Original Article

Veterinary Pathology
1-5
Oral Lesions in Captive Nondomestic Felids ª The Author(s) 2020
Article reuse guidelines:
sagepub.com/journals-permissions
With a Focus on Odontogenic Lesions DOI: 10.1177/0300985820943539
journals.sagepub.com/home/vet

Katherine L. Scott1, Michael M. Garner2, Brian G. Murphy3 ,

and Elise E. B. LaDouceur1,2

Abstract
Odontogenic lesions are well described in domestic cats, but published literature describing these lesions in nondomestic felids is
limited. This study reports oral lesions in 109 captive, non-domestic felids. Ten cases of odontogenic lesions were diagnosed,
including 9 with fibromatous epulis of periodontal ligament origin (FEPLO) and one odontogenic cyst in a cougar. FEPLO was
common in lions. FEPLO did not recur after surgical removal in any of the 3 cases for which follow-up information was available.
Increased occurrences of oral papillomas in snow leopards and eosinophilic granulomas in tigers were identified, which is con-
sistent with the reported literature. With the exception of oral papillomas in snow leopards and FEPLO in lions, the spectrum of
oral lesions in nondomestic felids was similar to what is reported in domestic cats, with squamous cell carcinoma being the most
common oral malignancy, and stomatitis/gingivitis/glossitis accounting for approximately one third of all cases. Rare diagnoses with
one case each included hemangioma, fibrosarcoma, melanoma, cleft palate, and glossal amyloidosis.

Keywords
nondomestic felids, odontogenic, histology, retrospective, fibromatous epulis of periodontal ligament origin, peripheral odonto-
genic fibroma

Odontogenic lesions are well described in animals. Although
classification schemes in veterinary oral pathology generally
closely follow those in human oral pathology, there are nota-
ble exceptions of lesions that may be unique to animals, such
as canine acanthomatous ameloblastoma and canine odonto-
genic parakeratinized cyst.1,5,7,13 While recent advances have
been made in the nomenclature and classification of odonto-
genic tumors in animals, reports on the incidence of odonto-
genic lesions among various species are generally sparse,
particularly for nondomestic species. A recent review of
reported odontogenic tumors in domestic animals is avail-
able.1 Reports of odontogenic lesions in nondomestic species,
including nondomestic felids, are usually single cases, and are
generally uncommon.
The purpose of this study is to report oral lesions diagnosed
in nondomestic felids in human care and compare findings to
those in domestic cats and current literature. This study focused
on odontogenic lesions, which are not commonly reported in
these animals.
neoplasms; inflammation included all lesions that were com-
posed primarily of inflammation; odontogenic lesions included
all proliferative odontogenic lesions and odontogenic cysts;
other diagnoses included non-odontogenic developmental and
deposition disorders. Hematoxylin and eosin (HE)-stained his-
tologic sections from formalin-fixed paraffin-embedded tissue
blocks were reviewed and the diagnoses made by one pathol-
ogist (MMG). Cases of odontogenic lesions were reviewed
histologically by 2 additional pathologists (BGM and EEBL).
For odontogenic lesions, additional case information, including
clinical history, outcome, radiographs, and gross photographs,
was requested from clinicians, and collated when available.
Results
Oral lesions were diagnosed in 109 captive felids, including 36
snow leopards (Panthera uncia), 25 tigers (Panthera tigris), 13
lions (Panthera leo), 12 cheetahs (Acinonyx jubatus), 5 cougars

1
Joint Pathology Center, Silver Spring, MD, USA
Materials and Methods 2
Northwest ZooPath, Monroe, WA, USA
3
For this retrospective study, the Northwest ZooPath (Monroe, University of California, Davis, CA, USA
WA) archives were searched for all diagnoses in felids. All
Corresponding Author:
diagnoses of oral lesions were summarized in table format. Elise E. B. LaDouceur, Joint Pathology Center, 606 Stephen Sitter Ave, Silver
Diagnoses were grouped into the following categories: non- Spring, MD 20910, USA.
odontogenic neoplasia included benign and malignant Email: elise.e.ladouceur.civ@mail.mil
2 Veterinary Pathology XX(X)

Table 1. Oral Lesions in 109 Captive Nondomestic Felidsa.

