Figure - available from: Case Reports in Veterinary Medicine
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(a) Left ethmoid mass. The nasal adenocarcinoma effaces normal turbinates. The patterns of neoplastic cell distribution varied between tubular (shown) and solid. Hematoxylin and eosin, 400x. (b) Right humerus. Metastatic nasal adenocarcinoma, with tubular pattern, invading cortical bone. Hematoxylin and eosin, 100x.
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Sinonasal neoplasia metastasizing to distant organs is rare in horses. This case report describes the clinical and imaging findings of a horse with sinonasal neoplasia, which had metastasized to the lung, liver, and humerus. Additionally, the prevalence of sinonasal neoplasia and their incidence of distant metastasis among horses that presented to...
Citations
... Neoplasms of paranasal sinus are conditions that are difficult to characterize regarding incidence, since it is not possible to affirm how many of these cases are actually recorded [10]. Surveys of cases of sinusitis treated in reference hospitals report 2% to 19% of them are related to neoplasm [5,8,9,14,25]. Despite their low incidence, they are challenging affections due to difficult early identification because of their generally insidious onset and prolonged evolution [23]. ...
... All cases presented with purulent nasal discharge, being bilateral in 3, with a longer evolution time. There are few reports of epistaxis [8], which was initially observed in case 2, where it is suggested to be due to the involvement of the ethmoid. Increases in facial volume are common, usually firm, with no pain on palpation and greater when compared to sinusitis of dental origin [5]. ...
... Direct visualization of the neoplasm was possible in 13 out of 20 cases reported by Dixon et al. [3]; the exam is also useful when there are deformities in the upper airways [23]. Cases of adenocarcinoma often present as lobulated masses in the ethmoid region, in a typical location of ethmoid hematoma [8,11], as was initially suspected in case 2. Reports of ossifying fibroma, as observed in the present case, present with historical frequency of noise and difficulty breathing [15,20]. At endoscopy, airway obstruction is observed, preventing progression of the endoscope, as in case 3, since its expansive growth leads to deformation of the nasal conchae. ...
Background: Sinus neoplasms are reported as low frequency in horses. Its clinical characteristics are often nonspecific, depend on complementary methods for diagnosis, and when diagnosed, generally they are already advanced, limiting therapeutic possibilities. The objective of this case series was to detail clinical aspects and complementary exams for sinus neoplasms for early diagnosis, comparing them with the literature.Cases: Four horses were treated at the College of Veterinary Medicine and Animal Science of the University of São Paulo, with different clinical signs and previous diagnoses, which when evaluated by respiratory endoscopy, radiography, oral cavity evaluation and histopathological exams, revealed the diagnosis of anaplastic carcinoma, poorly differentiated carcinoma, ossifying fibroma and lymphoma. Previous diagnosis, based mainly on clinical signs, were sinusitis secondary to apical infection, ethmoidal hematoma, sinus cyst and sinusitis secondary to periapical disease. The cases of anaplastic carcinoma (case 1) and lymphoma (case 4) presented with an advanced degree of the disease with involvement and destruction of paranasal structures and adjacent tissues, in addition to a poor general condition, which made surgical treatment impossible and led to euthanasia. In these cases, previous treatment was made to apical infection and periodontal disease with secondary sinusitis, but negative evolution led to suspicion of neoplasia, confirmed by histopathological exam of incisional biopsy of the mass in oral cavity. Benign ossifying fibroma (case 3) presented with progressive respiratory difficulty due to occlusion of the lumen of some nasal meatus and radiographic signs of invasion and deformation of the adjacent bones, it was submitted for surgical excision and there was no recurrence until hospital discharge. The poorly differentiated carcinoma (case 2) was a multilobulate neoformation in the ethmoidal region, similar to ethmoid hematoma in endoscopic and radiographic evaluation, it was submitted for excision and two sessions of electrochemotherapy with bleomycin, associated with administration of piroxicam, which obtained a good result until the period of 1 year after discharge.Discussion: It was found that many characteristics are common with these types of neoplasms, and the clinical signs, such as nasal secretions, airway obstruction, increased facial volume, severe alterations in oral cavity, although unspecific, suggest the differential diagnosis for neoplasms. It is important to differentiate from other diseases noting the evolution and growth of these tumors, like in cases 1 and 4, especially the growth to internal tissues, using complementary methods described here, like endoscopic and radiographic examination. Late identification or even manipulation of neoplasms, without proper diagnosis, leads to a few prognoses regarding life. When it is possible to perform surgical excision, complementary methods are important to guide the procedure, and definitive diagnosis is made through histopathologic exam and some need immunohistochemistry analysis. Cases 2 and 3 had surgical access, were submitted to excision and treatment with good results, both with close monitoring in first months and prolonged quality of life. These results highlight the importance of complementary methods for early diagnosis, correct intervention and monitoring of evolution.Keywords: sinus neoplasia, paranasal sinus, tumor, head, horses.
... In addition, the lesion caused by the tumor mass in expansion caused chronic sinusitis, with purulent and fetid nasal discharge at the affected site. In a retrospective study in which 5,558 horses were evaluated, sinonasal diseases were identified in 1.4% of the cases, and from these, 0.14% were nasal cavity tumors, all of them showing nasal discharge [8]. ...
