Use of chemical ablation with trichloroacetic acid to treat eyelid apocrine hidrocystomas in a cat

CASE DESCRIPTION: A 7-year-old Persian cat was evaluated for recurrence of multiple cystic periocular masses. A number of cyst-like lesions had been resected from the left eyelids 18 months earlier, with lesions recurring within 6 months after surgery. The cat had blepharospasm and signs of discomfort following rupture of the largest cyst the day prior to examination. Previous histologic examination of the cysts had revealed apocrine hidrocystomas. CLINICAL FINDINGS: Multiple pigmented nodules were seen around the skin of the upper and lower left eyelids. The nodules were brownish to black, round, soft, and fluid-filled. Signs of pain were not evident during palpation of the nodules. TREATMENT AND OUTCOME: The largest cyst on the upper eyelid was removed by means of a V-shaped full-thickness excision. Histologic and immunohistochemical examination of the excised tissue confirmed the diagnosis of apocrine hidrocystoma. The remaining periocular cysts were surgically debrided and then treated topically with 20% trichloroacetic acid. All lesions healed rapidly without any signs of discomfort. During a recheck examination 12 months later, the upper and lower left eyelids appeared morphologically normal, and there was no evidence of recurrence. CLINICAL RELEVANCE: Findings suggested that chemical ablation with trichloroacetic acid may be a useful treatment for apocrine hidrocystomas in cats.     

Periocular cutaneous mast cell tumors in cats: evaluation of surgical excision (33 cases)

Objective  To describe feline periocular cutaneous mast cell tumor (CMCT) clinical features, rates of local tumor recurrence and metastases, and cat survival time following surgical excision.
Animals studied  Thirty-three cats with periocular CMCTs.
Procedures  Medical records of cats diagnosed with periocular CMCTs were reviewed; cats were included if CMCTs were surgically excised and the diagnosis confirmed by histopathology. The appearance, size, location and histopathology findings of CMCTs were recorded. Rates of local recurrence, metastasis, and survival time following surgical excision were collected when available.
Results  All periocular CMCTs were restricted to the eyelids. In addition to surgical excision, three cats were treated with adjunctive therapy (strontium-90 irradiation or cryotherapy) intraoperatively. Local tumor control was achieved in 22/23 cats with a minimum follow-up of 30 days (median follow-up time of 711 days); one cat developed disseminated CMCTs but no local recurrence. Cats with periocular CMCTs had a median survival time of 945 days. Metastatic disease involving peripheral lymph nodes or abdominal viscera was not detected in any cat at any time during the study. All periocular CMCTs were classified as low-grade based on histopathology, and complete excision was achieved in approximately 50% of cases.
Conclusions  Surgical excision of periocular CMCTs in cats is an effective treatment option with rare local recurrence and metastases, even following incomplete surgical excision.     

Periocular sarcoid in a horse

A periocular nodular sarcoid of the right upper and lower eyelids was diagnosed in an 11-year-old Thoroughbred mare. Computed tomography scan revealed the extent of the tumor. The mass was surgically debulked under general anesthesia, and the affected periocular region was injected intralesionally with Bacillus of Calmette and Guerin (BCG). An emulsion of cell wall fractions was used, which has been modified to reduce the toxic and allergic effect, but retain the antitumor activity. In total, five injections were performed at 2-week intervals. At follow-up 7 months after the last BCG injection, the tumor was completely resolved. Two years after the last treatment, the horse remains tumor-free.     

Multifocal giant apocrine cystadenomas in a miniature poodle

Apocrine cystadenomas have rarely been reported in dogs. Herein, a dog with multiple, large (1.0–7.0 cm) fluctuant and cystic skin masses on the right pelvic limb and chest is described. Histopathological evaluation revealed cystic cavities lined by single to multiple layers of apocrine epithelium with papillary projections, consistent with apocrine cystadenoma.     

