Total laryngectomy in a cat with a laryngeal peripheral nerve sheath tumor.

OBJECTIVE: To report the surgical technique and outcome of total laryngectomy in a single clinical case. STUDY DESIGN: Case report. ANIMAL: A 5-year-old female spayed domestic shorthair cat. METHODS: A cat presented for acute, severe respiratory distress caused by an invasive laryngeal mass. Incisional biopsy was indicative of sarcoma. Computed tomography of head, neck, and thorax was performed revealing no evidence of metastasis. A total laryngectomy and permanent tracheostomy were performed, and the cat could breathe without difficulties immediately postoperatively. Histopathology confirmed a laryngeal low-grade peripheral nerve sheath tumor (PNST). RESULTS: Surgical margins were free of tumor cells. Surgical revision of the tracheostomy stoma due to obstructive granulation tissue was necessary 24 days after the initial surgery. Nine days after revision surgery, the cat was discharged from the hospital. No evidence of local recurrence or metastasis was detected on repeat computed tomography of the head, neck, and thorax at 6 months, nor on chest radiographs at 12 months postoperatively. At the time of writing (13 months postoperatively), the cat is still alive with a good quality of life. CONCLUSION: Total laryngectomy with permanent tracheostomy allowed the complete removal of an obstructive laryngeal PNST and provided a good quality of life in a cat. CLINICAL SIGNIFICANCE: To the authors' knowledge, this case report represents the first detailed description of the surgical procedure and clinical outcome for a total laryngectomy in a cat.

Use of an electronic brachytherapy surface applicator to treat an epiglottal fibrosarcoma in a dog.

Presented is the case of an epiglottal fibrosarcoma in a dog. The location of the mass resulted in challenges in the delivery of adequate dose to the tumor, and herein we describe the treatment using an electronic brachytherapy source. The treatment consisted of four Gy fractions, twice daily for a total of 10 fractions (40 Gy total). Visual reevaluation two weeks after treatment supported adequate spatial dose delivery, and the patient was reportedly improved six weeks after treatment. We demonstrate that plesiotherapy using an electronic brachytherapy device is feasible and may be useful in the treatment of carefully selected veterinary tumors.

Cartilaginous Tumors of the Larynx and Trachea in the Dog: Literature Review and 10 Additional Cases (1995-2014).

Cartilaginous tumors of the larynx and trachea are uncommon in the dog. The authors describe 10 cases diagnosed between 1995 and 2014 and review 16 cases in the literature. Seven of our cases were tracheal and 3 were laryngeal. Two of the laryngeal tumors were chondromas, which have not been previously reported in this site. The third laryngeal tumor was a myxochondroma. Of the 7 tracheal tumors, 6 arose from the ventral tracheal wall, including 2 that were extraluminal. Tracheal tumor types included chondrosarcoma (n = 3), chondroma (n = 2), and osteochondroma (n = 2). All of the laryngeal tumors and 5 of 7 of the tracheal tumors occurred in adult dogs (aged 5-11 years). The 2 tracheal osteochondromas were in young dogs (3-4 months) and were intrathoracic, while the remaining tracheal tumors were cervical. Surgical excision had a good outcome in most cases. Combining our 10 cases with the 16 previously reported cases showed that 6 (27%) of the affected dogs were Arctic breeds (Alaskan Malamute or Siberian Husky) suggesting a predisposition in this type of dog.

Laryngeal and oropharyngeal adenocarcinoma with pulmonary metastases in a common raven (Corvus corax).

A captive 15-year-old male common raven (Corvus corax) was presented for post-mortem examination. It had been previously presented to a local veterinarian due to a 3-4 weeks long history of abnormal respiratory sounds. Upon admission, the bird demonstrated severe dyspnea and a massive amount of mucous in the oropharynx. After symptomatic treatment, dyspnea deteriorated dramatically, and euthanasia was elicited because of poor prognosis. The necropsy revealed a 2.65 x 2.15 x 2.18 cm expansile and poorly delineated cauliflower-shaped mass around the glottis and extending inside the tracheal lumen. Additionally, a dilated salivary gland in the adjacent tissue and multifocal reddish-fleshy areas in the lung parenchyma were detected. Histopathological examination identified the mass as moderately differentiated, tubular adenocarcinoma with invasive growth and moderate to marked cellular atypia and numerous mitoses. The presumptive origin of the neoplasia was one of the salivary glands. Multiple metastases were identified in the lung both macroscopically and histologically. Bacterial culture and molecular testing for West Nile and Usutu viruses were negative. To the authors' knowledge, this is the first report of metastatic laryngeal and oropharyngeal adenocarcinoma in a common raven.

