Download Hemangiosarcoma of the Third Eyelid in a Dog

Acta Scientiae Veterinariae, 2015. 43(Suppl 1): 91.
CASE REPORT
ISSN 1679-9216
Pub. 91
Hemangiosarcoma of the Third Eyelid in a Dog
João Antonio Tadeu Pigatto, Luciane de Albuquerque, Juliana Voll & David Driemeier
ABSTRACT
Background: Hemangiosarcoma (HSA) is a malignant tumor of vascular endothelial origin. Primary neoplasms are extremely rare in the third eyelid of dogs. Neoplasia affecting ocular surface has been associated with increased exposure
to solar radiation. Treatment reported for dogs with conjunctival neoplasia is surgical excision. Definitive diagnosis is
confirmed in the histophatological examination. In this report, we describe a case of HSA of the third eyelid in a dog that
was successfully treated with surgical excision.
Case: A 5-year-old female Boxer dog was referred to the Ophthalmology Section of the Veterinary Clinics Hospital of the
Federal University of Rio Grande do Sul (UFRGS), presenting a red mass in the third eyelid of the right eye. Physical examination it was normal except for the ocular disease. The dog had signs of ocular discomfort an epiphora. On ophthalmic
examination a fixed, raised, red mass approximately 4 to 5 mm in diameter was identified on the anterior surface of the
third eyelid in the right eye. Under general anesthesia, and using an operating microscope the mass was excised with a gross
margin and submitted for histopathological analysis. Microscopic examination revealed a lesion composed of neoplastic
mesenchymal cells forming irregular channels containing blood. These plump cells showed moderate anisocytosis and
anisokaryosis with a low mitotic index. The postoperative treatment involved the administration of systemic carprofen 4
mg/kg, daily for 5 days. In addition, topical broad-spectrum antibiotic containing tobramycin 0.3%, and a non-steroidal
anti-inflammatory solution of sodium diclofenac 0.1%, administered six times a day for two weeks. The surgical wound
was left to heal by second intention. After surgery, the dog had no signs of ocular discomfort. No complications or recurrence of the lesion have been noted after two years of follow-up.
Discussion: Excessive exposure to ultraviolet radiation has been implicated as a risk factor for development of the ocular
surface tumors in dogs. In this case, the outdoor housing of the dog in a sunny area resulted in a high exposure to solar
radiation. In dogs these tumors usually present as small, red, raised lesions of the conjunctiva, most commonly on the leading margin of the third eyelid. In the present case, the ophthalmic examination revealed a small red mass protruding from
the anterior surface of the conjunctiva of the third eyelid. Definitive diagnosis is made after histopathologic examination.
Possible differential diagnoses for the nictitans mass in dogs include squamous cell carcinoma, melanomas, adenocarcinomas, mastocytomas, papillomas, hemangiomas, angiokeratomas, histiocytomas, and lymphosarcoma. The diagnosis of
hemangiosarcoma in this dog was confirmed through the histopathology of the mass after surgical excision. This case was
similar to previously reported HSA in dogs in terms of their histopahtological characteristics. There is little information
about the success of the treatment of HSA only by surgical removal as compared with surgical excision associated with
adjacent therapies. In this study, the surgical removal of the mass with a margin of safety was the treatment of choice.
The surgical wound was left to heal by second intention. After surgery, the dog had no signs of ocular discomfort. Postoperatively, antibiotic eye drops, and a non-steroidal anti-inflammatory were administered. The surgical wound healed well
postoperatively. Periodic evaluations were realized and there are no signs of recurrence after two years. HSA should be
considered as differential diagnosis in dogs with any third eyelid mass. In the present case, surgical excision was effective
for the treatment of HSA in third eyelid of a dog.
Keywords: hemangiosarcoma, nictitans membrane, canine.
Received: 21 December 2014
Accepted: 24 June 2015
Published: 30 July 2015
Faculdade de Veterinária (FaVet), Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil. CORRESPONDENCE: J.A.T. Pigatto [[email protected] - Fax: +55 (51) 3308-5131]. Avenida Bento Gonçalves n. 9090, Bairro Agronomia. CEP 91540-000 Porto Alegre, RS, Brazil.
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J.A.T. Pigatto, L. Albuquerque, J. Voll & D. Driemeier. 2015. Hemangiosarcoma of the Third Eyelid in a Dog.
