Metastasis or delayed local extension of ocular squamous cell carcinoma in four horses

Four horses treated for ocular squamous cell carcinoma (SCC) that subsequently developed local tumour extension or local metastases without ocular recurrence are included in this study. Medical records were examined and long‐term follow‐up obtained through contact with owners and referring veterinarians. In 2 horses, SCC developed in the nasolacrimal duct and maxillary sinus one and 3.5 years, respectively, after treatment for SCC in the medial canthus of the eye. No recurrence of the SCC was noted in the ocular structures. Both were treated successfully with surgery and radiation therapy. Two additional horses had delayed metastasis of SCC to the parotid lymph node one and 2 years after excision of the ipsilateral third eyelid for SCC. No recurrence of the SCC was noted in the ocular structures. One was treated with surgery and radiation without success and one was not treated. Ocular SCC can spread to local tissues or lymph nodes without recurrence in the eye. The clinical manifestation of tumour recurrence may be delayed. Delayed local extension or local metastasis in horses after ocular SCC without recurrence in the eye itself has not been previously reported. Clinical signs of ocular squamous cell carcinoma should prompt immediate treatment and local recurrence despite successful treatment of the ocular disease is a possibility.     

Challenges in the treatment of equine periocular squamous cell carcinoma

Management of periocular squamous cell carcinoma is challenging because of the need for adjunctive therapy, the adverse effects of therapies and the frequent recurrence of SCC. Appropriate treatment of equine ocular SCC usually involves surgical excision combined with adjunctive therapy selected as appropriate for the anatomic site of the lesion. Metastasis of periocular SCC has been reported to occur in approximately 6–15% of cases. The horse owner should be carefully educated to understand that for best long‐term results from the treatment of periocular SCC, they must be diligent in observing signs of recurrence or metastasis and be willing to have the horse examined as soon as adverse signs are observed. Furthermore, external beam radiation may be effective in the treatment of metastatic SCC and further clinical studies of this treatment modality are needed.     

Multiple skeletal metastases from a penile squamous cell carcinoma in a horse

A 21‐year‐old gelding with ventral abdominal and preputial oedema was evaluated for right hindlimb lameness. Partial phallectomy had been performed 3 years prior for treatment of squamous cell carcinoma. Regional analgesia did not localise the source of lameness and nuclear scintigraphy was recommended. The results of the scan revealed severe increased radiopharmaceutical uptake in the proximal femur. Radiographic and ultrasound examinations were inconclusive. The horse was discharged with recommendations of stall confinement and a 2 week course of nonsteroidal anti‐inflammatory drugs. Four weeks later the horse presented for an inability to elevate his neck and persistent hindlimb lameness. The owner elected humane euthanasia. Post mortem examination revealed metastatic squamous cell carcinoma in the proximal femur and fifth cervical vertebrae consistent with metastasis from the penile squamous cell carcinoma. To the authors’ knowledge, multiple site bone metastasis of squamous cell carcinoma has not been reported previously in the horse.     

Skeletal metastasis from a squamous cell carcinoma of the nictitating membrane in a Haflinger horse

A 12-year-old Haflinger gelding with a history of a persistent cough was referred for evaluation of a severe lameness of the left forelimb. An excision of the right nictitans had been performed 2 years prior to presentation, and a squamous cell carcinoma (SCC) with embolic neoplastic cells in several blood vessels had been confirmed by histopathology. The origin of the lameness could not be localised with regional analgesia; therefore, a nuclear scintigraphic examination was performed. This revealed an area of marked increased radiopharmaceutical uptake at the level of the caudodorsal border of the left scapula. Further examination, including ultrasound-guided biopsy of the suspect region, confirmed the presence of SCC invading the scapula. Due to poor a prognosis, the horse was subjected to euthanasia. Prior to euthanasia, the gelding was tested homozygous for the missense variant in the damage-specific DNA-binding protein 2 (DDB2) gene, which is reported as a risk factor for the development of nictitans SCC in Haflinger horses. Post-mortem evaluation revealed multiple SCC metastasis, affecting the scapula, the liver and the lungs. To the authors' knowledge, this is the first reported case of bone metastasis following a primary periocular SCC in a horse.     

