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Ocular and Periocular Tumorsin Cats2011 WSAVA
Jeju Island Korea
Richard R Dubielzig
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Anatomic distribution of feline Anatomic distribution of feline primary ocular neoplasia (n = 2599)primary ocular neoplasia (n = 2599)
82%
12.3%
4.4%
1.15%
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Melanoma: 1510 of 2766 tumors or 55%
– Diffuse Iris Melanoma ... 1340 (263 Early)– “Atypical” ….. 27– Limbal ……… 46– Conjunctival… 27– 70 mostly DIM improperly labeled
Kalishman JV, Chappell R, Flood LA, Dubielzig RR (1998).A matched observational study of survival in cats with enucleation due to diffuse iris melanoma. Vet. Ophthal. 1: 25-29.
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Typical Clinical Appearance of Feline Diffuse Iris Melanoma
Asymmetrical Darkening of the IrisThis process can occur rapidly
or it can take years
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Typical Histopathologic Appearance of Feline Diffuse Iris Melanoma
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Typical Gross Appearance of Feline Diffuse Iris Melanoma
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Ages of Cats with Melanosis, Early Melanoma, Melanoma, and Extensive Melanoma
0
0.02
0.04
0.06
0.08
0.1
0.12
0.14
Percent of n
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20Age (years)
Progression of Feline DIM
MelanosisEarly DIMDIM (not extensive)Extensive DIM
Melanosis n = 84
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Ages of Cats with Melanosis, Early Melanoma, Melanoma, and Extensive Melanoma
0
0.02
0.04
0.06
0.08
0.1
0.12
0.14
Percent of n
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20Age (years)
Progression of Feline DIM
MelanosisEarly DIMDIM (not extensive)Extensive DIM
Early Melanoma n = 325
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Ages of Cats with Melanosis, Early Melanoma, Melanoma, and Extensive Melanoma
Melanoma (not extensive) n = 1242
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Ages of Cats with Melanosis, Early Melanoma, Melanoma, and Extensive Melanoma
0
0.02
0.04
0.06
0.08
0.1
0.12
0.14
Percent of n
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20Age (years)
Progression of Feline DIM
MelanosisEarly DIMDIM (not extensive)Extensive DIM
Extensive Melanoma n = 272
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Metastatic Potential of Feline Diffuse Iris Melanoma
All of the cases with metastasisin the COPLOW collection wereextensive in the original enucleation
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Evisceration Followed by IntrascleralProsthesis is Not Recommended
in Cats with FDIM
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Cats with Extensive FDIM atthe Time of Enucleation are MoreLikely to Have a Shortened Life
7 of 9 cats alive at follow-up
6 of 12 cats alive at follow-up
2 of 13 cats alive at follow-up
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Early Stages of Feline Diffuse Iris Melanoma:
• Melanosis• Early Melanoma
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Melanosis
Proliferating melanocytes are entirely limited to the anterior
surface of the iris
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Melanosis
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Early FDIMTumor confined to the iris
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Early FDIM
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Feline Ocular Post-traumatic Sarcoma:234 of 2766 tumors, or ~8%
• Spindle cell variant– 149 cases– Lens epithelial origin
• Round cell variant– 54 cases– Variant of lymphoma
• Osteosarcoma/Chondrosarcoma– 26 OSA cases– 5 Chondrosarcoma cases– Unknown cell of origin
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Reasons to believe FOPTS is related to trauma
• Lens capsule rupture• History of trauma or abnormal eye• Time between trauma and tumor
– Between 2 months and 15 years
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Early Spindle Cell Variant FOPTS
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Spindle Cell PTS with
Tumor Distribution in the Spindle Cell Variant
Bone
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Feline Ocular Post-traumatic Sarcoma, Spindle Cell Variant
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Feline Ocular Post-traumatic Sarcoma,Spindle Cell Variant
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Cellular Features of Spindle Cell FOPTS
Collagen 4
Vimentin αA Crystallin
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Feline Ocular Post-traumatic Sarcoma,Spindle Cell Variant
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Follow-up Spindle Cell Variant
• Cases which have extended beyond the sclera have a bad prognosis– Local recurrence– Extension towards the brain
• Cases removed within the sclera have a good prognosis
• 8% of traumatized globes removed prophylactically have early FOPTS
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Round Cell Variant FOPTS
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Round Cell PTS
Round Cell Variant FOPTS
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Round Cell Variant FOPTS
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FOPTS Osteosarcoma
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Feline OPTS: Osteosarcoma
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Feline Iridociliary Epithelial Tumors
