Un cas d'hémangiosarcome cornéen chez un chat

1. Corneal hemangiosarcomaCorneal hemangiosarcoma
in a catin a cat
Clinique Vétérinaire La Borde Rouge - 150 rue Edmond Rostand -31200 Toulouse FRANCEClinique Vétérinaire La Borde Rouge - 150 rue Edmond Rostand -31200 Toulouse FRANCE
CORNEAL HEMANGIOSARCOMA IN A CAT
G. CAZALOT, A. REGNIER², A. DEVIERS², F. SERRA², M.N. LUCAS² and I.RAYMOND LETRON²
1. Clinique vétérinaire de la Borde Rouge, 150 rue Edmond Rostand, 31200 Toulouse, France
2. Département des Sciences Cliniques, Ecole Nationale Vétérinaire de Toulouse, 23 chemin des Capelles, BP 87614, Toulouse Cedex 3, France
Guillaume CAZALOT

2. IntroductionIntroduction
 Primary corneal neoplasm are rarePrimary corneal neoplasm are rare
 Secondary corneal neoplasm have been described in catsSecondary corneal neoplasm have been described in cats
from ocular or peri-ocular extensionsfrom ocular or peri-ocular extensions
 A recent case of combined squamous cell carcinoma andA recent case of combined squamous cell carcinoma and
corneal hemangiomacorneal hemangioma
 First report of a primary corneal hemangiosarcoma in aFirst report of a primary corneal hemangiosarcoma in a
catcat

3. Case report : anamnesisCase report : anamnesis
 A 10 years-old castrated white male Domestic Short-A 10 years-old castrated white male Domestic Short-
hairhair
 When it was adopted 6 years ago, mild signs of upperWhen it was adopted 6 years ago, mild signs of upper
respiratory disease with serous ocular discharge wererespiratory disease with serous ocular discharge were
treated with per os antibiotherapy and corticotherapy.treated with per os antibiotherapy and corticotherapy.
 Bilateral chronic keratitis since 6 years :Bilateral chronic keratitis since 6 years :
- PCR HSV, FeLV et FIV were negativePCR HSV, FeLV et FIV were negative
- Recurrent episodes of ocular discharge treated withRecurrent episodes of ocular discharge treated with
framycetin / dexamethasone phosphate ophthalmicframycetin / dexamethasone phosphate ophthalmic
ointment.ointment.

4. Case report : anamnesisCase report : anamnesis
 2 months prior to referral, ocular pain OS : STT2 months prior to referral, ocular pain OS : STT
8mm/min (16mm/min OD) > 0,2% cyclosporin8mm/min (16mm/min OD) > 0,2% cyclosporin
ophthalmic ointment once a dayophthalmic ointment once a day
 1 month prior to referral, OS had deteriored and was1 month prior to referral, OS had deteriored and was
treated with third eyelid flap : ocular problems continuetreated with third eyelid flap : ocular problems continue
to worsen.to worsen.

5. Case report : clinical examinationCase report : clinical examination
 Physical examinationPhysical examination
- No abnormalities- No abnormalities
 OD examinationOD examination
- Visual tests were normalVisual tests were normal
- STT 12 mm/minSTT 12 mm/min
- Stromal neovascularizationStromal neovascularization
- Sub-epithelial mineral depositsSub-epithelial mineral deposits
- No Rose Bengale or fluorescein stainingNo Rose Bengale or fluorescein staining
- PIO 12 mmHgPIO 12 mmHg
- Intraocular structures were safeIntraocular structures were safe

6. Case report : clinical examinationCase report : clinical examination
 OS examinationOS examination
- Loss of visual fieldLoss of visual field
- BlépharospasmBlépharospasm
- Lateral and inferior entropionLateral and inferior entropion
- SymblépharonSymblépharon
- Red-tinged serosanguinousRed-tinged serosanguinous
ocular dischargeocular discharge
(STT 20 mm/min)(STT 20 mm/min)

