Treatment of an invasive equine mast cell tumour in the extensor carpi radialis by extensive tenomyectomy and local corticosteroid injections

Equine mast cell tumours (MCT) have been reported to occur in the skin, respiratory tract, oral cavity, synovial structures and eye. These tumours are typically locally invasive and nonaggressive. In this case, a MCT was located in the extensor carpi radialis (ECR) and was highly infiltrative. Excision of the ECR and local corticosteroid injection was curative and resulted in a good functional outcome. A 12-year-old Thoroughbred gelding presented for lameness, swelling and pruritus associated with the right antebrachium. Sonographic changes were suggestive of severe tenosynovitis and purulent material in the ECR. Surgical exploration revealed maceration at the ECR musculotendinous junction. The extensor sheath contained a large quantity of caseous material and serosanguinous fluid. The ECR tendon and 75% of the muscle was excised. Cytology and histopathology were consistent with a MCT that infiltrated the surgical margins. Post-operatively the horse was treated with multiple local corticosteroid injections along the incision. Right forelimb movement was initially limited, however, there was steady improvement over 3 months with increasing exercise. At 18 months post-operatively, no lameness was detectable in the walk, trot or canter and no recurrence of MCT was apparent. The horse appeared to compensate for loss of the ECR by using the biceps during the swing phase. Partial excision and local corticosteroid treatment can be curative for cases of invasive MCT. Extensive excision of the ECR is a viable treatment option for neoplasia or other conditions affecting the ECR in the horse.     

Mastocytoma in the common carpal sheath of the digital flexor tendons of a horse

A 13-year-old Morgan gelding was examined for right forelimb lameness and tenosynovitis of the right common carpal sheath of the digital flexor tendons. The horse had moderate right forelimb lameness at the trot and marked effusion of the right common carpal sheath of the digital flexor tendons. Ultrasonographic examination revealed a soft tissue mass within the proximal pouch of the affected tendon sheath, located adjacent to the distal physis of the radius. Cytology and culture of the fluid revealed a sterile, eosinophilic tenosynovitis. Tenoscopic exploration confirmed the presence of a capsulated soft tissue mass. Thecotomy was required to fully debride the mass, which histology revealed to be a mast cell tumour. At 22 months postoperatively, the horse developed mild right forelimb lameness and eosinophilic tenosynovitis because of recurrence of the mastocytoma. Mastocytosis is a possible differential diagnosis in any horse exhibiting lameness associated with tenosynovitis. Surgical excision combined with rest and postoperative intrasynovial and systemic corticosteroids may be palliative.     

Primary hemangiosarcoma of the humerus in a Maltese dog

A 14-year-old intact male Maltese dog was presented with a history of pain and swelling of the left upper forelimb and lameness for 3 weeks. Hematological and radiographical examinations showed regenerative anemia and osteolysis of the humerus. Fine needle aspiration biopsy detected epithelioid- and fibroblast-like anaplastic cells with blood components. A hemorrhagic and osteolytic malignant tumor was suspected, and the affected forelimb was amputated. Histopathologically, the dog was diagnosed with primary hemangiosarcoma of the humerus. Thereafter, metastatic lesions appeared in the skin, and the dog was euthanized 1 month after the operation.     

Multifocal discrete osteolysis in a horse with silicate associated osteoporosis

Silicate associated osteoporosis (SAO) was diagnosed post-mortem in an adult horse with the shortest documented exposure to cytotoxic silicates of 2 years. The horse was evaluated for a 6-month history of progressive back tenderness and acute onset of lameness. The horse had a marked (4/5) (American Association of Equine Practitioners scale) left forelimb lameness, moderate (2/5) hindlimb ataxia and weakness, and cervical pain upon palpation. Physical examination did not reveal clinical skeletal deformities or respiratory compromise. Radiographs revealed widespread, discrete, sharply delineated, osteolytic lesions in the skull, vertebral column, ribs, scapulae and middle phalanx (P2) of the left forelimb and a diffuse bronchointerstitial lung pattern. The presumptive clinical diagnosis was widespread, metastatic osteolytic neoplasia. Due to the poor quality of life and grave prognosis, the horse was humanely euthanised. Post-mortem examination revealed pulmonary silicosis in the lungs and hilar lymph nodes and osteolytic lesions with numerous, large osteoclasts and disorganised bone remodelling both consistent with SAO. SAO should be included as a differential diagnosis for horses with widespread, multifocal, discrete osteolysis and history of exposure to endemic regions with possible cytotoxic silicate inhalation. Exposure time of 2 years is potentially sufficient to develop SAO.     

