The Expression Levels of CD20 as a Prognostic Value in Feline B-Cell Nasal Lymphoma: A Pilot Study

The effect of the semi-quantitative expression of CD20 in the prognosis of feline nasal lymphoma has not been described. This study investigated the prognostic significance of CD20 expression, clinicopathological characterization, and treatment outcomes in cats with nasal lymphoma. Clinical data from cats diagnosed with nasal lymphoma were retrospectively collected, including signalment, clinical signs, clinicopathological variables, treatment outcomes, and survival times. Using ImageJ software, CD20 expression was semi-quantitatively measured based on the proportion of CD20-positive areas. Correlations between laboratory findings, immunohistochemical expressions, and survival outcomes were investigated. All cats included in the study exhibited the B-cell immunophenotype. During treatment, a reduction in PCV was noted in the cats at the second and sixth weeks (p = 0.01 and p = 0.01, respectively). The cats with low CD20 expression exhibited a significantly shorter MST (91 days; 95% CI, 41-141) than those with high CD20 expression (MST, 214 days; 95% CI, 76-351) (p = 0.01). Stage T1 cats displayed a higher MST (143 days; 95% CI, 144-172) than those in other stages > T1 (120 days, 95% CI, 71-169 days) (p = 0.04). Anemia, a common adverse effect in feline nasal lymphoma, did not impact MST. T1 clinical staging and high CD20 expression showed a trend for better MST.

Tumours involving the retrobulbar space in cats: 37 cases

OBJECTIVES

The aim of this multicentre retrospective study was to describe the clinical presentation, imaging findings, diagnosis and outcomes of cats with retrobulbar neoplasia.

METHODS

A total of 37 cats that were diagnosed with retrobulbar neoplasia and underwent advanced imaging were recruited from searches of the clinical records of two referral hospitals. All cats had neoplasia confirmed via cytology or histopathology. Data relating to the signalment, presentation, results of investigations, treatment and outcome were recorded. A review of imaging studies was performed where possible.

RESULTS

In total, 23 cases (62%) were presented with respiratory signs. Exophthalmos was the most common ophthalmological examination finding, present in 18 cases (49%). Thirty-two cases (86%) had secondary extension of neoplasia to the retrobulbar space (most commonly from the nasal cavities), present in 20 cases (54%), of which 12 were lymphoma. In cases where contrast was administered, 28/35 (80%) had contrast-enhancing masses. Orbital extension was detected in 21 cases (57%), exophthalmos in 22 (59%), globe deformation in 12 (32%) and local lymphadenomegaly in 22 (61%). In total, 36 (97%) retrobulbar tumours were malignant. Thoracic imaging, where it was performed, was concerning for metastasis in 8/25 cases (31%), with abdominal imaging suggestive of metastasis in 5/12 (42%). The most common diagnosis was lymphoma with 19 cases (51%), with nasal lymphoma representing 12 of these, followed by carcinoma in 10 (27%). The median survival time, for cases where death was recorded, was 85 days (range 1-263 days).

CONCLUSIONS AND RELEVANCE

To the authors' knowledge, this is the largest study of neoplasia affecting the feline retrobulbar space. Retrobulbar tumours in cats are overwhelmingly malignant, and commonly due to secondary extension of tumours originating elsewhere. Lymphoma, particularly arising from the nasal cavities, was the most common cause. Cats presenting with signs suggestive of retrobulbar disease should be assessed for disease affecting any of the structures of the head.

Efficacy of chemotherapy and palliative hypofractionated radiotherapy for cats with nasal lymphoma

Nasal lymphoma (NL) is the most common nasal tumor in cats, and radiotherapy, chemotherapy, or a combination of these treatments have been described as the treatment for this disease. However, the previous studies included various machines and protocols of radiotherapy. Therefore, we aimed to retrospectively compare the prognosis among cases treated with palliative hypofractionated radiotherapy, chemotherapy, and a combination of them with united machine and protocol of radiotherapy. When compared overall survival and progression free survival, there was no significant difference among these three groups. The data of this study suggested that similar efficacy could be achieved by palliative hypofractionated radiotherapy, chemotherapy, or a combination of them.