Diagnosis Species affected

Non-odontogenic neoplasia (56; 51%)

Papilloma (39)
SCC (14)
Other (3)
Inflammation (41; 38%)
Stomatitis/gingivitis/glossitis
(non-eosinophilic) (33)
Eosinophilic granuloma (8)
Odontogenic lesions (10; 9%)
FEPLO (9)
Odontogenic cyst (1)
Other diagnoses (2; 2%)
Cleft palate (1)
Glossal amyloidosis (1)
Abbreviations: SCC, squamous cell carcinoma; FEPLO, fibromatous epulis of periodontal ligament origin.
a
Data in parentheses are number of cases.
Snow leopard (30), lion (4), cheetah (3), cougar (1), tiger (1)
Snow leopard (5), tiger (3), lion (2), cougar (1), leopard (1), lynx (1), ocelot (1)
Lion (1; hemangioma), ocelot (1; fibrosarcoma), tiger (1; melanoma)
Tiger (12), cheetah (8), leopard (3), cougar (2), lion (2), lynx (1), fishing cat (1), Geoffrey’s cat (1), jaguar
(1), serval (1), snow leopard (1)
Tiger (7), leopard (1)
Lion (4), jaguar (2), bobcat (1), cheetah (1), serval (1)
Cougar (1)
Tiger (1)
Ocelot (1)

(Puma concolor), 5 leopards (Panthera pardus), 3 jaguars
(Panthera onca), 3 ocelots (Leopardus pardalis), 2 lynx
(Lynx sp.), 2 servals (Leptailurus serval), 1 Geoffrey’s cat
(Leopardus geoffroyi), 1 bobcat (Lynx rufus), and 1 fishing cat
(Prionailurus viverrinus; Table 1). Each animal was diagnosed
with only one oral lesion. The most common diagnostic cate-
gory was neoplasia (56/109; 51%). Papillomas were the most
common neoplasm diagnosed with 39 cases, and were most
common in snow leopards (30/39 cases; 77%). At least 19 of
the 39 papilloma cases had evidence of viral cytopathic effects
consistent with viral etiology (ie, large cytoplasmic keratohyalin
granules, koilocytes, and/or intracytoplasmic viral inclusions);
further diagnostics to confirm papillomavirus infection were not
available. Squamous cell carcinoma was the second most com-
mon neoplasm diagnosed with 14 cases. The second most com-
mon diagnostic category was inflammation (41/109; 38%) with
predominantly lymphoplasmacytic (non-eosinophilic) inflam-
mation in 33 cases and predominantly eosinophilic inflammation
in 8 cases, 7 of which were tigers. Odontogenic lesions were the
third most common diagnostic category (10/109; 9%; see
below). Other diagnoses were rare (2/109; 2%).
The most common odontogenic lesion that was diagnosed
was fibromatous epulis of periodontal ligament origin
(FEPLO), which was diagnosed in 4 lions, including 3 females
and 1 male ranging in age from 13 to 21 years; age for 1 “adult”
was not specified. FEPLO was also diagnosed in 2 jaguars,
1 bobcat, 1 cheetah, and 1 serval that included 3 females and
2 males ranging in age from 3 to 12 years. FEPLOs were
reported to arise from the maxillary or mandibular gingiva
around the canine, premolar, or molar teeth. Gross photographs
of FEPLO were available in 1 cheetah (case 6; Fig. 1) and
revealed an exophytic mass arising from the tooth-associated
gingiva that partially entrapped the adjacent tooth. Microsco-
pically, in all of the FEPLO cases, the majority of the lesion
was composed of proliferative periodontal ligament-like
stroma with a moderate number of spindle to stellate
mesenchymal cells embedded in fibrous tissue composed of
finely bundled collagen with regularly spaced, dilated, small-
caliber blood vessels (Figs. 2, 3). These lesions often had
variable amounts of interspersed odontogenic epithelium, char-
acterized by small to moderately sized rests or branching plexi-
form ribbons of epithelial cells with a peripheral palisade of
columnar cells in which the nuclei were frequently antibasilar,
with rare cytoplasmic basilar clearing. Islands of cemento-
osseous matrix (COM) were variably present, and occasionally
abundant. COM demonstrated histologic features consistent
with both osteoid and cementoid matrices, and was sometimes
mineralized and had embedded cells within lacunae. Additional
clinical history and follow-up information was available in
3 cases (cases 1, 6, and 7). In cases 1 and 7, an excisional
biopsy of the FEPLOs was performed, but surgical margins
were incomplete and the FEPLOs extended histologically to
the deep surgical margins. Despite incomplete excision, surgi-
cal removal/debulking was presumably curative in both cases
as there was no regrowth at annual examinations for 7 years in
case 1, at which point the animal was euthanized for unrelated
disease, and for 2 years in case 7, at which point the animal was
lost to follow-up. In case 6, an excisional biopsy of the FEPLO
was performed, and surgical margins were narrow with cells of
the FEPLO extending <100 mm from the surgical margin.
Despite narrow excision, there was no regrowth of the FEPLO
at annual examinations for 3 years, at which point the animal
died of unrelated disease.
A single odontogenic cyst was identified in a 20-year-old,
female cougar who was euthanized for degenerative joint dis-
ease and urinary tract disease. Perimortem dental radiographs
were performed due to a history of periodontal disease and
revealed a periapical lucency associated with the root of one
of the mandibular canine teeth. A necropsy sample taken from
the cyst wall was submitted for histology. Histologically, a cyst
expanded the gingival subepithelial stroma (Fig. 4). The lining
epithelium of the cyst was non-keratinizing stratified squamous
Scott et al 3