Topical 5-fluorouracil as an adjunct treatment in equine corneolimbal squamous cell carcinoma

An 11-year-old crossbreed mare was presented with a nodular, pink mass at the temporal corneolimbal junction of the right eye. Histopathology confirmed the diagnosis of invasive squamous cell carcinoma. The mare underwent lamellar keratectomy and conjunctivectomy under general anaesthesia, followed by adjunctive topical chemotherapy with 1% 5-fluorouracil solution for 10 days post-operatively. Adverse effects included moderate conjunctival inflammation and exuberant granulation tissue formation at the surgical site, responding to surgical debulking and topical corticosteroid application. No mass regrowth was present at 12 months following discharge. This report describes the successful use of topical 1% 5-FU as an adjunctive treatment for equine ocular squamous cell carcinoma.     

Penile and preputial squamous cell carcinoma in the horse: a retrospective study of treatment of 77 affected horses

Reasons for performing study: The most common penile and preputial neoplasm in the horse is the squamous cell carcinoma (SCC), but no large surveys of treatment and effects of the grade of the tumour, based on the degree of differentiation, on outcome of affected horses are available. Objectives: Analysis of treatment of male horses affected with SCC of the external genitalia and long‐term results of treatment. Methods: Seventy‐seven cases of SCC were evaluated. Data recorded included treatment, outcome, post operative histopathology and retrospective tumour grading. Results: Treatments included: cryosurgery, excision, partial phallectomy, partial phallectomy and sheath ablation, and en bloc penile and preputial resection with penile retroversion and removal of inguinal lymph nodes. The incidence of recurrence after partial phallectomy was 25.6% (10/39) and following incomplete removal was 17.9% (7/39). The incidence of recurrence after en bloc resection with retroversion was 12.5% (1/8). In horses with confirmed inguinal lymph node metastasis, the incidence of recurrence was 25.0% (1/4). Poorly differentiated SCCs were more likely to metastasise than well differentiated SCCs, and there was a greater chance that the treatment would be unsuccessful. The success of treatment, complete removal and in preventing recurrence of the tumour, of male horses with SCC of the external genitalia was 55.7%. Conclusions: Horses that receive only partial phallectomy for treatment for SCC of the external genitalia have a high incidence of recurrence in contrast to horses that receive an en bloc resection. Tumour grading of SCC can help predict prognosis and guide selection of treatment.     

Mandibular squamous cell carcinoma in a 5‐year‐old Tennessee Walking Horse

Squamous cell carcinoma (SCC) is the second most common neoplasm reported in the horse, but occurs rarely in the oral cavity. Clinical signs may be insidious in onset and mimic other non‐neoplastic processes, thus delaying appropriate treatment. Timely evaluation and advanced diagnostic imaging may offer the opportunity to initiate definitive treatment. This report describes a young gelding with mandibular SCC that was evaluated for mandibular swelling failing to respond to symptomatic therapy.     

Squamous cell carcinoma of the paranasal sinuses in two horses

This case report describes the history, clinical findings, diagnostic imaging (including computed tomography), gross pathology and histopathology of 2 cases of squamous cell carcinoma in the paranasal sinuses. Radiography of the skull is a useful tool to detect a mass in the paranasal sinuses, but the position, extent and character of the lesion can be better visualised with computed tomography.     

Resection cystoplasty of a squamous cell carcinoma in a mare

A 22‐year‐old Arabian mare was examined for evaluation of haematuria of 2 months' duration. Complete blood cell count and chemistry revealed anaemia of chronic disease (i.e. normocytic, normochromic) and hypoproteinaemia. Cystoscopy revealed a haemorrhagic mass protruding into the lumen of the urinary bladder in the apical region. The mass was surgically removed by partial cystectomy performed through a caudal ventral midline laparotomy. Histological examination of the mass confirmed the diagnosis of squamous cell carcinoma. Tumours of the equine urinary bladder are rare, and when a partial cystectomy is indicated, a caudal ventral midline laparotomy may provide adequate surgical exposure even in adult horses.     