Histopathological and immunohistochemical studies of apocrine sweat gland adenocarcinomas in cats

Seven adenocarcinomas of apocrine sweat glands among the 67cutaneous tumours of cats were evaluated between 1980 and 2005. Histopathologically, three tumours were solid, tubular, tubular‐ductal, tubular‐cystic and papillar‐cystic types were also diagnosed each one. Cuboidal and squamous epithelial cells surrounding the cystic lumina and their papillar extensions into the cyst lumens were evident in almost all tumour types. Besides, fibrovascular stroma which surrounding neoplastic foci showed proliferation and stromal invasion. Immunohistochemical features of these tumours were examined with pan‐cytokeratin, vimentin and carcinoembryonic antigen.     

Keratitis and periocular lesions associated with equine herpesvirus‐3 in a 3‐month‐old filly

A 3‐month‐old Quarter Horse filly presented with corneal ulceration in the right eye with extensive coalescing periocular ulcerations, erosions, and cutaneous crusts. Similar periocular lesions were present around the left eye, on the gingival mucosa, and on the cutaneous and mucosal surfaces of the lips. Based on the severity of the filly's corneal lesions, expense and duration of treatment, euthanasia was elected. Histological post mortem examination revealed numerous hyperplastic and/or dysplastic epithelial cells adjacent to areas of ulceration and erosion with intranuclear viral inclusion bodies. Equine herpesvirus‐3 (EHV‐3) was identified by polymerase chain reaction from the right cornea and lip. The virus was isolated from the right cornea, right eyelid and lip. The dam presented with multifocal to coalescing perineal vesicles. EHV‐3 was confirmed by polymerase chain reaction from the vulvar lesions and the mare recovered spontaneously. This is the first case of EHV‐3 corneal infection reported in horses and emphasises that EHV‐3 should be included as a differential diagnosis for vesicular lesions involving the equine periocular and oronasal epithelium.     

Eyelid reconstruction using a split eyelid flap after excision of a palpebral tumour in a Persian cat

This case report documents the use in a cat of a method of palpebral reconstruction previously only described in a series of dogs. A split eyelid flap was used to reconstruct a deficit created by the removal of an apocrine adenoma of the paratrichial sweat gland on the upper lid. This particular technique was chosen over other methods because of its ability to create a smooth hairless eyelid margin. The method previously described in dogs was modified in the present case to address both the fact that the resection was more extensive and the difference in periocular anatomy in the cat.     

Steroid-sparing effect of mycophenolate mofetil in the treatment of a subepidermal blistering autoimmune disease in a dog

A 7-year-old female Cocker spaniel-cross was referred with an 8-month history of mucocutaneous erosive dermatitis. On physical examination, skin lesions affected the eyelids and periocular area, lips and vulva. Lesions were symmetrical with small diffuse superficial ulcers, haemorrhagic crusts, adherent purulent exudation in haired skin, and alopecia with hyperpigmentation and scarring. Histopathologic evaluation showed multiple, non-intact dermoepidermal junction vesicles and ulceration associated with a dermal lichenoid infiltrate. Immunohistochemistry showed strong to moderate reactivity in the dermoepidermal junction for the antibodies directed against canine IgG, human IgG lambda light chains and C3, respectively. A diagnosis of autoimmune subepidermal blistering dermatosis was made. Treatment with oral prednisone at 2 mg/kg and mycophenolate mofetil (MMF) at 20 mg/kg twice daily was initiated and after 4 weeks the ulcers and erosions were cured. During the rest of treatment, MMF was maintained at 10 mg/kg twice daily and prednisone could be tapered to 0.25 mg/kg once every other day without recurrences. In conclusion, this case report shows that MMF was well tolerated and might be effective as steroid-sparing agent in the long-term treatment of this autoimmune subepidermal blistering disease.     

Differential diagnoses,investigation, and management of a periocular swelling close to the nasolacrimal duct in a horse – A case report of Dacryops

To describe the differential diagnoses, investigation, and management of a periocular swelling close to the nasolacrimal duct in a horse that was consistent with a nasolacrimal duct dacryops (lacrimal cyst). A 16‐year‐old gelding, Connemara cross presented with a history of a periocular swelling rostroventral medial to the right eye that had been sampled by the referring veterinary surgeon. A cystic lesion was diagnosed following standing computed tomography. Surgical removal of the cystic lesion was performed, and the tissue was submitted for histopathologic and immunohistochemical examination. Surgical removal of the cyst was curative, and there was no recurrence of clinical signs 7 months later. There was a small amount of mineralized material in the center of the cyst. Histopathologic and immunohistochemical examination confirmed a nasolacrimal duct cyst. Dacryops can form in horses as well as other species and appears to have a favorable outcome if surgically removed.     

