Genetic characterization of Cryptosporidium spp. in the North African hedgehog (Atelerix algirus) in the Canary Islands, Spain.

The North African hedgehog (Atelerix algirus) is an introduced species from Northwest Africa and is currently distributed in the Canary Islands. This species of hedgehog has been studied as a reservoir of enteropathogens, including Cryptosporidium spp. However, there are no data at species level. Therefore, the aim of the present study was to identify the Cryptosporidium species present in a population of hedgehogs (n = 36) in the Canary Islands. Molecular screening was performed using conventional polymerase chain reaction (PCR) targeting the small subunit ribosomal RNA (18S rRNA) gene of Cryptosporidium spp. Seven of the 36 fecal samples (19.45%) were positive and confirmed by nested PCR targeting the 18S rRNA gene and Sanger sequencing. Cryptosporidium parvum and Cryptosporidium muris were identified in 11.1% (4/36) and 5.6% (2/36) of the samples, respectively, while one sample could only be identified at the genus level. The zoonotic subtypes IIdA15G1 (n = 1), IIdA16G1b (n = 1), and IIdA22G1 (n = 1) of C. parvum were identified by nested PCR followed by analysis of the 60 kDa glycoprotein (gp60) gene sequence. This study is the first genetic characterization of Cryptosporidium spp. in A. algirus, identifying zoonotic species and subtypes of the parasite.

The discovery of Moniliformis saudi (Acanthocephala: Moniliformidae) in the Algerian hedgehog Atelerix algirus in Malta: morphological, molecular, and metal analyses.

The acanthocephalan Moniliformis saudi Amin, Heckmann, Mohammed, Evans, 2016 was originally described from the desert hedgehog, Paraechinus aethiopicus (Ehrenberg) in central Saudi Arabia. The distribution of P. aethiopicus extends to North Africa and west to Mauritania. Moniliformis saudi was recently found in the Algerian hedgehog Atelerix algirus (Lereboullet) in Malta. The distribution of A. algirus is restricted to the North African and east Iberian Mediterranean coast and associated islands. Both host species cohabit and share the same feeding grounds in northern Algeria where common infections appear to take place. The morphology of specimens from both acanthocephalan populations was similar, with minor variations mostly related to the relatively larger Maltese specimens especially the trunk and the male reproductive system. Taxonomic features like the cone-shaped anterior trunk, size and formula of proboscis and hooks, the receptacle, size and shape of eggs, anatomy of the apical proboscis sensory pores, and the stellate body wall giant nuclei were, however, practically identical. SEM and microscope images of specimens of the Maltese population emphasize their qualitative characteristics such as the degree of the extreme spiral muscle development and the development of the posterior nucleated pouches of the proboscis receptacle. Proboscis hooks of specimens from both the Maltese and the Saudi populations had similarly high levels (percent weights) of calcium, moderate levels of phosphorus, and minimal levels of sulfur, magnesium and sodium marking the diagnostic value of the Energy Dispersive x-ray analysis in species recognition. Newly generated partial sequences of the 18S ribosomal RNA and cytochrome C oxidase subunit 1 (Cox1) of the mitochondrial gene were generated from M. saudi from Malta. Moniliformis saudi from Malta, when compared with other available sequences of the same species isolates available in the GenBank database, formed a strongly supported clade with other congeners. The comparison of the molecular profiles of specimens from populations in Malta, Spain, and Saudi Arabia shows no or low genetic variation between them. Ultimately, we provide a morphological and molecular description of a new population of M. saudi from a new host species in a new geographical location, vastly exceeding the originally described ones from Saudi Arabia. A Cox 1 haplotype network inferred with 10 sequences revealed the presence of eight haplotypes, one of which was shared between the populations of Malta and Spain of M. saudi.

Evaluation of supraglottic airway device use during inhalation anesthesia in healthy African pygmy hedgehogs (Atelerix albiventris).