Photodynamic therapy for the treatment of periocular squamous cell carcinoma in horses: a pilot study

Objective  Local photodynamic therapy (PDT) is a novel cancer therapy in veterinary ophthalmology. A prospective pilot study seeking to demonstrate proof of principle and safety for the treatment of equine periocular squamous cell carcinoma (PSCC) was therefore conducted. We hypothesized that surgical excision with adjunctive local PDT is an effective and safe treatment for equine PSCC.
Procedures  Nine horses (10 eyes) with PSCC were treated with surgical resection, local infiltration of resulting wound beds with 2-[1-hexyloxyethyl]-2-devinylpyropheophorbide-a (HPPH) and irradiation with 665-nm wavelength diode laser. Regular follow-up ophthalmic examinations were performed.
Results  Surgical resection and PDT yielded disease-free intervals of 25–68 months in our study horses as of January, 2008. These results were obtained following a single treatment in seven horses and two treatments in one horse. In one horse, carcinoma in situ developed 2.5 months after partial surgical excision and PDT, requiring local excision under standing sedation.
Conclusions  Preliminary results suggest that surgical resection and adjunctive local PDT is a safe and effective novel treatment for PSCC in horses. More research is needed before PDT for the treatment of equine PSCC can be adequately compared with other current modalities. Important to future investigations regarding PDT, tumor recurrence rate, length of hospitalization, number of treatment episodes required to effect tumor remission, and total treatment costs should be examined in a controlled manner. Our present results and experiences suggest that this treatment may be useful in the treatment of equine PSCC.     

Intralesional 5‐fluorouracil (5‐FU) for the treatment of eyelid squamous cell carcinoma in 5 horses

Eyelid squamous cell carcinoma in equine patients often presents a therapeutic challenge to practitioners due to the generally large area affected upon presentation. Surgical excision can be curative if wide enough margins are achieved, but this is not often attainable without enucleation. Other alternatives have been examined including cryotherapy, radiotherapy, brachytherapy, intralesional chemotherapy and photodynamic therapy. Intralesional chemotherapy using cisplatin, mitomycin‐C and bleomycin have been shown to be successful in treating eyelid squamous cell carcinomas but may be prohibitive to some owners due to the cost of therapy. To the authors' knowledge, this is the first case series to illustrate the effectiveness of intralesional 5‐fluoruracil in treating large equine eyelid squamous cell carcinomas. Macroscopic reduction in the size of the affected areas was noted in each case together with regression of clinical signs associated with the mass. This, coupled with the relative inexpensive nature of the procedure, makes this technique an attractive therapy for either primary treatment of eyelid squamous cell carcinoma or as a cytoreductive technique prior to surgical excision.     

Pigmented squamous cell carcinoma of the conjunctiva of a horse

Abstract A heavily pigmented tumor was removed from the lateral, perilimbal, bulbar conjunctiva of a bay Thoroughbred horse. Excision was incomplete and the base of the tumor was lasered on the assumption that the tumor was a melanoma. No other ophthalmic lesions were seen. Histology showed the mass to be a pigmented squamous cell carcinoma (SCC). The prognosis and recommended treatment protocols are different for SCC and melanoma. This is, to the best of our knowledge, the first report of an ocular, pigmented SCC in the veterinary literature.     

Oesophageal obstruction in an aged pony associated with squamous cell carcinoma

An aged miniature pony was referred for chronic recurrent oesophageal obstruction. Endoscopic examination demonstrated distal oesophageal constriction and radiography confirmed an irregular soft tissue mass in the region of the distal intrathoracic oesophagus. The pony was subjected to euthanasia and post mortem examination confirmed squamous cell carcinoma of the distal oesophagus and stomach. Oesophageal squamous cell carcinoma is a rare condition in horses, but should be considered as a differential diagnosis in cases of chronic recurrent obstruction, particularly in older horses.     