7. Case report : clinical examinationCase report : clinical examination
 OS examinationOS examination
- Central vascularized and- Central vascularized and
hemorrhagic neoformationhemorrhagic neoformation
- Dense peripheral edema- Dense peripheral edema
and infiltrationand infiltration
- No Rose Bengale / fluorescein- No Rose Bengale / fluorescein
stainingstaining
- Seidell test negative- Seidell test negative
- Ultrasonography of intraocular- Ultrasonography of intraocular
structures was normalstructures was normal

8. Case report : differential diagnosisCase report : differential diagnosis
 Granuloma : ulcer, perforationGranuloma : ulcer, perforation
 Stromal keratitisStromal keratitis
 Corneal neoplasmCorneal neoplasm

9. Case report : ancillary testsCase report : ancillary tests
 Corneal cytology : no conclusiveCorneal cytology : no conclusive
 Complete blood count,Complete blood count,
coagulation and biochemistrycoagulation and biochemistry
profiles : no abnormalitiesprofiles : no abnormalities
 Lamellar keratectomy combinedLamellar keratectomy combined
with superficial diathermy and third eyelid flapwith superficial diathermy and third eyelid flap
Morphine 0,2mg/kg IVMorphine 0,2mg/kg IV
Chloramphenicol ophthalmic ointment tidChloramphenicol ophthalmic ointment tid
L-Lysine twice dailyL-Lysine twice daily

10. Case report : diagnosisCase report : diagnosis
 PCR HSV negativePCR HSV negative
 The mass was friable, fleshy red, multilobulated, highlyThe mass was friable, fleshy red, multilobulated, highly
vascularized and hemorragic. The surgical excision wasvascularized and hemorragic. The surgical excision was
histopathologically complete.histopathologically complete.

11. Case report : diagnosisCase report : diagnosis
 Histopathological characteristicsHistopathological characteristics
- highly cellular- highly cellular
- pleomorphic spindle and polygonal- pleomorphic spindle and polygonal
cells with high mitotic indexcells with high mitotic index
(10 per 10 HPF) lining small and(10 per 10 HPF) lining small and
large-containing spaceslarge-containing spaces
- lymphocytic and plasmacytic- lymphocytic and plasmacytic
infiltrate at the marginsinfiltrate at the margins
Hémalun Eosine staining

12. Case report : diagnosisCase report : diagnosis
 ImmunohistochimieImmunohistochimie
Endothelial cell marker CD 31 labeled positivelyEndothelial cell marker CD 31 labeled positively in neoplasticin neoplastic
endothelial cells confirmed the diagnosis of cornealendothelial cells confirmed the diagnosis of corneal
hemangiosarcoma (HSA).hemangiosarcoma (HSA).
Endothelial neoplastic cells CD31 +

13. Case report : follow-upCase report : follow-up
 Removing of the third eyelid flap 12 days afterRemoving of the third eyelid flap 12 days after
- Partial epithelializationPartial epithelialization
- Highly vascularized and hemorragic marginsHighly vascularized and hemorragic margins

14. Case report : follow-upCase report : follow-up
 2 weeks after removal of third eyelid flap2 weeks after removal of third eyelid flap
A new hemorragic mass looking like the first one had raised intoA new hemorragic mass looking like the first one had raised into
the stroma.the stroma.

15. Case report : follow-upCase report : follow-up
 Extension check-upExtension check-up
- no signs of metastasis in submandibular lymph node cytology,- no signs of metastasis in submandibular lymph node cytology,
chest radiographs and abdominal ultrasonographychest radiographs and abdominal ultrasonography
 EnucleationEnucleation
- Inevitable local recurrences and risks of long-term metastasisInevitable local recurrences and risks of long-term metastasis
- Good to reserved prognosisGood to reserved prognosis
 No signs of local recurrence or metastasis 18No signs of local recurrence or metastasis 18
months after surgerymonths after surgery

