Ocular manifestations of a metastatic adenocarcinoma in a horse

A 10‐year‐old German Warmblood gelding was referred to the Equine Department of the Vetsuisse Faculty, University of Zurich, Switzerland, for an iris mass OD, lethargy, intermittent fever, and coughing. Ophthalmic examination revealed a 7 × 9 mm raised, fleshy, whitish to pinkish, vascularized iris mass at the 2 o`clock position OD. Fundic examination showed multifocal round, brown to black, slightly raised lesions with indistinct margins and a surrounding hyperreflective zone OU. Physical examination revealed a temperature of 39.2 °C, sinus tachycardia, preputial and ventral edema, and an enlarged right mandibular lymph node. Results of a complete blood count and plasma biochemical profile showed mild anemia, leukocytosis, and thrombocytopenia. Severe splenopathy, moderate splenomegaly, and severe pulmonary pathology with nodules and large areas of consolidated lung parenchyma were observed on abdominal ultrasound and thoracic radiographs, respectively. Fine needle aspirates of the enlarged mandibular lymph node showed malignant epithelial neoplastic cells. The horse was euthanized because of the poor prognosis and subsequently underwent postmortem examination. Macroscopic necropsy and histopathology revealed an adenocarcinoma of suspected pulmonary origin with involvement of eyes, heart, liver, kidneys, spleen, diaphragm, skeletal muscles, mandibular, pulmonary, and internal iliac lymph nodes. Metastatic adenocarcinoma should be considered as a differential diagnosis in horses with iris masses, multifocal chorioretinal infiltrates, and clinical signs that conform to a paraneoplastic syndrome.     

Neurologic signs and hyperammonemia in a horse with colic

A 23-year-old Thoroughbred gelding was referred for the evaluation of acute onset of ataxia and depression, and a 2-day history of fever. On physical examination, the gelding was profoundly depressed and 10-12% dehydrated. The horse appeared very unstable, with a wide-based stance in the hind limbs, severe symmetric ataxia in all 4 limbs, and proprioceptive deficits in both hind limbs. Nasogastric intubation produced 4 L of brown, fetid reflux, and rectal examination revealed mild small intestinal and cecal distention. Hematologic abnormalities included neutropenia with toxic change, compatible with acute inflammation and endotoxemia, and prolonged coagulation times. Serum biochemical abnormalities included prerenal azotemia. metabolic acidosis, and electrolyte abnormalities consistent with enteritis. Blood ammonia concentration was markedly increased (406 micromol/L; reference interval 4-49 micromol/L), however, serum bile acids concentration and hepatic enzyme activities were within reference intervals. Histopathologic examination of a liver biopsy revealed no abnormalities and results of tests for several infectious agents were negative. Clinical signs resolved with correction of the dehydration and electrolyte abnormalities and with antibiotic therapy. The horse was diagnosed with hyperammonemic neuropathy associated with gastrointestinal disease. In such cases, hyperammonemia is caused by increased production of ammonia by organisms in the gastrointestinal tract in combination with increased gut permeability that facilitates ammonia absorption.     

Resection of a ceruminous adenocarcinoma in a horse by a modified vertical ear canal ablation

A 13‐year‐old Swedish Warmblood mare was presented for evaluation of a mass on the medial aspect of the left vertical ear canal. The mass was initially resected using monopolar loop diathermy. Histopathological diagnosis of the excisional biopsy was a low‐grade malignant ceruminous adenocarcinoma. The clinical and histopathological features of this previously unreported neoplasm in the horse are described. A modified vertical ear canal ablation was performed in order to remove the base of the neoplasm with adequate free margins. The surgical technique is described. No recurrence was noted 2 years after surgery and the appearance and function of the pinna were retained.     

