Estrus Cycle: ( ) Regular ( ) Irregular Tipe:_________________________________________________________________ Number of Births: ( ) None ( ) One ( ) Two ( ) > 3 ___________________________________________________________ Pseudopregnancy: ( ) Yes ( ) No Abortion: ( ) Yes ( ) No Uterine Alterations (Secretions) ( ) Yes ___/___/_____ _________________________________________________( ) No Hormones: ( ) Contraceptive ( ) Abortive ( ) None ( ) Does not know Type: _________________________________________________ Date: ___/___/_____ How many times:___________ Evolution of Injuries: ___/___/____ ( ) Fast ( ) Slow Prior Injuries: ( ) Yes ( ) No Location: _____________________________________________________________________ Action: ( ) Surgery ( ) Other _____________________________________________________________________________ Mammary Glands:
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Macroscopy: Size and Location of Injuries: ( )_____×_____×_____ cm. ( )_____ ×_____×_____ cm. ( )_____ ×_____×_____ cm. ( )_____ ×_____×_____ cm. ( )_____ ×_____×_____ cm. ____________________________ Consistence: ( ) Firm ( ) Soft ( ) Mixed ( ) Cystic ____________________________________________________________ Tumor: ( ) Mobile ( ) Immobile __________________________________________________ Mammary Glands (Which ones? ___________________________________________________________ ( ) No alteration ( ) Ulcers ( ) Edema ( ) Reddish Aspect ( ) Absent ( ) Others ____________________________________________________________________________________________________ Secretions: ( ) Yes ( ) No ______________________________________________________________________________ Involved Lymph Nodes/Which ones: ( ) Yes ( ) No___________________________________________________________ |
Cytopathological: Clinical TNM: ______:______:______ Imaging Diagnosis: _____________________________________________________ Number of Sample Collections/Identification: ______________________________________________________________ Viability: ( ) Adequate ( ) Inadequate Directions to the Doctor: ( ) Inflammation ( ) Benignant Neoplasm ( ) Malignant Neoplasm ( ) Others _____________________________________________________________________________________________________ Preliminary Result: C1-C5:_______________________________________________________________________________ (C1, inadequate sample; C2, benignant cytology; C3, atypical cytology, probably benignant; C4, suspect, but not of malignancy; or C5, malignant) |
Surgical Indication: ( ) Yes ( ) No Date of Surgery: ___/___/____ Histopathological ( ) Yes ( ) No ___/___/____ Complementary Examination: ___________________________________ Pathological TNM ( ) Yes ( ) No ______:______:______ Notes_____:____________________________________________ _____________________________________________________________________________________________________ Final Diagnosis B1-B5: ___________________________________ B1, normal tissue; B2, benignant; B3, atypical; B4, suspect, but not of malignancy; or B5, Malignant Pathological Classification: _____________________________________________________________________________ |
Person in Charge: Date ___/___/____ |