Figures 1–4. Fibromatous epulis of periodontal ligament origin, gingiva. Figure 1. Cheetah, case 6. The buccal gingiva adjacent to a left
maxillary premolar tooth is expanded by a smooth, pink, exophytic mass. Gross photograph courtesy of Holly Haefele. Figure 2. Serval, case 9.
The majority of the neoplasm is composed of periodontal ligament-like stroma (ie, proliferative stellate mesenchymal cells embedded in
abundant collagen arranged in short bundles) with occasional islands of cemento-osseous matrix (arrowheads) and odontogenic epithelium
(arrows). Hematoxylin and eosin (HE), decalcified section. Figure 3. Cheetah, case 6. Periodontal ligament-like stroma is composed of
proliferative stellate mesenchymal cells embedded in abundant collagen arranged in short bundles. There are regularly spaced, dilated, empty
vessels throughout the mesenchyme. The overlying gingiva is at the top of the image. HE, decalcified section. Figure 4. Odontogenic cyst,
gingiva, cougar, case 10. The cyst lining is composed of non-keratinizing stratified squamous epithelium (inset). HE, decalcified section.

epithelium, the basal layer of which was palisading and rarely
exhibited features of odontogenic epithelium (antibasilar nuclei
and basilar clearing). Epithelial thickness varied from 2 to
10 layers. Lymphocytic and plasmacytic infiltration was mild
in the stroma around the cyst and within the epithelium.
Discussion
Odontogenic lesions comprised only 9% of the oral lesions
diagnosed in this group of nondomestic felids. Of the odonto-
genic lesions identified in this population, FEPLO was diag-
nosed in 9/10 cases. FEPLO is also called peripheral
odontogenic fibroma; the authors prefer the former term, which
indicates that the lesion originates from the periodontium, as
opposed to the latter term, which implies a neoplasm.5 While
common in domestic dogs, FEPLO are less common in domes-
tic cats, and the number of cases diagnosed in nondomestic
felids was surprising.5,12 FEPLO was diagnosed in 5 different
species, and lions were the most commonly affected species.
There is only one previous report of any proliferative odonto-
genic lesion in any nondomestic felid, and it was a FEPLO in a
lion.3 Lions may be predisposed to this condition, similar to
domestic dogs. Recurrence of FEPLO was not noted in any of
the animals for which follow-up information was available.
4 Veterinary Pathology XX(X)
This is similar to the biologic behavior of FEPLO in domestic
animals, where regrowth is rare even in cases of incomplete
excision.5
The only other odontogenic proliferative lesion diagnosed in
nondomestic felids was a single odontogenic cyst diagnosed
in a cougar. Odontogenic cysts have been rarely reported in
domestic cats and dentigerous cysts are the most common-type
reported. 5 The odontogenic cyst in this case was not
anatomically consistent with a dentigerous cyst as it was asso-
ciated with an erupted tooth. The cougar had a history of severe
dental disease, and the cyst was radiologically associated an
inflamed tooth root. These findings are consistent with a radi-
cular cyst, which is uncommon in domestic animals, but occurs
secondary to tooth-associated periapical inflammation.5
Non-odontogenic neoplasia and oral inflammatory lesions
collectively comprised 89% of oral lesions of nondomestic
felids. Feline papillomavirus-associated oral papillomas have
been reported in a variety of nondomestic felids and have been
well documented as a relatively common finding in captive
snow leopards.8,9,11 The histologic characteristics of oral
papillomas in captive snow leopards include viral cytopathic
changes within the granular cell layer such as large cytoplas-
mic keratohyalin granules, koilocytes, and rare intracytoplas-
mic viral inclusions. 9,11 This report is consistent with
