Orbital extraskeletal osteosarcoma following enucleation in a cat: a case report

Objective We present a unique case of a feline orbital extraskeletal osteosarcoma that developed 5 years post‐enucleation. History In 2002, an ophthalmologist enucleated the left eye of a 2‐year‐old neutered male DSH and submitted it to the Comparative Ocular Pathology Laboratory of Wisconsin (COPLOW). COPLOW diagnosed the left eye with feline diffuse iris melanoma. In June 2007, the cat presented to another veterinarian for moderate swelling of the enucleation site. Palpation suggested a firm mass along the lateral orbital rim and an exploratory orbitotomy revealed a cyst with a mass adhered to it and the ventrolateral orbital rim. The cyst and mass were excised by the veterinarian and submitted to COPLOW. COPLOW diagnosed the tissue as an orbital conjunctival inclusion cyst and an acquired orbital osteosarcoma. Conclusions Following the enucleation, retained conjunctival epithelium became embedded in the connective tissue of the orbit and caused a cyst to develop. The cyst wall consisted of a myofibroblastic collagen‐rich matrix and acted as a nidus of chronic irritation and tumor growth. This orbital osteosarcoma resembles feline vaccine‐associated sarcomas (VAS), feline post‐traumatic ocular sarcomas, and microchip‐associated sarcomas in terms of it histopathology and its hypothesized pathogenesis related to exposure to antigenic material such as implanted epithelium, lens protein, vaccine components, and microchips as foreign bodies.     

Pulmonary fibrosis after high cumulative dose nitrosourea chemotherapy in a cat

Small to intermediate cell alimentary lymphoma was diagnosed in a cat after abdominal exploratory surgery with no prior history of pulmonary disease. Initial response to several chemotherapy regimens was poor, but a long‐term remission was achieved with CCNU (lomustine) and corticosteroid therapy. After receiving a total cumulative CCNU dose of 552 mg m^?2 over 12 months, an acute episode of respiratory distress occurred and the cat died. Necropsy identified severe diffuse pulmonary fibrosis and no signs of lymphoma. This is the first report of pulmonary fibrosis following high cumulative dose nitrosourea chemotherapy in a cat.     

CHEMOTHERAPY FOLLOWED BY ABDOMINAL CAVITY IRRADIATION FOR FELINE LYMPHOBLASTIC LYMPHOMA

Combination chemotherapy is standard care for feline lymphoma, although clinically relevant improvements in remission duration are unlikely to result from manipulations of chemotherapy agents alone. Lymphopoietic tissues generally are sensitive to radiation, and support for chemoradiotherapy as a treatment for lymphoma is found in both humans and dogs. The goal of this prospective pilot study was to determine the normal tissue tolerance to 15 Gy total abdomen fractionated radiation therapy following induction chemotherapy in cats with lymphoblastic lymphoma. Eight cats with lymphoblastic gastrointestinal or multicentric lymphoma confined to the abdominal cavity were treated with a 6‐week combination chemotherapy protocol followed 2 weeks later by whole‐abdomen radiation therapy consisting of 10 daily fractions of 1.5 Gy. Treatment was well tolerated; renal insufficiency documented in one cat at the start of radiation therapy progressed to stable chronic renal failure. One cat not in complete remission at the time of radiation therapy relapsed 2 weeks later, one cat with multicentric lymphoma relapsed with hepatic large granular lymphoma, and one cat was euthanatized 3 weeks following completion of radiation therapy for other reasons; no evidence of lymphoma or radiation toxicoses was identified on post mortem evaluation. The remaining five cats remain in remission at least 266 days after starting therapy; median remission duration has not been reached (range, >266 to >1332 days). Results of this study suggest that 15 Gy total abdomen fractionated radiation therapy after induction chemotherapy is tolerated satisfactorily. This protocol is suitable for further testing to quantify efficacy.     

