Marginal resection and infracyanine green-mediated photodynamic therapy in the management of feline eyelid squamous cell carcinoma: Two cases.

OBJECTIVE: Describe the presenting features, surgical procedure, and clinical outcomes of two cats managed with marginal resection and photodynamic therapy (PDT) for eyelid squamous cell carcinoma (SCC). ANIMALS STUDIED: A 12-year-old female spayed domestic shorthair cat (case 1) and a 10-year-old female spayed domestic shorthair cat (case 2). PROCEDURES: Following marginal resection of the eyelid neoplasm, hemostasis was achieved using a handheld cautery unit then 1 mL of infracyanine green was injected into the surgical wound bed. Photodynamic therapy was performed using an 810 nm diode laser in two consecutive steps: (i) six cycles at 500 mW for 30 s per cycle, using a rapid movement; then (ii) one (case 1) or two cycles (case 2) of 30 s at 2000 mW, using a slow deliberate movement to effect (charred surface). RESULTS: Histopathology was consistent with SCC resected with incomplete margins in both cats. Follow-up duration was 416 and 161 days in case 1 and case 2, respectively. Consecutive exams and photo-documentation (in clinic or by owners) showed appropriate healing of the lower eyelid, with a smooth lid margin, and no evidence of tumor regrowth or ocular irritation. Subtle trichiasis was noted in case 1 on day 185, but not at the last follow-up. CONCLUSIONS AND CLINICAL RELEVANCE: Marginal resection followed by PDT may be a valid alternative to complete surgical resection of periocular SCC in cats. The procedure was easy to perform, post-operative recovery was uncomplicated, and neither cat developed recurrent disease during the follow-up period.

Mucocutaneous subdermal plexus flap for complete excision of a malignant dermal and conjunctival melanoma in a dog.

PURPOSE: To perform a reconstructive blepharoplasty to obtain complete surgical excision of a darkly pigmented raised conjunctival-eyelid mass of the lower eyelid in a dog. ANIMAL STUDIED: A 7-year-old, female-spayed, Yorkshire Terrier was evaluated for a slowly progressive, dark brown-to-black raised mass of the lower left eyelid. Sampling of the mass via fine-needle aspirate or incisional biopsy was declined, and an excision of the mass with the goal to obtain complete margins and maintain normal eyelid function with cosmesis was elected. PROCEDURES: The lower palpebral conjunctival-eyelid pigmented mass was excised en bloc and the lower eyelid was reconstructed with a mucocutaneous subdermal plexus flap. RESULTS: Histopathology revealed a malignant dermal and conjunctivalmelanoma excised with complete margins (1-2 mm). Short-term complications included corneal ulceration and eschar formation, which resolved completely at the 1-month follow-up. Long-term complications included mild trichiasis with epiphora and porphyrin staining. Tumor recurrence was not observed during an 8-month follow-up period. CONCLUSIONS: The en bloc excision with mucocutaneous subdermal plexus flap was successful in obtaining complete surgical margins for a malignant conjunctival-eyelid melanoma. An excellent functional and cosmetic outcome was achieved without tumor recurrence during an 8-month follow-up period. A mucocutaneous subdermal plexus flap can be considered as a surgical option for malignant melanoma of the lower eyelid.

Standard and modified glabellar flap for medial canthus reconstruction following mass removal in three dogs and two cats.

