Could this be neoplasia? Cat iris abnormality

Re: Could this be neoplasia? Cat iris abnormality

Rob Loxley — Wed, 07 May 2014 21:52:09 GMT

[quote user="Neil Wheadon"]Davidwilliams.org.uk[/quote]

Unless you're looking to vote in Crewe and Nantwich, you need an 'L' in between david and williams

Re: Could this be neoplasia? Cat iris abnormality

Emma Middleton — Wed, 07 May 2014 16:21:02 GMT

[quote user="Tim Browning"] treat for inflammation for a reasonable time and if worsening enucleate[/quote]

I'm all for pragmatism, but have already started a basic work up and also the owner is quite difficult/demanding/emotional/draining etc, so I'm inclined to be a little more thorough initially. Since the eye is comfortable and visual, both myself and the owner would need some convincing to enculeate at this stage.

[quote user="Neil Wheadon"]you could always E mail the image to him[/quote]

Great idea, thanks for this. I will do this and see what his thoughts are.

Update: Fortunately I had the opportunity to discuss the case in depth with a specialist at our local referral centre and their feeling was this is either anterior uveitis or ocular lymphoma. Unfortunately not terribly easy to differentiate. They advised routine bloods, UA and blood smear examination and if owner willing, the next step would be GA and take a sample of aqueous (the iris will likely bleed+++ as others have said), which should be diagnostic if it is lymphoma, with correct sample prep.

I've had the cat back in today for bloods, FeLV and FIV negative. Awaiting haematology and biochem which were sent externally. UA revealed haematuria, which I'm hoping is coincidental (he has had bouts of cystitis in the past but nothing for 3 years). Then we'll likely be sampling the eye next week...

Re: Could this be neoplasia? Cat iris abnormality

Martin Atkinson — Wed, 07 May 2014 11:10:33 GMT

[quote user="Tim Browning"]

The pragmatic approach on a first presentation would be to treat for inflammation for a reasonable time and if worsening enucleate, its unlikely to stay the same (but my cat's iris has a strange unilateral crystalline appearance for years that is progressing very very slowly.......)

[/quote]This is of course a reasonable choice as I have had a similar case that looked neoplastic but turned out to be inflammatory probably secondary to an unknown penetrating wound and eventually cleared up with long term steroid drops. But at the same time there is the risk of missing the opportunity to treat the bigger picture if there is one. I had the luxury of the client wanting a referral for the diagnosis.

Re: Could this be neoplasia? Cat iris abnormality

Tim Browning — Tue, 06 May 2014 11:47:09 GMT

Re: Could this be neoplasia? Cat iris abnormality

Neil Wheadon — Mon, 05 May 2014 19:39:42 GMT

Davidwilliams.org.uk (the d is lower case - ipads are a nuisance sometimes) worth a look but there doesn't appear to be a picture of a feline iris lymphoma on the database, maybe he'd like this one!! (If that's what it is) It's a really good website, you could always E mail the image to him, he might give you an answer in exchange for the image. Neil

Re: Could this be neoplasia? Cat iris abnormality

Martin Atkinson — Sat, 03 May 2014 09:59:29 GMT

[quote user="grumpyoldman"] If you pretreat with anit-inflam drugs you will affect the cell morphology and make neoplastic lymhocytes look like inflam cells [/quote] Good theoretical point but how true is this in practice really? Using a NSAID like Accular drops rather than steroid may lessen this effect, or just forego the pre-procedure treatment and use anti-inflammatories after.

Re: Could this be neoplasia? Cat iris abnormality

Michael Woodhouse — Fri, 02 May 2014 22:19:06 GMT

Enucleation is quick and easy surgery. I'd bet I could whip the eye out in the time you spend getting biopsies and messing about, If we think neoplasia most likely then that's what I would do. Doesn't need to be expensive either.

I love a good enucleation.

Re: Could this be neoplasia? Cat iris abnormality

Stephen Courtney — Fri, 02 May 2014 22:14:51 GMT

If referral is oiut of the question i think enucleation is the best plan - get rid of the eye and there is some chance you will remove the potential tumour in toto, and at very least buy more time than doing nothing.

Primum non nocere - i would not attempt a wedge or incisional biopsy, and i wouldn't fna this either - the iris will bleed like a stuck pig. If you pre treat with steroids you will wreck the morphology anyway.

If surgery is ruled out then pred forte tid and perhaps systemic prednisolone as well. If it was infectious or immune mediated you should see flare as has been ,mentioned above.

Re: Could this be neoplasia? Cat iris abnormality

Gareth C. — Fri, 02 May 2014 19:24:54 GMT

Yes it probably is some sort of tumour.

Iris thickening in a cat is a worrying sign , and with lack of obvious flare makes an active inflammatory uveitis less likely. The location and shape of the lesion (near irido-corneal angle) would make melanoma high up on the list. Lack of flare (as far as week can see) will also make aqueocentesis less likley to yield cells

Re local lymph nodes, the iris acts as the lymph node for the internal eye and drains to the blood supply so the nearest lymph node to the inside of the eye is in fact the spleen.

Is the IOP raised?

Please post whatever it turns out to be!

