A case of feline injection-site sarcoma at the site of cisplatin injectionsby M. Martano, E. Morello, S. Iussich, P. Buracco

Journal of Feline Medicine and Surgery

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Year
2012
DOI
10.1177/1098612X12449407
Subject
Small Animals

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Text

Journal of Feline Medicine and Surgery 14(10) 751 –754 © ISFM and AAFP 2012

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DOI: 10.1177/1098612X12449407 jfms.com

A spayed 14-year-old female domestic shorthair cat presented with a clinically suspected squamous cell carcinoma (SCC) of the nasal planum. A complete work-up, including a clinical examination of the lesion and the regional lymph nodes (that were normal in size, shape and consistency), thoracic radiographs, a serum biochemical profile, feline immunodeficiency virus (FIV) and feline leukaemia virus (FeLV) tests, a complete blood cell count and a wedge biopsy of the lesion was performed. The histology report described an unencapsulated and poorly demarcated epithelial neoplasia composed of basal cells and mature keratinocytes arranged in clusters infiltrating the dermal tissue.

Neoplastic cells with abundant eosinophilic cytoplasm and paracentral nuclei with one amphophilic nucleolus were present. Multifocal foci of central keratinisation within concentric layers of abnormal squamous cells were visible. A high mitotic index (5–6/HPF) and an abundant neutrophilic lymphocytic and plasmacellular inflammatory infiltrate were present. A diagnosis of SCC was formulated and intralesional administration of cisplatin (Cisplatino; Teva) (1.5 mg/cm3 of lesion mixed with an equal volume of the cat’s own blood serum) was performed because the tumour was too large for surgical excision and the owner declined radiation. Cisplatin was administered under injectable anaesthesia once a week for 4 weeks and then every other week for an additional four doses. During the treatment course a new SCC lesion was detected and cytologically confirmed on the medial canthus of the right eye. The new lesion was also infiltrated with cisplatin/serum. Following treatment, both tumours were in complete clinical remission and only a nasal planum deformity due to tumour erosion was evident. Two months after the completion of the intralesional chemotherapy course, a mass developed at the site of the eyelid infiltration, where it grew to a diameter of 1.5 cm within a few weeks. Differential diagnoses included a SCC recurrence, a granulomatous process and other tumour types. A fine needle aspirate was performed and the mass was subsequently diagnosed as a soft tissue sarcoma. Surgical excision was recommended, but the owner was reluctant; therefore, doxorubicin (Doxorubicina; Sandoz) (1 mg/kg body weight) was administered intravenously twice, with a 3-week interval between doses. The lesion partially necrotised and reduced in size, but renal failure developed and doxorubicin administration was stopped. At this point, the owner was still reluctant for us to perform surgery on

A case of feline injection-site sarcoma at the site of cisplatin injections

Marina Martano, Emanuela Morello, Selina Iussich and Paolo Buracco

Abstract

A spayed 14-year-old female domestic shorthair cat presented with a squamous cell carcinoma of the nasal planum and was treated with intralesional chemotherapy. During nasal infiltrations with cisplatin mixed with the cat’s own serum, a new carcinomatous lesion developed at the medial canthus of the right eye, which was also treated using intralesional chemotherapy. Two months after the treatment course, the cat developed a new mass at the site of the eyelid chemotherapy, which was diagnosed as a soft tissue sarcoma. At the owner’s request, the tumour was marginally excised, but it recurred after 10 months. No lung or lymph node metastases were evident at the time of euthanasia. The histotype of the tumour, the coincidence with injections and the histological description make the hypothesis of an injection-site sarcoma likely. To the authors’ knowledge, this is the first case of an injection-site sarcoma at the site of a cisplatin injection.

Accepted: 1 May 2012

School of Veterinary Medicine, Italy

Corresponding author:

Marina Martano DVM, PhD, School of Veterinary Medicine,

Via Leonardo da Vinci, 44 – 10095 Grugliasco (TO), Italy

Email: marina.martano@unito.it 449407 JFM141010.1177/1098612X12449407Martano et alJournal of Feline Medicine and Surgery 2012

Case Report 752 Journal of Feline Medicine and Surgery 14(10) the cat. After 3 months the tumour began growing again and surgical excision was finally agreed to by the owner.

The nasal SCC was still under control at that time, although a crusty lesion was evident (Figure 1). The clinical condition of the cat was determined to be satisfactory after a blood work-up; therefore, surgery was performed after radiographs of the chest had been performed in three standard views, the regional lymph nodes had been palpated and evidence of metastasis was ruled out. The excision involved the lesion and a small amount of macroscopically normal tissue around the gross tumour burden. This excision was not a wide excision, as indicated for feline injection-site sarcoma (FISS), but both the localisation of the mass and the owner’s reluctance to enucleate the eye did not allow for a wider resection. The surgical site was closed with a transposition skin flap1 and an Elizabethan collar was worn by the cat until complete healing occurred (in approximately 20 days without major complications) (Figure 2).

A histological examination, performed according to the criteria of the World Health Organization (WHO)

Classification for Tumours of Domestic Animals,2 revealed a partially pseudoencapsulated tumour extending to the cut borders. The tumour comprised a monomorphic population of spindle cells immersed in an abundant hyaline matrix. The cells were characterised by indistinct borders, abundant cytoplasm and one paracentral nucleus with 1–2 prominent nucleoli, and a low mitotic index. A small central necrotic area and peripheral multifocal inflammatory infiltrates were present.

Moderate and diffuse chronic inflammation was also visible in the perinodular dermis. The final diagnosis of a well-differentiated fibrosarcoma was confirmed with immunohistochemical staining for vimentin (monoclonal mouse anti-vimentin, diluted 1:50, DakoCytomation) and cytokeratin (monoclonal mouse anti-human cytokeratin clone AE1-AE3, ready to use, DakoCytomation) (Figure 3a, b). No further treatment was proposed.