PURPOSE: To describe the surgical technique and clinical outcomes of the glabellar flap and its modification for the reconstruction of the medial canthus following resection of tumors in three dogs and two cats. METHODS: Three dogs (7-, 7-, and 12.5-year-old mixed breeds) and two cats (10- and 14-year-old Domestic shorthair) presented with a 7-13 mm tumor affecting the eyelid and/or conjunctiva in the medial canthal region. Following en bloc mass excision, an inverted V-shaped skin incision was made in the glabellar region (i.e., the area between the eyebrows in humans). The apex of the inverted V-shaped flap was rotated in three cases, whereas a horizontal sliding movement was performed in the other two cases to better cover the surgical wound. The surgical flap was then trimmed to fit the surgical wound and sutured in place in two layers (subcutaneous and cutaneous). RESULTS: Tumors were diagnosed as mast cell tumors (n = 3), amelanotic conjunctival melanoma (n = 1), and apocrine ductal adenoma (n = 1). No recurrence was noted in a follow-up time of 146 ± 84 days. Satisfactory cosmetic outcome with normal eyelids closure was achieved in all cases. Mild trichiasis was present in all patients and mild epiphora was noted in 2/5 patients, but there were no associated clinical signs such as discomfort or keratitis. CONCLUSIONS: The glabellar flap was easy to perform and provided a good outcome in terms of cosmetic, eyelid function, and corneal health. Postoperative complications from trichiasis appear to be minimized by the presence of the third eyelid in this region.

Caudal Auricular Axial Pattern Flap for the Reconstruction of the Upper Eyelid in Three Cats.

Three cats bearing malignant tumors (two squamous cell carcinomas and one peripheral nerve sheath tumor) affecting the upper eyelid (UE) were treated by en bloc tumor removal. A caudal auricular axial pattern flap was used for reconstruction, and its margin was sutured to only the medial and lateral canthus in two cats; in the third cat, a narrow strip of spared conjunctiva was sutured to the flap margin. Postoperatively, superficial corneal ulcers occurred in two cats, but they healed with topical treatment. Apart from a reduced ability to blink, no further functional deficits persisted, and the long-term cosmetic appearance was considered satisfactory by the owners. Tumor-free excisional margins were achieved in two cases. Tumor recurrence in the long-term was observed for two cats, 350 and 380 days after surgery, one of whom had excisional noninfiltrated margins on histologic examination. UE reconstruction to preserve eyelid function following tumor excision without exenteration is challenging. In selected cases, caudal auricular axial pattern flap is one of the surgical options available to reconstruct the defect resulting from en bloc UE removal without any replacement of the mucosal layer.

Hübner's eyelid reconstruction using a free tarsomarginal autograft in eight dogs. A retrospective study.

OBJECTIVE: The aim of our work was to study the potential of tarsomarginal grafting technique, in canine. ANIMAL STUDIED: All dogs included in this study had tumors of the upper or lower eyelid. Furthermore, resection of the tumor necessitated excision of the eyelid margin comprising 1/4 and 2/3. PROCEDURE: Harvesting of the graft with the length of half the length of the tumor, including its free margins was performed via a full-thickness incision on the ipsilateral healthy eyelid. The cutaneous layer and all of the muscle fibers of the transplant were meticulously removed except a 3 mm strip along the free lid margin. A full-thickness tumor excision was then performed. The graft was sutured at the level of the defect to be reconstructed. A sliding H flap was generated. The resulting nourishing myocutaneous flap was then sutured along the free margin of the tarso-conjunctivo-marginal graft. The lateral edges of the advancement flap were sutured to the edges of the receiving sites. RESULTS: The average size of the reconstructed area was 17.8 mm. The resulting stretched lid fissure length after surgery was shortened over 7 to 11 mm. This technique for grafting was used to reconstruct an eyelid that had lost tissue measuring between 1/4 and 2/3 of its length. The few complications that were encountered were mainly the occurrence of keratitis or suture dehiscence. CONCLUSIONS: This tarsomarginal grafting technique has yielded encouraging results in dogs. This technique can fill large lid defects with a physiologic lid margin but is shortening the stretched lid fissure length.

Clinical and immunophenotypic findings in 4 forms of equine lymphoma.

The clinical, histological, and immunophenotypic findings are presented for 4 horses affected by different types of lymphoma. Diagnoses of a monomorphic epitheliotropic intestinal T-cell lymphoma, a diffuse splenic large B-cell lymphoma, a peripheral T-cell lymphoma, and a T-cell rich large B-cell lymphoma of the third eyelid were made.

