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Canine and Feline Nasal Neoplasia

Christine Malinowski, BS, DVM


Dogs and cats of our society have outgrown their status as merely pets and are now
considered our close companions and even family members. This shift in their roles has led
to pet owners seeking improved preventative medicine for their four-legged friends. Sub-
sequently, dogs and cats are living longer lives than ever before and developing more
old-age-related diseases. One of the most devastating diseases of older animals is cancer.
Once a veterinarian has detected cancer in a pet, pet owners seek advice on their next
course of action. This article is intended to provide concise information regarding the
diagnosis and treatment of intranasal tumors of the dog and cat. This article outlines the
forms of nasal tumors that are the most common, the recommended imaging and biopsy
techniques to diagnose the tumor, and the most appropriate treatments of them.
Clin Tech Small Anim Pract 21:89-94 2006 Elsevier Inc. All rights reserved.
KEYWORDS intranasal neoplasia, nasal carcinoma, nasal sarcoma, nasal lymphoma, nasal
turbinate destruction, epistaxis, rhinoscopy, rhinotomy, radiation therapy
I
ntranasal tumors comprise only about 1% of all neoplasms
of dogs and are even less common in cats.
1
Speculation has
been made, although no proof has been offered, to suggest
that dolichocephalic, long-nosed, breeds of dogs or those
animals living in urban environments with relatively high
amounts of air pollution are more predisposed to developing
this type of cancer.
1
Dogs
Nasal Carcinoma
Incidence and Clinical Signs
Carcinomas, including adenocarcinoma, squamous cell car-
cinoma, and undifferentiated carcinoma, comprise two-
thirds of intranasal cancer in dogs.
1
The average age of pa-
tients with this form of cancer is 10 years, and a slight
predilection exists for male dogs.
1
Medium- to large-breed
dogs seem to also be at a greater risk.
1
The most common clinical signs secondary to intranasal
carcinoma are epistaxis, mucopurulent nasal discharge, facial
deformity, and occasionally epiphora.
1,2
Potential differential
diagnoses for dogs with these clinical signs include systemic
hypertension, fungal or bacterial infections, and develop-
mental anomalies.
1
However, a strong presumptive diagnosis
of intranasal neoplasia can be formed for an older dog who
presents with a history of intermittent and progressive, uni-
lateral epistaxis or nasal discharge.
1
Certain dogs may present
with concurrent neurologic decits as well, which is consis-
tent with extension of the cancer into the central nervous
system.
1
Staging and Diagnosis
A denitive diagnosis of intranasal cancer requires evaluation
of a tissue biopsy. Before a biopsy procedure, a complete
work-up should be performed to rule out other forms of
systemic disease. A complete physical examination including
an ocular examination should be completed looking for evi-
dence of retinal hemorrhage or tortuous retinal vessels. Ac-
curate systemic blood pressure should be assessed along with
a complete blood count (CBC), serum biochemistry prole,
urinalysis, and clotting prole (PT/PTT or ACT).
1
If these diagnostic tests are otherwise normal, three-view
thoracic radiographs should be completed and possibly skull
radiographs to assess the nasal cavity.
1
The most benecial of
the skull radiographs is commonly the open-mouth DV view
performed under anesthesia.
1
In capturing this view, the ex-
posure lm is placed inside the mouth of the patient and
exposed in the DV plane. This view allows initial evaluation
of the nasal turbinates for extent of disease and for detection
of asymmetrical turbinate destruction.
1
Other benecial
views include the following: lateral, dorsoventral (entire
skull), ventro 15 rostral-dorsocaudal oblique, dorso 60
right-ventral left oblique, and dorso 60 left-ventral right
oblique.
1,3
Thoracic radiographs are most often normal at the
time of diagnosis.
1
Skull radiographs have an additional benet in that they
offer direction as to where the most benecial biopsy site
should be. A soft-tissue opacity superimposed over an area of
turbinate destruction in the caudal half of the nose most often
indicates nasal neoplasia.
1
Nevertheless, the benets of skull
Michigan State University, Department of Small Animal Clinical Sciences,
Lansing, MI.