16. DiscussionDiscussion
 Primary corneal tumors are rare in cats, particularlyPrimary corneal tumors are rare in cats, particularly
with vascular origin since cornea is avascular.with vascular origin since cornea is avascular.
- Secondary corneal tumors more frequent in horses and cattleSecondary corneal tumors more frequent in horses and cattle
- HA and HSA reported in cat in bulbar conjunctiva and anteriorHA and HSA reported in cat in bulbar conjunctiva and anterior
surface of the third eyelidsurface of the third eyelid
- Corneal HSA reported in German Shepherd without details on itsCorneal HSA reported in German Shepherd without details on its
originorigin
- Combined squamous cell carcinoma and hemangioma recentlyCombined squamous cell carcinoma and hemangioma recently
reported in a cat.reported in a cat.
(Perlman E. et coll.- Co-existing squamous cell carcinoma and hemangioma on the ocular surface of a cat. Vet(Perlman E. et coll.- Co-existing squamous cell carcinoma and hemangioma on the ocular surface of a cat. Vet
Ophthamol. 2010, 13:63-66.)Ophthamol. 2010, 13:63-66.)

17. DiscussionDiscussion
 Epidémiologie des HSAEpidémiologie des HSA::
- Pas de prédisposition raciale (mais souvent M>F)Pas de prédisposition raciale (mais souvent M>F)
- Age médian d’apparition à 10 ansAge médian d’apparition à 10 ans

18. DiscussionDiscussion
 Symptomatology of HSASymptomatology of HSA ::
- visceral typevisceral type :: often multi-organic and already metastatic whenoften multi-organic and already metastatic when
diagnosed (bad prognosis)diagnosed (bad prognosis)
- (sub)cutaneous type(sub)cutaneous type :: unique tumor in a non hairy and nonunique tumor in a non hairy and non
pigmented skin (local recurrence but less metastasis)pigmented skin (local recurrence but less metastasis)
-> Ocular HSA can be metastasis (palpebral, ciliary or choroidal HSA)-> Ocular HSA can be metastasis (palpebral, ciliary or choroidal HSA)
or primary (upper or third eyelid, bulbar conjunctiva)or primary (upper or third eyelid, bulbar conjunctiva)
-> First case of primary corneal HSA looking like a cutaneous type in-> First case of primary corneal HSA looking like a cutaneous type in
a cata cat

19. DiscussionDiscussion
 Risk factorsRisk factors ::
- UV exposureUV exposure
 Non haired and non pigmented areas (carcinoma, HA/HSA…)Non haired and non pigmented areas (carcinoma, HA/HSA…)
Ultraviolet radiation-induced corneal tumours in the South AmericanUltraviolet radiation-induced corneal tumours in the South American
opossum, Monodelphis domestica.-opossum, Monodelphis domestica.- Sabourin CLSabourin CL,, Kusewitt DFKusewitt DF,, Fry RJFry RJ,, Ley RDLey RD.-.-
J Comp Pathol. 1993 May;108(4):343-59.J Comp Pathol. 1993 May;108(4):343-59.
- Chronic inflammationChronic inflammation
 KCS, CSK, entropion in dogs…KCS, CSK, entropion in dogs…
 Post-inflammatory sarcomas in cats (post-traumatic ocularPost-inflammatory sarcomas in cats (post-traumatic ocular
sarcoma, post-vaccinal sarcoma, post-metritis sarcoma…)sarcoma, post-vaccinal sarcoma, post-metritis sarcoma…)
->-> Old male cats propensity to develop sarcomas in chronicOld male cats propensity to develop sarcomas in chronic
inflammatory diseases.inflammatory diseases.

20. DiscussionDiscussion
 Risk factorsRisk factors ::
- Combination with Herpes virusCombination with Herpes virus
 Pathognomonic signsPathognomonic signs
 Latence trigéminale vraisemblable…Latence trigéminale vraisemblable…
 Generates a chronic corneal inflammationGenerates a chronic corneal inflammation
 Herpesvirus implication in tumoral diseaseHerpesvirus implication in tumoral disease
(HHV-4 : Burkitt lymphoma and carcinomas; HHV-8 : Kaposi sarcoma;(HHV-4 : Burkitt lymphoma and carcinomas; HHV-8 : Kaposi sarcoma; HerpesHerpes
Saïmiri : lymphoma…)Saïmiri : lymphoma…)
 Possible implication of others virus : retrovirus are to blame forPossible implication of others virus : retrovirus are to blame for
HSA in birds…HSA in birds…