Partial laryngectomy for the management of laryngeal masses in six cats.

OBJECTIVES: Partial laryngectomy is an organ-sparing surgical procedure for the removal of laryngeal masses which has not been described in cats. The aim of this study was to report on the surgical procedure and the short- and long-term clinical outcomes of cats that underwent partial laryngectomy. METHODS: Medical records were retrospectively collected over a 4-year period in two institutions. The following data were retrieved: signalment, history, clinical signs, diagnostic test results, surgical procedure, postoperative management, complications and outcome. RESULTS: Six cats underwent partial laryngectomy. The most common clinical signs in cats with laryngeal masses were stridor (n = 4) and dyspnoea (n = 4). In all cats, a full-thickness portion of one or several laryngeal cartilages was resected, including thyroid cartilage alone (n = 2), thyroid cartilage and arytenoid (n = 2), and arytenoid cartilage and epiglottis (n = 2). The resected laryngeal masses were reported to be lymphoma (n = 3), carcinoma (n = 1), laryngeal cyst (n = 1) and inflammatory laryngeal disease (n = 1). All cats survived the surgical intervention of partial laryngectomy. Four cats showed varying degrees of respiratory distress in the short-term postoperative period. A temporary tracheostomy tube was placed in two cats. No other postoperative complications were noted in the short- or long-term. Four cats were still alive at the time of writing. These cats survived at least 252 days. CONCLUSIONS AND RELEVANCE: In a small number of cases, our results show that successful long-term outcomes after partial laryngectomy are achievable, with longer survival times than previously reported. Therefore, partial laryngectomy should be considered as a viable treatment option in cats with laryngeal masses.

Total laryngectomy and permanent tracheostomy in six dogs.

The objective of this report is to describe the surgical technique for total laryngectomy and outcome in six dogs. Laryngeal cancer is an uncommon and challenging clinical problem. Total laryngectomy can provide local disease control but is uncommonly performed. Detailed procedural descriptions are limited and similarly limited information is available regarding patient outcome. Institutional medical records were searched for dogs treated with total laryngectomy. Six dogs were identified. The procedure resulted in postoperative quality of life similar to permanent tracheostomy alone. Surgical margin status was evaluated in five of six cases and was complete in those five. All dogs survived to discharge from the hospital. Complications were mostly related to tracheostomy occlusion or collapse which is recognized as a complication associated with permanent tracheostomy. Patient quality of life was acceptable. Local recurrence was suspected in one dog. Recurrence was not observed in the case with unknown margin status.

Undifferentiated laryngeal carcinoma with hyaline bodies in a cat.

BACKGROUND: Primary laryngeal neoplasms are rare in cats, with lymphoma and squamous cell carcinoma being the most commonly diagnosed tumour types. These tumours are usually highly aggressive, difficult to treat, and have a poor prognosis. Here an undifferentiated laryngeal carcinoma with hyaline bodies in a cat is reported. CASE PRESENTATION: A 13-year-old cat was presented for progressive respiratory signs. Diagnostic procedures revealed a partially obstructive laryngeal mass. Cytology was compatible with a poorly differentiated malignant tumour, with neoplastic cells frequently containing large intracytoplasmic hyaline bodies. After 1 month the patient was euthanised due to a worsening clinical condition and submitted for post-mortem examination, which confirmed the presence of two laryngeal masses. Histopathology confirmed the presence of an undifferentiated neoplasm with marked features of malignancy. Strong immunolabelling for pancytokeratin led to a diagnosis of undifferentiated carcinoma, however, histochemical and immunohistochemical investigations could not elucidate the origin of the large intracytoplasmic hyaline bodies observed in tumour cells, which appeared as non-membrane bound deposits of electron-dense material on transmission electron microscopy. CONCLUSION: This is the first report of primary undifferentiated laryngeal carcinoma in a cat. Our case confirms the clinical features and the short survival that have been reported in other studies describing feline laryngeal tumours. Moreover, for the first time in feline literature, we describe the presence of intracytoplasmic hyaline bodies in neoplastic cells that were compatible with the so-called hyaline granules reported in different human cancers and also in the dog.