previous literature as oral papillomas were diagnosed in
30/36 of snow leopards with oral lesions. The occurrence of
oral papillomas in snow leopards was more frequent than in
all other nondomestic felids combined. With the exception of
snow leopards, oral papillomas were relatively uncommon in
nondomestic felids and accounted for 9/26 of all other non-
odontogenic neoplasms identified. This is similar to domestic
cats, in which oral papillomas are infrequently reported.5
Squamous cell carcinoma (SCC) is the most common oral
malignancy in domestic cats, and accounts for over 60% of all
feline oral tumors.5 Results of this study are consistent with this
finding as 14/17 of the oral malignancies diagnosed in nondo-
mestic felids were SCC. The incidence of SCC was higher in
snow leopards compared with other nondomestic felids in this
study and has been previously reported in this species.11 Given
the high incidence of papillomas in snow leopards, a relation-
ship between SCC and papillomavirus-induced neoplasia has
been suggested.11 However, the role of papilloma virus in the
pathogenesis of oral SCC in domestic cats is controversial as
the incidence of oral SCC in domestic cats is much greater than
the incidence of oral papillomas.5
Inflammatory lesions are the most common oral lesions in
domestic cats and chronic gingivostomatitis is the most com-
monly diagnosed of these lesions.12 The cause of gingivitis is
multifactorial and often associated with bacterial plaques/cal-
culi.5 With the exception of snow leopards, inflammatory
lesions were the most common oral lesion in all species of
nondomestic felids in this study; lesions of stomatitis, gingivi-
tis, or glossitis were diagnosed in 33/41 cases of oral inflam-
matory lesions. The incidence of oral inflammatory lesions was
highest in tigers, which accounted for 12/33 of stomatitis/gin-
givitis/glossitis cases and 7/8 of oral eosinophilic granuloma
cases. The incidence of oral eosinophilic granulomas in tigers
reported here is consistent with previous reports suggesting
oral eosinophilic granulomas are an underreported and possibly
common lesion of tigers.4,10 Oral eosinophilic granuloma com-
plex lesions are fairly common in domestic cats, with which
tigers share 95.6% similarity in their genome sequence.2 The
genetic relatedness of domestic cats and tigers may make these
species similarly predisposed to oral eosinophilic granulomas.
Further research is needed to elucidate what role (if any) genet-
ics plays in the development of oral inflammatory diseases.
Cheetahs accounted for 8/33 cases of stomatitis, gingivitis, or
glossitis. Captive cheetahs have been reported to have a higher
incidence of focal palatine erosions compared to other nondo-
mestic felids.8 Specific location of biopsy specimens was not
always provided in biopsy submission forms in this study, and
as such incidence of focal palatine erosions could not be deter-
mined. One of the cases of stomatitis in a cheetah was associ-
ated with intranuclear inclusion bodies; this animal also had
rhinotracheitis and was confirmed to have feline herpesvirus-1,
to which cheetahs may be predisposed.6 There were multiple
limitations of the interpretation of inflammatory lesions in this
series. Anatomic location of the lesions within the oral cavity,
and/or any associated periodontal disease (eg, dental calculi)
were often not specified. Additionally, polymerase chain reac-
tion or cultures for infectious agents were either not performed
or not available to the pathologist.
Conclusion
With the exception of papillomas in snow leopards and FEPLO
in lions, the spectrum of oral lesions in nondomestic felids is
similar to what is reported in domestic cats. Inflammatory
lesions are the most common oral lesions, SCC is the most
common oral malignancy, and odontogenic lesions comprised
