pISSN 1598-298X
J Vet Clin 31(4) :319-321 (2014)
319
Epiphora by Non-viral Squamous Papilloma of the Conjunctiva in a Dog
Jury Kim*, Ul Soo Choi*, Caryn E. Plummer**, Dennis E. Brooks** and Min-Su Kim*,**
*College of Veterinary Medicine, Chonbuk National University, Jeonju, 561-756, Korea
**Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, Florida, 32608 USA
(Accepted: August 18, 2014)
Abstract : A 12-year-old mixed breed male dog was referred to Chonbuk National University Animal Medical Center with unilateral left epiphora. Magnified ophthalmic examination revealed a very small tissue mass on the palpebral conjunctiva of the left eye. The mass was surgically removed and microscopic examination confirmed moderate papillary hyperplasia of the squamous epithelium without viral cytopathic effects. Based on the histology, the mass was diagnosed as a non-viral squamous papilloma. After removal of the mass, the epiphora was completely solved. This case report describes the non-viral squamous papilloma arising from the conjunctiva in a dog with epiphora.
Key words : epiphora, conjunctiva, dog, non-viral squamous papilloma.
Introduction
Epiphora may frequently occur in dogs and cats and that is a clinical feature of essential disease of the anatomical lacri- mal gland (11,14). However, overproduction of tears is more related to inflammation of the eye such as entropion, ectro- pion, distichiasis, trichiasis, corneal and conjunctival inflam- mation, and foreign bodies. In addition, disorders of naso- lacrimal drainage system including malposition or absence of the puncta, obstruction of the nasolacrimal duct are involved (5,8,11). The treatment of epiphora is focused on the cure of original problem. Although medical and surgical management for tear overproduction is frequently documented and has a good prognosis, which is not always satisfied for the patients throughout their life unless an underlying cause can be treated. Exact diagnosis is the most important to treat over- production of tear.
Squamous papilloma is a common and generally benign squamous epithelial tumor of the skin, oral cavity, eyelid and conjunctiva (1,2). Papillomas in dogs less commonly affect the ocular region, including the conjunctiva and cornea (9).
In the conjunctiva, papillomas are typically characterized by finger-like projections that have a fibrovascular core in the epithelium and stroma of the mucous membrane (3,6). The etiology of the conjunctival papilloma in the dog remains unclear. However, the majority of reported cases have been virally induced by either solitary cutaneous papilloma produc- ing virus or canine oral papilloma (COP) virus (9). In cases with no evidence of viral origin, the proliferative masses are considered to be non-viral squamous papilloma (2). The his- tological changes associated with non-viral papilloma include exophytic papillated projections of pleomorphic epithelium
which lack the characteristics of viral cytopathic effect (13).
This case report describes the epiphora result from very small non-viral squamous papilloma of the conjunctiva in a dog.
Case
A 12-year-old intact female mixed breed dog was referred with a history of unilateral epiphora and mild ocular dis- charge from the left eye. Although the dog already had been several medications including eye-drop from local animal hospital, it had been suffered from moderate lacrimation for approximately 12 month. No abnormalities were found on routine physical and radiological examinations. Schirmer tear test (STT-1) values were 35 mm wetting in the left eye, and 23 mm in the right eye during 60 seconds. The conjunctiva
1Corresponding author.
E-mail: [email protected]
Fig 1. Very small non-viral squamous papilloma in the left lower palpebral conjunctiva.
320 Jury Kim, Ul Soo Choi, Caryn E. Plummer, Dennis E. Brooks and Min-Su Kim
and cornea were normal with no inflammatory reaction or other signs of irritation. In addition, the cilia disorders includ- ing distichiasis, trichiasis, or ectopic cilia were not found at the left eyelid and no anatomical problems of nasolacrimal drainage system and foreign bodies were found. Magnified ophthalmic examination revealed a very small mass in the left lower palpebral conjunctiva. The mass was pink less than 0.7 mm in diameter, and had a cauliflower-like appearance (Fig 1). The differential diagnosis for the conjunctival mass included squamous papilloma or squamous cell carcinoma.
At the owner’s request, the lesion was surgically removed.
