Eye Lid Tumor in a Donkey

A 2 year-old female donkey presented to PHD Veterinary services for the complaint of multiple tumors surrounding the left and right eye. The tumors have been present for several months and have been treated by surgical debulking and intra-lesional injections with a variety of chemotherapy agents. However, the tumors continue to return. There is a golf ball size tumor just below the right eye and the left eye is nearly closed due to the tumor's involvement of the entire eye lid!
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The plan for this donkey involves biopsy of the tumors followed by local treatment with an immune stimulant that contains mycobaterial cell wall extract. PHD veterinary services will be working with Dr. Brendan Mangan from Affiliated Veterinary Specialist in Gainesville, Florida. Dr. Mangan is a board certified ophthalmologist with extensive experience treating such cases! Dr. Mangan suspects that these tumors are sarcoids and not squamous cell carcinomas. Certainly, an unusual presentation for sarcoids in a young donkey!! Dr. Mangan submitted several core biopsies this week for confirmation and began treatment with the mycobaterial cell wall extract.

After the initial treatment with the immune stimulant, Dr. Mangan plans to surgically remove the tumors surrounding both eyes! Thereafter, it is likely that the injection of the local immune stimulant will be repeated along with focal cryotherapy. The biopsy results and follow-up pics will be added to this post next week so stay tuned!!!

Sarcoids in a Horse

The following images represent 3 different cases of sarcoid tumors in horses. The images in Figure 1 and 2 are that of sarcoid tumors on a horse's hind limb. The tumors had been removed several times before however they continue to re-develop. The sarcoid tumors in this case have been treated by surgical resection and a topical anti-sarcoid medication called Xxterra. This gelding will require additional surgical debulking and more aggressive post-operative treatment with cryotherapy AND chemotherapy agents. Prognosis is guarded due to the large tumor size and the location of the sarcoid tumors.
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Figure 1

Figure 2

In Figures 3,4 and 5, the sarcoid tumor in this horse is located along the sheath of the gelding and is flatter compared to the sarcoid tumors in the horse in Figures 1 and 2. This sarcoid was treated with multiple injections of a chemotherapy agent known as cisplatin. There was minimal response to the chemotherapy agent hence this sarcoid tumor will likely require surgical debulking followed by additional chemotherapy treatment.

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Figure 4

Figure 5

The gelding in Figure 6 and 7 was suffering from a horrible sarcoid that weighed more than 2 pounds and was dangling from his right ear. The sarcoid was removed by surgical debulking and the ear was treated with both injectable cisplatin and cryotherapy (liquid nitrogen). The image in Figure 7 is several months after the initial surgical debulking. To date, there does NOT appear to be any re-development of the sarcoid tumor.

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Figure 7

These 3 cases represent the diversity of the appearance and location of sarcoid tumors in horses!  However, what they have in common is the aggressive and persistent nature of sarcoid tumors in horses. As such, the take home message of these cases is that sarcoid tumors should be identified EARLY and treated as AGGRESSIVELY as possible. There is no ONE treatment that is typically suffice for treatment but rather a combination of surgical debulking, chemotherapy and cryotherapy!

Gastric ulceration in Horses

Two adult horses presented to PHD Veterinary Services this Fall/winter for very different complaints yet the same disease process. Horse #1 was a 10 year-old gelding that presented for the complaint of rearing under saddle and refusing to go forward. Horse #2 was a 5 year-old mare that presented for the complaint of recurrent low grade colic after eating. A gastroscopy was performed on both horses and both horses were diagnosed with gastric ulcers. In Figure 1, the area of ulceration is within the blue circle and the ulcerated tissue is highlighted by the red arrows. The ulcers in Figure 1 correspond to the horse which was rearing and the ulcers scored a 3 out of 5 with 5 being severe. In Figure 2 and 3, the ulcers appear less severe (score 2/5) and correspond to the horse that was demonstrating abdominal pain after eating. Interestingly, the gastric ulcers in the horse that was rearing under saddle appear worse than the horse with recurring symptoms of colic.
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Figure 1

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 In Figure 4, a "normal stomach" is imaged through gastroscopy. The horse's stomach can be divided into the glandular stomach (darker red tissue) and the non-glandular stomach (lighter tissue). The junction of the two types of tissue (yellow arrows) is called the margo plicata. Most gastric ulcers in horses occur at the margo plicata and in the non-glandular stomach immediately adjacent to the margo plicata.

Listed below are a list of clinical symptoms which can fit with gastric ulcers in horses:

1- Recurring colic
2: Weight loss and failure to thrive
3: Poor performance
4: Sudden change in behavior
5: Unwilling to go forward
6: Rearing under saddle
7: Increased sensitivity to brushing/touching of abdominal and flank area
8: Repeated straining to urinate: parking-out for geldings and tail flagging for mares

The take home message is that gastric ulcers can present in many different ways and should always be considered when evaluating horses for performance/behavior issues.