Use of Acrylic Resin to Fill the Orbital Cavity after Exenteration in a Dog with Conjunctival Hemangiosarcoma

Background: The hemangiossarcoma (HSA) is a malignant tumor originated from the alterations of vascular endothelial cells. As it has an aggressive behavior, it is indicated, as initial treatment, wide surgical excision, such as the exenteration, which results in the surgical removal of the ocular bulb and adjacent tissues. The referred technique has as a result a concave orbit and aesthetically unacceptable. Therefore, various materials, used as orbital implants, have been studied and used in several species. Thus, it was aimed to report the use of the polymethylmethacrylate (PMMA) to fill the orbital cavity after exenteration in a dog with conjunctival HSA.Case: A 10-year-old male Pitbull dog was assisted, with a clinical history of growth of a reddish tissue in the left eye, causing constant hemorrhage, with an evolution of two months. At ophthalmic examination of the left eye, in the temporal bulbar conjunctive was found a reddish neoformation, with an irregular surface, measuring approximately 4x2x2 cm. The biopsy and aspiration cytology of the neoformation, revealed cells that inferred that they were those of conjunctival HSA. The hemogram revealed normocytic anemia; the biochemical profile was with the standards of normality and no metastasis were found in the ultrasonography and X-ray. The treatment of choice was the exenteration. Initially, the palpebral borders were approximated using continuous simple suture wit monofilament nylon thread. An incision was made in the skin, along the orbital rim and then was performed a rhombus dissection of the conjunctive and all the extraocular muscles. Next, the eye globe, together with the neoplasia, soft tissues of the orbital cavity and third eyelid were removed. The PMMA was obtained from a mixture of the powder (polymer) and of the liquid (monomer) in the ratio of 1:1 in a sterile recipient, in order to obtain a liquid suspension. Still in its paste-like form, the PMMA was molded in the orbit itself without going beyond its limits, filling in. At the moment of the polymerization of the PMMA, the site was irrigated with cold sterile saline solution for the reduction of the temperature caused by the thermal reaction. For the closing of the conjunctive, a continuous simple suture was performed, using 910 4-0 polyglactin thread and, in the suture of the skin, simple interrupted stiches were used with 3-0 monofilament nylon thread. After the surgery, tramadol hydrochloride was administered at a dose of 2 mg/kg/SC and meloxicam at a dose of 0.1 mg/kg/SC.  In the post-operative phase, the animal was treated with ampicillin suspension at a dose of 20 mg/kg/TID/PO during 10 days; metronidazole at a dose of 15 mg/kg /BID/PO during 10 days and the application of 0.5% chloramphenicol ocular ointment, 10.000UI of retinyl acetate and 2.5% amino acids on the stiches, SID, until their removal. After nine months, the owner reported a satisfactory result in relation to the aesthetic aspect, denying the presence of any ocular alterations or discomfort of the animal.Discussion: The use of the PMMA implant proved to be an excellent alternative to fill the anophthalmic cavity after exenteration in a dog with conjunctival HSA, seen as it provided, most importantly, the maintenance of the orbital volume, granting an adequate aesthetic aspect, already established among some authors, without the presence of secretion, inflammation and local infection.  It is worth emphasizing that, despite the patient in question having been treat with a broad-spectrum antibiotic after the surgery, in other reports, the absence of local infection was associated to the high temperature that the PMMA reaches during the exothermic reaction in the polymerization stage. Furthermore, the referred implant is cost-effective, offers easy molding to the orbit and absence of extrusion. In light of this, it is therefore suggested that the referred implant is a pertinent alternative for use in similar cases

Progressive Histiocytosis of Non-Epitheliotropic Dendritic Cells in a Feline

Background: Histiocytic tumors in felines are nodules that commonly develop on limbs and head extremities. They can be divided into many subtypes including cutaneous histiocytoma, histiocytic sarcoma, reactive fibrohistiocytic nodule, Langerhans cell histiocytosis, and progressive feline dendritic cell. Despite the same origin, they have behaviors that differ from each other, thus it is important to confirm diagnosis with histopathological and immunohistochemical tests, because early identification can facilitate prognosis and treatment. In this study, we describe the pathological and immunohistochemical characteristics, enabling differentiation feline neoplasms derived from histiocytes. Case: A 5-year-old, crossbreed, male, feline presented with a nodulation at the base of the left ear. The mass was slow growing, partially alopecic, with no other changes associated with tumor development. The nodule was round and circumscribed, movable, with an elevated surface. He was referred for surgery and an elliptical sample around the tumor was carefully dissected. Routine histopathological evaluation was performed with hematoxylin and eosin (HE), as well as immunohistochemistry. Histopathology showed circumscribed proliferation of histiocytic cells, with abundant and eosinophilic cytoplasm. The proliferative cells were large and rounded, extending from the superficial dermis and basement membrane to the deep dermis. At the extremities, some cells had visible vacuoles. Mitotic activity ranged from 3 to 4 mitoses per field in 40x magnification. Immunohistochemistry showed positive staining for histocompatibility complex MCII and lysozyme antibodies, marking histiocytic cells. Labeling was positive for CD20 in cells of lymphoid lineage B and negative for E-cadherin. Histiocytic cells did not invade the epidermis; hence, proliferation was classified as nonepitheliotropic. These methods contribute to the literature regarding the diagnosis of this rare tumor. Therefore, histological as well as immunohistochemical evaluation are important bfor confirming clinical diagnosis of histiocytic proliferation non-epitheliotropic. Discussion: Progressive histiocytosis of feline dendritic cells, in both epitheliotropic and non-epitheliotropic forms, is considered a clinically progressive and rare disorder. There are reports which include cytological, clinical, histological and immunohistochemical examinations, but the diagnostic characteristics regarding the non-epitheliotropic classification have not yet been properly identified. Nodulations are predominantly observed in head and limb regions, usually non-ulcerated, which can both increase and decrease in size, and are typically painless. The tumor in the present case was restricted to the base of the ear and no evidence of infiltration or metastasis was found. Progressive histiocytosis may spread and reach the lymphatic system through the lymph nodes, subsequently becoming systemic. The non-aggressive behavior observed in this case is possibly related to the non-epitheliotropic pattern. In the present case, MHC II histocompatibility complex markers, a phenotype compatible with dendritic cells, were used. Lysozyme antibodies marked histiocytic cells and the reactive lymphoid infiltrate was composed of CD20-positive B lymphoid lineage cells. Staining for E-cadherin was negative, negative results in labeling experiments is common, it is dependent upon the cellular origin of the leukocytes present in the sample. Staining for these molecules is recommended for differentiating feline progressive histiocytosis from Langerhans cells. Langerhans cells can be characterized by E-cadherin expression in about 10% of cases and marked T lymphocyte and neutrophil expression in the affected tissue. In this case, the histopathological exam along with immunohistochemistry was essential for differentiating them