OBJECTIVE: To evaluate a supraglottic airway device (SGAD) designed for rabbits in African pygmy hedgehogs (Atelerix albiventris) during inhalation anesthesia. STUDY DESIGN: Prospective, randomized, blinded experimental study. ANIMALS: A total of 12 adult African pygmy hedgehogs (seven male, five female). METHODS: Hedgehogs were placed in a chamber and anesthesia was induced using isoflurane in oxygen. Oropharyngeal endoscopy was performed and video recorded. The SGAD (v-gel R1) was inserted and connected to a Mapleson D circuit. Capnography, pulse oximetry and physiologic variables were measured during anesthesia, and lung inflation was tested at 10 and 20 cmH2O. With the SGAD temporarily disconnected, anesthetized hedgehogs were randomly positioned into right and left lateral, dorsal and sternal recumbency to evaluate the effect of a change in body position on SGAD placement. Oropharyngeal endoscopy was repeated at the end of anesthesia, and recovery time was recorded. Pre- and post-SGAD placement endoscopy videos were retrospectively reviewed and scored for gross trauma. RESULTS: The median [interquartile range (IQR)] time to successful SGAD placement was 38 (16-68) seconds. The time to SGAD placement decreased as the study progressed. SGAD required repositioning in six hedgehogs, median 2.5 (IQR, 1-3.5) adjustments each, to successfully perform lung inflation or maintain capnography readings. Lung inflation at 10 cmH2O was successfully performed without leakage in nine animals, and in the other three animals after adjusting the SGAD at 1-2 time points. Inflation at 20 cmH2O was rarely achieved without an air leak. Changes in heart and respiratory rates during anesthesia were not clinically relevant. Median endoscopic scores were 0 (no lesions) for both pre-and postplacement. CONCLUSIONS AND CLINICAL RELEVANCE: The SGAD was relatively quickly and easily placed, permitted lung inflation and caused no significant oropharyngeal damage. The SGAD is a practical option for airway management in African pygmy hedgehogs.

Combined morphology and DNA-barcoding to identify Plagiorhynchus cylindraceus cystacanths in Atelerix algirus.

The acanthocephalan parasite Plagiorhynchus cylindraceus has a global distribution and utilizes isopods and birds as intermediate and definitive hosts, respectively. Occasionally, mammals of various orders can act as paratenic hosts. In hedgehogs, severe cases have been reported in juvenile specimens due to secondary infections, as a consequence of complete penetrations of the intestinal wall by cystacanths. In a 66-month study period, we found seven larvae of this parasite encysted in both, the peritoneal cavity and intestine of the Algerian hedgehog, Atelerix algirus in Majorca. Morphology alone was insufficient to identify the species, due to the lack of previous reports and taxonomy-informative characters. In the present report, we combined the use of morphology and the DNA-barcoding approach to confirm to identify cystacanths as P. cylindraceus. This is the first report of this parasite in this hedgehog species. The epidemiological implications will be discussed, including the risk of zoonosis and the importance of using modern approaches to identify immature acanthocephalan larvae in wildlife hosts.

Proliferative Lesions of the Endometrium of 50 Four-Toed Hedgehogs ( Atelerix albiventris).

Uteri from 50 four-toed hedgehogs ( Atelerix albiventris) with clinical signs of uterine disease were histopathologically examined. Sixteen animals (32%) were diagnosed with endometrial hyperplasia, 7 animals (14%) were diagnosed with endometrial polyp, and 27 animals (54%) were diagnosed with endometrial neoplasia. The mean ages of the animals with endometrial hyperplasia, polyp, and neoplasia were 28.7 months, 29.4 months, and 25.2 months, respectively. The neoplasms were classified into 7 endometrial mixed tumors, 12 endometrial stromal nodules, and 8 endometrial stromal sarcomas. However, the endometrial stromal nodules and endometrial stromal sarcomas often developed within or were contiguous with an endometrial polyp or mixed tumor. Interestingly, the stromal tumors and the stromal components of the endometrial polyp and mixed tumor displayed extraendometrial differentiation (eg, into adipocytes, granular cells, smooth muscle cells, and osteoid tissue). The endometrial stromal sarcomas exhibited severe cellular atypia and invaded subendometrial tissue. Immunohistochemical examinations demonstrated that the stromal cells of the hyperplastic lesions as well as the neoplastic lesions were positive for CD10, the progesterone receptor, and Wilms tumor 1. The four-toed hedgehog develops unique uterine neoplasms that are mainly composed of endometrial stromal cells and probably arise from endometrial polyps and/or mixed tumors.

The Pathology of Wobbly Hedgehog Syndrome.