Constatations cliniques et immunophénotypiques pour quatre formes de lymphomes équins. Les constatations cliniques, histologiques et immunophénotypiques sont présentées pour quatre chevaux affectés par différents types de lymphome. Des diagnostics d'un lymphome intestinal épithéliotrope et monomorphe à cellules T, d'un lymphome splénique diffus à grandes cellules B, d'un lymphome périphérique à cellules T et d'un lymphome à grandes cellules B riche en cellules T de la troisième paupière ont été posés.(Traduit par Isabelle Vallières).

Orbital invasive squamous cell carcinoma with adnexal involvement clinically mimicking feline restrictive orbital myofibroblastic sarcoma: 19 cases (1990-2016).

OBJECTIVE: To describe the clinical presentations of patients diagnosed with ocular adnexal or orbital squamous cell carcinoma (SCC), which possess features similar to feline restrictive orbital myofibroblastic sarcoma (FROMS). PROCEDURES: A retrospective review of adnexal and/or orbital SCC was performed. Cases were collected from the University of Georgia College of Veterinary Medicine and the Comparative Ocular Pathology Laboratory of Wisconsin (COPLOW) (1990-2016). Data included signalment, ophthalmic clinical signs, nonophthalmic history and clinical signs, clinician suspicion of FROMS, advanced imaging results, and subsequent histopathologic diagnosis. FROMS cases from the COPLOW over the same time span were reviewed and compared statistically to the SCC cases with a significance threshold of 0.05. RESULTS: Nineteen cases (20 eyes) were identified with adnexal SCC with features similar to FROMS, including keratitis and eyelid/third eyelid restriction and/or thickening. There were no statistically significant differences between clinical findings in the SCC cases and the identified and compared FROMS cases (57 cases; 67 eyes), except for exophthalmos and/or resistance to retropulsion, which was less common in SCC cases (20%) than in FROMS cases (47.8%) (P = 0.027); and clinical or imaged presence of an overt eyelid or orbital mass, which was more common in the SCC cases (30%) than in the FROMS cases (4.5%) (P = 0.0010). CONCLUSIONS: SCC with adnexal involvement has many features similar to FROMS. In addition to FROMS, SCC should be considered a differential diagnosis in cats with restrictive adnexal or orbital signs and corneal changes.

Periocular Neoplasia in the Horse.

Periocular neoplasia is common in horses. Treatment of the periocular skin and ocular adnexal structures can be technically challenging. Common neoplastic conditions, a treatment algorithm, surgical principles, and therapeutic modalities are reviewed. Regardless of the type of neoplasia found or the treatment that is applied, success is most likely when the neoplastic tumor is small.

Characterization of fibropapillomatosis in green turtles Chelonia mydas (Cheloniidae) captured in a foraging area in southeastern Brazil.

Fibropapillomatosis (FP) is a multifactorial disease that affects all species of marine turtles, including green turtles Chelonia mydas (Linnaeus, 1758). It is characterised by the development of internal or external tumours that, depending on their locations and sizes, may intensely impact the health condition of sea turtles. The goal of this study was to characterise the disease in C. mydas found in a foraging area in southeastern Brazil, evaluate the prevalence in this region, and correlate presence and absence, size, body distribution, number of tumours, and disease severity with biometric variables of the captured green turtles. Between 2008 and 2014, the prevalence rate of FP was 43.09%, out of 246 green turtles. The size of the animals with FP was relatively greater than animals without tumours, and the prevalence of FP increased with animal size, peaking in the 60-80 cm size class. From 2013 to 2014, gross evaluation of fibropapillomas was performed. The number of tumours per turtle ranged from 1 to 158. The size of tumours ranged from <1 cm (Size A) to >10 cm (Size D); Size A tumours and turtles slightly affected by the disease (Score 1) predominated. Tumour progression (72.1%) and regression (32.8%) were seen in some recaptured individuals (n = 61). Moreover, 24.6% of these turtles showed both progressions and regressions of tumours.