Fracture repair of the distal portion of the radius by use of a condylar screw implant in an adult horse.

An 8-year-old American Quarter Horse gelding was evaluated because of an open fracture involving the left radius. The horse had fallen during training and became immediately non-weight-bearing in the left forelimb. On initial evaluation, the horse was unable to bear weight on that limb; radiography revealed a long oblique fracture of the distal metaphysis of the radius with minimal displacement of the fracture fragments. Because of the configuration of the fracture, we recommended surgical intervention with internal fixation. A condylar screw implant and 4.5-mm broad dynamic compression plate were applied to the medial and dorsolateral aspects of the radius, respectively. The horse recovered in a sling and full-limb bandage. Six months after discharge, the horse was reevaluated because of a grade 4/5 lameness in the same limb. Palpation revealed signs of severe pain over the distomedial aspect of the radius. Radiography of the left radius revealed severe osteolysis beneath the distal aspect of the condylar screw implant. Surgical removal of the medial plate was performed. Sixteen months after the initial fracture repair, the horse had returned to light training without signs of lameness. Removal of the dorsal plate may be indicated if this horse is to return to aggressive training or becomes lame in the left forelimb.     

Primary sinonasal malignant melanoma with systemic metastasis in a non-gray horse

A 27-y-old Anglo-Arabian gelding with bay coat color was presented with a swelling of the left maxillary region. Fenestration on the left maxilla revealed that the left maxillary sinus was filled with black-red tissue. A portion of the tissue was excised and diagnosed histologically as malignant melanoma. Genotyping of the STX17 gene for gray coat color revealed that the horse did not have the “gray” factor. The horse was euthanized ~3 mo after first presentation. During autopsy, a black-to-gray mass extended from the left nasal cavity to the surrounding paranasal sinus and invaded the hard palate, cribriform plate, and the cranial portion of the left olfactory bulb. Moreover, identical black nodules were present in lymph nodes from the mandible to the larynx, and in the spleen, liver, kidney, and adrenal glands. However, masses were not found in the skin, perineal region, or pelvic cavity. All of the black-to-gray nodules were malignant melanomas that were histologically identical to the initial biopsy; tumor emboli were also found in the kidney. Sinonasal mucosal melanoma is a rare disease in horses.     

Use of kit internal tandem duplications to establish mast cell tumor clonality in 2 dogs

Mast cell tumor (MCT) is one of the most common tumors of dogs. Some affected dogs develop multiple cutaneous tumors in various locations over months to years. In these cases, it is not clear whether the tumors have arisen de novo, or if each tumor represents a recurrence of the previously excised original tumor (ie, distant metastasis). We used the presence of an internal tandem duplication (ITD) in c-kit to demonstrate that in 2 dogs with recurrent cutaneous MCT that had developed over 1-2 years, each recurrent MCT tumor possessed an identical ITD when compared to the original MCT, indicating that the multiple tumors were clonal in origin. This study demonstrates that similar to the situation in humans, specific somatic mutations identified in oncogenes found in canine neoplasms can be used to provide evidence of tumor clonality.     

Cellulitis associated with coagulase-positive staphylococci in racehorses: nine cases (1975-1984)

Nine Thoroughbred racehorses were admitted with cellulitis (of one or more limbs) associated with coagulase-positive staphylococci. The right hindlimb was affected in 4 horses, the right forelimb in 2, the left hindlimb in 1, and both hindlimbs in 2. Typical abnormalities included high values for rectal temperature (9 horses) and heart rate (5 horses), hyperfibrinogenemia (7 horses), leukocytosis (7 horses), and neutrophilia (6 horses). The staphylococcal isolants were speciated in 3 horses and classified as Staphylococcus aureus. Complications included skin loss (5 horses), laminitis of the affected limb (2 horses), laminitis of the contralateral limb (4 horses), osteomyelitis and sequestrum formation (2 horses), and bacteremia (1 horse). Five horses were euthanatized because of the severity of the complications, ie, laminitis in 4 horses and severe skin loss in 1 horse. The remaining 4 horses were discharged from the clinic. At follow-up evaluation (mean, 16.7 months), the swelling in 3 of the horses had completely resolved. One horse returned to racing; of 2 used for pleasure riding, one was mildly lame. The remaining horse was not lame, but was used for breeding because of persistent swelling of the affected limb.     