Wobbly hedgehog syndrome (WHS) is a leading cause of neurologic disease in African pygmy hedgehogs (APHs; Atelerix albiventris). This study describes the signalment, clinical signs, gross, microscopic, and ultrastructural lesions of WHS in a cohort of 12 pet APHs. Microscopically, lesions consisted of status spongiosus of the white matter, typically bilateral and symmetrical, with myelin degeneration and loss that was accompanied by neuronal/axonal degeneration plus reactive microgliosis and mild, focal astrocytosis and astrogliosis. Lesions were most severe in the cerebellum and medulla oblongata, as well as cervical and thoracic spinal cord. Less affected areas were the corona radiata, corpus callosum, corpus striatum, internal capsule, and the mesencephalon. Ultrastructurally, the lesions consisted of splitting of the myelin sheath at the intraperiod line with subsequent focal expansion, resulting in status spongiosus, disruption, dilatation, rhexis, and phagocytosis. Based on these results, WHS is best described as a "spongy myelinopathy" with widespread central nervous system involvement.

OSTEOSARCOMA IN AFRICAN HEDGEHOGS (ATELERIX ALBIVENTRIS): FIVE CASES.

Osteosarcomas are unusual neoplasms in African hedgehogs ( Atelerix albiventris ) and have been reported in extraskeletal and skeletal locations, including mandible, ribs, and vertebra. Five hedgehogs with osteosarcoma submitted to the Pathology Department at Facultad de Medicina Veterinaria y Zootecnia, National Autonomous University of Mexico are reported. In two cases, the neoplasm arose from the skull; one case arose from the ribs with associated compression of the thoracic and abdominal cavity, and another case involved the vertebrae. In the last case, the neoplasm arose from the scapula. Histologic lesions were similar in all cases and consisted of well-demarcated nodules in which neoplastic cells were arranged in sheets of polyhedral to spindle-shaped cells with interspersed areas of necrosis. Numerous trabeculae of osteoid were present throughout the tumors. No metastases were detected. The predominant histologic pattern was osteoblastic, but a telangiectatic-like pattern was observed in the vertebral osteosarcoma. Electron microscopy was performed in two cases, and malignant osteoblasts had features consistent with descriptions in other species, including deposits of hydroxyapatite in osteoid. According to these cases and previously published data, axial osteosarcomas are more frequent in contrast to appendicular osteosarcomas in African hedgehogs, and metastases are rare.

A different kind of hedgehog pathway: tinea manus due to Trichophyton erinacei transmitted by an African pygmy hedgehog (Atelerix albiventris).

The unusual case of a 29-year-old woman with tinea manus caused by infection due to Trichophyton erinacei is described. The patient presented with marked erosive inflammation of the entire fifth finger of her right hand. Mycological and genomic diagnostics resulted in identification of T. erinacei as the responsible pathogen, which had been transmitted by a domestic African pygmy hedgehog, Atelerix albiventris. Upon prolonged treatment with topical and systemic antifungal agents skin lesions slowly resolved. This case illustrates that the increasingly popular keeping of extraordinary pets such as hedgehogs may bear the risk of infections with uncommon dermatophytes.

Efficacy and safety of subcutaneous methadone hydrochloride in four-toed hedgehogs (Atelerix albiventris).

OBJECTIVE: To evaluate the efficacy and safety of SC methadone in four-toed hedgehogs. ANIMALS: 9 to 12 healthy adult four-toed hedgehogs (7 to 9 males and 3 females). METHODS: Hedgehogs underwent 3 randomized, blinded, placebo-controlled, complete crossover studies. Hind limb withdrawal latencies in response to an acute thermal noxious stimulus were measured to evaluate the antinociceptive efficacy of methadone. Single doses of SC methadone were evaluated at 0.5 and 1 mg/kg for dose-dependent effects. Additionally, methadone (1.5 mg/kg) was administered at different concentrations to assess the effect of injection volume on antinociceptive efficacy. Finally, the safety of multiple doses of methadone (1.5 mg/kg, SC, q 2 h, for 3 doses) was also evaluated. In addition to monitoring behavior during latency measurements, animals were assessed for overt sedation. Food intake, body weight, and running wheel activity were assessed daily for 6 days following methadone administration to evaluate for adverse effects. RESULTS: Methadone at 1 and 1.5 mg/kg provided antinociception lasting < 2 hours, and injection volume had no significant effect on efficacy. Methadone at 0.5 mg/kg did not induce antinociception. Methadone produced transient abnormal behaviors in all hedgehogs, with more animals affected at the 1.5-mg/kg dose. Behaviors included periods of standing motionless, vocalization, chewing motions, and paw raising. Single- or multiple-dose administration of methadone had no significant effect on total food intake, body weight, or running wheel activity. CLINICAL RELEVANCE: The results of this study provide additional information on providing analgesia to hedgehogs. Subcutaneous methadone (1 to 1.5 mg/kg) can be used for short-term antinociception in hedgehogs.