Cervical thymoma originating in ectopic thymic tissue in a cat

Abstract: An 11‐year‐old female spayed domestic shorthair cat was referred to The Ohio State University Veterinary Teaching Hospital (OSU‐VTH) for evaluation of a 6 × 4 × 3.5 cm mass in the left midcervical region causing increased respiratory sounds and lateral deviation of the trachea. A fine needle aspirate of the mass was obtained before referral and the cytology results were compatible with a reactive lymph node. Immunocytochemistry showed increased numbers of CD3+ T lymphocytes and small numbers of CD20+ and CD79a+ medium to large lymphocytes. Differential diagnoses from the referral pathologist were T‐cell‐rich B‐cell lymphoma and feline Hodgkin's‐like lymphoma. A subsequent fine needle aspirate performed at the OSU‐VTH showed similar results. On flow cytometry the majority of cells were CD3+ T lymphocytes that were double positive for CD4 and CD8 (73%), compatible with either a double‐positive (CD4+CD8+) T‐cell lymphoma or lymphocytes from ectopic thymic tissue. The mass was surgically removed. Histopathology and immunohistochemistry of the mass revealed a predominant population of CD3+ small lymphocytes and small numbers of medium to large lymphocytes with moderate anisocytosis and anysokaryosis. A population of cytokeratin‐positive epithelial cells surrounded small microcystic structures filled with eosinophilic material and structures interpreted as Hassall's corpuscles. These findings were consistent with thymic tissue and a diagnosis of ectopic thymoma was made. PCR results for lymphocyte antigen receptor rearrangement (PARR) were negative. The cat had no evidence of disease 16 months after removal of the mass. To our knowledge this is the first report of an ectopic cervical thymoma in a cat. The clinical and diagnostic features of this unusual case will be useful in helping veterinarians and pathologists obtain a presurgical diagnosis and establish a prognosis for similar lesions.     

Surgical excision of a feline orbital lacrimal gland adenocarcinoma with adjunctive cryotherapy and carboplatin‐impregnated bead implantation

The purpose of this report was to discuss the diagnosis, treatment, and outcome of a cat with an orbital lacrimal gland adenocarcinoma. A 14.5‐year‐old spayed female domestic shorthair cat was evaluated for a firm swelling at the left dorsotemporal orbital rim. The orbital mass was excised with preservation of the globe, and adjunctive cryotherapy was performed. A definitive diagnosis of lacrimal gland adenocarcinoma was obtained after histopathologic evaluation and histochemical staining with periodic acid–Schiff and mucicarmine. Thirteen months postoperatively, tumor regrowth occurred with a much larger osteolytic lesion, and a second surgery was performed consisting of tumor excision with implantation of carboplatin‐impregnated calcium sulfate hemihydrate beads. The cat has remained free of recurrence 11 months after the second surgery (26 months after initial diagnosis and surgery). A feline orbital lacrimal gland adenocarcinoma was successfully managed utilizing globe‐preserving surgical excision with adjunctive cryotherapy and subsequent carboplatin‐impregnated bead implantation. Orbital lacrimal gland adenocarcinoma in cats may not be as aggressive as other forms of periocular, head, and neck adenocarcinomas.     

