Ocular neoplasia and treatment (Proceedings)


Ocular neoplasia and treatment (Proceedings)

Apr 01, 2009

Given the plethora of locations and types of neoplastic disorders of the canine and feline eye, this hour long lecture cannot possibly do more than scratch the surface of this subject matter. We can divide the subject material by the following anatomic locations: eyelid, conjunctiva and third eyelid, cornea/sclera, uvea, optic nerve, and orbit, and by species given the differences in disease progression.

Eyelid neoplasia in dogs

Approximately 75%-85% are benign. Most present as brown proliferative or verrucous, usually slow-growing lesions involving the lid margins and meibomian glands. Some may grow to be quite large (see lecture slide show). More than 50% of these masses are sebaceous adenomas, epitheliomas, and adenocarinomas. Squamous papillomas (more papillary in appearance, may be viral in origin and part of papilloma complex) and melanocytomas (Weimeraners and Vizlas appear to be over-represented) are the next most common – approx 25%. Melanomas of the lid margin appear to behave in a benign fashion and are sensitive to excision or cryosurgery in dogs. Ten such other tumor types have been reported such as histiocytomas (young dogs, pink circular masses, that may spontaneously regress), fibromas, lipomas, mast cell, basal cell, and squamous cell tumors, but make up only 10% or less. Small snip or 2-3mm punch biopsies from large infiltrative masses can provide a diagnosis if reconstructive blepharoplasty is anticipated (greater than 1/3 lid length), or simple excision or cryotherapy of small proliferative and benign appearing masses may be curative. Expect recurrence 10-15% of time. Performing histopathology on excisional procedures is recommended as follow up treatment may be necessary. Surgical lid reconstruction will be addressed in our wet-lab. Needle aspirates of lid masses are often non-diagnostic in dogs.

Feline: In general, unlike dogs, most of these tumors are malignant. Some such as SCC may metastasize to regional lymph nodes and other organs (usually very late though – average 5 years for lid SCC in cats). The most commonly reported lid tumors in cats are SCC (Graefe'sArchv245n8p1217-1220 ;VOv10n6p337-343), basal cell carcinoma, mast cell tumors, fibromas/fibrosarcomas, hemangiosarcoma, melanoma, lymphosarcoma, adenomas, and peripheral nerve sheath tumors (VOv8n3p153-158 '05 Hoffman, Blocker, Dubielzig). Apocrine gland hidrocystomas are benign cystic tumors that appear as multiple dark brown proliferative masses around the lids, often seen in brachycephalic cats that can be excised if needed. (JAVMA 15;230(8):1170-3.;VO 7(2):121-5). Needle aspirates, cytology, or biopsies of lid masses in cats prior to surgery is recommended given most are malignant and this will help when deciding on the need for wide-surgical excision, or when pre-surgical treatments (radiation) may be necessary. SCC's are usually locally invasive and ulcerative (vs. proliferative in horses and cattle) lesions in mostly white cats – (13x more common than other colors) – surgical excision with wide margins and adjuvant radiation or cryotherapy is the most successful treatment. Many other treatments reported in literature but less available to us (photodynamic therapy, radioactive gold beads, etc).

Conjunctiva and third eyelid

Canine conjunctival neoplasms

Most are benign but can be locally aggressive.

Squamous papilloma (17%); Nodular granulomatous episcleritis (NGE) – 16%

Vascular neoplasia (hemangioma/hemangiosarcoma) – 15% ; Mast cell tumors – 6%

Nictitans adenocarcinoma – 5% ; Conjunctival melanomas 10-20%? (and many other less common types): Most melanomas are malignant by morphologic criteria and can grow to be quite locally aggressive; most will recur elsewhere on the conjunctiva when removed, but they seldom metastasize. Those on the palpebral conjunctiva are more likely to metastasize– but reports of metastasis are lacking in the literature. Data obtained from Dr. Brian Wilcock.