Outcome of permanent tracheostomy for treatment of upper airway obstruction in cats: 21 cases (1990-2007).

OBJECTIVE: To determine clinical outcome of permanent tracheostomy in cats with upper airway obstruction. DESIGN: Retrospective case series. ANIMALS: 21 cats. PROCEDURES: Medical records were reviewed for information on history, signalment, clinical signs, results of preoperative clinicopathologic testing, cause of upper airway obstruction, surgical procedure, postoperative complications, and outcome. RESULTS: Causes of upper airway obstruction included neoplasia (squamous cell carcinoma [n = 6] or malignant lymphoma [2]), inflammatory laryngeal disease (5), laryngeal paralysis (4), trauma (3), and a laryngeal mass of unknown cause (1). Fourteen cats had dyspnea in the immediate postoperative period; dyspnea most often resulted from mucous plugs at the stoma or elsewhere in the respiratory tract. Eleven cats died, including 6 cats that died while hospitalized after surgery and 5 cats that died after discharge; 7 cats were euthanatized, most often because of progression of neoplasia; and 2 were still alive at the time of the study. The remaining cat was lost to follow-up after discharge from the hospital. Overall, median survival time for the 20 cats for which information was available was 20.5 days (range, 1 day to 5 years). Cats that underwent permanent tracheostomy because of inflammatory laryngeal disease were 6.61 times as likely to die as cats that underwent permanent tracheostomy for any other reason. CONCLUSIONS AND CLINICAL RELEVANCE: Results indicated that permanent tracheostomy was an uncommon procedure in cats with upper airway obstruction that was associated with high complication and mortality rates.

Laryngeal squamous cell carcinoma and papilloma associated with Equus caballus papillomavirus 2 in a horse.

A case of laryngeal squamous cell carcinoma (SCC) and squamous papilloma in a 19-year-old Thoroughbred stallion is described. The animal exhibited severe wheezing caused by laryngopharyngeal stenosis. Histological examination identified laryngeal, laryngotracheal, and guttural pouch tumor masses consisting of areas of SCC. In the epiglottic lesion, the overlying epithelium was replaced by papilloma cells, and superficial cells frequently had nuclear inclusion bodies that expressed oncoprotein E6, which is characteristic of high risk human papillomaviruses. The papillomatous epithelium was continuous with epithelium composed of SCC cells. Equus caballus papillomavirus 2 (EcPV2) DNA was detected in the guttural pouch tumor. These findings suggest that laryngeal SCC and papilloma are a continuum of EcPV2-induced neoplastic lesions in horses.

Granular cell tumour affecting the left vocal cord in a dog.

Granular cell tumours (GCTs) have been described in human vocal cords, but not in those of the dog. A single polyp in the left vocal cord, associated with laryngeal oedema and monolateral hyperplasia of the tonsil, was observed endoscopically in a 6-year-old male dog. Cytologically, the mass was characterized by well-defined polygonal cells, with granular cytoplasm and an eccentric nucleus. Histologically, the mass showed sheets of globoid to polygonal cells, filled with numerous diastase-resistant, periodic acid-Schiff-positive granules, and scanty stroma. Ultrastructurally, the granules were represented by heterogeneous lysosomes of variable size, suggesting a diagnosis of GCT. As reported in man, hyperplasia of the laryngeal and tonsillar epithelium and the presence of foci of pearl-like epithelial cells, mimicking invasive squamous cell carcinoma, were observed. Immunohistochemical examination revealed labelling of neoplastic cells for S-100 protein, CD68, collagen IV, and, focally, for glial fibrillary acidic protein, neuron-specific enolase and vimentin. These findings suggested a Schwann cell origin of the GCT.

Tracheostomy in cats: 23 cases (1998-2006).