Detection of an epidermoid cyst in the foot of a horse by use of magnetic resonance imaging

CASE DESCRIPTION-A 4-year-old Quarter Horse stallion was evaluated because of a 10-month history of moderate (grade 3/5) left forelimb lameness (detectable during trotting over a smooth, hard surface). CLINICAL FINDINGS-No abnormalities were detected in either forelimb via palpation or application of hoof testers; however, lameness was eliminated after administration of a palmar digital nerve block in the left forelimb. Whereas radiography and ultrasonography did not identify any left forelimb foot abnormalities, magnetic resonance (MR) imaging revealed a circumscribed soft tissue mass in the distal aspect of the digital flexor tendon sheath (DFTS) dorsal to the lateral aspect of the deep digital flexor tendon. Subsequently, the left forelimb DFTS was injected with local anesthetic, which resulted in 90% improvement of the horse's lameness. TREATMENT AND OUTCOME-The distal aspect of the left forelimb DFTS was evaluated tenoscopically. The mass was removed under tenoscopic guidance, after which the distal digital annular ligament was transected. The horse received phenylbutazone orally for 10 days, and the left forelimb DFTS was injected with hyaluronic acid and methylprednisolone acetate 7 days after the surgery. Following a rehabilitation program, the horse was returned to full training at 6 months after surgery and competed successfully during a 2-year follow-up period. CLINICAL RELEVANCE-Use of MR imaging should be considered in all lame horses for which a definitive diagnosis cannot be made via radiography, ultrasonography, or other imaging techniques, especially when the lameness has been localized to a specific anatomic region by use of diagnostic anesthesia.     

Equine multisystemic eosinophilic epitheliotropic disease: A case report and review of literature

CASE HISTORY: A 2-year-old Standardbred gelding presented with a history of fever over 1 week, anorexia and skin lesions on all four legs. The lesions were associated with severe pruritus and oedema, and there was no response to therapy.

CLINICAL FINDINGS: The horse was in poor body condition, was lethargic and severely pruritic. Skin lesions consisted of diffuse alopecia and crusting of the distal extremities. Initially it was slightly febrile, but subsequently its temperature increased up to 40°C. Ten days after admission it developed profuse watery diarrhoea and the skin lesions progressed. Skin biopsies revealed superficial and deep perivascular dermatitis with lymphoplasmacytic and eosinophilic predominance. Based on the poor prognosis the horse was subject to euthanasia.

PATHOLOGICAL FINDINGS: The most notable lesions included ulcerative gastritis, typhlitis and colitis with prominent oedema of the intestines, marked subcutaneous oedema and severe thickening of the large bile ducts. Histopathology showed marked eosinophilic and lymphoplasmacytic infiltration of various tissues including the skin, gastrointestinal tract, mesenteric lymph nodes, large bile ducts, pancreatic duct and kidney. Immunohistochemistry revealed a clear predominance of CD3-positive cells in the lymphocytic infiltrations.

DIAGNOSIS: Based on the clinical findings and histopathology a diagnosis of multisystemic eosinophilic epitheliotropic disease (MEED) was made.

CLINICAL RELEVANCE: Multisystemic eosinophilic epitheliotropic disease is rare in horses, and usually chronic. In the current case the horse showed an apparently acute onset with high fever and rapid clinical deterioration. A diagnosis of MEED should be considered in horses presenting with weight loss and skin lesions with or without fever. A final diagnosis is based on histological results of biopsy specimens from affected organs.     

Bilateral hypoplasia of the minor tubercle of the humerus with medial luxation of the biceps tendon in two Quarter Horses

Two Quarter Horses were examined at the Washington State University Veterinary Teaching Hospital with forelimb lameness. Case 1 was a 4‐year‐old female with a 4 month history of intermittent forelimb lameness that had partially responded to oral anti‐inflammatories. The horse was in full training and actively competing in cutting. Case 2 was a one‐year‐old filly bred for cutting that presented with a right forelimb lameness of 3 weeks’ duration, which was not responsive to oral anti‐inflammatories. The horse was not in training. On lameness examination, Case 1 was grade 1/5 (American Association of Equine Practitioners scale) lame in the left forelimb in a straight line on a hard surface, extension and flexion of the shoulder was resented and exacerbated the lameness. Case 2 was grade 3/5 lame in the right forelimb in a straight line on a hard surface, flexion and extension of the shoulder was resented and exacerbated the lameness. Both horses had a characteristic dished appearance to the dorsal aspect of the shoulder, with prominence of the proximal aspect of the humerus. Ultrasound and proximodistal oblique (skyline) radiographic views of the scapulohumeral joints demonstrated bilateral hypoplasia of the minor tubercle of the humerus with bilateral medial luxation of the proximal biceps tendon in both cases. To the authors' knowledge this is the first report of 2 cases of bilaterally affected horses, as well as the first report of the condition in the Quarter Horse breed.     