Re: Could this be neoplasia? Cat iris abnormality

grumpyoldman — Fri, 02 May 2014 17:32:55 GMT

[quote user="Emma Middleton"]

Thanks for this Martin, really useful. Not sure which way she's going to go yet as going on her past animals/cases, she changes her mind at the drop of a hat and doesn't tend to think rationally

[quote user="Martin Atkinson"]A tru-cut needle would be a bit over aggressive! [/quote]

Thought it might be!

Thanks again

[/quote]

Use a yellow needle and just allow a bulb of fluid to leak onto a slide ,a bit like dropping the IOP after a phaco . If you pretreat with anit-inflam drugs you will affect the cell morphology and make neoplastic lymhocytes look like inflam cells . Maybe better to aspirate Drainage LN , You could also look for uveal irregularities with an ultrasound probe ,but make a good standoff with a glove filled with gel. Also look at the Alb/glob ratio , Do not enucleate and send for histo for at least a month, as the same changes often appear in the other eye a few weeks later ,and you will look bad.

Re: Could this be neoplasia? Cat iris abnormality

Emma Middleton — Fri, 02 May 2014 16:44:24 GMT

Thanks for this Martin, really useful. Not sure which way she's going to go yet as going on her past animals/cases, she changes her mind at the drop of a hat and doesn't tend to think rationally

[quote user="Martin Atkinson"]A tru-cut needle would be a bit over aggressive! [/quote]

Thought it might be!

Thanks again

Re: Could this be neoplasia? Cat iris abnormality

Martin Atkinson — Fri, 02 May 2014 15:31:45 GMT

[quote user="Emma Middleton"]Any tips on how on earth to get a biopsy of this?? Would an FNA be adequate or a tru-cut biopsy perhaps? Approach?[/quote]First you've got to explain the risks to the owner, it is unlikely you'll lose an eye but you will probably get some hyphaema which should rapidly resolve. Also like any FNA you may not get a usable sample. Clearly any risk has to be put in the context of the risk of leaving it and losing the eye anyway or worse if its part of a generalised condition.

I would pre-treat for several days with anti-inflammatory drops to reduce the post-procedure inflammatory response. GA of course, stabilise and rotate the eye laterally if you're going for the medial lesion the eye with mosquito forceps on the dorsal and ventral conjunctiva, Pass a 23 gauge needle through the limbal cornea as parallel to the iris as possible and advance the tip into the visible lesion then apply gentle suction. You may get some aqueous as well of course but that may actually be beneficial as it will be easier to express the sample out of the needle onto a slide. You will get some leakage from the wound but it will soon seal and re-inflate. Continue for several days afterwards with topical antibiotic and anti-inflammatory drops.

A tru-cut needle would be a bit over aggressive! However an excisional biopsy through a limbal incision, like one would perform for a lendectomy and sutured with fine silk or 6/0 Dexon, would yield a more reliable biopsy sample but clearly is more technically demanding and carries a greater risk of complication.

Re: Could this be neoplasia? Cat iris abnormality

Emma Middleton — Fri, 02 May 2014 11:08:02 GMT

[quote user="Stephen Courtney"]what does the other eye look like? any signs of systemic illness (yet...)?[/quote]

Other eye normal and no signs of systemic illness yet. Owner can't afford referral unfortunately.

[quote user="Martin Atkinson"]Attempting an FNA from the eye is not as scary as you may think[/quote]

It certainly sounds scary Martin! However after your post and given referral isn't an option I would definitely give it my best shot. I have just spoken to the owner and offered it here if she wants to get a diagnosis. She's going to think about it as she is quite emotional at the moment.

Any tips on how on earth to get a biopsy of this?? Would an FNA be adequate or a tru-cut biopsy perhaps? Approach?

Re: Could this be neoplasia? Cat iris abnormality

Martin Atkinson — Fri, 02 May 2014 09:18:11 GMT

I would share the other's concerns but it could also be just inflammatory so what you do depends on the owner's wishes. If they are likely to go for enucleation/chemo if its a malignancy then you need a diagnosis and you're only going to get that with a biopsy.Attempting an FNA from the eye is not as scary as you may think but you may wish to refer. If on the other hand the owner is not willing and/or can't afford/ to proceed in this manner you could do worse than use some anti-inflammatory drops like pred-forte, Maxidex or Accular.

Re: Could this be neoplasia? Cat iris abnormality

Stephen Courtney — Thu, 01 May 2014 23:37:54 GMT

That is a worrying presentation., I too would put lymphoma right at the top of my list. Other options FIP, toxo, other neoplasia, other inflammatory conditions....what does the other eye look like? any signs of systemic illness (yet...)?

Refer if possible, it will be hard to get a definitive diagnosis without harvesting the entire eye as a biopsy specimen and that is fairly destructive and expensive. If the owner is likely to want chemo eg for a lymphoma protocol you need to confirm a diagnosis

Re: Could this be neoplasia? Cat iris abnormality

Ceri Gruffudd Jones — Thu, 01 May 2014 21:47:06 GMT

I'd be more worried about ocular lymphoma. Worth doing FIV/FeLV test? Possibly screen FIP as well? I'm sure a proper eye person will be along soon!