• 102 of 2766 neoplastic cases, ~4%• Tend to be non-pigmented• Solid• Cavitated• About half have metaplastic
bone• Vimentin+, Cytokeratin-
Neglected Feline Iridociliary Adenoma
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Feline Iridociliary Epithelial Tumors
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Feline Iridociliary Adenoma
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Feline Iridociliary Adenoma
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Feline Iridociliary AdenomaSpindle Cells
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Feline Iridociliary Epithelial TumorsImmunohistochemistry
NSE+ 100%Cytokeratin+ 20%Not related to tumor type
Vimentin+ 34%
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Feline Conjunctival and Lid Squamous Cell Carcinoma
•Total SCC in the Database: 233•Multifocal (Bowenoid): 15•Orbital: 30•Associated with lymphocytic inflammation: 53•No age or breed associations
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Feline Conjunctival and Lid Squamous Cell Carcinoma
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Feline Conjunctival and Lid Squamous Cell Carcinoma
Multifocal or Bowenoid
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Feline Orbital Squamous Cell CarcinomaDDx Feline Restrictive Orbital Myofibroblastic Sarcoma
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Feline Conjunctival and Lid Squamous Cell Carcinoma
Severe Lymphocytic Inflammation
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Feline Conjunctival Melanoma•46 cases in the COPLOW database
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Feline Conjunctival Surface Adenocarcinoma
•Formerly Mucoepidermoid Carcinoma•18 cases in the COPLOW database•Malignant potential
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Feline Conjunctival Surface Adenocarcinoma
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Feline Conjunctival Surface AdenocarcinomaMetastatic Potential
L
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Feline HidrocystomaApocrine gland originSiamese predilection
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Feline Eyelid Peripheral Nerve Sheath Tumor
36 cases in the COPLOW Database
S100
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Feline Eyelid or ConjuctivalMast Cell Tumors
55 Cases in the COPLOW Database
•All but 3 are cutaneous•Most common at medial canthus
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Feline Restrictive Orbital MyofibroblasticSarcomaFROMS
(formerly, Feline Orbital Pseudotumor)
Bell CM, Schwarz T, Dubielzig RR. (2011) Diagnostic Features of Feline Restrictive Orbital MyofibroblasticSarcoma. Vet Pathol. 48: 742-750.
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14 cases of FROMS• Breed:
– 9 DSH– 3 DLH– 1 Maine Coon– 1 unknown
• Gender– MN = 5 FS = 9
• Age– Mean = 10.5 years, Median = 10 years– Range = 4 - 16 years
• Unilateral = 13 Bilateral = 1• Oral lesions = 1
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Clinical Characteristics• Restricted mobility of globe and eyelids• Thickened and distorted eyelids • Profound corneal disease
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FROMS Clinical Characteristics• Thickening +/- ulceration of lips• Proliferative gingival lesions (neoplastic?)
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•Local extension to adjacent tissues
•Thickening and effacement along fascial planes
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•Severe corneal disease
•Dense, fibrous orbital tissues
•Globe spared
Feline Restrictive Orbital Myofibroblastic Sarcoma
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Feline Restrictive Orbital Myofibroblastic Sarcoma
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Feline Restrictive Orbital Myofibroblastic Sarcoma
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Subepithelial neoplastic cellsare not SMA+, unlike the remainder of the tumor
Smooth Muscle Actin (SMA)
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Tooth
Orbit
Orbit from necropsy specimen
Orbit
Tumor in bone
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FROMS Histopathology:
•Spindle cells in irregular short bundles with collagenous matrix
•Bland nuclear profile
•Mitotic activity virtually absent
Trichrome
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Total + -Vimentin 8 8 0S-100 8 8 0SMA 8 8 0Melan A 2 0 2
FROMS Immunohistochemistry
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Clinical Progression & Survival
• 9 of 10 cases with adequate follow-up had spread to the contralateral eye and/or oral cavity/lips
• All cats (5) that were confirmed deceased were euthanized due to progressive FROMS
• Of 3 cats currently living, 2 have signs of progressive FROMS
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Feline Restrictive Orbital Myofibroblastic Sarcoma: Summary
• FROMS behavior is locally invasive and severely restricts the mobility of globe, eyelids and lips
• Morphology suggests an infiltrative myofibroblasticsarcoma, seldom forms a mass lesion, lacks cellular atypia
• Diagnosis requires histopathology plus clinical picture• Distribution and extent in the oral cavity and elsewhere
in the head is not obvious at the first diagnosis but becomes very apparent at necropsy
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Squamous Cell Carcinomamasquerading as FROMS