Establishment of a histiocytic sarcoma cell line and anti-tumor effect of bortezomib in the African pygmy hedgehog (Atelerix albiventris).

The African pygmy hedgehog (Atelerix albiventris) is known to have a high incidence of tumor. However, investigating the tumors of this species has been constrained by the limited availability of research materials such as cell lines and genome information. In this study, we successfully established a novel cell line from a histiocytic sarcoma (HS) of an African pygmy hedgehog, allowing us to conduct a drug screening. We investigated using FDA-approved drug library screening to determine which anticancer drug this tumor cell line is sensitive to, and as a result of apoptosis experiments, bortezomib among the three proteasome inhibitors was found to induce cell death of cancer cells by significantly increasing caspase-3 cleavage (P<0.01). Thus, we elucidated that the proteasome inhibitors, particularly bortezomib, exhibit anti-tumor effects on a cell line derived from an HS in an African pygmy hedgehog through a mechanism comparable to that described in human tumors. This study reports the first characterized cell line from the African pygmy hedgehog and also highlights the potential utility of bortezomib as an anti-tumor treatment for HS in this species.

Morbidity and Prognostic Factors Associated with Wild Hedgehogs Admitted to a Wildlife Rehabilitation Center in Catalonia (NE Spain) from 1995 to 2020.

Wildlife rehabilitation centers (WRC) play a crucial role in the collection of data and the monitoring of hedgehog populations. The main objective of this study was to identify the morbidity and prognostic factors associated with the mortality of wild hedgehogs admitted at a WRC in Catalonia. A total number of 3397 hedgehogs admitted from 1995 to 2020 were studied. The principal cause of admission was orphaned/young category (41%) followed by misplacement (19%), natural disease (17%), and trauma (14%). The best outcomes for release were for misplacement (93.6%), orphaned/young (72.3%), and other causes (77.6%), and the lowest proportion of released animals were found for natural disease (41.4%) and trauma (44.7%) categories. The most common macroscopic findings were the respiratory and digestive lesions. Internal parasites were also prevalent in 61% of the animals but with no association with a higher mortality. In the multivariate analyses, the prognostic indicators related with the mortality outcome were the presence of systemic (OR = 3.6, CI 95%: 2.8-4.6) and neurological (OR = 4.3, CI 95%: 2.9-6.4) signs. Morbidity and prognostic factors in wildlife rehabilitation are essential for providing effective care, making informed decisions, optimizing resources, and improving rehabilitation success rates.

High Prevalence of Microsporidia in the North African Hedgehog (Atelerix algirus) in the Canary Islands, Spain.

Microsporidia are unicellular eukaryotic obligate intracellular parasites with a wide range of hosts reported worldwide; however, little is known about the epidemiological data on microsporidia infection in animals from the Canary Islands. Since data on microsporidia infection in hedgehog species are scarce, the aim of this study was to analyze the presence and identity of microsporidia in a group of North African hedgehogs (Atelerix algirus) using microscopic and molecular methods. From December 2020 to September 2021, a total of 36 fecal samples were collected from naturally deceased hedgehogs from Tenerife and Gran Canaria. All samples showed spore-compatible structures (100%; 36/36) under microscopic analysis, of which 61.1% (22/36) were amplified via the nested-polymerase chain reaction (PCR) targeting the partial sequence of the 16S rRNA gene, the internal transcribed spacer (ITS) region, and the partial sequence of the 5.8S rRNA gene. After Sanger sequencing and ITS analysis, Enterocytozoon bieneusi was detected in 47.2% (17/36) of the samples, identifying two novel genotypes (AAE1 and AAE2), followed by the detection of an undetermined species in 8.3% (3/36) and Encephalitozoon cuniculi genotype I in 5.6% (2/36) of the samples. This study constitutes the first report of microsporidia species in Atelerix algirus worldwide, highlighting the high prevalence of zoonotic species.

An outbreak of Caparinia tripilis in a colony of African pygmy hedgehogs (Atelerix albiventris) from Korea.

