Pathology in Practice

In collaboration with the American College of Veterinary Pathologists

Clinical and
Gross Findings
The cervical swellings
had a soft tissue opacity with
radiopaque centers on post-
mortem radiography. The
lizard was in moderate body
condition with bilateral ingui-
nal fat pads. A bilateral, large
(approx 1 X 1.4-cm), fluc-
tuant, firm, subcutaneous,
round swelling was present
dorsal to the proximal cer-
vical vertebrae (Figure 1).
Upon cut section, the left
lobe of the mass contained
white viscous material and
the right contained clear, yel-
low-tinged fluid with a firm,
bright white central area. No
other clinically meaningful
Figure 1—Postmortem images of the dorsal aspect of a euthanized adult 7.9-g male gross findings were detected.
American anole lizard (Anolis carolinensis) with a history of progressive weight loss and the Representative sections of
presence of bilaterally large, slowly enlarging dorsal cervical masses before (A) and after the cervical mass and addi-
(B) removal of the skin overlying the mass. A—Bar = 1 cm. B—The interior of the mass tional organs were collected
consists of yellow fluid to viscous content.
and fixed in neutral-buffered
10% formalin, sectioned at 5-µm slice thickness, and
stained with H&E stain.
History
Formulate differential diagnoses, then continue reading.
An adult 7.9-g male American anole lizard (Ano-
lis carolinensis) with a history of progressive weight
loss and the presence of bilaterally large, slowly Histopathologic Findings
enlarging dorsal cervical masses was euthanized and Histologic examination of the mass revealed a
presented for necropsy. partially intracranial epithelial-lined cyst that abutted
the leptomeninges of the brain and extended into the
cervical musculature of the atlanto-occipital region
Heather M. A. Fenton, DVM, MVSc1*; Jonathan Spears, DVM, MVSc2 ;
(Figure 2). The cyst was located dorsocaudal to the
Shannon Martinson, DVM, MVSc3 calvarium, and the cyst lining was congruent with the
1Canadian
inner ear with the same singular lining epithelium
Wildlife Health Cooperative, Department of Pathology
and Microbiology, Atlantic Veterinary College, University of Prince
and visible sections of macule and spiral ganglion
Edward Island, Charlottetown, PE, Canada located ventral to the cyst. The cyst lumen contained
2Department of Biomedical Sciences, Atlantic Veterinary College, homogenous to vacuolated pale eosinophilic mate-
University of Prince Edward Island, Charlottetown, PE, Canada rial that stained positive with periodic acid-Schiff
3Department of Pathology and Microbiology, Atlantic Veterinary
(PAS) staining and was interpreted as proteinaceous
College, University of Prince Edward Island, Charlottetown, PE,
Canada fluid, frequent deposits of basophilic granular mate-
rial (mineral), rare corpora amylacea, and scattered
*Corresponding author: Dr. Fenton (HFenton@rossvet.edu.kn) aggregates of necrotic debris and rare macrophages
https://doi.org/10.2460/javma.20.11.0609 (Figure 3). The cyst was lined by a single thin layer