Preoperative complete blood count and serum chemistry were within the normal range. Under general anesthesia, the conjunctival surfaces were cleaned with 0.5% povidone- iodine solution and the mass was excised. It was placed in 10% phosphate buffered formalin for histological examina- tion. After surgery, topical medications applied to the left eye included artificial tears (Lacure; Samil Pharm., Seoul, Korea) and ciprofloxacin (CF; Samcheondang Pharm., Seoul, Korea).
Microscopically, there was a single tiny fragment of conjunc- tival tissue demonstrating moderate papillary hyperplasia of the lining stratified squamous epithelium. A small portion of the superficial submucosa contained confluent marked lym- phoplasmacytic stromal inflammation (Fig 2). Based on the histology, a diagnosis of non-viral squamous papilloma with focal marked lymphoplasmacytic conjunctivitis was made.
Three weeks after removal of the mass, the STT valves were 18 mm in the left eye and 19 mm in the right. The epiphora was completely resolved.
Discussion
Epiphora as clinical sign rather than specific disease is most commonly associated with insufficient drainage or an overproduction of the tear in small breed dogs (11). Although it is not life threatening disease, epiphora results in some problems such as inflammation, skin problem, and patient discomfort. The causes of epiphora are varied, and much care- ful examination has been focused on various pathological considerations (5). Generally, it may be caused either by ana- tomical disorders including nasolacrimal duct, cilia and eyelid abnormalities or secondary by chronic irritation/inflammation of the cornea, conjunctiva, or lacrimal sac (5,8,11). For treat- ment of epiphora if the cause is related to another eye prob-
lem, the primary cause is directly cured (8). If a specific cause should not be recognized, the patient is focused on cos- metic part in nature that its vision or comport is not threat- ened. In this case, the owner could not find a specific problem which caused the epiphora. In addition, the squamous papil- loma as foreign body could not be easy to find without mag- nified ophthalmic device due to very small size and the tumor location at lower bulbar conjunctiva near the fornix.
Squamous papilloma is one of two types of papilloma clas- sified as non-neoplastic epithermal papillated mass (2). It is slow growing, with demarcated lesions of papillomatous con- figuration occurring at the squamous epithelium (4). Squa- mous papillomas frequently occur at the ocular region in animals. In the dog, mucosal squamous papilloma has been described on the eyelids, the cornea, the conjunctiva and adjacent structures (2). Conjunctival papillomas are the most commonly acquired epithelial lesions of the conjunctiva, and usually involve multiple lesions with a cauliflower-like appear- ance. These papillomas may have an exophytic growth pat- tern and are typically white pink in color (12). In this case, the mass was a tiny, pink, cauliflower-like lesion. Based on the histological appearance of the mass, the conjunctival pap- illoma can be classified as having either viral or non-viral eti- ology (2,13). In humans, conjunctival papillomas associated with Human Papilloma Virus (HPV) have a characteristic frond-like appearance (6,7). In dogs, skin lesions are caused by a cutaneous papilloma-producing virus and the oral lesions by a COP virus (8). However, non-viral squamous papillo- mas, in which viral cytopathic effects are not evident, occur rarely in dogs. Non-viral papillomas are delicate, papillated masses that may be pedunculated and are generally smaller than viral warts, like the lesion in the present case (13). In this case, a reactive non-neoplastic papillary proliferative response to ongoing inflammation or trauma cannot be ruled out. However, there were no demonstrated clinical signs of chronic conjunctivitis, such as erythema or chemosis. Viral proteins could also be evidenced by polymerase chain reac- tion (PCR) or immunohistochemistry, but unfortunately in this case the unstained sections were too small to perform immunohistochemistry (IHC) for the detection of papilloma virus. However, the mass is consistent with a benign non-viral squamous papilloma based on the histological findings. In this case, foreign body like acting of squamous papilloma might induce the epiphora. The mass was successfully Fig 2. Papillary hyperplasia of the lining stratified squamous epithelium with lymphoplasmacytic stromal inflammation in the super- ficial submucosa.
Epiphora by Non-viral Squamous Papilloma of the Conjunctiva in a Dog 321
removed, and the epiphora was simply cured in the dog.