Diarrhea and hyperammonemia in a horse with progressive neurologic signs

A 2-year-old, Quarter Horse filly was referred to Michigan State University, Veterinary Teaching Hospital with a 2-3 day history of depression and partial anorexia progressing to severe, watery diarrhea with severe neurologic abnormalities, including repetitive muscle fasciculations, muscle stiffening, and collapse. Laboratory findings included severe polycythemia, neutropenia, metabolic acidosis, and electrolyte and fluid loss, consistent with watery diarrhea and endotoxic shock. Increased creatine kinase and aspartate transaminase activities were consistent with recent transport and the muscle abnormalities. Severe hyperammonemia (1369.0 micromol/L; control value, 15.3 micromol/L) was found, without other substantial laboratory evidence of hepatic dysfunction. The horse was euthanized because of poor prognosis and rapid clinical deterioration. Necropsy findings were unremarkable with the exception of severe diffuse colitis. Culture of colonic contents recovered >1000 colony-forming units of Clostridium perfringens. Based on these findings, marked hyperammonemia in this filly was attributed to changes in colonic flora leading to increased bacterial production of ammonia that was readily absorbed through the inflamed bowel wall, exceeding the hepatic capacity for deamination. Intestinal bacteria as a source of hyperammonemia in the absence of hepatic disease has been linked rarely to positive culture results for clostridial organisms.     

Severe hyperkalaemia associated with renal dysplasia in a 2-day-old foal

A 2-day-old filly foal presented with signs of depression, recumbency and inappetence. Blood analyses revealed hypoalbuminaemia, hyperfibrinogenaemia, hyperglycaemia and hyperkalaemia. The foal deteriorated despite intensive treatment and was subjected to euthanasia. At post mortem examination, the urinary bladder, ureters and kidneys appeared normal grossly. Histologically both kidneys showed disorganised development with the presence of structures inappropriate for a foal of this age, including primitive glomeruli, immature renal tubules and persistent metanephric ducts. Based on these findings a diagnosis of bilateral renal dysplasia was made.     

A retrobulbar meningioma as a cause of unilateral exophthalmos and blindness in a horse

This report describes the unusual diagnosis of a retrobulbar syncytial meningioma in a 16‐year‐old Thoroughbred gelding. The horse initially presented with unilateral left sided exophthalmos and apparent blindness characterised by unilaterally absent menace and pupillary light responses. Magnetic resonance imaging (MRI) identified a well‐defined soft tissue mass intimately associated with the optic nerve. Based on the characteristic MRI appearance, a meningioma was suspected. The eye was enucleated under general anaesthesia and partial excision of the mass was achieved. Histopathology confirmed the diagnosis and the horse underwent a course of adjuvant radiotherapy. Twelve months following surgery the horse is back in work, no neurological abnormalities have been detected and follow‐up computed tomographic imaging of the skull has revealed mild bone sclerosis with no remnants of the mass identified.     

Renal carcinoma as a cause of sudden death in an aged horse

This report describes rupture of a primary renal carcinoma as a cause of sudden death of an aged horse that presented with mild clinical signs of colic. The case is considered in the context of the few reported cases in the veterinary literature. The most striking feature of this case was the absence of prodromal signs prior to a catastrophic rupture of the tumour during a diagnostic work‐up.     

A review of equine paranasal sinusitis. Aetiopathogenesis,clinical signs and ancillary diagnostic techniques

The equine paranasal sinuses are air filled cavities of uncertain function that are susceptible to inflammation, usually associated with bacterial infection. A common feature of most types of sinusitis is the accumulation of exudate within the affected sinus and subsequent ipsilateral nasal discharge. Equine sinusitis can have a variety of causes, including primary sinusitis following upper respiratory tract infections, and secondary sinusitis caused by dental infections, intrasinus benign and malignant growths and head trauma.     

Severe lameness caused by metastatic renal adenocarcinoma of the third phalanx in a Warmblood mare

Malignant osseous neoplasia has been extremely rarely reported in the horse and, therefore, it is not commonly considered as a differential diagnosis for acute lameness. In the present report, a 19‐year‐old Warmblood mare in poor body condition and with a history of chronic haematuria, presumably attributable to renal neoplasia, was referred with acute, progressive, unilateral right forelimb lameness with marked unilateral digital pulsation and metacarpal oedema. No hoof abscess was found. Radiographic examination revealed a well defined osteolytic area in the dorsomedial half of the third phalanx. Dermal laminae at the dorsomedial aspect of the hoof showed a dark red appearance with poor vascularisation. Thoracic radiographs revealed pulmonary nodules. As osseous metastasis of the third phalanx was suspected, the mare was subjected to euthanasia. Post mortem histopathological examination confirmed the diagnosis of primary renal adenocarcinoma with metastasis to the lungs, myocardium, along the perirenal lymphatic tract and to the third phalanx, with extensive osteolysis in the latter location. Post mortem computed tomography of the hoof provided excellent visualisation of the osseous metastasis. The rare possibility of osseous metastatic neoplasia should be included in the differential diagnosis of severe lameness, especially in aged horses with a history of chronic renal disease.     