RADIOGRAFIA E MACROSCOPIA do JOELHO APÓS ESTABILIZAÇÃO EXTRA-ARTICULAR UTILIZANDO FÁSCIA LATA, FIO DE POLIÉSTER TRANÇADO OU FIO DE POLIAMIDA PARA CORREÇÃO da RUPTURA do LIGAMENTO CRUZADO CRANIAL em CÃES

A ruptura do ligamento cruzado cranial é uma das principais doenças ortopédicas que afetam os cães. Muitas técnicas cirúrgicas foram descritas no intuito de aliviar a dor, restaurar a estabilidade biomecânica do joelho e prevenir a progressão da osteoartrite. Fáscia lata, fio de poliéster trançado e fio de poliamida foram empregados na estabilização do joelho após excisão do ligamento cruzado cranial em cães, os quais foram submetidos à avaliação radiográfica e macroscópica da articulação. Neste estudo, foram utilizados 18 cães com massa corporal superior a 15Kg (peso médio - 19,67kg), separados em 3 grupos eqüitativos correspondentes a cada técnica, avaliados durante 30 e 60 dias. Ao exame radiográfico, independentemente de grupo, os cães apresentaram evidência de efusão articular moderada a severa, distensão da cápsula articular e, na maioria dos casos, ausência de sinais de doença articular degenerativa. Ao exame macroscópico da articulação do joelho observou-se espessamento da cápsula articular e tecidos moles periarticulares, erosão da cartilagem articular dos côndilos femorais em todos os grupos e afrouxamento dos fios nos cães submetidos às técnicas de estabilização extra-articular com fio de poliéster trançado e fio de poliamida.The cranial cruciate ligament rupture is one of the main orthopaedic diseases which affect dogs. Many surgical techniques have been described and they aim to relief the pain, restore stifle biomechanical stability and prevent the progression of osteoarthritis. Fascia lata, braided polyester and polyamida were used in lateral fabellar suture to stifle stabilization after induced cranial cruciate ligament rupture in dogs that were submitted to radiographic and macroscopic evaluation of joint. In this study 18 dogs weighting more than 15kg were used (middleweight - 19.67kg), distributed in three groups corresponding to each technique, evaluated during 30 and 60 days. In the radiographic exam, the dogs had evidence of moderate to severe joint effusion, capsular distension and, in most cases, lacking of degenerative articular disease features. At the macroscopic exam of the stifle joint thickening of the joint capsule and periarticular soft tissues, erosion of the femoral condyles cartilage in all groups and loosening of the suture were observed in dogs submitted to extra-articular stabilization techniques employing braided polyester and polyamida

Clínica e radiografia da prótese de poliéster em cães com ruptura do ligamento cruzado cranial

Os achados clínicos e radiográficos após reparo intra-articular do ligamento cruzado cranial com prótese de poliéster, utilizando a técnica over-the-top modificada, foram avaliada em seis cães. Sete cirurgias foram realizadas devido ao acometimento bilateral em um dos animais. A avaliação clínica foi realizada ao 3º, 10º e 40º dias de pós-operatório, e a avaliação radiográfica realizada ao 5º e 24º meses após a cirurgia em cinco cães, por meio da qual se confirmou a progressão da doença articular degenerativa. A resolução dos sinais clínicos foi observada entre o 25º e 68º dias após a cirurgia, segundo avaliação realizada pelos proprietários. A função do membro operado foi considerada boa. Dois cães apresentaram desgaste e ruptura da prótese após a cirurgia. Concluiu-se que a prótese de poliéster, da forma como foi implantada neste estudo, não pode ser considerada como substituto satisfatório, uma vez que resultados superiores podem ser obtidos com ténicas menos invasivas e mais simples.Clinical and radiographic findings after intra-articular replacement of cranial cruciate ligament with a polyester prosthesis using a modified over-the-top technique were evaluated in six dogs. Seven surgeries were done due to bilateral involvement of the cranial cruciate ligament in one dog. Clinical evaluation was performed on postoperative days 3, 10 and 40, and radiographic evaluation was done at 5 and 24 months after surgery in five dogs, where signs of progressive degenerative joint disease were confirmed. Resolution of clinical signs was observed from 25 to 68 days after surgery as evaluated by dog owners. Overall function of joint movement after surgery was classified as good. Two dogs presented fraying of the implant after surgery. It was concluded that the polyester prosthesis, as implanted in these dogs, was not a satisfactory replacement for the injured ligament, as better results may be obtained with less invasive and simpler techniques