Address reprint requests to: Dr. Christine Malinowski, Michigan State Uni-
versity, Department of Small Animal Clinical Sciences, 2016 Clifton
Avenue, Lansing, MI 48910. E-mail: cmmalinowski@michvet.com.
89 1096-2867/06/$-see front matter 2006 Elsevier Inc. All rights reserved.
doi:10.1053/j.ctsap.2005.12.016
radiographs are surpassed by computed tomography (CT).
CT is the ideal diagnostic tool to assess for the extent of
disease and the degree of bony involvement. This technology
has the capability of dorsal and sagittal reconstructions that
can show tumor/uid-to-air interfaces that are completely
obscured in conventional radiographs.
4
CT can indicate
cause of change more reliably than conventional radio-
graphs
1,3,4
(Fig. 1).
Magnetic resonance imaging (MRI) certainly has the po-
tential to be an important imaging modality for intranasal
cancer, as well. However, at this time, its limited availability
in veterinary medicine limits its practicality.
While the patient is still under anesthesia from its imaging
procedures, rhinoscopy can be used to visualize the tumor
before a biopsy procedure. Although tissue samples are rela-
tively easy to obtain through most endoscopes, this method is
not a recommended sampling procedure. Samples from en-
doscopically introduced forceps are generally limited to the
supercial layer of tissue due to the small size of the instru-
ment.
1,2
The supercial layer of most nasal neoplasms con-
sists of septic inammation and does not yield a diagnostic
sample of the tumor itself.
1,2
Therefore, rhinoscopy should be
utilized as a visual tool only, and a nasal biopsy should be
collected using a closed nasal biopsy technique: a closed
suction technique, a bone curette, or alligator forceps.
1
With the closed suction technique, a large-bore (3 to 5
mm) plastic cannula is directed into the nasal cavity and the
tumor while the patient is under anesthesia.
1
Negative pres-
sure is applied as the cannula is redirected at multiple an-
gles.
1
Care should be taken during any biopsy procedure not
to advance the biopsy tool beyond the level of the medial
canthus of the eye to prevent entering the cribriform plate
and the brain.
1,2
This precaution can be taken by premeasur-
ing the tool from the naris to the medial canthus and placing
a mark on the instrument. Mild-to-moderate hemorrhage is a
secondary complication of this and other biopsy procedures
and should be avoided in any patient for which there are
concerns about coagulopathies or high risk for anesthesia.
2
Cytological analysis can be facilitated by using a small
cylindrical brush that is introduced into the nasal cavity via
endoscope and then brushed against the lesion.
2
This pro-
cedure is less invasive than the previously mentioned biopsy
techniques, but again requires an anesthetic event. Unfortu-
nately, the brush technique also has a higher likelihood of
being nondiagnostic as compared with evaluation of a biopsy
or an impression smear from a biopsy sample.
1,2,5
More spe-
cically, brush cytology can fail to reveal malignancy versus
benign disease in specimens with low cellularity.
2,5
Research
examining the reliability of brush cytology found that the
most accurate results came from cell-rich samples.
5
In the
case of a low cell harvest, the procedure should be repeated
or a histological biopsy recommended.
2,5
Nasal ushing and
swabbing are additional although generally unreliable cyto-
logic techniques and should not be used as a sole means of
diagnosis.
1,5
Nasal carcinomas are locally aggressive tumors, as is dem-
onstrated by their ability to extend through the cribriform
plate into the brain.
1
Any patient with central nervous system
signs should have a sample of cerebrospinal uid collected
and evaluated. Increased protein or cellularity is suggestive of
brain involvement.
1
Although these tumors are rarely meta-
static, local lymph node aspiration is diagnostic in about 10%
of patients with nasal carcinoma.
1
Treatment
Treatment of nasal neoplasia is focused on local control in a
critical location, being adjacent to the brain and eyes.
1
Clin-
ical signs are not usually observed and a diagnosis is not
usually made until the tumor is advanced. Although surgery
alone has been attempted, it is rarely curative.