Prevalence of ophthalmic disease in blue‐eyed horses

A perception exists amongst referring veterinarians and the lay public that blue‐eyed horses have increased frequency of ocular disease. The aim of this retrospective study was to assess the prevalence of ocular disease in horses with blue or heterochromic eyes relative to those with brown eyes. The medical records of horses presenting to either the Comparative Ophthalmology services or Equine Medicine/Surgery services at 2 institutions were reviewed. Signalment, ocular and nonocular diagnoses were recorded. Ocular disease was divided into 4 categories: adnexa, cornea, intraocular/orbit and squamous cell carcinoma (SCC). Owners were contacted by telephone to confirm iris colour. Chi‐square analysis was used to compare group proportions. A total of 164 eyes of horses with ocular disease and 212 eyes of horses without ocular disease were included. Blue eyes were equally common in the ocular disease and nonocular disease groups (P = 0.265). There was no significant difference in the proportion of blue‐ and brown‐eyed horses when comparing the adnexal and corneal (P = 0.548), corneal and intraocular/orbit (P = 0.379) and adnexal and intraocular/orbit (P = 0.843) categories. A significant difference was detected in the proportion of blue‐eyed horses between the adnexal (P = 0.000), corneal (P = 0.033), intraocular/orbital (P = 0.000) and SCC categories, with a higher proportion of blue‐eyed horses in the SCC than in the other 3 groups. Horses with blue or heterochromic irides are more likely to develop ocular SCC than horses with brown irides, but are not more likely to have adnexal, corneal or intraocular/orbital disease or to be presented for evaluation of ophthalmic disease. Veterinarians should consider the results of this study when answering questions from the lay public regarding the predisposition of blue‐eyed horses to ocular disease.     

Long-term outcome of treatment of a squamous cell carcinoma of the foot by amputation of the distal limb in a pony

This report describes a rare case of squamous cell carcinoma (SCC) in a 10-year-old Shetland pony. The pony was presented for evaluation of a chronic, ulcerating mass of the foot associated with a nonweightbearing lameness of the right forelimb. Foot radiographs revealed an aggressive bone lesion with severe osteolysis of the distal phalanx. Amputation of the digit was performed under general anaesthesia at the level of the metacarpophalangeal joint using a palmar flap technique and a transfixation cast for protection of the stump. Avascular necrosis, infection and dehiscence of the stump occurred 3 weeks later and a second amputation was performed at the level of the proximal third of the third metacarpal bone. Histopathology revealed a squamous cell carcinoma. After healing of the stump, a prosthesis was fitted to the limb for improved ambulation of the pony. Two years after the amputation, telephone follow-up with the referring veterinarian and the owner, revealed that the pony was healthy and able to go out daily in a paddock with its prosthesis. SCC represents an unusual indication for limb amputation. Successful outcome is rarely reported in horses.     

Urinary bladder rupture secondary to penile and preputial squamous cell carcinoma in a gelding

Squamous cell carcinoma (SCC) is the most common external genital neoplasm. Early detection, diagnosis and treatment are paramount to successful outcome; overlooked or misdiagnosed SCC can rapidly invade tissues and metastasise, producing potentially fatal complications. This report describes a case of overlooked SCC that resulted in severe penile infiltration, urethral stricture, and subsequent urinary bladder rupture and peritonitis.     

Co-existing squamous cell carcinoma and hemangioma on the ocular surface of a cat

A 14-year-old spayed female domestic short-haired cat was presented for evaluation of a mass in the right eye. Ophthalmic examination revealed a blind right eye and presence of two distinct masses: a pink and a red-to-brown mass, the latter occupying most of the cornea and part of the conjunctiva. Exenteration was performed under general anesthesia, and the ocular tissues were processed routinely for histopathology. Upon microscopic examination, a malignant epithelial neoplasm and a benign vascular neoplasm were present in the cornea. The conjunctiva and the third eyelid were also affected. Upon immunohistochemistry, the epithelial tumor was positive for cytokeratin and negative for vimentin and the endothelial tumor was negative for cytokeratin and positive for vimentin. A diagnosis of squamous cell carcinoma (SCC) and hemangioma was made. The SCC was affecting the cornea, bulbar conjunctiva (lateral and inferior) and the base of the third eyelid, whereas the hemangioma was affecting the cornea and medial limbus. To the authors' knowledge, this is the first report of concomitant SCC and hemangioma affecting the ocular surface in a cat.