Multiple eyelid cysts resembling apocrine hidrocystomas in three Persian cats and one Himalayan cat.

Multiple eyelid cysts were evaluated and treated in four cats. Surgical removal of the cysts was performed in two cats. Histopathologic examination revealed multilocular cystic structures of various size. The cysts were lined by cuboidal to columnar cells with papillary or cystic projections into the cyst lumen. Periodic acid-Schiff-positive, diastase-resistant granules were seen within the apical cytoplasm of many of the cells. The eyelid masses in these cats resembled apocrine hidrocystomas in human beings, both clinically and on histopathologic examination.     

Tattooing of the Equine Eyelid: A Retrospective Study

In this retrospective study, medical records of 26 horses whose eyelids were tattooed were analyzed, and data regarding age, breed, eyelid pigment, eye color, sex, and reproductive status of the horses were compiled. Owners of the horses were contacted by telephone and questioned about their horses. Twenty-six horses were tattooed at Colorado State University (CSU), and one of them was tattooed twice. Records were available for 26 horses, and follow-up results by telephone were completed for 22 of those. Telephone follow-up times ranged from 3 months to 17 years after tattooing. American Paint Horses constituted 62% (16/26) of the cases, followed by Appaloosas (19% = 5/26), and Quarter Horses (8% = 2/26). In 100% (22/22) of cases, the reason for presenting the horse for a tattoo was lack of periocular pigmentation. Only two horses developed ocular or periocular squamous cell carcinoma (SCC) after their tattoos. Although the results of this study suggest that tattooing may be protective against SCC and solar blepharitis, it is by no means conclusive. However it appears to have no deleterious effects, and often owners like the appearance of the tattooed eyelid.     

Apocrine adenocarcinoma of possible sweat gland origin in a male rabbit

A five-year-old, male crossbreed rabbit was referred for acute caudal abdominal swelling. On physical examination, the rabbit was slightly depressed and showed an enlarged subcutaneous cyst in the caudal abdomen and an adjacent small, ulcerated solid mass. A drainage tube was placed in the cystic area, and surgical resection of the solid mass was performed. The histopathological diagnosis of the mass was apocrine adenocarcinoma. To the authors' knowledge, this report describes the first case of spontaneous apocrine adenocarcinoma of possible sweat gland origin in a male rabbit.     

Canine mesenchymal hamartoma of the eyelid

Objective Characterization of a benign disease syndrome involving the eyelids of dogs, describing the signalment, clinical appearance, anatomic location, and pathologic features. Animal studied The records and submitted tissue of 10 dogs with mesenchymal hamartomatous lesions of the periocular connective tissues were retrieved from the Comparative Ocular Pathology Laboratory of Wisconsin (COPLOW) database. Procedure The submitted tissue in each case was stained with hematoxilyn & eosin and Masson’s Trichrome stain and examined histopathologically. Clinical information was collected from the submission requests. The clinical history, treatment, and follow‐up are described in more detail for one of the 10 dogs. Results Seven different breeds, including four Golden Retrievers, were represented. The ages of affected dogs ranged from 6 to 11 years. Eight of 10 lesions were located at the temporal canthus, ranging in diameter from 0.6 to 3 cm. Clinically, the masses were subcutaneous, firm, lobular soft‐tissue growths, which were in some cases adherent to the underlying orbital rim, and in others, freely palpable between the skin and conjunctiva of the eyelid. Histologically, all had distinct margins but were not encapsulated and contained normal appearing collagen‐rich connective tissue with some adipose tissue. Five also contained fully differentiated skeletal muscle tissue arranged in poorly formed aggregates or as individual muscle fibers. Conclusion Mesenchymal hamartoma of the eyelid has not been previously described. The mass has a predisposition to occur at the temporal canthus and should be included in the list of differential diagnoses of benign eyelid masses in dogs.     