Standing biceps brachii tenectomy to treat chronic bicipital tendinopathy associated with bursal fibrosis and humeral adhesions in a Quarter Horse gelding

Chronic biceps brachii (BB) tendinopathy is a rare cause of lameness in horses that can be challenging to diagnose and treat successfully. This pathology is typically insidious in onset and unresponsive to conservative treatment. A 12-year-old Quarter Horse gelding presented for chronic severe lameness of the left forelimb that was localised to the left shoulder area. The horse was unresponsive to conservative management and surgical exploration revealed a grossly enlarged proximal BB tendon, a thickened fibrotic bicipital bursa and adhesions between the tendon, humerus and bursa. With standing sedation and local anaesthesia, the adhesions were debrided and 10 cm of the affected tendon was excised. Immediately post-operatively, the left forelimb lameness dramatically decreased. The horse recovered well and after rehabilitation returned to the previous level of athletic performance without evidence of lameness or gait abnormality. In this case, tenectomy of the chronic unresponsive BB tendinopathy, with associated bursal fibrosis and humeral adhesions, was successful and resulted in a return to previous athletic performance without complications. Standing excision of the BB tendon may be a viable treatment option for chronic BB tendinopathy and associated conditions when there is significant compromise to the integrity of the BB tendon.     

Malignant fibrous histiocytoma in a cat

A malignant histiocytoma of the carpus and distal portion of the right antebrachium of a cat was treated by forelimb amputation. The tumor remained in remission 35 months after surgery. The response to treatment in this cat and similar findings reported by others suggest that the biological behavior of malignant fibrous histiocytoma is such that prolonged remission, if not cure of the disease, can be achieved with early radical excision of the tumor.     

Successful Management of Severe Open Metacarpophalangeal Joint Dorsal Luxation in a Horse

A 3-year-old Darreh-Shuri stallion was presented with left forelimb open dorsal fetlock luxation immediately after being hit by a motorized vehicle. The horse was in a non–weight-bearing position on the affected limb. General physical examination revealed normal vital parameters and no special concurrent abnormality. Radiographic examination in lateromedial and dorsopalmar views of the affected limb showed complete luxation of the metacarpophalangeal joint with no fractures. Ultrasonographic evaluation revealed intact collateral ligaments. Under general anesthesia and following routine preparations, forceful manual pressure was exerted on the distal part of the metacarpus and proximal part of the first phalanx to reduce the luxation. Joint capsule and skin laceration were sutured. Intraarticular amikacin (500 mg) was administered and repeated on the third and fifth days postoperatively. A palmar polyvinyl chloride, synthetic plastic polymer (PVC) splint was placed following adequate padding from the carpus to the toe. The higher and lower third of the splint was casted and the middle part left open to manage the joint and skin lesion. Intraarticular sodium hyaluronate (20 mg) was administered 10 days later. After cast removal following 5 weeks, the stallion revealed no sign of lameness. The owner was instructed to keep the stallion confined to a stall for at least 2 more months with a restricted daily short hand walk. Special casting methods for immobilization of a limb with an open joint luxation can tremendously improve the healing process.     

Evaluation of surgical margins required for complete excision of cutaneous mast cell tumors in dogs

OBJECTIVE: To determine whether neoplastic mast cells extended into tissue 1, 2, or 3 cm laterally or deeper than 1 fascial plane from the visible edge of cutaneous mast cell tumors (MCTs) in dogs. DESIGN: Prospective study. ANIMALS: 21 client-owned dogs with > or = 1 cutaneous MCT PROCEDURES: After preparation for surgery, each dog's skin was marked 1, 2, and 3 cm from the tumor edge at 0 degrees, 90 degrees, 180 degrees, and 270 degrees. At each 3-cm mark, deep fascia was exposed and sutured to the skin; the tumor was excised in routine fashion and fixed in formalin. Tumors were graded; margins were examined histologically for neoplastic mast cells. RESULTS: 23 cutaneous MCTs in 21 dogs were included in this study. Fifteen (65%) tumors were located on the trunk, 5 (22%) on the hind limbs, and 3 (13%) on the head and neck. There were 3 (13%) grade-I and 20 (87%) grade-II tumors. All grade-I tumors were completely excised at all margins. Seventy-five percent of the grade-II tumors were completely excised at the 1-cm margin, and 100% were completely excised at the 2-cm margin. Two grade-II MCTs located on the hind limbs of dogs were excised with a complete but close (within 1 mm) deep margin. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that a 2-cm lateral margin and a deep margin of 1 fascial plane appear to be adequate for complete excision of grade-I and -II MCTs in dogs.     