Background: Osteosarcomas are common malignant bone tumors described in dogs, humans and cats. However, there are rare reports in horses. The tumor etiology has not been fully elucidated. Clinical signs are associated to the tumor size, location and growth characteristics. When located on the face, the most common findings are facial distortion, nasal discharge and inspiratory dyspnea. The aim of this study was to report an osteoblastic osteosarcoma in a horse, located on the right maxillary region with projections into the corresponding nostril. Case: A 6-year-old mixbreed saddle gelding, presenting bay coat was admitted to a University Hospital with a chronic sinusitis history. The animal was previously examined and treated by other veterinarians, who suspected of odontogenic maxillary sinusitis, and therefore a repulsion of the fourth premolar from the right maxilla hemiarcade was performed. However, an improvement of the clinical signs was not observed and subsequently the gelding was referred to a Veterinary Hospital. During physical examination the patient presented dyspnea, tachypnea and tachycardia. An increase on the face size was observed, together with a fetid and purulent nasal discharge. During oral cavity inspection, a diagonal wear was detected at the occlusal surface of the right hemiarcade; food accumulation was seen at the dental extraction site, and a communication with the rostral maxillary sinus was evidenced, from where a purulent fetid discharge was draining. At the radiographic exam, well defined margins of a tumor were observed, with adjacent bone lysis and the presence of a central nucleus showing a gross granular mineral radiopacity, distorting the frontal and nasal bones. During the endoscopic exam, a mass partially occluding the right nasal cavity close to the nasal opening was seen, which was blocking the progression of the endoscopy. However, during the left cavity inspection, at the end of the nasal septum a mass with irregular surface was detected emerging from the border of the right choana, which extended up to the nasopharynx region. The diagnosis was established based on clinical evaluation and histopathological findings of the tumor, which confirmed osteoblastic osteosarcoma. The animal was euthanized due to poor clinical conditions and prognosis. There was no evidence of metas-tasis to other organs during necropsy. Discussion: The majority of reported osteosarcoma cases in horses do not define the tumor histopathological subtype. The occurrence of metastasis in equine osteosarcoma is not well established, however it seems to be uncommon. It is important to emphasize the relevance of performing a necropsy in patients presenting osteosarcoma, in order to establish a pattern concerning the metastasis incidence in the species. The predominant osteosarcoma location is the mandible, although there are few reports in the paranasal sinuses and appendicular skeleton. The tumor usual location makes the treatment difficult because of the impossibility of performing a complete surgical resection, which leads to a euthanasia decision. Although osteosarcoma has been little reported in horses, it should be a differential diagnosis for facial alterations and paranasal sinuses abnormalities, which would contribute to an early diagnosis and increase the chances of a favorable prognostic.
... Occasionally, the presence of metastases can only be detected during postmortem examinations. Literature describing neoplastic lesions in horses mainly provides reports of possible metastatic adenocarcinomas of paranasal sinuses [16,19]. In light of the current literature, this clinical case report is untypical, as it presents contact metastases of SCC to the thyroid gland from the affected lymph nodes of the neck area. ...
A 16-year-old mare was subjected to examinations due to episodes of nose bleeding, facial bone deformity, dyspnea, and progressive emaciation. Clinical and radiological examinations as well as laboratory analyses revealed the presence of a neoplasia in the paranasal sinuses, which was confirmed by a biopsy examination. The deterioration of the general condition of the animal and the nonoperative nature of the lesion were an indication for euthanasia. The necropsy displayed massive tumor in the bilateral maxillary sinuses, nasal cavity, and hard palate. In addition, nodal metastases of the neck area as well as contact metastases from the affected lymph nodes to the thyroid gland were detected. Based on the histopathological findings and additional immunohistochemical investigations, the tumor was classified as squamous cell carcinoma. This article also provides a review of the literature on various aspects of the presented case.
Computed tomography (CT) imaging of the head in equine patients is now commonly performed as CT scanners are more readily available. Head CT has proven valuable in evaluating spatially complex anatomic structures, where radiographic superimposition, or restricted access via endoscopy or ultrasound, limit complete evaluation of the disease process. Head CT has been demonstrated to be incredibly valuable in the evaluation of dental and paranasal sinus disease, disease of the hyoid apparatus and ear, and in evaluation of skull trauma. CT is an excellent modality for assessment of both osseous and soft tissue structures; however, evaluation of complex vascular anatomy and determination of tissue viability is limited without the use of contrast agents. Therefore, various contrast agent protocols including intravenous and intraarterial iodinated contrast administration techniques have been established. CT also has limitations in the evaluation of brain and spinal cord disease, for which magnetic resonance imaging (MRI) has major advantages. Head CT images are most commonly evaluated in transverse planes. However, standard multiplanar reconstructions of the head including dorsal and parasagittal planes improve the understanding of spatially complex disease processes. These reconstructions can be crucial for accurate identification of diseased teeth and determination of the extent and severity of osseous and paranasal sinus disease. Head CT examinations are becoming an increasingly important diagnostic tool in the evaluation of horses with head disorders, and CT imaging findings are an important aspect in the clinical decision-making process. The following review discusses the indications, benefits, and technical considerations for the use of computed tomography (CT) in evaluating non-neurologic head pathologies in equine patients.
