corneal hemangiosarcoma in a cat - cazalot - esvo pragues 2011

Corneal hemangiosarcoma Corneal hemangiosarcoma in a catin a cat

Clinique Vétérinaire La Borde Rouge - 150 rue Edmond Rostand -31200 Clinique Vétérinaire La Borde Rouge - 150 rue Edmond Rostand -31200 Toulouse FRANCEToulouse FRANCE

CORNEAL HEMANGIOSARCOMA IN A CATG. CAZALOT, A. REGNIER², A. DEVIERS², F. SERRA², M.N. LUCAS² and I.RAYMOND LETRON²1. Clinique vétérinaire de la Borde Rouge, 150 rue Edmond Rostand, 31200 Toulouse, France2. Département des Sciences Cliniques, Ecole Nationale Vétérinaire de Toulouse, 23 chemin des Capelles, BP 87614, Toulouse Cedex 3, France

Guillaume CAZALOT

IntroductionIntroduction

Primary corneal neoplasm are rare Primary corneal neoplasm are rare

Secondary corneal neoplasm have been Secondary corneal neoplasm have been described in cats from ocular or peri-ocular described in cats from ocular or peri-ocular extensionsextensions

A recent case of combined squamous cell A recent case of combined squamous cell carcinoma and corneal hemangiomacarcinoma and corneal hemangioma

First report of a primary corneal First report of a primary corneal hemangiosarcoma in a cathemangiosarcoma in a cat

Case report : anamnesisCase report : anamnesis

A 10 years-old castrated white male A 10 years-old castrated white male Domestic Short-hair Domestic Short-hair

When it was adopted 6 years ago, mild signs When it was adopted 6 years ago, mild signs of upper respiratory disease with serous of upper respiratory disease with serous ocular discharge were treated with per os ocular discharge were treated with per os antibiotherapy and corticotherapy.antibiotherapy and corticotherapy.

Bilateral chronic keratitis since 6 years :Bilateral chronic keratitis since 6 years :- PCR HSV, FeLV et FIV were negativePCR HSV, FeLV et FIV were negative- Recurrent episodes of ocular discharge Recurrent episodes of ocular discharge

treated with framycetin / dexamethasone treated with framycetin / dexamethasone phosphate ophthalmic ointment.phosphate ophthalmic ointment.

Case report : anamnesisCase report : anamnesis

2 months prior to referral, ocular pain OS : 2 months prior to referral, ocular pain OS : STT 8mm/min (16mm/min OD) > 0,2% STT 8mm/min (16mm/min OD) > 0,2% cyclosporin ophthalmic ointment once a daycyclosporin ophthalmic ointment once a day

1 month prior to referral, OS had deteriored 1 month prior to referral, OS had deteriored and was treated with third eyelid flap : ocular and was treated with third eyelid flap : ocular problems continue to worsen.problems continue to worsen.

Case report : clinical Case report : clinical examinationexamination

Physical examinationPhysical examination- No abnormalities- No abnormalities

OD examination OD examination - Visual tests were normal Visual tests were normal - STT 12 mm/minSTT 12 mm/min- Stromal neovascularizationStromal neovascularization- Sub-epithelial mineral depositsSub-epithelial mineral deposits- No Rose Bengale or fluorescein stainingNo Rose Bengale or fluorescein staining- PIO 12 mmHgPIO 12 mmHg- Intraocular structures were safeIntraocular structures were safe


OS examinationOS examination- Loss of visual fieldLoss of visual field- BlépharospasmBlépharospasm- Lateral and inferior entropionLateral and inferior entropion- SymblépharonSymblépharon- Red-tinged serosanguinous Red-tinged serosanguinous ocular discharge ocular discharge (STT 20 mm/min)(STT 20 mm/min)


OS examinationOS examination - Central vascularized and - Central vascularized and hemorrhagic neoformationhemorrhagic neoformation- Dense peripheral edema - Dense peripheral edema and infiltrationand infiltration- No Rose Bengale / fluorescein- No Rose Bengale / fluorescein stainingstaining- Seidell test negative- Seidell test negative- Ultrasonography of intraocular - Ultrasonography of intraocular structures was normalstructures was normal

Case report : differential Case report : differential diagnosisdiagnosis

Granuloma : ulcer, perforationGranuloma : ulcer, perforation

Stromal keratitisStromal keratitis

Corneal neoplasmCorneal neoplasm

Case report : ancillary testsCase report : ancillary tests

Corneal cytology : no conclusiveCorneal cytology : no conclusive

Complete blood count, Complete blood count, coagulation and biochemistry coagulation and biochemistry profiles : no abnormalitiesprofiles : no abnormalities

Lamellar keratectomy combinedLamellar keratectomy combinedwith superficial diathermy and third eyelid flapwith superficial diathermy and third eyelid flapMorphine 0,2mg/kg IV Morphine 0,2mg/kg IV Chloramphenicol ophthalmic ointment tidChloramphenicol ophthalmic ointment tidL-Lysine twice dailyL-Lysine twice daily

Case report : diagnosisCase report : diagnosis

PCR HSV negativePCR HSV negative

The mass was friable, fleshy red, The mass was friable, fleshy red, multilobulated, highly vascularized and multilobulated, highly vascularized and hemorragic. The surgical excision was hemorragic. The surgical excision was histopathologically complete.histopathologically complete.


Histopathological characteristicsHistopathological characteristics - highly cellular - highly cellular - pleomorphic spindle and polygonal - pleomorphic spindle and polygonal cells with high mitotic index cells with high mitotic index (10 per 10 HPF) lining small and (10 per 10 HPF) lining small and large-containing spaceslarge-containing spaces- lymphocytic and plasmacytic - lymphocytic and plasmacytic infiltrate at the marginsinfiltrate at the margins

Hémalun Eosine staining


ImmunohistochimieImmunohistochimie Endothelial cell marker CD 31 labeled positivelyEndothelial cell marker CD 31 labeled positively in in

neoplastic endothelial cells confirmed the diagnosis of neoplastic endothelial cells confirmed the diagnosis of corneal hemangiosarcoma (HSA).corneal hemangiosarcoma (HSA).

