Simone Carvalho dos Santos Cunha

Radiation therapy for feline cutaneous squamous cell carcinoma using a hypofractionated protocol

The objective of this paper was to evaluate the efficacy of a hypofractionated radiation protocol for feline facial squamous cell carcinoma (SCC). Twenty-five histologically confirmed SCCs in 15 cats were treated with four fractions of 7.6–10 Gy each, with 1 week intervals. The equipment used was a linear accelerator Clinac 2100 delivering electron beam of 4 or 6 MeV, and a bolus of 5 or 10 mm was used in all lesions. Of the lesions, 44% were staged as T4, 16% as T3, 8% as T2 and 32% as T1. Of the irradiated lesions, 40% had complete response, 12% had partial response and 48% had no response (NR) to the treatment. For T1 tumors, 62.5% had complete remission. Mean overall survival time was 224 days. Owners requested euthanasia of cats having NR to the treatment. Mean disease free time was 271 days. Side effects observed were skin erythema, epilation, ulceration and conjunctivitis, which were graded according to Veterinary Radiation Therapy Oncology Group (VRTOG) toxicity criteria. Response rates found in this study (52%) were lower when compared to other protocols, probably due to technique differences, such as fractionation schedule, bolus thickness and energy penetration depth. However, the hypofractionated radiation protocol was considered safe for feline facial SCC. Modifications of this protocol are being planned with the objective of improving the cure rates in the future.

Duodenal perforation caused by Rhizomucor species in a cat.

Clinical summary A 7-month-old female Persian cat presented with gastrointestinal (GI) necrosis and perforation caused by Rhizomucor species. Unfortunately, the cat died of bacterial peritonitis and sepsis before a definitive diagnosis, based on histopathology and fungal culture, was achieved. Practical relevance This appears to be the first reported case of GI disease caused by Rhizomucor species in a cat. Mucorales infections typically cause acute and rapidly progressive disease. As illustrated by this case, clinicians should be alert to the potentially fatal consequences of an opportunistic Rhizomucor species infection in their feline patients.

Recurrent pulmonary edema secondary to elongated soft palate in a cat.

A 9-month-old intact female Persian cat presented with recurrent pulmonary edema secondary to an elongated soft palate. Endoscopic evaluation of the pharynx and larynx showed that the elongated soft palate was overlying the epiglottis. Partial resection of the soft palate was performed and the cat showed no further respiratory signs. This report is the first description of elongated soft palate causing airway obstruction in a brachycephalic cat.

Miltefosine Administration in Cats with Refractory Sporotrichosis

Background: Sporotrichosis is a zoonosis caused by fungi of the Sporothrix schenckii complex. Cats have important zoonotic potential due to the high parasite load found in the cutaneous lesions. Refractory cases to antifungal therapy are increasing, becoming a public health problem. Miltefosine is a drug with high in vitro activity against Sporothrix brasiliensis. However, this efficacy has not been confirmed in vivo yet and administration has not been studied in the feline species. This study aimed to evaluate the effectiveness and safety of miltefosine administration in cats with resistant sporotrichosis. Materials, Methods & Results: Ten cats with refractory sporotrichosis were included in this study. Inclusion criteria were previous diagnosis for sporotrichosis associated with therapy with oral antifungals (itraconazole and/or potassium iodide) for more than one year, followed by one of these conditions: incomplete clinical remission, worsening of disease during treatment or recurrence after conventional treatment. Cats underwent clinical and dermatological examinations. Data on lifestyle and previous treatments were provided by the owners. Fungal culture and histochemical techniques were performed in all cats before miltefosine treatment. Blood samples were collected before and during the study for laboratory tests, such as blood count, blood urea nitrogen (BUN), serum creatinine, alanine aminotransferase (ALT) and alkaline phosphatase, as well as serology for Feline Immunodeficiency (FIV) and Feline Leukemia (FeLV). Miltefosine was prescribed at a dosage of 2 mg/kg orally every 24 h. The animals were monitored by phone during the whole process and reassessed on days 0, 15, 30 and 45 of the treatment. Out of 10 cats, lesions were present on the nose in nine, ears in four, periocular areas in one and limbs in four. One cat received treatment for 45 days, six for 30 days, one for 21 days, one for 15 days and one for 3 days. One cat showed no response to the treatment and nine showed disease progression. Hyporexia and weight loss were the most frequent clinical signs related to miltefosine treatment, followed by sialorrhea, vomiting and diarrhea. Few adverse effects on hematology and biochemistry (mainly renal and hepatic parameters) were observed during the study. Hematocrit decrease was observed in four animals. However, only one cat had hematocrit decrease below normal values (anemia), which was already present before miltefosine administration. Other cats had a decrease of five points. Three cats showed elevation in leucometria and four in plasma protein. In relation to renal and hepatic biochemistry, one animal showed a BUN increase and another one showed a transient increase in ALT. Two animals started the treatment with increased ALT but had no problems during the study and values decreased even during the miltefosine administration. Discussion: Although two cats showed sialorrhea, most owners did not report difficulty in administering the drug orally, representing an advantage of this medication. Weight loss, secondary to gastrointestinal changes, was the most clinically relevant alteration. The most frequent hematological alteration was hematocrit decrease and only the animal that started the study with 20% hematocrit ended the study with anemia. Renal and hepatic parameters were not significant in the cats of this study. Miltefosine did not lead to sporotrichosis remission in this small population of cats, which reveals that, despite its in vitro efficacy against Sporothrix spp., the drug is not effective in vivo in the feline species. Further studies are needed to investigate the efficacy of this drug in a larger number of cats, and possible reasons for its in vivo ineffectiveness.