Large anaplastic spinal B‐cell lymphoma in a cat

Abstract: A 5‐year‐old female spayed domestic shorthair cat was presented for evaluation of tetraparesis. The neurologic lesion was localized to the cervical spinal segment (C1–C6). A left axillary mass was identified, and the results of fine needle aspiration cytology indicated malignant round cell neoplasia of possible histiocytic origin. The cells were large, had marked anisocytosis and anisokaryosis, occasional bi‐ and multinucleation, and cytoplasmic vacuolation. Euthanasia was performed due to the poor prognosis associated with severe, progressive neurologic signs and a malignant neoplasm. Postmortem examination revealed spinal cord compression and an extradural mass at the C1–C2 spinal segment, with neoplastic cells in the adjacent vertebral bodies, surrounding skeletal muscle, left axillary lymph node, and bone marrow from the right femur. The initial histologic diagnosis was anaplastic sarcoma, but immunohistochemical results indicated the cells were CD20+ and CD45R+ and CD3?, compatible with a diagnosis of B‐cell lymphoma. CD79a staining was nonspecific and uninterpretable. Weak to moderate CD18 positivity and E‐cadherin positivity were also observed. Clonality of the B‐cell population could not be demonstrated using PCR testing for antigen receptor gene rearrangement. To the authors' knowledge, this is the first reported case of a feline spinal anaplastic B‐cell lymphoma exhibiting bi‐ and multinucleated cells. The prognostic significance of this cell morphology and immunophenotype is unknown.     

B‐cell lymphoma with Mott cell differentiation in a cat

A 12‐year‐old, male castrated Domestic Shorthair cat was presented to Animal Medical Center of Gifu Univeristy with anorexia and vomiting. Physical examination revealed an enlarged left tonsil and right mandibular lymph node (approximately 2–3× the normal size), and a submucosal mass on the right side of the epiglottis (1.5 × 2.0 cm). On computed tomography images, an enlarged left tonsil, and enlarged right mandibular, right pharyngeal, and left and right cervical lymph nodes were observed. Cytologic examination of smears of tonsil and lymph nodes revealed numerous medium‐ to large‐sized neoplastic lymphoid cells, approximately half of which contained one or several light‐blue homogenous globoid cytoplasmic inclusions (5–10 μm), which stained magenta with periodic acid–Schiff (PAS) stain. Histopathologic examination of the left tonsil revealed diffuse proliferation of medium‐ to large‐sized neoplastic lymphoid cells effacing the original lymphoid architecture. Half of the cells contained one or several eosinophilic globoid cytoplasmic inclusions, which stained magenta with PAS and showed positive immunohistochemical reactions for immunoglobulin M (IgM) and λ light chain. Neoplastic lymphoid cells were also CD20⁺, Pax5⁺, and MUM1⁺, and CD3^?. Thus, the neoplastic lymphoid cells expressed a B‐cell immunophenotype, and the globoid cytoplasmic inclusions represented an aberrant IgM λ light chain accumulation, similar to Russell bodies. B‐cell lymphoma with Mott cell differentiation was diagnosed based on cytologic, histopathologic, and immunohistochemical features. This is the first report of B‐cell lymphoma with Mott cell differentiation in a cat.     

The localization of a conjunctivoscleral foreign body via high‐resolution microscopy coil magnetic resonance imaging in a dog

A 3‐year‐old French bulldog was presented to the ophthalmology service of the Vetsuisse Faculty, University of Zurich with a 3‐day history of conjunctival swelling of the left eye (OS). Ophthalmologic examination revealed a moderate conjunctival hyperemia and chemosis. A migrating foreign body having entered the conjunctival fornix behind the nictitating membrane was suspected. Within the first 24 hours of medical management, OS developed a panuveitis and a scleral perforation was highly suspected. Ocular and orbital ultrasound as well as conventional magnetic resonance imaging (MRI) examinations failed to confirm the presence of a perforating foreign body. A High‐Resolution MRI (HR‐MRI) using a microscopy coil was then performed with findings consistent with a perforating and migrating foreign body. A grass awn of 12 mm length was surgically retrieved “ab externo” from its’ point of entry into the sclera. To the best of our knowledge, HR‐MRI has not yet been used to examine canine eyes. This case report supports the idea that orbital imaging can be greatly enhanced with the introduction of HR‐MRI using microscopy coils with clinically relevant implications.     