Tracheostomies can be used to provide a patent airway in animals with upper airway obstruction but have been reported to be more difficult to manage in cats than in other animals. The purpose of this study is to retrospectively describe the indications, complications and outcome of cats undergoing tracheostomy. Twenty-three cats underwent tracheostomy for laryngeal mass (n=13), trauma (n=5) and upper airway swelling (n=5). Major and minor complications were recorded in 10 and 17 cats, respectively. Seventeen cats were discharged to home, four cats were euthanased and two cats died in hospital. Complications with stoma healing were reported in one cat. Of seven cats discharged with a permanent tracheostomy, one cat is alive and six cats survived at home for between 2 and 281 days. Although complications are common, temporary tracheostomies can be beneficial for conditions in which the underlying cause can be treated. Despite risk of occlusion, permanent tracheostomies can be effective palliative procedures for cats with severe upper airway disease.

Solitary extramedullary plasmacytoma of the canine larynx.

An 11-year-old, female, spayed cocker spaniel was presented with dysphonia caused by a solitary laryngeal mass. Excisional biopsy was performed, and a diagnosis of plasmacytoma was made on the basis of histological examination. Further investigations showed no signs of systemic involvement. Coarse fractionated radiation therapy failed to control the tumour. Therapy was successfully instituted with a conventional combination chemotherapy protocol over a period of 14 months. The dog remains disease free 30 months after diagnosis. Most solitary, extramedullary plasmacytomas in dogs arise in the gastrointestinal tract, with fewer reports in other sites. The larynx is an uncommon sight of involvement in any species, and to the authors' knowledge, this is the first report of this tumour type in the canine larynx. In contrast to the therapeutic benefits reported in humans, the combination of surgery and radiation therapy was unsuccessful in this case, although sustained remission was gained following chemotherapy.

A cat with suspected laryngeal metastasis with mucosal irregularity resulting from apocrine/salivary gland adenocarcinoma in the head.

A 16-year-old castrated male mongrel cat presented with swelling under the left pinna and a 3 -month history of voice change. Laryngeal endoscopy revealed circumferential oedema around the arytenoid cartilages and hypersecretion of saliva. Histopathological examination of the mass around the left ear canal was considered the primary lesion that originated from cutaneous apocrine adenocarcinoma or parotid gland adenocarcinoma, and it metastasized to the larynx, lung and medial retropharyngeal lymph nodes. This report provides new insights into feline laryngeal diseases which could result in laryngeal metastasis with slight mucosal irregularity alone and without obvious radiographic abnormalities. Therefore, histopathological examination should be performed when a cat presents clinical signs such as stridor, dysphonia or voice change without any mass-forming laryngeal lesion.

Charcot-Leyden crystals: do they exist in veterinary species? A case report and literature review.

The Charcot-Leyden crystal (CLC) is a major human eosinophil protein that readily crystallizes; these crystals are common in eosinophilic diseases. Although anecdotal existence of these crystals is known in veterinary pathology, definitive reports do not exist, to our knowledge. We identified eosinophilic crystals in a laryngeal myxosarcoma from a 2-y-old, spayed female, Labrador Retriever dog that were tentatively interpreted as CLCs. However, Ziehl-Neelsen acid-fast stain was negative, arguing against CLCs. The crystals stained red with Masson trichrome, precluding collagen. Periodic acid-Schiff and alcian blue were negative. The crystals stained positively with Okajima, and no myoglobin immunoreactivity was detected, supporting their identity as hemoglobin crystals. In the absence of a hematologic abnormality, these crystals were interpreted to be abnormal hemoglobin breakdown products. Protein sequence comparison was pursued to determine whether a protein similar to CLC exists in mammals. Only 3 nonhuman primate species, the Sumatran orangutan ( Pongo abelii), rhesus macaque ( Macaca mulatta), and cynomolgus monkey ( Macaca fascicularis), had a sequence similarity of >80%. Of the crystal-forming residues, 12 of 54 (22%) were different in the Sumatran orangutan and 15 of 54 (28%) were different in the Macaca spp., which may affect the crystallization process. The lack of reports of CLCs in nonhuman species and our results collectively suggest that CLCs are human-specific.

Laryngeal, laryngotracheal, and tracheal masses in cats: 27 cases (1998-2003).

Medical records of 27 cats with masses of the larynx and trachea were examined. Six cats had inflammatory masses, and 21 cats had neoplastic lesions. A definitive diagnosis was reached in 22 cats with a single biopsy. The median age of the cats was 12.0 years (range 6 to 20 years). Dyspnea was the most common clinical sign. Accurate diagnoses were best obtained through direct laryngeal or tracheal examination combined with histological examination of tissue biopsies. Kaplan-Meier survival data for all inflammatory and neoplastic lesions showed a median survival of 5 days, with 7.4% of cats alive at 1 year.