Series of extranodal natural killer/T-cell lymphoma, nasal type, with periorbital involvement

PURPOSE

To describe the clinical presentation, diagnosis and treatment of periorbital extranodal natural killer/T-cell lymphoma, nasal type.

METHODS

Case series of three patients with periorbital involvement of extranodal natural killer/T-cell lymphoma, nasal type, of whom clinical data, orbital imaging and immunohistochemical analysis were collected. For the purpose of this study, all histopathological and immunohistochemical slides were re-examined.

RESULTS

All patients presented with painless eyelid swelling and a history of sinonasal disease, of whom one with bilateral panuveitis, not responding to systemic antibiotics. Extraocular muscle involvement was present in 2 cases upon presentation and in 1 case later on. Initial paranasal and orbital biopsies were negative in 2 patients, with only the second orbital biopsy leading to the diagnosis. Natural killer/T-cell and cytotoxic markers were present in all cases, as well as Epstein-Barr virus encoded RNA in situ hybridization. The patients died respectively 5, 9 and 35 months from diagnosis despite treatment with chemotherapy and radiotherapy.

CONCLUSION

Extranodal natural killer/T-cell lymphoma, nasal type, should be suspected in a painless periorbital cellulitis with chronic sinusitis, not responding to conventional therapy. A high index of suspicion is necessary in biopsies showing angiodestruction and necrosis. Epstein-Barr virus encoded RNA in situ hybridization and expert hematopathologist consultation is necessary to decrease the delay in diagnosis.

Extranodal natural killer/T-Cell lymphoma: A population-based comparison of sinonasal and extranasal disease

OBJECTIVES/HYPOTHESIS

Extranodal natural killer/T-cell Lymphoma (ENKTL) is a rare, aggressive malignancy that preferentially affects the paranasal region. This study analyzes the demographic, clinicopathologic, incidence, and survival characteristics of sinonasal ENKTL (SN-ENKTL) and extranasal ENKTL (EN-ENKTL) in a comparative fashion.

STUDY DESIGN

Retrospective analysis.

METHODS

The Surveillance, Epidemiology, and End Results database was queried; 528 cases were available for frequency and incidence analysis, and 473 for survival analysis. Data were examined according to age, gender, race, histology, the presence of systemic (or B) symptoms, treatment, and Ann Arbor stage.

RESULTS

Extranasal disease was a poor prognostic factor (hazard ratio [HR] = 1.69, 95% confidence interval [CI] = 1.30-2.19, P < .05). Patients with EN-ENKTL were older (mean 53.8 vs. 49.9 years, P < .05), most were male (72.5% vs. 59.8%, P < .05), and they were more likely to present with stage IIIE/IV disease (38.33% vs. 18.26%, P < .05). B symptoms were present in 38.41% of the EN-ENKTL group (vs. 22.86%, P < .05), and were a poor prognostic factor in this group only (HR = 1.6593, 95% CI = 1.05-2.62, P < .05). Radiation therapy demonstrated a survival advantage among both groups, especially in early stage disease.

CONCLUSIONS

SN-ENKTL carries a significantly better prognosis than EN-ENKTL, which presents at more advanced stages. Radiation therapy was associated with increased survival in both groups, especially in cases of localized disease.

LEVEL OF EVIDENCE

2b.

The usefulness of immunohistochemistry to differentiate between nasal carcinoma and lymphoma in cats: 140 cases (1986-2000)

A retrospective evaluation of 232 feline nasal biopsies initially diagnosed as either carcinoma or lymphoma was performed by two pathologists. One or both pathologists disagreed with the original diagnosis in 15 cases (7%), 14 of which had original diagnoses of carcinoma. Out of the 232 cases, 140, including the disputed ones, were subjected to immunohistochemical staining with epithelial and lymphoid markers. Immunohistochemical staining of the 15 disputed cases showed that the original diagnoses were incorrect in 67% (10/15), unverified in 13% (2/15) and correct in 20% (3/15). Among the consensual diagnoses, immunohistochemistry revealed that 3% (4/125) of diagnoses were unverified because they did not stain for any of the markers evaluated. This report demonstrates the importance of immunohistochemistry in establishing a correct histologic diagnosis for nasal neoplasms in cats.