Ethmoid adenocarcinoma: Severe neurological complications after combined laser ablation and intralesional formalin injection

An 11‐year‐old Warmblood gelding with chronic bilateral epistaxis was diagnosed with an adenocarcinoma of the right ethmoid, based on transendoscopic biopsy. On computed tomography images, the cribriform plate was considered intact and the tumour was minimally invasive in surrounding tissue. The palliative treatment included a combination of surgical exploration and laser ablation. Following recurrence of the clinical signs one month later, intralesional formalin injection was performed. In the immediate post injection period, the horse developed severe neurological signs. Because of the overall poor prognosis, the horse was subjected to euthanasia. On post mortem examination, changes were seen in the frontal lobe consistent with diffusion of formalin through the cribriform plate. Care is needed when treating horses with intralesional formalin because macroscopic appearance of the cribriform plate may not relate to its functionality.     

Salt (sodium) deficiency in dairy cattle: polyuria and polydipsia as prominent clinical features.

Polyuria in a herd of forty-five dairy cattle was the chief complaint in the first case. Polydipsia was the principle sign in a second case involving one dairy cow. Less conspicuous clinical findings included salt hunger, pica, weight loss and decreased milk production. Clinicopathologic investigation included monitoring the concentrations of sodium, potassium and chloiride in urine, parotid saliva and plasma. These analyses indicated a primary sodium deficiency which responded to sodium chloride ad libitum.     

Clinical course of renal adenocarcinoma associated with hypercupraemia in a horse

A four-year-old shire mare with haematuria, colic, terminal weight loss and an abdominal mass had a large unilateral renal adenocarcinoma. Clinical signs were monitored for 11 months. Increased serum copper concentrations were measured on two occasions. Hypercupraemia is discussed as a possible paraneoplastic change.     

Severe hindlimb lameness and pathological femur fracture in a horse secondary to haemangiosarcoma

An 18‐year‐old Warmblood stallion was presented for an acute onset nonweightbearing right hindlimb lameness following a mild lameness of 2 weeks' duration. Severe swelling was present in the right femoral area. Despite extensive diagnostic procedures, no definitive diagnosis could be made. Packed red cell volume was persistently low. The horse improved with supportive treatment and was discharged at the owner's request. The horse presented 4 days later for bleeding from a previously made incision on the lateral femoral area. Due to deterioration of his condition, the stallion was subjected to euthanasia. Diagnosis of disseminated haemangiosarcoma, affecting primarily the hindlimb musculature and leading to pathological fracture of the femur was made at necropsy and subsequent histopathology.     

Severe cryptococcal granulomas of the nasopharynx in a horse treated with standing endoscopic laser surgery and oral fluconazole

An Arabian mare was referred due to a 4-month history of bilateral mucopurulent nasal discharge, which was unresponsive to multiple courses of antimicrobials and intravenous sodium iodide. Digital radiographs revealed multiple variably sized nodular opacities within the nasopharynx. Upper airway endoscopy showed multiple, ulcerated granulomatous masses originating from the walls of the nasopharynx. Repeat culture of the exudate and from endoscopic biopsies grew only a mixed bacterial population. Standing endoscopic guided laser excision of two granulomas was performed and histopathology and culture from the center of a surgically excised granuloma identified Cryptococcus terrestris. Treatment with fluconazole (14 mg/kg bwt per os once then 5 mg/kg bwt per os q. 12 h) was administered for a total of 11 weeks. Follow-up endoscopic examination was used to guide therapy duration, and the horse has since returned to competition and remained free of infection for >1.5 years. Establishing a diagnosis of cryptococcal infection was difficult in this horse despite multiple culture attempts. This is the first report of Cryptococcus terrestris infection in a horse and treatment with oral fluconazole after surgical de-bulking was successful.     