Late Abscess Formation Caused by Silk Suture Following Hysterectomy in a Female Dog

A 5‐year‐old female cross‐breed dog was presented for a one‐month history of lethargy, poor appetite and weight loss. A hysterectomy had been performed 2 years ago. Abdominal palpation revealed a mid‐abdominal mass and haematological analysis showed leucocytosis with left shift. On abdominal radiographs, a 9 cm in diameter soft tissue opacity mass ventral to the colon and caudal to the left kidney was observed. The abdominal ultrasonography revealed a mass well circumscribed, with a hyperechoic capsule and hypoechoic center with echoic debris. The presumptive diagnosis was an abscess due to foreign body granuloma. Laparotomy was performed and a mass close to the left ovary was found. Adhesions and residues of the suture material were observed close to the right ovary and the uterine body stump. The mass, both ovaries and adhesions were removed. On cut section of the mass two cavities were observed. The small one contained three embedded silk suture residues. Histopathological examination confirmed the diagnosis of a chronic abscess caused by silk suture.     

C-arm fluoroscopy for the removal of an intraorbital foreign body in a cat

This report describes the clinical manifestations, diagnosis and minimally surgical intervention of a cat with an intraorbital foreign body. A spayed female cat of unknown age was presented with a recurrent cutaneous sinus tract of the left suborbital region. The cat had not vocalized at all since the adoption. A sharp-edged radiopaque foreign body was visualized on dental radiography. Computed tomography outlined the length of the foreign body from the intraorbital soft tissue to the pharynx. The foreign body was removed under the guide of C-arm fluoroscope with minimal skin incision. The surgical site healed completely on the 11th postoperative day, and the cat vocalized normally after healing.     

Wooden orbital foreign body in a Weimaraner

A 2-year-old, male Weimaraner presented with acute-onset nonaxial exophthalmos with dorsal deviation of the left globe. Periorbital swelling, pain and a profuse purulent ocular discharge were present on the left side. A draining sinus tract was present in the left ventral conjunctival fornix and another in the left pterygopalatine fossa. The right eye was normal on complete ophthalmic examination. Orbital ultrasonography revealed large, double, linear, parallel echogenic bands with shadowing present in the ventrolateral aspect of the left orbit suggestive of a foreign body. Deformation of the posterior segment was also present. Removal of the orbital foreign body was attempted under ultrasound guidance via the discharging sinuses in the ventral conjunctival fornix and the pterygopalatine fossa. Neither approach was successful; however, a small amount of organic material was retrieved confirming the diagnosis of orbital foreign body. Magnetic resonance imaging (MRI) revealed a linear foreign body of 8 x 1.5 x 0.8 cm extending from the orbit to the level of the oropharynx. A modified lateral orbitotomy with zygomatic arch resection on the left side allowed removal of the wooden foreign body.     

Dacryocystography in a cat with orbital pneumatosis

A 2‐year‐old neutered male European short‐haired cat was presented for a persistent discharge from the scar of previous left eye enucleation, performed 6 months prior by the referring veterinarian. A surgical exploration of the orbit was performed and retained nictitating membrane glandular and conjunctival tissues were removed. Eleven days later, the cat developed an orbital pneumatosis caused by retrograde movement of air through a patent nasolacrimal system and diagnosed by survey radiographic examination of the skull. Nasolacrimal system patency was assessed by dacryocystography performed by injection of iodinated contrast medium under pressure into the orbital cavity. Computed tomography dacryocystography confirmed the radiographic findings. The condition resolved following dacryocystography, possibly as an inflammatory response to the contrast medium. To our knowledge, this is the first case of orbital pneumatosis reported in a cat.     