Acta Scientiae Veterinariae. 43(Suppl 1): 91.
INTRODUCTION
The surgical procedure was performed under inhalation anesthesia, and using an operating
microscope. The mass was excised completely with
safe margin using tenotomy scissors. The surgical
wound was left to heal by second intention. After
surgery, the dog had no signs of ocular discomfort.
Postoperative treatment consisted of topical broadspectrum antibiotic (tobramycin 0.3% - Tobrex®)4
and a non-steroidal anti-inflammatory solution
(sodium dicofenac 0.1% - Still ®) 5 administered
six times a day, for two weeks. Systemic carprofen (Rimadyl) 6, 4 mg/kg per day for 5 days, was
prescribed. The removed tissue was placed in 10%
buffered formalin, fixed and processed routinely
for histological examination. The histopathological evaluation was performed by the Sector of
Veterinary Pathology (SVP), Department of Veterinary Clinical Pathology, Faculdade de Veterinária
(FaVet), Universidade Federal do Rio Grande do
Sul (UFRGS), Porto Alegre, RS, Brazil. HSA was
diagnosed based on the results of histopathological
examination, which revealed tumor infiltration in
third eyelid. The tumor was composed of neoplastic mesenchymal cells forming irregular channels
containing blood (Figure 2). These plump cells
showed moderate anisocytosis and anisokaryosis
with a low mitotic index
The dog was re-examined 10 days postoperatively and the surgical wound was healed. Two years
post surgically there was no evidence of neoplasm
recurrence.
Hemangiosarcoma is a malignant tumor of vascular origin that may originate anywhere in the body [4,5,8].
Primary neoplasms, especially of vascular origin, are
extremely rare in the third eyelid of dogs and include only
four documented cases in literature [2,7,9]. The cause of
HSA in most cases is unknown. Neoplasia affecting ocular
surface has been associated with increased exposure to
solar radiation [11,12]. HSA may occur in any part of
the eye and ocular adnexa [2,6,7,9]. Treatment reported
for dogs with conjunctival neoplasia is surgical excision
[2,7,9]. Definitive diagnosis requires histophatological
examination. The morphology of HSA range from well
differentiated cavernous dilatations of blood vessels to
highly cellular and anaplastic neoplasms [9]. This report
describes a case of HSA of the third eyelid in a dog that
was successfully treated with surgical excision.
CASE
A 5-year-old Boxer dog was referred to the
Ophthalmology Section in the Veterinary Clinics Hospital of the Federal University of Rio Grande do Sul
(UFRGS), Porto Alegre, RS, Brazil, for evaluation of a
red mass on the third eyelid in the right eye. This mass
was observed two months before the appointment. The
owner reported that the dog live outdoors on a farm.
The patient was in good physical condition. The dog
had signs of eye discomfort, epiphora, and bleeding
at the right eye. On ophthalmic examination a fixed,
raised, red mass approximately 4 to 5 mm in diameter
was identified on the anterior surface of the third eyelid
in the right eye (Figure 1). The dog was visually with
pupillary normal light reflexes in its both eyes (OU).
Schirmer tear test (Schirmer Tear Strips®)1 values were
17 and 30 mm in the left and right eye, respectively.
Fluorescein stain (Fluorescein strips®)1 was negative.
Intraocular pressure measured with an applanation
tonometer (Tonopen XL®)2 was normal (16 mmHg
OD, 18 mmHg OS). Portable slit lamp biomicroscopy
(Kowa SL 15)3 of the OD revealed a mild hyperemia
of the palpebral and bulbar conjunctiva of the nictitans
membrane. The remainder of the ophthalmic examination of the right eye was unremarkable. The left eye
was normal. Regional lymph nodes showed no increasing volume, and, thoracic and abdominal radiography
showed no abnormality. A complete blood count and
serum chemical profile were also normal.
DISCUSSION
Neoplasia of third eyelid has been described
in horses, cats and dogs [1,5,6,13]. HSA in the third
eyelid of dogs are quite uncommon and include only
four documented cases in literature [2,7,9].
Various studies have shown a linear relationship between exposure to ultraviolet radiation and
development of neoplasia affecting ocular surface
[2,4,5,7,12,13]. The outdoor housing of the dog of this
report in a sunny area resulted in a high exposure to
solar radiation. This case presents similarities to reports
previously described. Previous studies have indicated
that the average age for presenting the HSA in dogs is
between 5 and 13 years old and usually affecting large
breed dogs [2,7,9]. In our case, the dog was large breed
and had five years of age.