Clinical outcomes in cats with renal carcinoma undergoing nephrectomy: A retrospective study

Renal carcinomas (RC) are uncommonly encountered in feline medicine. Limited information regarding clinical presentation and postoperative outcomes is available. The purpose of this multi-institutional, retrospective study was to describe the presenting features and clinical outcomes of cats with RC undergoing nephrectomy. Thirty-six client-owned cats were included. Medical records from participating institutions were searched to identify cats that had a histopathologic diagnosis of RC and underwent nephrectomy from January 2001 to October 2021. The most common presenting complaints were weight loss (36.1%) and hyporexia (30.6%). Based on preoperative imaging and intraoperative findings, eight cats had suspected metastasis at the time of surgery (22.2%). Twenty-eight cats survived to discharge (77.8%). Median progression free interval (PFI) could not be determined, as only six cats developed suspected recurrence (16.7%) and seven cats developed suspected metastasis (19.4%). The all-cause median survival time (MST) was 203 days (95% confidence interval [CI]: 84, 1379 days). When cases that died prior to discharge were excluded, MST increased to 1217 days (95% CI: 127, 1641 days). One-year, two-year, and three-year survival rates were all 40.4%. Neither renal tumour histologic subtype nor the presence of preoperative azotemia, anaemia, erythrocytosis, haematuria, or suspected metastasis at diagnosis were found to influence survival. For cats surviving to discharge, prolonged survival times were possible. Further studies are necessary to elucidate other potential prognostic factors, the utility of postoperative adjuvant treatment, and to identify cats at-risk of mortality in the perioperative period.     

Primary lacrimal gland adenocarcinoma of the third eyelid in a horse

A 5-year-old Draft Horse gelding presented for evaluation of a large, fleshy, ulcerated third eyelid mass OD of 3 weeks duration. Complete ophthalmic examination, ocular ultrasound and skull radiographs revealed a large soft-tissue mass involving the entire third eyelid OD and extending into the ventral right orbit to the level of the globe equator. No other abnormalities were noted on physical or ophthalmic examination. Surgical removal via exenteration was performed 3 months after initial presentation. A lacrimal adenocarcinoma of the third eyelid was diagnosed based on histopathology. Concurrent asymptomatic intra-ductal and intra-acinar Demodex caballi parasites were found in the eyelid sebaceous glands, likely as an incidental finding. No tumor recurrence or metastasis has occurred 12 months after excision. To the author's knowledge, this case is the first reported primary lacrimal adenocarcinoma in a horse. Complete surgical excision was curative.     

Vasopressin response to osmotic stimulation in 18 young dogs with polyuria and polydipsia

Common disorders of water homeostasis leading to polyuria include a variety of endocrine, metabolic, and renal disturbances. After exclusion of most of these conditions, the diagnostic dilemma of differentiating between central diabetes insipidus, primary polydipsia, and nephrogenic diabetes insipidus may remain. Here, we report on 18 young dogs with polyuria that had been present in most cases since the dogs were puppies. The conditions were categorized according to the plasma vasopressin (VP) response to hypertonicity. The VP response to osmotic stimulation was tested by IV infusion of 20% NaCl for 2 hours. The VP response in all dogs was abnormal. Three categories could be distinguished: an exaggerated response (n = 3), a subnormal response (n = 4), and a nonlinear response with high plasma VP concentrations unrelated to increases in plasma osmolality (n = 11). The VP response to hypertonicity did not consistently distinguish among different clinical entities. In the 9 dogs with variations in urine osmolality compatible with primary polydipsia, exaggerated, subnormal, and nonlinear responses were observed. Examination of the present data questions the generally accepted notion that VP measurements during hypertonic saline infusion are the "gold standard" for the diagnostic interpretation of causes of polydipsia and polyuria. Studies of the peripheral reflection in plasma of the pulsatile VP release in healthy and polyuric individuals, with and without osmotic provocation, should be performed.     

The use of computed tomography to diagnose bilateral forelimb tendon pathology in a horse with unilateral lameness

A horse with unilateral forefoot lameness had bilateral deep digital flexor tendon (DDFT) lesions on computed tomography (CT). Venous contrast enhanced CT revealed distal sesamoidean impar desmitis in the lame forelimb. Computed tomography is useful for diagnosis of soft tissue lesions within the hoof capsule and contrast enhancement improves lesion conspicuity.