1,3
Rhinotomy
Figure 1 (A) CT scan of a 9-year-old, neutered male Rottweiler with
a 2-month history of unilateral epistaxis. Diagnosis of a nasal tran-
sitional cell carcinoma was made based on histopathology of a bi-
opsy sample obtained with alligator forceps. Notice the mass in the
dorsal aspect of the left side of the nasal cavity with the additional
uid opacity in the ventral aspect. (B) The same Rottweiler with a
view of the nasal cavity at the level of the eyes. Notice that the mass
completely obstructs the passage of air on the left side. This nding
corroborated with physical examination ndings.
90 C. Malinowski
has the additional downfall of a high level of acute and
chronic morbidity.
1
Case reports reveal patient survival times
are not signicantly different if surgery is performed or if no
treatment is offered.
1
The mean survival time after diagnosis
of intranasal carcinoma with no further treatment is 3 to 6
months due to progression of local disease.
1
Immunotherapy
and cryosurgery have also been used for a small number of
dogs but have done nothing to improve survival times.
1
Radiation therapy is the most effective treatment available
at this time.
1
Used either alone or in combination with rhi-
notomy, survival times are increased to 8 to 25 months de-
pending on the treatment protocol followed.
1
In one study of
42 dogs with intranasal tumors, the disease-free interval for
dogs treated with radiotherapy alone was shorter than for
dogs treated with surgery and radiotherapy; however, the
overall survival times of the two groups were not signicantly
different.
6
On retrospective analysis, the researchers of that
study concluded that radiation treatment alone caused less
patient morbidity than rhinotomy and radiation combined
despite the earlier recurrence of clinical signs.
6
In a more
recent retrospective analysis, dogs that underwent surgery
followed by radiation therapy were signicantly more likely
to develop rhinitis or osteomyelitis than dogs treated with
radiation therapy alone.
7
Also noted in that study was that the
rate of local recurrence of neoplasia was not signicantly
different between the two groups. The median survival time
for dogs in the radiotherapy-only group was signicantly
shorter (68% alive after 1 year) than for the radiotherapy and
surgery group (77% alive after 1 year).
7
Treatment with orthovoltage, high-energy megavoltage
and cobalt radiation have been used individually and in com-
bination.
1
Overall, adenocarcinomas respond better to radi-
ation therapy than squamous cell carcinoma or undifferenti-
ated carcinoma and have a relatively better long-term
prognosis.
1
Unfortunately, no single protocol has been em-
braced by the veterinary community, which complicates ap-
propriate comparison of survival times.
1
Chemotherapeutic
agents such as cisplatin seem to be effective adjunctive treat-
ments, improving survival times when used as a radiation
sensitizer.
1
During and after the completion of radiation therapy,
acute phase side effects are often noted. Specically, rhinitis
and mucositis can be severe and can last up to 4 to 8 weeks
after treatment.
1
Keratoconjunctivitis sicca, corneal ulcer-
ation, and cataracts are common secondary ocular changes.
1
Nasal Sarcoma
Incidence and Clinical Signs
Sarcomas, including brosarcoma, chondrosarcoma, osteo-
sarcoma, and undifferentiated sarcoma, comprise the re-
mainder of common intranasal tumors in dogs.
1
The average
age of patients with this form of cancer is again about 10
years; however, chondrosarcoma has been shown to occur
commonly in young dogs.
1
Medium- to large-breed dogs
seem to be at a greater risk as well.
1
The most common clinical signs occurring secondary to
intranasal sarcoma are epistaxis, mucopurulent nasal dis-
charge, facial deformity, and occasionally epiphora
1
(Fig. 2A
and B). The differential diagnoses for intranasal neoplasia
were listed in the Incidence and Clinical Signs of nasal
carcinoma.
1
As before, a strong presumptive diagnosis for
intranasal neoplasia can be formed for an older dog who
presents with a history of intermittent and progressive, uni-
lateral epistaxis or nasal discharge.
1
Concurrent neurologic
decits are consistent with extension of the neoplasia into the
central nervous system.
1
Staging and Diagnosis
A complete physical examination including an ocular exam-
ination should be completed. Accurate systemic blood pres-
sure should be assessed along with complete blood work,
urinalysis, and a clotting prole.