Laryngeal squamous cell carcinoma in a North American black bear (Ursus americanus).

A 10-yr-old female black bear (Ursus americanus) at the North Carolina Zoological Park presented with a 2-wk history of intermittent coughing and stertor. The animal was anesthetized for examination, and at intubation, a large mass associated with the tonsils and larynx was observed obstructing the airway. Cardiopulmonary collapse occurred during the procedure, and efforts at resuscitation were ineffective. At necropsy, an 8 cm times 6 cm times 5 cm mass was present in the larynx, infiltrating the epiglottis and obstructing the airway. Regional lymph nodes were mildly enlarged and contained tan inspissated substance. Histologically, the neoplasm was composed of nests of keratinizing squamous epithelial cells with evidence of lymphatic invasion and metastases to regional lymph nodes.

Intraoral diode laser epiglottectomy for treatment of epiglottis chondrosarcoma in a dog.

Laryngeal tumours are rare in dogs. Surgery is the treatment of choice, but it is usually palliative in malignant conditions, due to advanced stage of the tumour at the time of diagnosis. In veterinary medicine, little information is available about the use of diode laser in laryngeal oncological surgery. In the case reported here, a dog with an epiglottic chondrosarcoma was successfully treated with diode laser epiglottectomy. The surgical technique and follow up are described.

Spontaneous laryngeal disease in the canine.

This report describes the type and incidence of spontaneous laryngeal disease in the dog. Signs of laryngeal disease are similar to those in other species. Dogs are usually presented with inspiratory obstructive dyspnea or stridor, since earlier signs are often missed. Severe, congenital abnormalities may occur unrecognized due to neonatal death. Subtle anomalies are seldom presented. Congenital paralysis of the laryngeal musculature has been seen in the Bouvier des Flandres and the Siberian Husky. Laryngeal obstruction occurs commonly in brachycephalic dogs (Bulldog, Boxer, Boston Terrier, Pug, Pikingese). The forshortened nasal cavity and pharynx result in reduced airway space. The result is inspiratory obstruction varying from noisy respiration to severe obstruction with cyanosis and syncope. Everted laryngeal ventricles are most common in these dogs. Mild degrees of ventricular edema are common in small breed dogs with lower respiratory disease and in field-trial Beagles due to voice abuse. Traumatic injuries to the larynx and hyoid apparatus are not rare. Bite wounds from dog fights are the most common cause. Compression fractures are rare, but injuries associated with shearing stresses, due to being shcken by the neck cause airway obstruction. These types of injuries include avulsion of the aryepiglottic folds, longitudinal tearing of the epiglottis, arytenoid displacement, hyo-laryngeal separation, and laryngotracheal separation. Delayed signs of recurrent nerve damage are common in severe laryngotracheal injuries.

Laryngeal carcinoma in a cat.

Laryngeal neoplasia was diagnosed in a 5-year-old domestic shorthair cat examined for cough and gagging episodes. Resection of the mass revealed a squamous carcinoma which had invaded the deep floor of the larynx. Primary neoplasia of the feline larynx is a rare condition but needs to be distinguished from other obstructive laryngeal conditions, using radiography, laryngoscopy and biopsy.

Development of hypoparathyroidism after excision of laryngeal rhabdomyosarcoma in a dog.

An uncommon neoplasm of the larynx, rhabdomyosarcoma, was diagnosed in a 6-year-old 14-kg neutered female Spitz. In addition to the progressive onset of expected clinical signs of the tumor (exercise intolerance, respiratory stridor, inability to bark), the dog experienced hyperthermic crisis. Laryngectomy was successful in eradicating the local neoplastic tissue; however, unusual postoperative complications developed and included acute complications of pharyngotracheal fistula and hypoparathyroidism, and long-term complications of periodic collapse of the tracheal stoma and intolerance to heat. Probable causes and successful management of these complications are described. At 22 months after laryngectomy, the dog was admitted for a solitary hepatic metastasis. While hospitalized, the dog died of apparent asphyxiation attributable to stoma collapse.