Osteolysis of the radius and ulna induced by a circumferential foreign body in a cat

CASE DESCRIPTION: A 1-year-old neutered male cat was examined because of a 6-month history of recurrent swelling and draining wounds affecting the craniomedial aspect of the distal portion of the left forelimb. CLINICAL FINDINGS: No lameness or neurologic deficits were evident. Examination of craniocaudal and lateromedial radiographic views revealed nonprogressive circumferential osteolysis and a mildly radiopaque, ring-shaped foreign body surrounding the radius and ulna. TREATMENT AND OUTCOME: During surgery, a tight elastic band surrounded by a thick fibrous tissue capsule was found encircling the limb. Microbial culture yielded a Staphylococcus sp that was susceptible to clindamycin. Follow-up monitoring via telephone communication with the owners 1.5 years after removal of the foreign body indicated that the cat had healed with no recurrence of drainage. CLINICAL RELEVANCE: Pressure osteolysis of the bones of the forelimb can be caused by a circumferential foreign body without associated neurologic abnormalities or lameness.     

Erythrophagocytic low‐grade extranodal T‐cell lymphoma in a cat

Abstract: A 13‐year‐old male castrated domestic shorthair cat was presented to the referring veterinarian with a 2‐month history of weight loss and lethargy. Splenomegaly, hepatomegaly, nonregenerative anemia, neutropenia, and hyperbilirubinemia were noted. Results of testing for feline immunodeficiency virus, feline leukemia virus, Toxoplasma gondii, and Mycoplasma sp. were negative. On cytologic examination of aspirates from the enlarged spleen and liver, a population of erythrophagocytic round cells was observed. Splenectomy and a liver biopsy were done which revealed a population of CD3+/CD79a– erythrophagocytic mononuclear round cells localized in the hepatic and splenic sinusoids. T‐cell PARR (PCR for antigen receptor gene rearrangements) analysis of bone marrow and spleen demonstrated a single band indicative of a clonal proliferation of T cells. Based on the marked splenomegaly, sinusoidal infiltration, lack of lymphadenopathy, and results of cytology, PARR, and immunophenotyping, a diagnosis of low‐grade extranodal T‐cell lymphoma was made. The cat was treated with chlorambucil and prednisolone; clinical and laboratory abnormalities resolved and the cat has remained clinically normal for 2.5 years. To our knowledge, this report documents the first case of an erythrophagocytic T‐cell lymphoma in a cat. The clinicopathologic findings were suggestive of hepatosplenic T‐cell lymphoma, a neoplasm described previously only in humans and dogs.     

Multimodal therapeutic approach and interdisciplinary challenge for the treatment of unresectable head and neck squamous cell carcinoma in six cats: a pilot study

Feline head and neck squamous cell carcinoma (SCC) is a loco‐regional disease harbouring a poor prognosis. The complex anatomic location precludes aggressive surgical resection and tumours recur within weeks to few months. Response to chemotherapy and local control after radiation therapy has been disappointing. In this study, a multimodal approach including medical treatment (thalidomide, piroxicam and bleomycin), radiation therapy (accelerated, hypofractionated protocol) and surgery was attempted in six cats. Treatment was well tolerated. Three cats with sublingual SCC were alive and in complete remission at data analysis closure after 759, 458 and 362 days. One cat with laryngeal SCC died of renal lymphoma after 51 days and the other with maxillary SCC died of a primary lung tumour 82 days after diagnosis. In both cats, the SCC was in complete remission. Only one cat developed metastases after 144 days. These encouraging preliminary results merit further evaluation in future trials.     

Successful medical treatment of an orbital osteoma in a dog

A 6‐year‐old neutered male German Shepherd‐mixed breed with a 2‐month history of bilateral conjunctival hyperemia, epiphora, and a firm, slowly progressive swelling of the medial canthal region of the left eye (OS) was examined. Ophthalmic examination OS revealed a firm and smooth mass, extending from the medial canthus toward the medial orbital wall. Indirect ophthalmoscopy revealed indentation of the nasal part OS, which corresponded to the position of the orbital mass. Orbital neoplastic diseases were the main differential considerations. Computerized tomography revealed a bony smooth orbital mass without bone destructive features. Biopsy was performed, and histologic features were suggestive of osteoma. Systemic nonsteroidal anti‐inflammatory (NSAID) drugs resulted in complete mass regression and absence of clinical signs for 5 years following initial diagnosis. This report describes the first case of canine orbital osteoma, which was responsive to NSAIDs.     