1
If these diagnostic tests do
not suggest underlying metabolic disease, three-view tho-
Figure 2 (A) An example of a nasal chondrosarcoma in a 12-year-old,
neutered male American Foxhound. Notice the asymmetry of the
left side of the face, rostral to the zygomatic arch that is visible on
close observation. (B) The same American Foxhound diagnosed
with a nasal chondrosarcoma metastatic to the lungs. Notice the
soft-tissue swelling to the left of midline and at the caudal aspect of
the hard palate that is visible on oral examination. (Color version of
gure is available online.)
Tumors of the nasal cavity 91
racic radiographs and imaging of the nasal tumor should be
completed.
1
As with nasal carcinomas, thoracic radiographs
are often within normal limits at the time of diagnosis.
1
CT is
the ideal diagnostic tool available to assess for the extent of
disease and the degree of bony involvement, but skull radio-
graphs can be very benecial in directing a biopsy proce-
dure.
1
A denitive diagnosis of intranasal cancer requires evalu-
ation of a tissue biopsy. Rhinoscopy and endoscopic biopsy
instruments are limited in their function as it relates to nasal
sarcomas as well as nasal carcinomas. A nasal biopsy should
be collected using a closed nasal biopsy technique.
1
Mild-to-
moderate hemorrhage should be expected; therefore, a bi-
opsy procedure should be avoided in any patient for which
there are concerns about coagulopathies or high risk for an-
esthesia.
2
Special attention should be given during any bi-
opsy procedure not to advance the biopsy tool beyond the
level of the medial canthus of the eye to prevent entering the
cribriform plate and the brain.
1,2
Local lymph node aspiration has had a limited amount of
success in detecting nasal sarcomas as these tumors are rarely
metastatic.
1
Fluid analysis, nasal washing, and brush cytol-
ogy have a high likelihood of being nondiagnostic when mes-
enchymal tumors are present as compared with evaluation of
a biopsy.
1,2
These methods can fail to reveal malignancy ver-
sus benign disease.
2
Treatment
Treatment of nasal sarcomas is focused on local control.
1
As is
the case with nasal carcinoma, patient survival times are not
signicantly different if surgery is performed or if no treat-
ment is offered. Bone invasion occurs early, and although
surgery alone has been attempted, it is rarely curative and has
a high level of acute and chronic morbidity.
1
The mean sur-
vival time is 3 to 6 months due to progression of local dis-
ease.
1
Radiation therapy is the most effective treatment available
at this time.
1,6
Used either alone or in combination with rhi-
notomy, survival times are increased to between 8 and 25
months depending on the treatment protocol followed.
1,6
Nasal sarcoma has been treated with orthovoltage, high-en-
ergy megavoltage, and Cobalt radiation alone and in combi-
nation as was discussed for nasal carcinoma.
1,6
During and
after the completion of these protocols, acute phase side ef-
fects of radiation on the mucosal surfaces and eyes were often
noted.
1,6
Even if dogs have a resolution of clinical signs, fewdogs are
considered cured if followed to necropsy.
1
Despite the rela-
tively nonmetastatic nature of nasal sarcoma in untreated
animals, metastatic lesions were found beyond the local site
in 40% of 285 cases given radiation therapy and followed to
necropsy.
1
Most metastatic lesions were found in the lymph
node or lungs of those dogs and believed to be due to their
prolonged survival times.
1
As more improvements in long-
term survival are achieved, the true metastatic potential of
nasal neoplasia may be revealed.
1
Chemotherapeutic agents,
especially platinum agents, seem to be effective adjunctive
treatments improving survival times when used as radiation
sensitizers.
1
Overall, nasal sarcomas have a better long-term prognosis
than carcinomas, with chondrosarcomas responding the best
to treatment.
1,6
Cats
Nasopharyngeal Polyps
Incidence and Clinical Signs
Nasopharyngeal polyps typically occur in cats less than 2
years of age. In one study, greater than 80% of affected cats
were less than 1 year of age.
2
The most common clinical signs
were sneezing, snufing, and upper airway stridor.