Endothelial neoplastic cells CD31 +

Case report : follow-upCase report : follow-up

Removing of the third eyelid flap 12 Removing of the third eyelid flap 12 days afterdays after

- Partial epithelialization Partial epithelialization - Highly vascularized and hemorragic marginsHighly vascularized and hemorragic margins


2 weeks after removal of third eyelid 2 weeks after removal of third eyelid flapflap

A new hemorragic mass looking like the first one had A new hemorragic mass looking like the first one had raised into the stroma.raised into the stroma.


Extension check-upExtension check-up - no signs of metastasis in submandibular lymph node - no signs of metastasis in submandibular lymph node

cytology, chest radiographs and abdominal cytology, chest radiographs and abdominal ultrasonographyultrasonography

EnucleationEnucleation- Inevitable local recurrences and risks of long-term Inevitable local recurrences and risks of long-term

metastasismetastasis- Good to reserved prognosisGood to reserved prognosis

No signs of local recurrence or No signs of local recurrence or metastasis 18 months after surgerymetastasis 18 months after surgery

DiscussionDiscussion

Primary corneal tumors are rare in cats, Primary corneal tumors are rare in cats, particularly with vascular origin since particularly with vascular origin since cornea is avascular.cornea is avascular.

- Secondary corneal tumors more frequent in horses Secondary corneal tumors more frequent in horses and cattleand cattle

- HA and HSA reported in cat in bulbar conjunctiva and HA and HSA reported in cat in bulbar conjunctiva and anterior surface of the third eyelidanterior surface of the third eyelid

- Corneal HSA reported in German Shepherd without Corneal HSA reported in German Shepherd without details on its origindetails on its origin

- Combined squamous cell carcinoma and hemangioma Combined squamous cell carcinoma and hemangioma recently reported in a cat.recently reported in a cat.

(Perlman E. et coll.- Co-existing squamous cell carcinoma and hemangioma on the ocular (Perlman E. et coll.- Co-existing squamous cell carcinoma and hemangioma on the ocular surface of a cat. Vet Ophthamol. 2010, 13:63-66.)surface of a cat. Vet Ophthamol. 2010, 13:63-66.)


Epidémiologie des HSAEpidémiologie des HSA: :

- Pas de prédisposition raciale (mais souvent Pas de prédisposition raciale (mais souvent M>F)M>F)

- Age médian d’apparition à 10 ansAge médian d’apparition à 10 ans


Symptomatology of HSASymptomatology of HSA : :

- visceral typevisceral type : : often multi-organic and already often multi-organic and already metastatic when diagnosed (bad prognosis)metastatic when diagnosed (bad prognosis)

- (sub)cutaneous type(sub)cutaneous type : : unique tumor in a non hairy unique tumor in a non hairy and non pigmented skin (local recurrence but less and non pigmented skin (local recurrence but less metastasis)metastasis)

-> Ocular HSA can be metastasis (palpebral, ciliary or -> Ocular HSA can be metastasis (palpebral, ciliary or choroidal HSA) or primary (upper or third eyelid, choroidal HSA) or primary (upper or third eyelid, bulbar conjunctiva)bulbar conjunctiva)

-> First case of primary corneal HSA looking like a -> First case of primary corneal HSA looking like a cutaneous type in a catcutaneous type in a cat


Risk factorsRisk factors : :

- UV exposure UV exposure Non haired and non pigmented areas (carcinoma, Non haired and non pigmented areas (carcinoma,

HA/HSA…)HA/HSA…) Ultraviolet radiation-induced corneal tumours in the South Ultraviolet radiation-induced corneal tumours in the South

American opossum, Monodelphis domestica.- American opossum, Monodelphis domestica.- Sabourin CLSabourin CL, , Kusewitt Kusewitt DFDF, , Fry RJFry RJ, , Ley RDLey RD.- J Comp Pathol. 1993 May;108(4):343-59..- J Comp Pathol. 1993 May;108(4):343-59.

- Chronic inflammationChronic inflammation KCS, CSK, entropion in dogs…KCS, CSK, entropion in dogs… Post-inflammatory sarcomas in cats (post-traumatic Post-inflammatory sarcomas in cats (post-traumatic

ocular sarcoma, post-vaccinal sarcoma, post-metritis ocular sarcoma, post-vaccinal sarcoma, post-metritis sarcoma…)sarcoma…)

->-> Old male cats propensity to develop sarcomas in Old male cats propensity to develop sarcomas in chronic inflammatory diseases.chronic inflammatory diseases.


Risk factorsRisk factors : :

- Combination with Herpes virus Combination with Herpes virus Pathognomonic signsPathognomonic signs Latence trigéminale vraisemblable…Latence trigéminale vraisemblable… Generates a chronic corneal inflammation Generates a chronic corneal inflammation Herpesvirus implication in tumoral diseaseHerpesvirus implication in tumoral disease

(HHV-4 : Burkitt lymphoma and carcinomas; HHV-8 : Kaposi (HHV-4 : Burkitt lymphoma and carcinomas; HHV-8 : Kaposi sarcoma; sarcoma; Herpes Saïmiri : lymphoma…)Herpes Saïmiri : lymphoma…) Possible implication of others virus : retrovirus are Possible implication of others virus : retrovirus are

to blame for HSA in birds…to blame for HSA in birds…

corneal hemangiosarcoma in a cat - cazalot - esvo pragues 2011

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