In February 2010, dermatitis characterized by scale and self-trauma due to puritis was recognized in a group of 22 four-toed hedgehogs (Atelerix albiventris Wagner, 1841) from a local pet shop in Gwangju, Korea. Microscopic examinations of skin scraping samples showed numerous mites of all developmental stages. Morphologically, pedicels of adult mites were short and unjointed. Tarsal caruncles were bell-shaped on all legs of males while they were absent on legs III and IV of females. Three long setae on the third pair of legs in both sexes were present. Adult males had posterior end of the abdomen with trilobate projection on each side, each lobe with a long seta. Based on these features, the mites were identified as Caparinia tripilis. This is the first report of caparinic mite infestation in hedgehogs from Korea. Identification keys for the family Psoroptidae and the genus Caparinia are provided.

New Data on Pterygodermatites (Pterygodermatites) plagiostoma Wedl, 1861 (Nematoda, Rictulariidae) Parasite of the Algerian Hedgehog Atelerix algirus Linnaeus, 1758 (Eulipotyphla: Erinaceidae) from the Canary Islands.

A redescription of the rictulariid nematode Pterygodermatites (Pterygodermatites) plagiostoma Wedl, 1861, is made by means of light and scanning electron microscopy, including the first data on male specimens. The morphologic study was based on specimens recovered from two Algerian hedgehogs (Atelerix algirus) from Tenerife and Gran Canaria islands (Canary Archipelago, Spain). The main characteristics of P. (P.) plagiostoma males are the presence of 49-53 pairs of cuticular projections, the presence of one or two midventral precloacal fans (generally one), and the size of two unequal spicules, measuring 98-123 µm (right spicule) and 185-236 µm (left spicule). The cloacal papillae are arranged according to the Ascaridida type. They include two precloacal pairs, an unpaired precloacal papilla, one pair lateral to the cloaca, six postcloacal pairs, and a pair of phasmids near the tail tip. Females are mainly characterized by the presence of 71-77 pairs of cuticular projections, with 43-46 pairs of prevulvar combs, by the differentiation from combs to spines at the level of or slightly posterior to the vulva and by the position of the vulva, located posteriorly to the esophagus-intestine junction. Clear differences were found between P. (P.) plagiostoma and related species of the subgenus P. (Pterygodermatites).

Histological and immunohistochemical features of cutaneous mast cell tumor in six captive four-toed hedgehogs (Atelerix albiventris).

This report described the histopathological and immunohistochemical features of cutaneous mast cell tumor (MCT) in six hedgehogs. The hedgehogs presented single cutaneous mass with ulcer and crusting. Histologically, the neoplastic lesions were characterized by the proliferation of well-differentiated mast cells (3 cases), and atypical mast cells (3 cases) with one atypical histiocytic morphology. Immunohistochemically, tumor cells were positive for KIT and mast cell tryptase, and were negative for Iba-1. In well-differentiated MCT, all patients were clinically improved and survived more than 365 days after surgical excision, whereas an atypical histiocytic MCT showed aggressive behavior with re-recurrence, and the animal died 115 days after surgery. These findings suggest that, compatible with other animals, well-differentiated MCT has a better prognosis in hedgehogs.

Ovarian mixed germ-cell tumor comprising mature teratoma and embryonal carcinoma in a four-toed hedgehog (Atelerix albiventris).

This report describes the clinical and histopathological characteristics of a rare mixed germ-cell tumor comprising teratoma and embryonal carcinoma in the left ovary of a 10-month-old four-toed hedgehog, with chief complaints of loss of appetite and lethargy. Laparotomy revealed a swollen left ovary with small disseminated peritoneal nodules, and bilateral ovariohysterectomy was performed. The left ovary had a mature teratoma with well-differentiated fat, bone, cartilage, salivary gland, trachea, keratin cyst, and nervous tissues, and an embryonal carcinoma consisting of poorly-differentiated epithelial cells arranged in tubular, alveolar, or solid patterns. Immunohistochemically, the embryonal carcinoma cells were positive for placental alkaline phosphatase and c-KIT. This is the first case of mature teratoma with embryonal carcinoma in the ovary of a hedgehog.

Primary localized histiocytic sarcoma of the lumbar vertebrae in a four-toed hedgehog (Atelerix albiventris).