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Figure 2—Photomicrograph of a longitudinal section
through the cervical mass of the anole in Figure 1. Note the
cystic structure (black asterisks) caudal and dorsal to the
brain (white asterisk) and extending along the nuchal region;
bar = 1,000 μm. Inset—The cyst contains mostly eosinophilic
proteinaceous fluid and is lined by a simple cuboidal epithe-
lium with rare blunt projections into the lumen. H&E stain;
bar = 20 μm.
Figure 3—Photomicrograph of a section of the cervical mass
of the anole in Figure 1. The cystic structure contains deposits
of amorphous, basophilic material (black asterisk; interpreted
as mineral) and is narrowly separated from the brain (white
asterisk) by a thin membrane consisting of meninges and the
attenuated cyst lining. H&E stain; bar = 20 µm.
of low cuboidal cells that were often attenuated and
occasionally formed delicate papillary projections
into the cyst lumen. The lining epithelial cells had
occasional positive intracytoplasmic granular stain-
ing with PAS stain. At the apical surface of these cells,
there were occasional small clear vacuoles within
the proteinaceous fluid. Multifocal deposits of min-
eral throughout the lesion stained positive with von
Kossa staining and occasionally were associated with
fibrous connective tissue and infiltrated by small
numbers of macrophages, heterophils, lymphocytes,
and plasma cells. The infiltrates extended into the
surrounding perimysium. Focally, the cyst was sepa-
rated from the brain by only the lining epithelium and
the leptomeninges; no clinically meaningful abnor-
malities were noted in the brain. Radiating deposits
of acicular material surrounded by macrophages and
multinucleated giant cells were scattered multifo-
cally throughout the kidney (consistent with urate
tophi). Deposits of granular purple material (mineral
confirmed with von Kossa staining) were present
within the glomerular tufts and within the lumina
of the renal tubules. The renal tubules and collect-
ing ducts rarely contained flocculent urate deposits
or deeply eosinophilic amorphous material (protein)
within their lumina. Diffuse hepatocellular atrophy
was present throughout the liver. Hepatocytes were
frequently shrunken and contained small amounts of
pale cytoplasm with large, well-defined clear vacu-
oles (fat). An acid-fast stain was applied to an impres-
sion smear of the yellow-tinged fluid from the right
lobe of the cervical mass, and a swab of the fluid was
submitted for routine bacteriologic culture. Both the
acid-fast stain and routine culture failed to reveal the
presence of any bacterial or fungal organisms.
Morphologic Diagnosis
and Case Summary
Morphologic diagnoses: bilaterally symmetric,
endolymphatic sac dilation and mineralization and
mild, chronic lymphohistiocytic sacculitis; moder-
ate, multifocal, chronic renal urate deposits (gout)
and mineralization; and diffuse, moderate, chronic
hepatocellular atrophy.
Case summary: inspissated, cystic endolymphatic
sacs in an anole lizard.
Comments
Although believed clinically and upon gross
examination to be an abscess or granuloma, upon his-
tological examination, the bilobed cervical mass was
determined to be of cystic origin. A cyst is defined
as a cavity lined by epithelium and filled with liquid
or semisolid material.1 This structure was compatible
with the endolymphatic sac based upon the anatomic
location and bilobed appearance. The material within
the cyst was inspissated and largely mineralized with
multifocal disruption of the cyst wall associated with
mild inflammation of the surrounding tissues. The
endolymphatic sac is intracranial in most species;
however, in some geckos and anoline iguanids, it has
been reported to extend extracranially into the cer-
vical musculature, as seen in this case.2 In reptiles,
endolymphatic sacs are thought to play a role in cal-
cium metabolism, perhaps acting as a site of storage
of calcium carbonate that can be mobilized during
egg formation and can be referred to as the chalk
gland or sac.3,4 The endolymphatic duct is found in
all species as part of the membranous labyrinth of
the inner ear and forms embryologically from an out-
pouching of the otic vesicle (neuroectoderm).5 Endo-
lymph (a mixture of fluid and crystals) moves within
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the membranous labyrinth, composed of the endo-
lymphatic duct, sacculus, cochlear duct, and semicir-
cular canals, and stimulates the lining sensory cells
responsible for interpretation of sound.6
The underlying pathogenesis resulting in dilation
of the endolymphatic sacs in this case was unknown.
As the anatomic structures are thought to be involved
with calcium metabolism associated with egg laying,
it was interesting that the affected animal in this case
was an adult male. Renal gout was detected in this
case and may have been attributed to dehydration
resulting from decreased food and water intake. One
could speculate that renal disease could have resulted
in serum calcium abnormalities in this case, thus
stimulating the endolymphatic sacs.
Disease of the endolymphatic sacs is poorly
described in the veterinary literature, but nuchal
mycotic granulomas and hematomas associated with
Trichosporon cutaneum, thought to have been due
to a bite wound in the cervical region, have been
reported in the American anole and appear to be
located in the same anatomic region.7,8 Neoplas-
tic lesions thought to originate in endolymphatic
sacs have also been described in reptiles, dogs, and
humans.9–12 In humans, pseudotumors of endolym-
phatic origin have been described with a benign
histological appearance that can be associated with
syndromes such as Ménière disease and von Hippel-
Lindau disease with hearing loss, tinnitus (inflam-
mation of the tympanic membrane), facial nerve
paralysis, and vertigo.12 True neoplasms of endolym-
phatic origin have been described to have tubular to
papillary formation and local invasion and appear-
ances similar to adenocarcinomas.9–11 Dilatation and
inspissation of normal anatomic structures should be
included as differential diagnoses for clinicians that
encounter any species with nodular swellings, with
endolymphatic sacs being of particular importance in
reptiles. These lesions could easily be misdiagnosed
as abscesses and treated inappropriately with antimi-
crobials. Comparative anatomy and understanding
of unique adaptations of species are essential for the
exotic animal clinician and pathologist.
References
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