Third eyelid gland neoplasms of dogs and cats: a retrospective histopathologic study of 145 cases.

PURPOSE: To describe the various types of primary neoplasms affecting the third eyelid (TEL) gland of dogs and cats. METHODS: A retrospective search of the Comparative Ocular Pathology Laboratory of Wisconsin (COPLOW) database was performed. Veterinary ophthalmologists, primary care veterinarians, and, when appropriate, owners were contacted for patient follow-up information. Patient data points collected included species, age, sex, breed, laterality, tumor type, surgical margins, recurrence, metastasis, and length of follow-up. RESULTS: A total of 127 canine and 18 feline cases met the inclusion criteria. The most common canine TEL gland tumor was adenocarcinoma (n = 108; 85.0%) followed by adenoma (n = 18; 14.2%) and squamous cell carcinoma (SCC) (n = 1; 0.8%). For canine cases with follow-up information available (n = 62), 8.1% had confirmed or suspected metastasis and 11.3% had confirmed or suspected local recurrence of disease. The most common feline TEL gland tumor was adenocarcinoma (n = 15; 83.3%) followed by SCC (n = 3; 16.7%). For feline cases with follow-up information available (n = 9), 40.0% had confirmed or suspected metastasis and 30.0% had confirmed or suspected local recurrence of disease. CONCLUSIONS: This study determined that adenocarcinoma was the most common third eyelid gland tumor in both dogs and cats. The overall survival times were less, and metastatic occurrence and recurrence rates appeared to be higher for feline tumors as compared to those diagnosed in dogs. This is the first report of SCC originating from glandular ductular epithelium.

Evaluation of one- vs. two-layered closure after wedge excision of 43 eyelid tumors in dogs.

OBJECTIVE: The aim was to evaluate how two closure techniques after full-thickness V-shaped excision relate to wound recovery and how these techniques affect eyelid function and stability of the preocular tear film. ANIMALS STUDIED: Thirty-eight dogs with 43 eyelid tumors involving <25% of eyelid margin length were included in a prospective randomized trial. PROCEDURES: The method for wound closure was chosen randomly before the operation. In group A (n = 20), the wound was closed in one layer and in group B (n = 23) in two layers. The wound and eyelid structure were directly evaluated by slit-lamp biomicroscopy several times postoperatively. Eyelid function was indirectly evaluated by interferometry, noninvasive tear film breakup time (nTFBUT), and Schirmer's tear test at the last examination, 5 weeks to 19 months postoperatively. RESULTS: No significant differences were found in group A vs. B although slightly more cases with perfect alignment of the eyelid were seen in group B. In both groups, neither slit-lamp biomicroscopy, interferometry, nTFBUT, nor Schirmer's tear test revealed negative influence on the eyelid function by the previous surgery. Histologically, 29 of 32 tumors were diagnosed as meibomian gland adenomas. CONCLUSIONS: These results do not demonstrate a significant difference in wound recovery, eyelid structure, and function after wound closure in 1 vs. 2 layers.

Solitary eosinophilic granulocytic sarcoma in a dog.

A 6-year-old male golden retriever presented with swelling of the left upper eyelid of 2 months duration, which did not improve following a course of antibiotics. Routine serum biochemistry, complete blood count and diagnostic imaging identified no clinically significant abnormalities. The mass was surgically excised, and histopathologic examination was performed. Eosinophilic granulocytic sarcoma (GS) was diagnosed based on the results of histopathology and immunohistochemistry. This is the first report of GS affecting the eyelid of a dog.

A case of well-differentiated palpebral liposarcoma in a Guinea pig (Cavia porcellus).

