سرطان الخلايا الحرشفية النامية في قاعدة الورم الحليمي عن طريق الفم لدى الكللاب الصغيرة فليلة المناعة
Viral papillomatosis associated with Canine Oral Papilloma Virus (COPV) commonly occurs in young, immunosuppressed dogs. In addition to causing benign proliferations in the mucous membrane, papillomaviruses (PVs) are also reported to be related to the development of squamous cell carcinoma (SCC). The purpose of the presentation of this case is to show the recovery of a young, immunosuppressed dog with oral SCC on a severe case of PV infection.
MATERIAL AND METHOD
A one year old, mixed breed, neutered female dog was brought to Ada Veterinary Polyclinic with complaints of severe lesions in the mouth, difficulty in eating and problems regarding salivation. Patient tested positive for Ehrlichia in SNAP4xPlus test and had multiple ulcerative, exophytic masses in different sizes in the oral cavity, lips and on the sides of the mouth. Blood tests revealed pancytopenia. Biopsy samples were taken from the oral mucous membrane for histopathological examination. Biopsy samples were fixed in a 10% formaldehyde buffered solution for 24 hours. Then samples were embedded in paraffin blocks after routine tissue processing. Paraffin blocks were sectioned in 3-4 μm width, stained in hematoxylin and eosin dye and examined under light microscope. P16 antibody was used to determine the existence of PV antigens with immunohistochemistry (IHC). Patient was administered 0.75 mg/kg IV of Vincristine (Vinkristin, Koçak, 1 mg/1ml) for 5 weeks, 10/kg/day PO for 30 days of doxycycline (Monodox capsule, Deva, 100 mg). When improvement was observed in the patient’s PV lesions and blood results, she was administered 12 fractions 48 Gy radiotherapy. During and after the treatment, patient received Vitamin C (1gr/kg).
Serological tests showed positive for Ehrlichia.
Macroscopic findings: Exophytic pinkish, pedunculated, cauliflower shaped masses in the oral cavity, lips, sides of the mouth ranging in 1.5 to 3 cm (Fig. A). In the process of Vincristine treatment PV lesions subsided and SCC became more apparent (Fig. B).
In the histopathological findings, severe epithelial hyperplasia from mucosa to submucosa were observed. In some areas, differentiation in neoplasia characterized by varying degrees of keratinization in clusters of squamous epithelial cells supported by fibrovascular stroma was seen (Fig. C). Neoplastic cells were seen to be of morphologies ranging between circular to polygonal and with eosinophilic cytoplasm; in addition show high amounts of anisocytosis and anisokaryosis and atypical mitosis (Fig. D, arrows). Nuclear hyperchromasia and multiple nucleoli per nucleus were observed. Extensive surface ulceration was also seen. (Fig. E and F).
P16 antigen was revealed to be positive with IHC in neoplastic lesions. Positive reaction in neoplastic squamous cells were seen as brown dye stain in intrastoplasmic (Fig. G and H) and intranuclear (Fig. I and J) locations.
DISCUSSION AND CONCLUSION
Studies have been conducted on the possible role papillomaviruses may play on the emergence of SCC both in human and veterinary medicine. In human medicine, regarding oral SCCs, while PV DNA’s PCR analyses are done on a molecular level, marking the PV antigen is a method used to determine PV etiology on an immunohistochemistry level. On this level, in human medicine, marking the P16 protein is a diagnostic criterion. Similar methods have been used in veterinary medicine and P16 gave a positive response in canine oral SCCs. In this case presentation, similar findings in various studies support that the young, immunosuppressed dog was infected with PV and oral SCC developed associated with PV. Patient made a full recovery as of 22/06/2018 and her clinical condition is stable (Fig. K). Radiotherapy, Vincristine and Vitamin C combination after the diagnosis is considered to be a preferable treatment for PV related SCCs.
وسائل الاعلام الاجتماعية
ADA VETERINARY ONCOLOGY CLINIC Levent Mah. Sülün Sokak No: 14 1. Levent - Beşiktaş - Istanbul / TURKEY 0212 324 67 32 - email@example.com