Ocular consequences of blunt trauma in two species of nocturnal raptors (Athene noctua and Otus scops)

Objective To determine the type, prevalence, and prognosis of ocular and periocular lesions in free‐living little owls (LO) and scops owls (SO), injured by blunt trauma. Procedures Medical records from LO and SO with ocular or periocular lesions secondary to blunt trauma were reviewed. A complete ophthalmic examination was performed in all birds. Short protocol electroretinography (ERG) and ocular ultrasound were performed as dictated by the case. Results During the study period, a total of 158 LO and 99 SO with blunt trauma were admitted. Among these, 43 LO (27.8%) and 27 SO (27.3%) had ocular or periocular lesions. Bilateral injuries (72.1% LO and 81.5% SO) were more common than unilateral. Common findings in both species were: corneal erosions/superficial ulcers, anterior and posterior uveitis, cataracts, hyphema, posterior synechia, vitreal hemorrhage, and retinal detachment. Electroretinography was performed in 32 LO and eight SO, which had posterior segment lesions or opacity of the transparent media. Normal to nonrecordable b‐wave amplitudes were observed. Follow‐up was available in 13 LO and 11 SO. Among these, nine LO (14 eyes) and 10 SO (17 eyes) had resolution of the clinical signs following medical treatment. Conclusions Ocular lesions are common in LO and SO injured by blunt trauma. Electroretinography is a valuable diagnostic tool to assess the severity of retinal dysfunction secondary to blunt trauma and to determine the response to medical treatment. A complete ophthalmic examination is a determining factor in the early management of trauma in these species.     

Partial orbital rim resection, mesh skin expansion, and second intention healing combined with enucleation or exenteration for extensive periocular tumors in horses

Ocular and periorbital sarcoids and squamous cell carcinoma are common in equine practice. Extensive involvement of periorbital tissues often necessitates removal of the globe if the function of the eyelids can not be maintained with tumor removal alone. This report describes a modification of the standard enucleation or exenteration technique for cases in which there is insufficient skin to achieve primary closure following complete surgical excision. The caudal portion of the dorsal orbital rim is protuberant; partial excision with an osteotome facilitates skin closure by decreasing the size of the wound. Mesh expansion of skin via multiple rows or parallel stab incisions can also be used as an adjunct to facilitate closure. Four horses underwent enucleation or exenteration using the orbital rim resection and mesh skin expansion techniques for extensive periocular tumors that were unresponsive to prior treatments. Follow-up intervals ranged from 6 to 42 months and no horses had tumor regrowth.     

Apocrine adenocarcinoma in a golden hamster.

An apocrine adenocarcinoma was observed in the subcutis of the abdomen of golden hamster. Histologically, the tumor cells irregularly formed multiple layers of cysts and some detached cells were presented in the cystic space. PAS stain with alpha-amylase digestion revealed PAS-positive alpha-amylase-resistant granules in the cytoplasm. Immunohistochemically, cytokeratin was demonstrated in the tumor cells. By electron microscopy, the tumor cells had an oval nucleus with invagination, abundant cytoplasmic organelles and microvilli protruding into the intercellular spaces.     

Clinical features of skin lesions in rabbit syphilis: a retrospective study of 63 cases (1999-2003)

Skin lesions in rabbit syphilis are usually diagnostic, but it is occasionally difficult to differentiate these lesions from those of other skin diseases. Skin lesions in 63 cases of rabbit syphilis were analyzed for early and accurate diagnosis. Lesions were found most frequently around the nose (55 cases) followed by the genitalia (22), lips (20), eyelids (12), and anus (10). Sneezing was observed in 33% of cases with nasal lesions. In cases of maternally acquired infection, lesions could be initially found mainly on the face. Rabbits should be examined carefully not only for facial lesions, but also for lesions of the genitalia and anus, locations easily overlooked.     