We describe a case of primary localized histiocytic sarcoma of the lumbar vertebrae in a four-toed hedgehog. The case showed aggressive osteolysis of lumbar vertebrae on radiography, and a soft-tissue mass effacing this region was noted, suggesting a neoplastic lesion. No metastatic lesions were apparent. Antemortem diagnosis was challenging, and necropsy was performed. Histopathological and immunohistochemical findings were consistent with localized histiocytic sarcoma. This report provides documentation of the clinical and pathologic features of an unusual form of histiocytic sarcoma localizing to lumbar vertebrae in a four-toed hedgehog.

Geriatric Hedgehogs.

African hedgehogs are susceptible to aging changes like those of other small exotic mammals. Common conditions of the geriatric hedgehog include heart disease, chronic renal disease, and dental/periodontal disease. Hedgehogs are unique in that they have an unusually short life span and a propensity for neoplasia. These 2 factors make it especially common for exotic animal practitioners to encounter geriatric hedgehogs affected by one of the many conditions outlined in this article.

Study of Zoonotic Enteric Pathogens of Atelerix algirus in Tenerife, Canary Islands, Spain.

Atelerix algirus is an invasive species in the Canary Islands (Spain). There are few studies about the zoonotic pathogens this species could be hosting; therefore, this study was focused on analyzing causative agents of diarrhea in humans in feces from hedgehogs. A total of 45 fecal samples obtained in Tenerife (Canary Islands) were analyzed in this study using Biofire FilmArray gastrointestinal panel with an integrated Biofire FilmArray system. Forty-two (93.33%) of the samples presented at least one of the pathogens detected by the panel. The prevalence of four bacteria stands out as for enteropathogenic Escherichia coli (71.11%), Salmonella (66.67%), Clostridioides difficile (33.33%), and Campylobacter sp. (22.22%), all of which were widely distributed along Tenerife. Besides, other pathogens were found, Cryptosporidium sp. and enterotoxigenic E. coli lt/st in 6.66% of the animals, Shigella/enteroinvasive E. coli in 4.44%, and Norovirus GI/GII, Plesiomonas shigelloides, and Vibrio sp. in 2.22%. Of the hedgehogs, 26.66% were hosting just one pathogen, and the others showed coinfection: 24.44% hosted two, 31.11% hosted three, and 11.11% hosted four or more. The close contact with hedgehogs may imply the transmission of not only one causative agent of diarrhea but also multiple agents, since coinfection is highly prevalent. The lack of management measurements for this animal in the Canary Islands, the common habit of adopting hedgehogs from wildlife without veterinary control, and the fact that most of the hedgehogs studied belonged to highly populated areas imply a high risk of transmission of pathogens to humans.

Histological and Immunohistochemical Features of Normal Histiocytes and Langerhans Cells, and Histiocytic Sarcomas in Four-Toed Hedgehogs (Atelerix albiventris).

Histiocytic sarcoma (HS) is a haematopoietic tumour of histiocyte origin that has been sporadically reported in four-toed hedgehogs (Atelerix albiventris). The present study aimed to investigate clinical, gross, histopathological and immunohistochemical features of HS in eight hedgehogs. Histological and immunohistochemical features of normal histiocytes and Langerhans cells (LCs) of hedgehogs were also investigated. HLA-DR-, Iba-1- and E-cadherin-positive LCs were observed in the epidermis, while Iba-1- and CD204-positive histiocytes were detected in the lymph nodes and spleen of normal hedgehogs. Localized HS (six cases) developed in the skin and spleen, while disseminated HS (two cases) occurred in the intestine. Tumour cells of disseminated HS were also distributed within the mesenteric lymph nodes, liver, kidney, spleen, lung and adrenal glands. Tumour cells of both localized and disseminated HS were composed of histiocytic cells, spindle to pleomorphic cells, multinucleated giant cells and erythrophagocytic cells. Most tumour cells were immunopositive for Iba-1, CD204 and lysozyme. A small number of tumour cells were positive for E-cadherin and CD208, and the tumour cells in one case were positive for HLA-DR. These results suggest that the tumour cells have variable features of histiocyte origin, including dendritic cells, LCs and macrophages. The behaviour of HS in the hedgehog was very aggressive, and 50% of cases died within 90 days of resection. The present study also highlighted the tendency for local tumour recurrence in localized cutaneous HS cases, suggesting a requirement for a long-term follow-up after excision.