EVALUATION OF LYMPHOMA IN A CAT USING 99mTc-SESTAMIBI

This report describes the evaluation of cutaneous lymphoma in a cat using 99mTc-sestamibi. A mass in the left pes with extension to the left popliteal lymph node was diagnosed as B-cell lymphoma. Thoracic and abdominal radiography and abdominal ultrasound were unremarkable. Scintigraphy using 99mTc-sestamibi confirmed the lesion was confined to the left hind leg, and the leg was amputated. The cat made a full recovery.     

Anterior uveal spindle cell tumor in a cat

Purpose To describe a case of anterior uveal spindle cell tumor in a cat with features similar to spindle cell tumor of blue eyed dogs. Methods A 10‐year‐old female spayed domestic short‐haired cat was referred for an iris mass OS. The mass was solitary, nodular, nonpigmented, located medially, and causing dyscoria. A diagnosis of a benign epithelial tumor was suggested by a FNA of the mass. The cat was lost to follow‐up for 2 years, after which time she re‐presented with glaucoma, blindness and grossly evident iridal mass enlargement OS. Transconjunctival enucleation was performed and the globe submitted for histopathology. Results Histopathology of the enucleated globe revealed the superior iris to be infiltrated and effaced by a large population of neoplastic spindle cells. The cells were arranged in streams and bundles and exhibited Antoni‐A and Antoni‐B tissue patterns, which are characteristic of Schwann cell tumors. Mitotic figures were rare and cellular pleomorphism moderate. Immunohistochemical staining was positive for S‐100 protein and glial fibrillary acidic protein (GFAP), and negative for Melan‐A. Interestingly, there was no histological evidence of glaucoma. Conclusions Based on its histopathologic characteristics, this iris tumor was diagnosed as a Schwann cell variant of a peripheral nerve sheath tumor (PNST) closely resembling the spindle cell tumor of blue‐eyed dogs. Anterior uveal PNST has not been previously reported in cats to the authors’ knowledge. The presence of Antoni type A and type B tissue patterns along with immunohistochemical staining may facilitate a diagnosis of PNST and rule out malignant melanoma.     

Bilateral orbital and nasal aspergillosis in a cat

A 12-year-old, 4 kg, castrated male Persian cat was referred with a 2-month history of sneezing and bilateral mucopurulent nasal discharge. Rhinoscopically acquired nasal biopsies at this time revealed bilateral lymphoplasmacytic rhinitis. A tapering dose of oral prednisone caused the complete remission of the clinical signs, but 2 months after discontinuation of the therapy, the rhinitis recurred and the OD became exophthalmic. Computed tomography showed a soft tissue mass in both sides of the nasal cavity, both frontal sinuses, the right orbit, and to a lesser extent the left orbit. A fine needle aspirate of the right orbit revealed pyogranulomatous inflammation and Aspergillus spp. hyphae. Repeat nasal biopsy demonstrated multi-focal necrosis and a mixed inflammatory cell process which now included macrophages and scattered septate fungal hyphae. A few days later the cat became bilaterally blind and a contrast enhancing lesion involving the optic chiasm was found on magnetic resonance imaging. Despite a poor prognosis, therapy consisted of exenteration of the right orbit and trephination of both frontal sinuses before the planned initiation of medical antifungal therapy. Unfortunately, the cat died of cardiac arrest intraoperatively. Aspergillus fumigatus was cultured from both orbits at necropsy. Orbital aspergillosis has been rarely reported in cats and its relationship with lymphoplasmacytic rhinitis is unclear. In this patient lymphoplasmacytic rhinitis or previous antibiotic/corticosteroid therapy may have allowed secondary fungal invasion of the nasal mucosa and subsequently both orbits and the brain. Alternatively, Aspergillus infection may have preceded the lymphoplasmacytic rhinitis.