BCG emulsion immunotherapy of equine sarcoid

Of 61 horses with sarcoids treated with intralesional injection of a double emulsion incorporating inactivated bacillus Calmette Guérin organisms, 36 (59 per cent) showed complete regression and 11 (18 per cent) showed partial regression. The majority of cases required only one treatment. Not all sarcoids were responsive to this therapy; those not responding were usually large or on horses with multiple sarcoids.     

Clinical observations on the use of BCG cell wall fraction for treatment of periocular and other equine sarcoids

Clinical observations on the use of BCG cell wall fraction in oil for treating seven horses with periocular sarcoids and five horses with sarcoids in other regions are described. Therapy was successful when used for periocular or solitary and smaller sarcoids. For sarcoids previously treated with cryosurgery, therapy appeared to be less efficient. A horse with a sarcoid on the stifle developed a septic gonitis due to necrosis of the sarcoid tissue adjacent to the joint. Sarcoids of the axilla appeared to be more aggressive than sarcoids at other locations and did not respond favourably to this form of therapy.     

Radiotherapy for the treatment of periocular tumours in the horse

Periocular tumours are a relatively common problem in the horse, and present some unique challenges. Radiotherapy has long been considered the ‘gold standard’ for the treatment of periocular tumours in the horse, and there are various techniques of delivering this treatment. Although teletherapy and plesiotherapy are occasionally used, the most commonly used technique is interstitial brachytherapy. Low-dose rate interstitial brachytherapy has reported success rates of between 74 and 100% for the treatment of periocular sarcoids, and other tumours can also be successfully treated using this technique. There are significant disadvantages to the low-dose rate brachytherapy approach, and recently, a technique using high-dose rate brachytherapy has been described with a reported success rate of 100% for periocular sarcoid treatment. Electronic brachytherapy is a technique which may provide an alternative to high-dose rate brachytherapy, but its use for the treatment of periocular tumours has not been reported, and the requirement for general anaesthesia is a significant disadvantage.     

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.     

Cell-mediated immunity in horses with sarcoid tumors against sarcoid cells in vitro

Cell-mediated immunity in horses with sarcoid tumor against sarcoid antigens was studied in vitro by means of mixed lymphocyte tumor cell culture assay and lymphocyte-mediated cytotoxicity of 52Cr-labeled target cells. When Mc-1 sarcoid cells were used as stimulatory cells for peripheral blood lymphocytes in the mixed lymphocyte tumor cell assay, a clear difference in the kinetics of the generated lymphocytic proliferative response could be detected between sarcoid and control horses. With sarcoid horses, their proliferative maximum was reached 3 days earlier than that of the control horses, and at this time their proliferative activity was significantly increased over that of control horses. When normal allogeneic fibroblasts were used as stimulatory cells, no such difference between sarcoid and control horses could be seen. The cellular cytotoxicity of peripheral blood lymphocytes from sarcoid and control horses against Mc-1 cells or normal allogeneic fibroblast targets was very low. However, the mean cytotoxicity against Mc-1 was slightly increased for sarcoid horses as compared with that of control horses. In contrast, the cytotoxicity against allogeneic fibroblasts was slightly lower for sarcoid than for control horses. In contrast, the cytotoxicity against allogeneic fibroblasts was slightly lower for sarcoid than for control horses. Furthermore, it was shown that sarcoid horses, but not control horses, had a slightly but consistently increased cytotoxicity against Mc-1 cells as compared with that against normal allogeneic fibroblasts.     

A review of equine sarcoid

Equine sarcoid is the most common tumour of horses and accounts for over half of all equine skin tumours. Six types of sarcoid based on gross appearance and clinical behaviour have been described including occult, verrucous, nodular, fibroblastic, mixed and malevolent. Common locations for sarcoid development include the periocular region, ear pinnae, lips, neck, extremities and ventrum (including groin region). Bovine papillomavirus (BPV) is causally associated with equine sarcoid with genetic haplotype, fly vectors and skin trauma identified as potential risk factors for development of the disease. Histopathology is required for definitive diagnosis of equine sarcoid but incomplete excision is thought to activate latent BPV and stimulate growth. Although there are no uniformly effective treatment options, several modalities have been successful in eliminating or managing equine sarcoid. Surgical excision, intratumoural chemotherapy, cryotherapy, hyperthermia, radiotherapy, immunotherapy and immune modulators are used with degrees of success relative to the accessibility and invasiveness of the tumour. Prevention of equine sarcoid may be facilitated by future development of vaccines against bovine papillomavirus.     

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.     

Diagnosis and treatment of a periocular myxosarcoma in a bearded dragon (Pogona vitticeps)

A 5-year-old male Australian bearded dragon (Pogona vitticeps) was presented with a 2-month history of a periocular mass. The clinical evaluation included a physical examination, hematology, biochemistry, and radiographs. The mass was treated surgically and diagnosed as myxosarcoma. Strontium-90 plesiotherapy was attempted, but the mass recurred 5 mo later.     

Immunotherapy in ocular equine sarcoid.

A modified Bacillus Calmette-Guerin (BCG) preparation was used successfully in the treatment of 7 cases of equine sarcoid. The BCG preparation was injected into the lesions. The longest period of remission has been 24 months, and the shortest period of remission has been 9 months, with no signs of recurrence of the tumor in any of the presented cases.     

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.     