Cinematographic analysis of the gait of lame horses V: Fibrotic myopathy

A horse with fibrotic myopathy of the semitendinosus muscle of the right hind limb was studied. Observation of the horse in movement showed that protraction of the affected limb terminated abruptly and the hoof was slapped down on the ground. High speed cinematography with computer-aided analysis of the film was used to analyze the gait in greater detail. The results showed that the right hind limb approached the ground almost vertically making impact toe-first, whereas the left hind limb was moving forward relative to the ground when it made heel-first impact. Significant differences were recorded in the sequence and placement of the limbs on the 2 diagonals. The hind limb preceded the forelimb at impact on both diagonals, but at lift-off the lame right hind limb preceded the left forelimb, whereas the sound left hind limb lifted off later than the right forelimb. The distance between the diagonal limb pair during the stance phase was shorter for the left diagonal (left fore-right hind limb pair) than for the right diagonal (right fore-left hind limb pair) (P<0.01). The suspension following the left diagonal was longer than that following the right diagonal (P<0.01).     

Foxtail-induced ulcerative stomatitis outbreak in a Missouri stable.

Twenty of 25 horses in a well-managed Missouri boarding stable were diagnosed with gingivitis/stomatitis. Gross examination of the affected horses revealed varying degrees of gingivitis ranging from mild periodontal swelling to marked swelling and erythema with ulceration and hemorrhage. Fine hair-like material was embedded within the intensely affected areas. Gingival biopsies from 4 affected horses contained pyogranulomatous inflammation with, in some cases, numerous eosinophils and several grass awns in cross and longitudinal section. Numerous foxtail seed heads were identified in hay samples. Examination of the records revealed that all of the affected horses had been fed the suspect hay, with the exception of 1 horse. Although not deliberately fed the suspect hay, this horse did have access to the hay when turned out into the exercise paddock. The lesions resolved following a change in hay source.     

Halicephalobus gingivalis infection in a 5-year-old Tinker gelding

A 5-year old Tinker gelding was referred to the Department of Equine Sciences with a left eye uveitis and fever. At presentation the horse showed a mild lethargy, fever and decreased vision of the left eye. Rectal examination revealed an enlarged left kidney, with a hard and an irregular surface. The cranial mesentery artery had an enlarged and irregular aspect. Blood analysis showed anaemia, leucocytosis, increased blood urea nitrogen and creatinine and a hyperproteinemia. Urine analysis repeatedly showed a marked proteinuria and an increased gammaGT/creatinine ratio. The amount of abdominal fluid was slightly increased. However, the aspect, amount of cells and protein were normal. In the following two days the fever persisted and the horse showed anorexia and severe neurological signs. The horse was euthanized with permission of the owner. Post mortem examination showed a generalized parasitic infestation of Halicephalobus gingivalis in the uvea of the left eye, the kidneys and the central nerve system.     

Ossifying fibroma in a llama.

A 4.5-year-old llama was admitted for evaluation of a firm mass rostral and ventral to the medial canthus of the left eye. Mucopurulent nasal discharge and absence of airflow through the left nostril were noted. Radiographs of the skull revealed a sharply demarcated soft tissue mass with faint mineralization. Endoscopy of the nasal passages revealed a mucosa-covered mass originating in the area of the second premolar, extending to the edge of the soft palate, and obstructing the airway. Examination of the oral cavity revealed a missing second molar and a mass protruding 2-cm from the empty alveolus. An ossifying fibroma, a previously unreported tumor in llamas, was diagnosed at postmortem examination.     

Unilateral intraocular mastocytosis and anterior uveitis in a dog with subcutaneous mast cell tumors

A 9‐year‐old male castrated Scottish terrier was referred to the Radiation Oncology Service at the William R. Pritchard Veterinary Medical Teaching Hospital for palliative radiation therapy of an incompletely excised, recurrent subcutaneous mast cell tumor (MCT) located over the right scapula, and surgical removal of a perianal MCT. Three weeks after initial presentation and prior to the fifth radiation treatment, the patient was presented with cloudiness of the left eye of 3–7 days duration. Ophthalmic consultation revealed 3+ aqueous flare with a dependent, swirling component filling approximately one‐third of the anterior chamber. Aqueocentesis was performed under general anesthesia. Cytology revealed mast cells with highly atypical morphology and considered most consistent with neoplasia. The patient died 7 months after pathologic diagnosis of MCT on the right shoulder and 2 months after the cytologic diagnosis of malignant mast cells in the left anterior chamber. To the authors' knowledge, this is the first report of intraocular involvement in a mammal with MCTs, described here as intraocular mastocytosis.