1,2
Less
commonly, aural or nasal discharge was noted. This disease
of cats is less likely to be of neoplastic origin and more likely
of primary or secondary inammatory origin.
1
The polyps
generally arise from the mucosa of the tympanic bullae or
eustachian tube. The pedunculated mass then extends into
the oral cavity or external ear canal.
1
Additional clinical signs
to note include head tilt, circling, and possible nystagmus.
2
Staging and Diagnosis
Staging includes a minimum database of a CBC, serum bio-
chemistry prole, urinalysis, FeLV/FIV serology, T
4
testing,
and three-viewthoracic radiographs. In addition, skull radio-
graphs can assess for soft-tissue opacities within the tym-
panic bullae, indicating uid or mass extension into the area.
1
Open-mouth radiographs to assess each of the bullae are
recommended, but can give equivocal information. CT scan
of the skull would reveal the full extent of the mass.
2
Treatment
Involvement of the bulla is an indication for treatment.
2
In
that situation, bulla osteotomy with concurrent appropriate
sampling of the contents for bacteriologic culture and sensi-
tivity should be performed. The patient should then be
treated appropriately in coordination with the results. The
owner should be warned about the likely development of
Horners syndrome postoperatively, which is likely a tran-
sient complication that resolves within a month of surgery.
2
If involvement of the bulla is not noted, removal should be
sought by excision, including as much of the pedicle as pos-
sible or by placing traction on the mass leading to rupture of
the pedicle.
2
Recurrence was noted after surgical removal in
about 20% of cases according to one study and can occur
anywhere from 1 month to 3 years after surgery.
2
Regrowth
can occur multiple times.
Benign Nasal Tumors
Benign tumors, such as adenomas, bromas, bropapillo-
mas, hemangiomas, and chondromas, have been described in
various case reports.
2
Such benign tumors, especially papil-
lomas and bromas, may be difcult to differentiate from an
inammatory nasopharyngeal polyp and vice versa.
2
They
most commonly cause sneezing and snufing, but can be
associated with facial deformity as well.
2
Surgical removal
with histopathology is generally curative as well as diagnos-
tic.
2
Nasal Carcinomas
Although tumors of the nasal planum, especially squamous
cell carcinoma (SCC), should be considered when evaluating
a patient with facial deformity, sneezing, or upper airway
92 C. Malinowski
stridor, this article describes only tumors of intranasal origin.
Carcinomas are the most common form of intranasal neo-
plasm of cats second to nasal lymphoma.
2
Incidence and Clinical Signs
As opposed to nasopharyngeal polyps, intranasal carcino-
mas generally affect cats greater than 6 years of age.
2
The
most common clinical signs include sneezing, snufing,
facial deformity, enophthalmos, exophthalmos, and
chronic epiphora.
1,2,8
Unlike nasal neoplasms in the dog,
nasal discharge and epistaxis are less common signs in
cats, occurring in only about one-third of those affected.
2
Seizures can be an associated sign if the neoplasm has
extended beyond the cribriform plate.
2,8
Clinical signs re-
lating to a nasal carcinoma can be present for a relatively
short period of time, 2 to 4 weeks, to years before a diag-
nosis is made.
2
Of the carcinomas reported, about equal proportions have
been of adenocarcinoma and undifferentiated carcinoma as
well as a small number of SCC.
2
As is the case for dogs,
speculation has been made for cats with longer nasal pas-
sages, such as the Oriental breeds, to have a predisposition
for developing nasal tumor malignancies.
2
No denitive sup-
port for such a claim exists in the literature.
Staging and Diagnosis
The minimum database for a patient with nasal carcinoma
includes a CBC, serum biochemistry prole, urinalysis,
FeLV/FIV serology, T
4
testing, and three-viewthoracic radio-
graphs.
2
In addition, evaluation of local lymph nodes, nasal
radiographs, and a CT scan is recommended.
2
Skull radio-
graphs may indicate destruction of nasal turbinates with or
without a mass lesion and can direct one to an area likely to
yield the most diagnostic material from a biopsy.
1,2
Rhinos-
copy allows direct visualization of the gross disease present;
however, CT is necessary to accurately delineate its full ex-
tent.