A pilot study on the use of ultra-deformable liposomes containing bleomycin in the treatment of equine sarcoid

The efficacy of a novel topical liposome-encapsulated preparation of bleomycin (Bleosome) was studied in 118 clinical cases of equine sarcoid and efficacy was compared with two other standard conventional treatments, tazarotene and 5-fluorouracil (5-FU) as well as with the Bleosome in combination with each of these two conventional treatments. Treatments were arbitrarily assigned. Fifty-two of the 118 sarcoids (44%) were resolved after 12 months but there were significant differences between treatment groups with the combinations of either 5-FU and bleomycin, or tazarotene and bleomycin resulting in significantly superior resolution of 77 and 78% of the lesions, respectively. The preliminary results suggest that bleomycin in a liposomal carrier may be a useful treatment modality for superficial, diffuse and verrucose sarcoids. The treatment process was simple, and outcomes were functionally and cosmetically excellent. Liposome-encapsulated bleomycin is economic compared to radiation and other treatment options and can be applied effectively by the owner under guidance. Further studies with different administration protocols and higher concentrations of bleomycin are warranted.     

Inheritance of equine sarcoid disease in Franches-Montagnes horses

The mode of inheritance for susceptibility to equine sarcoid disease (ES) remains unknown. The objectives of this study were to analyse a large sample of the Franches-Montagnes (FM) horse population and investigate the heritability and mode of inheritance for susceptibility to ES. Horses were clinically examined for the presence of sarcoid tumours. A standardized examination protocol and client questionnaire were used and a pedigree- and subsequent segregation-analysis for the ES trait performed. To investigate the mode of inheritance, five models were evaluated and compared in a hierarchical way.The analyses reveal that variation in susceptibility to ES is best explained by a model incorporating polygenic variation. The possible effect of a major gene, such as specific equine leukocyte antigen alleles, is unlikely, but cannot be ruled-out entirely. The heritability of the phenotype on the observation scale for the trait ‘affected with ES’ was estimated to be 8%. A corrected value for the heritability on a liability scale was estimated at 21% and it is therefore possible to estimate breeding values for ES. The arguments against the practical implementation of an estimated breeding value in a multifactorial condition like ES are discussed.     

The diagnosis and treatment of periorbital sarcoid in the horse: 445 cases from 1974 to 1999

OBJECTIVE: Diagnosis and management of periorbital sarcoids in horses is a significant clinical challenge for the practicing veterinary surgeon and pathologist. The purpose of this study was to investigate the response of various types of sarcoids to different therapeutic methods. Animals studied Medical records of 445 clinical patients. Procedures This paper retrospectively examines the clinical and histological features of periorbital sarcoids and the treatment of 445 cases. Treatment by surgical excision, cryosurgery, Bacillus-Calmette-Gaérin (BCG) immunomodulation, topical cytotoxic applications, and radiation are described. RESULTS: Six types of sarcoid can be found in the immediate periorbital region and each has some characteristics of other disorders of the skin with which they can be confused. The diagnosis of sarcoids is, however, relatively simple in most cases. The lesions are not necessarily restricted to the dermis and epidermis, but commonly invade into the subcutis and the deeper muscular structures around the eye. Treatment with radiation is expensive and difficult to manage but resulted in the best outcome with almost 100% resolution in 66 cases. By contrast, surgical excision has serious potential complications that arise primarily as a result of the infiltrative nature of periorbital sarcoids. The value of BCG immunomodulation therapy for fibroblastic and nodular lesions described by previous workers is confirmed in this paper, with a good overall response (69%), provided that the material was injected intralesionally. Perilesional injection did not appear to carry a significant benefit. However, treatment of verrucose or occult lesions by this method gave generally poor results. The results of intralesional injection of cisplatin emulsions suggest that this may be an effective method of treatment in cases where other modalities are not feasible. In common with previous reports, failure to resolve the lesions frequently resulted in regrowth of the tumor, and in most cases this recurrence appeared to be more aggressive, with extensive local infiltration and faster growth. Conclusion The periorbital tissues are less tolerant of damage than those at many other sites and therefore certain treatment methods may be contraindicated. This suggests that it is important to select the best possible treatment at the first opportunity. It is a wise precaution to warn owners of horses with periorbital sarcoids of the dangers of leaving them and the particular risks associated with the currently available treatments.     

Histopathological characteristics of five clinical types of equine sarcoid

The purpose of this study was to determine the characteristics of occult, verrucous, fibroblastic, nodular and mixed equine sarcoids. Ten tumours of each type were examined histologically and analysed for the presence of bovine papilloma virus (BPV)- DNA. All tumours were positive for BPV - DNA and showed an increased density of dermal fibroblasts. Epidermal hyperplasia, hyperkeratosis, rete peg and 'picket fence' formation were only found consistently in the verrucous and mixed types and were often not present in occult and nodular sarcoids. Immunohistochemical staining for Keratins 10 and 16, Ki67 and p53 showed no important differences between the clinical types.It can be concluded that the presence of BPV - DNA and the increased density of dermal fibroblasts were the only common characteristics for all sarcoids of the different clinical types. The presence of other microscopic alterations was variable but could not be used in the differentiation of the clinical types based on histology.     

Guttural pouch empyema secondary to a periocular foreign body

This report describes a 3‐year‐old gelding presenting with signs of injury to its left eye following an accident in which the horse crashed into a hedge. The first treatment attempted to treat infections in the eye and respiratory tract due to secretions identified in the trachea. The horse did not improve and further clinical and radiographic evaluations detected a guttural pouch empyema. Surgical drainage was performed and antimicrobial treatment continued. However, the horse presented with severe epistaxis and euthanasia was elected due to suspected arterial rupture. At necropsy, a round and stiff branch plant was found creating a fistula from the left orbit to the left guttural pouch. Another branch was found inside the pouch, confirming the origin of the persistent infection and severity of the tissue lesion.