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EQUINE VETERINARY EDUCATION / AE / OCTOBER 2014
Oncology Virtual Issue Articles
The following three articles have been published online as part of the EVE Oncology Virtual Issue which is available online at
wileyonlinelibrary.com/journal/eve
Case Report
Imaging findings of a haemangiosarcoma in a cervical vertebra of a horse
E. V. Raes*,I. Durie†,B. Wegge‡,I. Gielen,K. Vanderperren and J. H. Saunders Department of Veterinary Medical Imaging and Small Animal Orthopaedics; †Department of Internal Medicine and Clinical Biology of Large Animals; and ‡Department of Pathology, Bacteriology and Poultry Diseases, Faculty of Veterinary Medicine, Ghent University, Salisburylaan, Merelbeke, Belgium. *Corresponding author email:
Els.Raes@UGent.be
Keywords: horse; imaging; cervical; vertebra; neoplasm
Summary An 18-year-old Warmblood gelding was presented with a recent, abrupt onset of ataxia. Transcranial magnetic stimulation (TMS) was performed and revealed a delayed response in both thoracic and pelvic limbs. Radiographic examination of the cervical region demonstrated osteolytic lesions in the vertebral body and arch of the third cervical vertebra (C3). A cervical myelogram revealed spinal cord swelling in this region on the lateral projection. Computed tomographic (CT) myelography was performed, which showed osteolytic lesions and circumferential thinning of the contrast column due to extra-dural compression at the cranial cervical region. These findings were compatible with an aggressive bone lesion compressing the spinal cord. Primary or secondary neoplasia and osteomyelitis were considered in the differential diagnosis. Because of the severity of the findings and poor prognosis, the horse underwent euthanasia. Post mortem histopathological diagnosis was a haemangiosarcoma involving the cranial cervical vertebrae and epidural space. This report demonstrates the additional value of CT myelography on the extent and exact location of cervical vertebral compressive lesions in the horse. This information can be useful for prognosis, biopsy and/or planned surgery of these lesions.
Introduction
Haemangiosarcoma is a malignant tumour of the vascular endothelium and rarely occurs in the horse. This tumour type is morecommonlyseenin small animalsandis mainlydetectedat the heart base, spleen, liverandlungs. In horses, they are mainly reported in the musculoskeletal and respiratory systems (Van Pelt et al. 1972; Von Reinachter 1978; Valentine et al. 1986; Johns et al. 2005). Clinical signs are determined by tumour location. As haemangiosarcomas rapidly metastasise it is often difficult to determine the primary site of the tumour and early diagnosis and aggressive therapy are mandatory (Waugh et al. 1977; Frye et al. 1983; Hargis and McElwain 1984; Johnson et al. 1988; Sweeney and Gilletee 1989).
© 2012 EVJ Ltd
This case report describes the clinical, imaging and pathological findings in a gelding with a haemangiosarcoma at the level of the cranial cervical region, characterised by a recent onset of ataxia. To the authors’ knowledge this is the first report describing CT myelography of a haemangiosarcoma in the cervical region in the horse.
Clinical history and clinical findings
An 18-year-old Warmblood gelding was presented with a recent, abrupt onset of ataxia. The horse was stabled and had not previously shown clinical signs. The patient showed a normal body condition, normal rectal temperature, heart and respiratory rates. Mental status was unremarkable and the horse did not show involvement of the cranial nerves. Marked deficits of proprioception were noticed at the walk and at trot. During circling, circumduction of both outer pelvic limbs was visible. Head elevation caused the horse to scuff the hooves of the thoracic limbs. Transcranial magnetic stimulation (TMS) was performed to
evaluate the integrity of the descending motor pathway. This is a noninvasive, nonpainful test. For stimulation of the brain cortex,acoil1 withadiameter of 70mmgeneratingamagnetic field of approximately 4 Tesla, was used. From the brain cortex, signals are transmitted along the spinal cord. Magnetic motor evoked potentials (MMEP) are measured in both the fore- and hindlimbs (extensor carpi radialis and tibialis cranialis muscles). Morphology of the complexes and latency time are registered. In case of disruption of this pathway, the evoked potentials can have an abnormal morphology and/or the onset latency can be prolonged. In this case, the evoked potentials had an abnormal morphologyandlatency timewasclearly prolonged in both thoracic and pelvic limbs, with the delay being more pronounced on the left side compared to the right (latency times: Left front 26.2 ms, right front 23.4 ms [reference front legs: 20–21 ms], left hind 51.4 ms and right hind 43.9 ms [reference hind legs: 36–38 ms]). Abnormal complexes and/or latency times in all 4 limbs suggested a lesion in the cervical spinal cord. Lateral radiographic projections of the cervical region
were obtained showing heterogeneous radiolucencies at the caudoventral aspect of the body and ventral aspect of
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