Liposarcomas are rare malignant tumors of the adipose tissue which are well described in humans and animals. Wide margin excision is the recommended treatment for these infiltrative, slow to metastasize tumors. Primary liposarcoma with ocular localization is a very rare tumor in humans, dogs and cats. This report describes, for the first time, a palpebral liposarcoma in a 18-month old guinea pig that presented with a large palpebral mass and purulent discharge in the right eye. The ophthalmic evaluation revealed a one-centimeter infiltrating subcutaneous mass within the upper eyelid, a severe chemosis and hyperhemia of the palpebral and bulbar conjunctiva of the right eye. Cytologic examination of the mass revealed only epithelial cells. Histologic examination interpreted the lesion as a xanthogranulomatous reaction possibly secondary to meibomian gland rupture or inflammation. One month later, the mass had increased in size and the animal had stopped eating. Euthanasia was performed and a large biopsy was submitted for another histological examination. Histopathology revealed polygonal to rounded cells with a large, empty intracytoplasmic vacuole, and an ovoid, eccentrically located nucleus. The histology was consistent with a well-differentiated liposarcoma. Given the unusual location, immunohistochemistry was performed to ascertain the mesenchymal nature of the neoplasm.

Malignant transformation of a putative eyelid papilloma to squamous cell carcinoma in a dog.

A 6-year-old female spayed Chihuahua was presented for the evaluation of generalized pigmented cutaneous masses, one of which was present on the lower right eyelid. The dog was not on immunosuppressive medications and did not have historical or laboratory evidence of underlying endocrine disease, including hypothyroidism and hyperadrenocorticism. Histopathology, immunohistochemistry, and polymerase chain reaction of a cutaneous biopsy from the left antebrachium containing representative lesions confirmed viral papillomatosis. Additionally, histopathology of the antebrachial mass revealed regions of epithelial dysplasia suggestive of possible early transformation to malignancy. Over the course of 5 months, the mass on the right lower eyelid progressed to encompass and efface the majority of the eyelid margin. Additionally, the eyelid tumor had changed from an ovoid, brown pigmented mass to an irregular, flesh-colored mass. At the dog's last recheck examination, a corneal ulcer had developed beneath the irregular dorsal margin of the tumor. Histopathology of the eyelid mass was consistent with squamous cell carcinoma (SCC) and was positive for the presence of papillomavirus using polymerase chain reaction. This report describes the transformation of a putative viral eyelid papilloma into a malignant SCC in an adult dog.

Moh's micrographic surgery for the management of a periocular mast cell tumor in a dog.

A 3-year-old neutered male boxer dog presented with a 6-month history of a waxing and waning mass of the left dorsotemporal eyelid margin. Cytology and biopsy confirmed a diagnosis of mast cell neoplasia. Systemic staging of the dog failed to reveal any evidence of metastatic neoplasia. Owing to the location of the tumor within the eyelid margin and the wide surgical margins recommended for excision of mast cell tumors, Mohs micrographic surgery (MMS) was chosen for its potential to conserve tissues while providing intraoperative confirmation the tumor was completely excised. Utilizing MMS horizontal sectioning technique, 100% of the surgical margins were assessed prior to closure of the surgical wound. This represents the first time a comprehensive MMS protocol was used in a veterinary patient under general anesthesia.

Combined excision and intralesional bevacizumab for sebaceous carcinoma of the eyelid in an Amur tiger (Panthera tigris altaica).

An 18-year-old zoo-kept female Amur tiger presented with an approximately 5 mm diameter lateral canthal eyelid mass in the left eye which grossly appeared red and irregular. The mass was completely excised via lateral canthoplasty. Histopathologic evaluation was consistent with a diagnosis of sebaceous cell carcinoma, which is a potentially aggressive cutaneous neoplasm. The sebaceous carcinoma recurred within 3 months and slowly increased in size until a second surgical excision was performed 9 months following the first surgery. The second surgical excision was combined with intralesional injection of 10 mg of the antiangiogenic drug bevacizumab. Histology confirmed the diagnosis. The tiger was euthanized 16 months postoperatively for reasons unrelated to, and without recurrence of, the eyelid neoplasm. At postmortem, no gross periocular or metastatic lesions were noted, and histopathology of the lateral canthus provided no evidence of recurrence. Surgical excision combined with intralesional bevacizumab treatment induced life-long resolution of the sebaceous carcinoma. Bevacizumab treatment may be associated with the regression of periocular angiogenic proliferative conditions, including neoplasia, by inhibiting angiogenesis.