Adenovirus group II-like infection in chukar partridges (Alectoris chukar)

Seven live 5-to-6-wk-old chukar partridges (Alectoris chukar) were examined because of increased lacrimation, swollen eyelids, and increased mortality. Gross lesions consisted of mildly enlarged and mottled white spleens, swollen eyelids with external scab formation, and watery intestinal contents. Microscopically, there were increased numbers of mononuclear phagocytic system cells in the spleen, some of which contained faintly staining basophilic intranuclear inclusion bodies, blepharoconjunctivitis, enteritis associated with coccidia and crop mycosis. Transmission electron microscopy of the spleen revealed icosahedral virus particles 65 to 75 nm in diameter, consistent with the morphology of adenovirus. Three out of seven chukars were positive for hemorrhagic enteritis virus by serology.     

Generalized Apocrine Cystomatosis in an Old English Sheepdog

Résumé— Les kystes sudoripares multicentriques sont des affections rares chez le chien caractérisées par une hyperplasie multifocale kystique des glandes apocrines au niveau du cou et de la tête. Dans ce cas, nous décrivons un cas sévére de kystes sudoripares multicentriques généralisés chez un Bobtail. Bien que cette affection soit considérée comme un processus non-néoplasique, le comportement et l'histologie des lésions sont compatibles avec révolution d'une tumeur bénigne. En outre nous avons mis en évidence l'expression de récepteurs pour un facteur de croissance épidermique, puissant mitogéne de l'épithélium glandulaire. [Generalized apocrine cystamatosis in an Old English Sheepdog. (Kystes sudoripares généralisés chez un Bobtail.) Zusammenfassung— Apokrine Zystomatose ist eine seltene Erkrankung beim Hund, die durch eine multifokale zystische Hyperplasie der apokrinen Drüsen über Kopf und Hals gekennzeichnet. In diesem Bericht wird der Fall einer schweren generalisierten apokrinen Zystomatose bei einem Bobtail beschrieben. Obwohl dieser Zustand gewöhnlich als nicht-neoplastisches Geschehen eigenstuft wird, war das Verhalten und die Histologie der Veränderungen in diesem Fall mit einem gutartigen Tumor vergleichbar. Weiterhin wurde die Expression eines Rezeptors für den epidermalen Wachstumsfaktor entdeckt, der ein potentes Mitogen für die Drüsenepithelien darstellt und in sekretorischen Zellen apokrine Zysten umgibt. [Generalized aprocrine cystomatosis in an Old English Sheepdog (Generlisierte apokrine Zystomatose bei einem Bobtail). Abstract— Apocrine cystomatosis is an uncommon disorder in the dog characterized by multifocal cystic hyperplasia of apocrine glands over the head and neck. In this report, we describe a case of severe generalized apocrine cystomatosis in an Old English Sheepdog. Although the condition is usually regarded as a non-neoplastic process, the behaviour and histology of the lesions in our case are compatible with a benign tumor. Furthermore, we detected the expression of the receptor for epidermal growth factor, a potent mitogen for glandular epithelia, in secretory cells lining apocrine cysts.     

Immunotherapy of periocular squamous cell carcinoma with metastasis in a pony.

A 5-year-old Pony of America mare was referred for evaluation of inflamed upper and lower right eyelids. Squamous cell carcinoma of the eyelids and ulcerative keratitis secondary to self-trauma were diagnosed. Initial treatment of the eyelid neoplasia with 2 applications of cryotherapy failed to resolve the lesions, and immunotherapy with bacillus of Calmette-Guerin (BCG) was instituted. Multiple injections of BCG over a 17-week period resulted in progressive shrinkage of the tumor mass, but regional metastasis to the ipsilateral submandibular lymph node occurred. Six months later, ocular neoplastic lesions were not evident, and the lymph node had regressed in size. Eighteen months after the diagnosis of metastatic disease, signs of recurrence were not noticed in either the primary or secondary tumor sites. Squamous cell carcinoma of the equine eyelid historically carries a poor prognosis for resolution. Immunotherapy for equine ocular squamous cell carcinoma should be considered as a treatment alternative to cryosurgery, radiotherapy, hyperthermy, and CO2 laser ablation, especially in cases involving the eyelid.