2
Differential diagnoses in the face of nasal turbinate erosion
include severe rhinitis and cryptococcosis as well as intrana-
sal neoplasia. However, neoplasia can be considered more
likely with the presence of unilateral radiographic lesions,
lysis of a lateral bone, or tooth loss.
2
The most accurate method of diagnosis short of rhinotomy
is a closed nasal biopsy, which also has the benet of reduc-
ing contamination through the skin.
2
Although biopsy dur-
ing an endoscopic procedure is relatively easy in cats, unfor-
tunately, it is inadequate for accurate diagnosis.
2
As is the
situation with dogs, the limited size of the biopsy sample
through the endoscope restricts samples to the supercial
layer, which usually consists of septic inammation.
2
There-
fore, a nasal biopsy should be collected using a closed suction
technique, a bone curette, or a small cup biopsy instrument
introduced through the nares.
With the closed suction technique, a large-bore (3 to 5
mm) plastic cannula is directed into the nasal cavity and the
tumor with negative pressure while the patient is under an-
esthesia.
1
Care should be taken during the biopsy procedure
to not advance the biopsy tool beyond the level of the medial
canthus of the eye to prevent entering the cribriform plate or
the brain.
1,2
Mild-to-moderate hemorrhage is a secondary
complication of this procedure and should be avoided in any
patient for which there are concerns about coagulopathies or
high risk for anesthesia.
2
Although metastases are uncommon, ne-needle aspira-
tion of an enlarged local lymph node can give valuable cyto-
logic information in combination with cytology or histopa-
thology performed on the gross mass.
1,2
Brush cytology is a
fairly noninvasive procedure that can be used in cats to pro-
vide valuable information. Caution should be used when
interpreting results as is described in Staging and Diagnosis
of canine nasal carcinomas.
2,5
Treatment
Cats have a poor tolerance for rhinotomy.
1
Surgery alone for
nasal carcinoma has been reported in a small number of cats
and was correlated with relatively fast tumor recurrence (1 to
12 weeks).
2
When surgery was combined with orthovoltage
radiation therapy in six cats with nasal carcinoma, the results
were much improved.
2
No recurrence was noted in four of
the cats, two of which died 5 months after therapy of unre-
lated causes and two of which remained disease-free at 26
and 40 months after therapy.
2
Recurrence was noted in the
other two cats 21 and 62 months after therapy.
2
Treatment
with surgery and Cobalt-60 irradiation has had less success
with tumor recurrence within 1 year of treatment for each of
three cats.
2
Cats treated with Cobalt-60, orthovoltage, or megavoltage
alone experienced moderate success, but all had either local
tumor regrowth or distant metastasis (local lymph node or
lungs) within 11 months of treatment.
2
The acute side effects
of radiation therapy were mild overall.
2
The degree of moist
desquamation and ocular effects were less than those noted
in similarly treated dogs.
2
These relatively mild side effects
could be a sign that cats may be tolerant of larger doses of
radiation.
2
Their higher tolerance for radiation therapy may
prove benecial and should be examined in future reports.
Multiple chemotherapeutic agents including mitox-
antrone, carboplatin, cyclophosphamide, and vincristine
have been used without surgery.
2
Unfortunately, the latter
two drugs did not cause any noticeable remission.
2
Carbo-
platin appears to be the most promising option for chemo-
therapeutic treatment of feline nasal carcinoma.
Finally, supportive care is an important treatment that
should not be overlooked. Affected cats will have a reduced
ability to smell and should be treated with appetite stimu-
lants and have their food heated to entice them to eat.
1
If oral
nutrition is not of an adequate amount, placement of an
enteral feeding tube should be considered if therapy is likely
to be prolonged.
2
In addition, topical eye care will be neces-
sary on a short-termand possibly long-termbasis in conjunc-
tion with radiation therapy.
2
Nasal Sarcomas
Limited reports of intranasal sarcomas have described intra-
nasal brosarcoma, chondrosarcoma, osteosarcoma, heman-
giosarcoma, and undifferentiated sarcoma.