a minority of the lesions. The results of this study largely agree
with the previously reported species-specific data regarding
well-documented oral lesions in nondomestic felids, specifi-
cally papillomas and SCC in snow leopards and eosinophilic
granulomas in tigers. As follow-up information was not con-
sistently available in the cases presented here, additional data
are needed to understand the clinical relevance and prognoses
of oral lesions in nondomestic felids.
Authors’ Note
The views expressed in this article are those of the authors and do not
reflect the official policy of the Department of the Army/Navy/Air
Force, Department of Defense, or the US government.
Acknowledgements
The authors thank Cathy Minogue and Christie Buie of Northwest
ZooPath for collection and processing of materials. We also thank
Leroy Brown of Histology Consultation Services for specimen prepara-
tion. The authors are also grateful to the institutions and individuals who
contributed case material and follow-up information, including Fort
Worth Zoo (especially Kim Rainwater), Fossil Rim Wildlife Center
(especially Holly Haefele), Hendricks County Animal Hospital, India-
napolis Zoo (especially Jeff Proudfoot and Abigail Rosenblum),
Scott et al
Jacksonville Zoo (especially Tiffany Martin), San Diego Zoo (espe-
cially Bruce Rideout), and Zoo Miami (especially Gwen Myers).
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect to
the research, authorship, and/or publication of this article.
Funding
The author(s) received no financial support for the research, author-
ship, and/or publication of this article.
ORCID iD
Brian G. Murphy https://orcid.org/0000-0003-0057-0604
Elise E. B. LaDouceur https://orcid.org/0000-0001-8510-1051
References
1. Bell CM, Soukoup JW. Nomenclature and classification of odontogenic
tumors—part II: clarification of specific nomenclature. J Vet Dent. 2014;
31(4):234–243.
2. Cho YS, Hu L, Hou H, et al. The tiger genome and comparative analysis with
lion and snow leopard genomes. Nat Commun. 2013;4:2433.
3. de Castro MB, Barbeitas MM, Borges TJ, et al. Fibromatous epulis in a captive
lion (Panthera leo). Braz J Vet Pathol. 2011;4(2):150–152.
4. Imai DM, Okimoto B, Reavill DR. Eosinophilic plaque in four related Sumatran
tigers (Panthera tigris sumatrae): review of diagnostic and management
5
challenges. In: Proceedings of the Annual Conference of the American Associ-
ation of Zoo Veterinarians; September 19-25, 2020; Nashville, TN.
5. Murphy BG, Bell CM, Soukup JW. Veterinary Oral and Maxillofacial Pathol-
ogy. Wiley-Blackwell; 2020.
6. Pennings A, Seeley K, Mathieu A, et al. Feline herpesvirus infection in four
captive cheetahs (Acinonyx jubatus) postvaccination. J Zoo Wildl Med. 2020;
51(1):210–216.
7. Soukup JW, Bell CM. Nomenclature and classification of odontogenic
tumors—part I: historical review. J Vet Dent. 2014;31(4):228–232.
8. Steenkamp G, Boy SC, van Staden PJ, et al. Oral, maxillofacial and dental
diseases in captive cheetahs (Acinonyx jubatus). J Comp Pathol. 2018;158:
77–89.
9. Sunberg JP, Van Ranst M, Montali R, et al. Feline papillomas and papilloma-
viruses. Vet Path. 2000;37(1):1–10.
10. Sykes JM 4th, Garner MM, Greer LL, et al. Oral eosinophilic granulomas in
tigers (panther tigris)—a collection of 16 cases. J Zoo Wildl Med. 2007;38(2):
300–308.
11. Terio KA, McAloose D, Mitchell E. Felidae. In: Terio KA, McAloose D, St
Leger J, eds. Pathology of Wildlife and Zoo Animals. Elsevier; 2018:
263–286.
12. Uzal FA, Plattner BL, Hostetter JM. Alimentary system. In: Maxie MG, ed.
Jubb, Kennedy, and Palmer’s Pathology of Domestic Animals. Vol 2. 6th ed.
Elsevier; 2016:1–257.
13. Verstraete FJ, Zin BP, Kass PH, et al. Clinical signs and histologic findings in
dogs with odontogenic cysts: 41 cases (1995-2010). J Am Med Assoc. 2011;
239(11):1470–1476.