Extraocular lymphoma in the horse.

OBJECTIVE: To describe the clinical findings and prognosis for extraocular lymphoma in the horse. PROCEDURES: Retrospective medical records study of horses diagnosed with third eyelid, corneoscleral, conjunctival, and/or eyelid lymphoma from multiple academic and private veterinary institutions. Data collected from the medical records included signalment, clinical descriptions of the extraocular lesions, treatment, and treatment outcomes. Nonparametric statistical analysis was performed with Fischer's exact tests. RESULTS: Extraocular lymphoma involving the eyelid, third eyelid, cornea, sclera, and/or conjunctiva was diagnosed in 26 horses. Differences in signalment, unilateral vs. bilateral extraocular involvement, and single vs. multiple extraocular lesion locations held no significance in terms of outcome. ANIMALS STUDIED: Horses with lesions localized to the eyelid or other nonextraocular cutaneous locations had a significantly higher chance of negative outcome when compared to the horses with no eyelid or cutaneous involvement (P = 0.019). Lesions to the third eyelid, corneosclera, and conjunctiva were either nodular or diffuse in nature. Nodular lesions when compared to diffuse lesions were associated with a higher chance of a positive outcome (P = 0.007). Surgical resection of the extraocular lesions as part of the treatment produced a statistically higher chance of a positive outcome when compared to horses where resection was not performed (P = 0.03). CONCLUSIONS: The prognosis for clinical remission in horses with extraocular lymphoma is generally fair to good, as long as the affected tissues are completely excised, and there is no eyelid or cutaneous involvement. Horses diagnosed with the nodular form of extraocular lymphoma seem to have the best prognosis with complete excision.

Canine eyelid granular cell tumor: a report of eight cases.

To describe a previously unreported neoplasm of the medial canthus and eyelid in dogs. Clinical and pathologic features of granular cell tumors in the dog were reviewed. Granular cell tumors, arising from the medial canthal eyelid of eight dogs, were identified from the archives of the Comparative Ocular Pathology Laboratory of Wisconsin (COPLOW). The affected dogs ranged in age from 5 to 12 years (mean of 9.25 years). Follow-up information was available for seven of the eight cases. The clinical presentation included swollen hyperemic lids (4/8), ulcerated skin overlying the mass (2/8), and red conjunctiva (7/8). All eight of the cases had firm masses extending from the palpebral conjunctiva to the eyelid margin at the medial canthus. Histologically, the tissue was composed of a highly collagenous neoplastic growth. The neoplastic cells were oval to strap-like cells with an oval bland appearing nucleus and abundant amounts of granular cytoplasm with very distinct cell boundaries. These granular cells were embedded in a dense collagen matrix. A PAS stain faintly highlighted the granular appearance of the neoplastic cells, which is a defining characteristic of this tumor. There was no recurrence in the seven cases available for follow-up. Canine granular cell tumors of the medial canthus present clinically and histologically as a benign neoplasm. Granular cell tumors have a characteristic histological appearance. Granular cell tumors should be on the differential list for nodules of the medial canthus in dogs.

Third eyelid dermoid in a horse.

An 8-year-old Gypsy Vanner gelding presented to the University of Florida Ophthalmology service for the evaluation of chronic, recurrent corneal ulcers behind the third eyelid of the right eye. On ophthalmic examination, a cluster of aberrant hairs was identified growing along the margin of the third eyelid. This portion of third eyelid was surgically excised, and histopathology identified the haired tissue as a dermoid. Chronic keratitis secondary to a third eyelid dermoid was diagnosed, and excision appeared curative at 6 months post-operative follow-up.

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.