2
Two cats with
chondrosarcoma were treated with surgery alone and both
experienced regrowth of the tumor 6 months later.
2
An in-
tranasal osteosarcoma was also treated with surgery alone
twice over a 14-week period and was insufcient to control
tumor growth.
2
Six cats with nasal brosarcoma or an undif-
ferentiated form of sarcoma were treated with radiation ther-
apy alone and had good results similar to cats with nasal
Tumors of the nasal cavity 93
carcinoma.
2
The median survival for this group was 10
months.
2
As can be speculated for cats with nasal carcinoma,
cats with nasal sarcoma that are to be treated with radiation
therapy alone may be able to be treated with larger doses of
radiation than those previously used.
2
Olfactory Neuroblastoma
Also referred to as sympathicoblastoma and esthesioneuro-
blastoma, olfactory neuroblastoma appears to be induced by
the feline leukemia virus (FeLV).
2
The most common clinical
signs in addition to nasal discharge and sneezing are CNS
signs including circling, ataxia, behavior changes, and pare-
sis.
2
This tumor originates from the neuroectoderm and the
clinical signs appear to stem from the extension of the tumor
into the CNS.
8
Support for the role of FeLV in the induction
of this neoplasmis in the presence of FeLV DNA in the tumor
of CNS affected cats correlated with its absence in normal
brain tissue of the same cats.
2
As opposed to other intranasal
neoplasia, this tumor is highly metastatic. Initial treatment
with radiation therapy appears to be the most effective, but
early recurrence is expected.
2
Follow-up treatment with che-
motherapeutics, doxorubicin and carboplatin, may be effec-
tive, but is often complicated by the concurrent FeLV infec-
tion.
2
Prognosis is generally poor.
Nasal Lymphoma
Incidence and Clinical Signs
Nasal lymphoma is the most common cause of nasopharyn-
geal disease in cats.
2
The median age of affected cats among
60 case reports was 8 years old, but ranged from 2 to 19
years.
2
Clinical signs vary in duration and are similar to those
reported for other forms of nasal neoplasia in cats: nasal
discharge, dyspnea, epistaxis, stertor, facial deformity, and
anorexia.
2,9
Staging and Diagnosis
A minimum database including a CBC, serum biochemistry
prole, urinalysis, FeLV/FIV serology, T
4
testing, and three-
view thoracic radiographs should be collected along with an
abdominal ultrasound, nasal CT or MRI, and bone marrow
aspiration.
1,2
Most affected cats do not have a concurrent
FeLV infection; however, those who are FeLV-positive have a
higher risk of developing systemic disease.
2
Brush cytology was used in the previously mentioned re-
ports to correctly identify nasal lymphoma in ve of six cats.
2
Rhinotomy or nasal biopsy, as described for feline nasal car-
cinoma, may still be needed to obtain an accurate diagnosis.
2
Treatment
In cats without systemic involvement, radiation therapy can
be curative.
2
Radiation therapy and chemotherapeutics have
been used alone and in combination to successfully treat
feline lymphoma limited to the nasal cavity.
2
A study that
compared the efcacy of the two modalities alone or in com-
bination in a group of 14 cats revealed no statistically differ-
ent survival times.
2
The most important prognostic factor
was not the treatment protocol that was followed, but the
patients FeLV antigenemia. Immunoblastic histologic phe-
notype and FeLV antigenemia were associated with poor sur-
vival rates.
2
Patients with systemic disease required chemo-
therapy, preferably multidrug treatments, including
vincristine, cyclophasphamide, and methotrexate, to achieve
long-term survival.
2
As with all feline nasal neoplasms and especially those
patients undergoing radiation therapy or chemotherapy,
supportive care is key. Maintaining adequate nutrition by
supplementing with appetite stimulants, antiemetics, or
placing a feeding tube is very important.
1,2
Topical eye care
should be maintained in the acute phase of radiation therapy
to the head.
2
Conclusion
Diagnosis of intranasal neoplasms in our dog and cat patients
employs relatively simple diagnostic procedures that can be
completed in a general practice. In most instances, the nature
of radiation therapy then requires referral of the patient to a
specialty facility to administer the most effective treatments.
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