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J.A.T. Pigatto, L. Albuquerque, J. Voll & D. Driemeier. 2015. Hemangiosarcoma of the Third Eyelid in a Dog.
Acta Scientiae Veterinariae. 43(Suppl 1): 91.
Figure 1. Appearance of the hemangiosarcoma of the third eyelid at presentation.
Figure 2. Histological appearance of the conjunctival hemangiosarcoma.
The tumor was composed of neoplastic mesenchymal cells forming irregular
channels containing blood (40x).
Clinical signs will depend on the size and location of the tumor but they are usually concomitant
with the presence of a red mass in the third eyelid with
spontaneous bleeding [2,7,9]. In this report, tumor
of vascular origin was considered due to bloody eye
discharge. However, to obtain a definitive diagnosis
is necessary histopathological evaluation of the mass
after an incisional or excisional biopsy [2,7,9]. Possible
differential diagnoses for the nictitans mass in dogs
include squamous cell carcinoma, melanomas, adenocarcinomas, mastocytomas, papillomas, hemangiomas,
angiokeratomas, histiocytomas, and lymphosarcoma
[1,3,5,8,11,14]. In the present case, the diagnosis was
based on history and clinical signs, and confirmed by
confirmed by histopathological examination of the
mass after surgical excision. Microscopically, HSA
is characterized by vasoformative proliferations of
neoplastic endothelial cells with frequent intraluminal
erythrocytes [2,5,7,9]. According to the histophatologic investigation performed on the mass excised, a
conjunctival HSA was diagnosed. In the present case,
histological appearance was similar to that previously
described. Treatment of the HSA of the third eyelid is
highly dependent on the location of the tumor and the
degree of invasion of the underlying tissue [2,7,9,10].
In this case, hemangiosarcoma was confined to the conjunctiva of the third eyelid without invading underlying
structures. Due to the location and size of the mass,
in the present case, the surgical removal including a
margin of normal tissue was performed. Through this
procedure, the nictitating membrane was preserved.
Although the nictitating membrane involvement often
requires removal, this procedure had to be avoided
because of the predisposition to the development of
keratoconjunctivitis sicca [2].
In two previous reports the third eyelid and
amputation of the affected third eyelid was performed
[2]. In dogs, gland of nictitating membrane provides
about 25-40% of the total tears. Complete excision
of the nictitating membrane can predispose to keratoconjunctivitis sicca at later time. This highlights
the importance of the diagnosis and early treatment
to prevent the spread of HSA through the nictitating
membrane. Furthermore, better prognosis has been
attributed to early detection and removal of the tumor
with a safety margin [7].
HSA of the third eyelid in a cat has been successfully treated with a combination of surgical excision and cryotheraphy [10]. Due to the limited number
of cases of HSA in the third eyelid reported in previous
studies limited information regarding the efficacy of
the treatments can be obtained. Moreover, there are
no publications in the literature comparing surgical
treatment alone with surgical excision associated with
adjacent therapies such as cryotherapy. In the present
case, the treatment was apparently successful, because
our patient is still alive without presenting evidence of
metastasis and recurrence two years after the treatment.
Due to the small number of cases reported on the HSA
in the third eyelid of dogs, it has been difficult to determine a prognosis regarding metastasis or recurrence.
Surgical excision was effective for the treatment of HSA in the third eyelid of a dog. The findings
indicate that HSA must be considered in the differential
diagnosis of the neoplasm that affects the third eyelid
in dogs.
3
J.A.T. Pigatto, L. Albuquerque, J. Voll & D. Driemeier. 2015. Hemangiosarcoma of the Third Eyelid in a Dog.
Acta Scientiae Veterinariae. 43(Suppl 1): 91.
Declaration of interest. The authors report no conflicts of
interest. The authors alone are responsible for the content and
writing of the paper.
MANUFACTURERS
1
Ophthalmos. São Paulo, SP, Brazil.
2
Mentor Medical Systems. Santa Barbara, CA, USA.
3
Kowa Company Ltd., Aishi, Japan.
4
Alcon. São Paulo, SP, Brazil.
5
Allergan. Guarulhos, SP, Brazil.
6
Laboratórios Pfizer Ltda. São Paulo, SP, Brazil.
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