Neoplasia of the Canine Eyelids, Conjunctiva and Cornea · Neoplasia of the Canine Eyelids,...
Transcript of Neoplasia of the Canine Eyelids, Conjunctiva and Cornea · Neoplasia of the Canine Eyelids,...
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Neoplasia of the Canine Eyelids, Conjunctiva and Cornea
Philippe Labelle, DVM, DACVPAntech Diagnostics
12th Biannual William Magrane Basic Science Course in Veterinary and
Comparative Ophthalmology
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Eyelids
Labelle AL et al. VO 2013 (review)
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General Considerations
• Any cutaneous neoplasm can affect the eyelid skin
• Eyelid predispostion is really prediposition to the head/neck region
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Trichoblastoma
• Solitary, firm, alopecic, dome-shaped or polypoid• “Basal cell tumor”• Epithelial neoplasm• “basal” cells: small, scant cytoplasm• Ribbons, nests, cords, trabeculae (combination)• Histologic subtypes• Some cells may be spindle
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Trichoblastoma
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Trichoblastoma
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Sebaceous Tumors
• Hyperplasia/adenoma, epithelioma• Solitary or multiple, dome-shaped or
papillated• Epithelial neoplasm• Nests of well-differentiated sebaceous glands
with ducts• Basal cell predominate in epitheliomas, may
be pigmented
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Sebaceous Tumors
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Mast Cell Tumor
• Solitary or multiple, alopecic, erythematous, edematous
• Sheets within collagenous stroma• Round cells with cytoplasmic granules• Giemsa and Toluidine blue stains for granules• Admixed with eosinophils• Grading (Patnaik, 2-tier) only for skin
• Patnaik Vet Path 1984; Romansik Vet path 2005; Kiupel Vet Path 2011; Thompson Vet Path 2011
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Mast Cell Tumor
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Mast Cell Tumor
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Lymphoma
• Variable gross appearance• Most are epitheliotropic• Sheets of lymphocytes that variably extend in the
surface and follicular epithelium• Round cells with scant cytoplasm• Almost all epitheliotropic lymphomas are of T cell
origin (CD3 positive, CD79a/CD20 negative)• Can be typed by cell size• Mitotic index corresponds to grade
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Lymphoma
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Canine Cutaneous Histiocytoma
• Button lesion, round, red +/- ulcerated• Round cell neoplasm• Histiocytic-Langerhans cells• Sheets and subepidermal cords, +/- epidermal
invasion• Cells have round to reniform nuclei• Mitotic index highly variable• Lymphocytic infiltrate with regression
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Canine Cutaneous Histiocytoma
• Mostly, but not exclusively in young dogs• PL database (150 cases): 48% are 3yo or
younger, 65% are 4yo or younger• Less spontaneously regression older dogs• Ddx histiocytoid lymphoma in older dogs
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Canine Cutaneous Histiocytoma
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Canine Cutaneous Histiocytoma
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Granular Cell Tumor
• Medial canthus• Solitary, firm, +/- ulcerated• Sheets• Round cells with abundant granular cytoplasm• Minimal pleomorphism, low mitotic index• Strong staining with PAS• Histologically similar to sublingual GCT• Lu JE et al. VO 2012
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Granular Cell Tumor
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Granular Cell Tumor
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Granular Cell Tumor
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Melanocytic Neoplasia
• Solitary, dome-shaped, pink to brown to black• Most are benign melanocytomas• Sheets, packets, bundles, whorls• Spindle or polygonal cells• Usually heavily pigmented• Junctional activity• Malignant : mitotic index of 3 or more, nuclear
atypia, deep extension and ki-67 of >15%• Smedley R et al. Vet Path 2011
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Melanocytic Neoplasia
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Melanocytic Neoplasia
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Melanocytic Neoplasia
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Melanocytic Neoplasia
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Eyelid Margin
Labelle AL et al. VO 2013 (review)
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Meibomian Adenoma/Epithelioma
• Tan, pink, gray or black• Adenoma, epithelioma• Well-circumscribed, variably exophytic• Lobules of sebaceous glands with ducts• Basal cell predominate in epitheliomas• May be pigmented
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Meibomian Adenoma/Epithelioma
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Meibomian Adenoma/Epithelioma
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Meibomian Adenoma/Epithelioma