In conclusion, this case report describes the treatment and histological analysis of non-viral squamous papilloma of the conjunctiva result in epiphora.
References
1. Bonney CH, Koch SA, Confer AW, Dice PF. A case report:
a conjunctival papilloma with evidence of a viral etiology. J Small Anim Pract 1980; 21: 183-188.
2. Cornegliani L, Vercelli A, Abramo F. Idiopathic mucosal penile squamous papillomas in dogs. Vet Dermatol 2007; 18:
439-443.
3. Hare CL, Howard EB. Canine conjunctivocorneal papillo- matosis : a case report. J Am Anim Hosp Assoc 1977; 13:
688-690.
4. Kim MS, Kweon DH, Yi NY, Lee JM, Jeong MB, Kang MS, Jeong SM, Nam TC, Kim DY, Seo KM. Corneal papilloma in a dog. Vet Rec 2005; 156: 454.
5. Miller PE. Lacrimal system In: Slatter’s fundamentals of Veterinary Ophthalmology, 4th ed, St. Louis: Saunders Elesvier, 2008: 157-174.
6. Ogun OA, Ogun GO, Bekibele CO, Akang EE. Squamous papillomas of the conjunctiva: a retrospective clinicopatho- logical study. Niger. J Clin Pract 2012; 15: 89-92.
7. Pearce WG, Nigam S, Mielke B, Wyatt HT. Conjunctival papillomas in norther Canadian natives. Can Med Assoc J 1975; 112: 1423-1427.
8. Saito A, Kotani T. Tear production in dogs with epiphora and corneal epitheliopathy. Vet Ophthalmol 1999; 2: 173-178.
9. Sansom J, Barnett KC, Blunden AS, Smith KC, Turner S, Waters L. Canine conjunctival papilloma: a review of five cases. J Small Anim Pract 1996; 37: 84-86.
10. Saornil MA, Becerra E, Mendez MC, Blanco G. Conjunctival tumors. Arch Soc Esp Oftalmol 2009; 84: 7-22.
11. Scotti S, Klein A, Vanore M, Hidalgo A, Fayolle P, Moissonnier P. A new surgical method for the control of the epiphora in dogs: modified parotid duct transposition. J Small Anim Pract 2007; 48: 279-282.
12. Sjö N, Heegaard S, Prause JU. Conjunctival papilloma. A histopathologically based retrospective study. Acta Ophthalmol Scand 2000; 78: 663-666.
13. von Bomhard W, Goldschmidt MH, Shofer FS, Perl L, Rosenthal KL, Mauldin EA. Cutaneous neoplasms in pet rabbits: a retrospective study. Vet Pathol 2007; 44: 579-588.
14. Yi NY, Park SA, Jeong MB, Kim MS, Lim JH, Nam TC, Seo K. Medial canthoplasty for epiphora in dogs: a retro- spective study of 23 cases. J Am Anim Hosp Assoc 2006;
42: 435-439.
개 결막의 비바이러스성 편평세포 유두종에 의한 유루증 증례
김주리*·최을수*·Caryn E. Plummer**·Dennis E. Brooks**·김민수*,**
*전북대학교 수의과 대학, **플로리다 대학교 수의과 대학
요 약 : 12년령 접종 수컷 개가 전북대학교 수의과 대학에 왼쪽 편측성의 유루증으로 내원하였다. 확대경을 통한 안 검사에서 왼쪽 안검 결막에 매우 작은 덩어리가 있는 것이 발견되었다. 이 조직을 외과적으로 제거하여 조직검사를 실 시한 결과 편평상피 세포에 바이러스성 변화가 없는 중등도의 유두세포 증식이 관찰되었다. 조직 검사를 바탕으로 비 바이러스성 편평세포 유두종으로 진단하였다. 조직 제거 후에 환자의 유루증은 완전히 해결되었다. 본 증례는 개에서 결막의 비바이러스성 편평세포 유두종에 의해 발생한 유루증을 치료한 것이다.
주요어 : 유루증, 결막, 개, 비바이러스성 편평세포유두종