Survival and Disease-free Interval of Cats with Mammary Carcinoma Treated with Chain Mastectomy

Background: Mammary tumors are extremely common in cats and have high metastatic rates with poor prognosis. The main objective of the present study was to evaluate the disease free interval and survival in cats undergoing radical mastectomy as sole therapy. Materials, Methods & Results: Twenty cats with mammary tumors and no evidence of distant metastasis were studied. General health and concomitant diseases were assessed by clinical and hematological examination. Thoracic radiographs and abdominal ultrasonography were performed to evaluate thoracic and abdominal metastases. All cats underwent chain mastectomy, which was unilateral when tumor was present in one mammary chain, and bilateral in steps if tumors were present in both mammary chains. Intact cats were spayed. An elliptical incision was made around the mammary chain with a three centimeter margin around tumor. Regional lymph node was removed. Mean age was ten years, and 14 cats were mixed breed, three were Persian and two were Siamese. Fifteen cats were spayed at tumor diagnosis, but only three had been spayed before one year old. The inguinal mammary glands were the most affected, followed by abdominal and thoracic glands. Histopathology diagnosed well-differentiated adenocarcinoma in eight cases, moderately differentiated adenocarcinoma in nine cases, poorly differentiated adenocarcinoma in two cases and carcinoma in situ in one case. Most tumors were grade II, and regional lymph node metastasis was present in two cases. Disease free interval ranged from 120 to 1800 days, with an average of 678 days. Four cats had tumor local recurrence and six developed lung metastasis. The survival time ranged from seven to 1800 days, with an average of 768 days. Twelve cats are still alive with no tumor recurrence. Discussion: The average age of onset of mammary carcinomas in cats was ten years old, similar to previous studies. Siamese cats have more risk of developing this disease, but mixed breed cats were frequent in this study. Intact or late spayed cats are predisposed to mammary tumors because of hormonal stimulation, the same was observed in this study. Inguinal and abdominal glands were most affected, similar to other reports. The histopathologic diagnosis was adenocarcinoma in most cases of this study, mostly grade II tumors, which was also observed in previous papers. Regional lymph nodes (axillary or inguinal) should always be removed during mastectomy in cats, as regional metastasis at diagnosis is common, even when not clinically palpable, as was observed in two cases. Distant metastasis occurs most often to the lungs, leading to severe dyspnea. In this study, four cats had local tumor recurrence and six developed lung metastasis. Aggressive and early surgical intervention is the treatment of choice for feline mammary tumors. Unlike dogs (where conservative mammary resections are appropriate in some cases), radical chain mastectomy is recommended for feline mammary tumors, as significantly reduces the risk of local recurrence. In this study, all animals underwent radical mastectomy, without previous cytology or biopsy. Survival is variable between studies, ranging from 220 to 1408 days. Several factors may be involved in disease free intervals and survival times, as tumor size, tumor histological grade, presence of metastasis at diagnosis, type of surgery performed, presence of concomitant diseases and adjuvant chemotherapy. In this study, mean survival time was 768 days and 12 cats are still alive and in follow-up, which may increase this number. This study supports that, if treated early and agressively, cats with malignant mammary tumors can have long survival after chain mastectomy.

Histoplasmose felina: relato de caso com envolvimento supraorbital

Histoplasmosis is a systemic fungal infection caused by the dimorphic fungus Histoplasma capsulatum that infects humans and a wide variety of mammalian species, including cats. In Brazil only four cases of this disease were reported in domestic cats. The present study reports a case of an indoor cat, rescued from street three years ago, that developed histoplasmosis with supraorbital involvement. The cat presented sneezing, dyspnea and increased respiratory sounds and the diagnosis suspected was allergic rhinitis. Prednisolone and amoxicillin were prescribed. The patient returned to clinic after clinical signs worsened with a swelling of the right supraorbital region, unilateral left side conjunctivitis and enlarged submandibular lymph nodes. Cytology and culture revealed Histoplasma capsulatum. Initially, itraconazole (10 mg/Kg SID orally) was prescribed and due to the worsening of clinical signs, was combined amphotericin B (0.5 mg/kg SC) for two weeks. The therapy with amphotericin was discontinued and itraconazole continued to be administered for six months. The clinical signs were resolved and no recrudescence was reported. It is important that veterinary practitioners to be aware of the clinical features of feline histoplasmosis and consider the possibility of a subclinical infection.

Tratamento hipofracionado de radioterapia em felinos portadores de carcinoma epidermóide facial

Avaliou-se a eficacia do protocolo radioterapico hipofracionado no tratamento de felinos portadores de carcinoma epidermoide facial. Um protocolo hipofracionado de radioterapia foi aplicado em cinco gatos portadores de um ou mais carcinomas epidermoides faciais, em um total de 10 lesoes neoplasicas, confirmadas por meio de analise histologica. Duas lesoes foram classificadas como T1, quatro como T2, duas como T3 e duas como T4. Os animais foram submetidos a quatro fracoes radioterapicas de 7,6 a 10gy, com intervalo de uma semana entre elas, utilizando-se um acelerador linear com feixe de eletrons. O acompanhamento dos animais foi realizado semanalmente durante o tratamento e aos 30 e 60 dias apos o termino da radioterapia. Neste estudo, 40% das lesoes resultaram em remissao completa, 40% em remissao parcial e 20% nao apresentaram resposta ao tratamento. A taxa de resposta encontrada nessa pesquisa foi baixa, porem o protocolo de hipofracionamento radioterapico foi seguro para gatos com carcinoma epidermoide facial e resultou em efeitos colaterais leves/moderados