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Conjunctiva
Labelle AL et al. VO 2013 (review)
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Squamous Papilloma
• Discrete, papillary lesions• Skin, eyelid margin or conjunctiva• No features of atypia• No viral cytopathic effects• Ddx reactive papillary hyperplasia (“reactive
papilloma”)
• Beckwith-Cohen B et al. Vet Path 2015
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Squamous Papilloma
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Squamous Papilloma
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Squamous Papilloma
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Viral Papilloma
• Exophytic, papillary • Papillary fronds of hyperplastic, variably
pigmented epithelium with a prominent granular layer and hyperkeratosis
• Koilocytes (abundant pale cytoplasm, large or pyknotic nuclei)
• Intranuclear inclusions (not required for the diagnosis)
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Viral Papilloma
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Viral Papilloma
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Viral Papilloma
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Third Eyelid Gland Adenocarcinoma
• Pink, firm• Infiltrative• Nests and tubules, or solid• Squamous metaplasia• Mitotic index highly variable• Rare adenomas• More aggressive and more mets in cats than dogs
• Wilcock B et al. JAVMA 1988; Dees DD et al. VO 2016
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Third Eyelid Gland Adenocarcinoma
Courtesy of Dr. Chris Reilly
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Third Eyelid Gland Adenocarcinoma
Courtesy of Dr. Chris Reilly
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Third Eyelid Gland Adenocarcinoma
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Vascular Neoplasms
• Smooth, raised, pink to red• Hemangiomas• Well-circumscribed, attenuated endothelial
cells, no mitoses• Hemangiosarcomas• Irregular channels, plump endothelium, +/-
mitoses• Leading edge of the third eyelid
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Vascular Neoplasms
• Most (2/3) are benign• Most conjunctival hemangiosarcomas are well
differentiated• UV exposure as a contributing factor
• Pirie CG et al. VO 2006
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Vascular Neoplasms
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Vascular Neoplasms
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Conjunctival Mast Cell Tumor
• Smooth, firm, subconjunctival• Well-circumscribed• Sheets of mast cells• Admixed with eosinophils• Edema• Grading only for skin• Most respond to excision and cryotherapy• Fife M et al. VO 2011
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Conjunctival Mast Cell Tumor
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Melanocytic Neoplasia
• Pink to brown to black• Most (>80%) are malignant melanoma (MI>4)• Most on the third eyelid• Poorly circumscribed, may be multifocal• Sheets, packets, bundles, whorls• Spindle or polygonal cells• Mildly pigmented• Local recurrence common; mets 10-20%• Collins et al. Prog Vet Comp Ophthalmol 1993
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Melanocytic Neoplasia
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Cornea/Sclera
Labelle AL et al. VO 2013 (review)
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Limbal Melanocytic Neoplasia
• Brown to black• Almost all benign melanocytomas• Broad-based nodular• Arise from the melanocytes that demarcate the
limbus at the junction of the corneal stroma and sclera
• Discohesive heavily pigmented plump polyhedral cells often admixed with fewer pigmented spindle cells
• No atypia, mitoses are rare to absent
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Limbal Melanocytic Neoplasia
• Expands along the planes of least resistance: conjunctiva > corneal stroma
• Necrosis in approx. 20% of cases• May extend intraocularly• Rare malignant limbal melanomas• Some benign neoplasms include areas with
atypical cells
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Limbal Melanocytic Neoplasia
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Limbal Melanocytic Neoplasia
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Limbal Melanocytic Neoplasia
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Canine Corneal SCC
• Brachycephalic dogs• Raised pink mass, axial• Distinct margins• Exophytic, often limited to epithelium (in situ)• May extend in the superficial stroma• Underlying chronic keratitis• Role of immunosuppressive drugs? • No metastasis reported
• Dreyfus J et al. VO 2011
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Canine Corneal SCC
Courtesy of COPLOW
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Canine Corneal SCC
Courtesy of Dr. Carol Naranjo
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Canine Corneal Neoplasia
• Hemangiosarcoma (Haeussler DJ Jr et al. VO 2011)• Melanocytoma (Bauer B et al. VO 2014)• Lymphoma (Dubielzig RR. 2010)• Nerve sheath tumor (Leis ML et al. VO 2016)• Others with unclear origin (conjunctiva vs
cornea)