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Feline Health Topics for Veterinarians

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Feline Health Topics for Veterinarians Feline Health Topics for veterinarians Summer 1994 Volume 9, Number 3 Eye Alert: Iris Pigmentation Ronald C. Riis, D.V.M., M.S. Pigment changes of the iris alert the owner or the clinician of a condition well worth concern. Differential diagnoses include iris freckle, nevus, cyst, and malignant melanoma. F re c k le The most benign of the iris pigment changes is an iris freckle. It is caused by increased pigmentation of the anterior border layer melanocytes, without an in­ creased number of melanocytes. There is no discrete mass or nodule on the iris surface (figures 1 and 2). Figure 3: This iris nevus has roughened edges and a nodular appearance. The pupil was uninhibited and the iridocorneal angle uninvolved. diffuse nevus of the iris (figure 5) may be associated with unilateral heterochromia, peripheral anterior synechia, or iris nodule (localized inflammation). An iris nevus or freckle has a low malignant potential but a high anxiety potential for the pet owner and veterinarian who worry about the possibility of malignant melanoma. Figure 1: The iris freckle is Figure 2: Note the slight characterized by a localized variation in density of the iris pigment spot, flush with the freckles and nevus, and the surrounding iris surface. No rather benign appearance of change in pupillary excur­ both. sions can be noted. Inside this issu e ... Eye Alert: Iris Pigmentation page 1 N evus An iris nevus results from an increased number of a- Research Briefs page 6 typical but benign-appearing melanocytes in a discrete Radiology Case Review page 7 mass or nodule within the anterior border layer of the iris (figure 3). A diffuse nevus of the iris is present in congenital melanocytosis (figure 4). An acquired Feline Health Topics Figure 4 - A diffuse nevus of the iris or congenital Figure 5 - An acquired diffuse nevus occurredfollowin g melanocytosis may be within the iris stroma without uveitis. Note the misshapen pupil. Melanocytic reactions causing a nodular or mass appearance. and macrophages laden with melanin granules account for the discoloration and irregularity of the iris surface. The inflammatory component o f this iris will alter in appearance after months of treatment with anti­ inflammatory medication. Iris Cysts ( ^ Iris cysts vary in size but they are always spherical­ Feline Health Topics ly shaped and usually pigmented. The densely pigmented cysts can challenge your diagnostic A publication for veterinary professionals capabilities. Utilizing procedures such as trans­ The ultimate purpose of the Cornell Feline Health Center is to improve illumination, ultrasound, and occasionally aspiration the health of cats everywhere, by developing methods to prevent or cure feline diseases, and by providing continuing education to veterin­ may be necessary to diagnose iris cysts. arians and cat owners. All contributions are tax-deductible. Director: Fred W. Scott, D.V.M., Ph.D The origin of iris cysts is poorly understood. Assistant Director: James R. Richards, D.V.M. Histologically, the cysts are generally a unilayered Editor: June E. Tuttle Secretaries: Gwen Frost structure of mature pigmented cells. The cells can be Marsha J. Leonard free floating in the chambers or attached to the pos­ Sheryl A. Thomas terior iris surface or ciliary body. The lumen of the ©1994 by Cornell University on behalf of the cyst is filled with unidentified fluid (probably of Cornell Feline Health Center, College of Veterinary Medicine, Ithaca, NY 14853-6401. aqueous properties). If the cyst is small, its size Phone: (607) 253-3414 Fax: (607) 253-3419 should be monitored with periodic examinations. If All rights reserved. Permission to reprint selected portions must be obtained in writing. the cyst is large and occurs in the primary pupillary Cornell University is an equal opportunity, af­ firmative action educator and employer. axis, it can be deflated by anterior chamber Printed on recycled paper. paracentesis with a Fine needle or by laser destruction V (figures 6 and 7). 3 Malignant Melanomas It is suspected that malignant melanoma of the feline iris constitutes a higher percentage of uveal melanomas than cited for humans (approximately 5 to 8%).5 Iris melanomas arise from the anterior border layer tissue of the iris, similar to nevi. Most, if not all, iris ma­ lignant melanomas arise from pre-existing nevi. A geographic distribution of iris malignant melanomas in the feline has not been categorized into frequency of occurrence. However, the categories established in human medicine are inferior, temporal, nasal, and superior locations.5 The clinical presentation of an iris melanoma may be as a discrete mass, a diffuse mass, a Figure 6 -An iris cyst in the ventral pupil. This cyst was heterochromia, freckle or nevi, glaucoma, or chronic very darkly pigmented making it difficult to differentiate uveitis. The masses may be deeply pigmented, from a solid mass. It was echolucent and was deflated partially pigmented, or even nonpigmented. They with laser therapy. frequently show neovascularization and a roughened surface. The mass may distort the pupil or the range of movement of the pupil. Gonioscopic examination of the iris surface and iridocorneal angle may help to classify the mass’ characteristics (figures 8 and 9). Figure 8 - This multifocal melanoma shows"breakthrough" Figure 7 - An iris cyst transilluminated from the side melanosis arising from a larger ventral mass. Minor pupillary showing the iris through the clear cystic fluid. This cyst interference and ventral iridocorneal invasion of pigment was was referred to as a "malignant melanoma." Because noted. The eye was visual. o f the cyst size, it was deflated to increase the pupillary visual aperture. Feline Health Topics 4 buphthalmic due to neoplastic cells infiltrating the iridocorneal angle, causing secondary glaucoma. Extension of the melanoma may be visible in portions of the conjunctiva and sclera. The above progression and threat of metastasis have stimulated debate among pathologists and ophthalmologists. Figure 9 - Diffuse melanoma with variable pigment qualities. Iridocorneal angle invasion noted. Also note the pigment on the adjacent lid margin as well. In humans, most iris malignant melanomas are composed of spindle cells that are usually benign.7 In cats, the composition is epithelioid or mixed (figures 10, 11, and 12). A recent article examined globes from 9 cats with localized to diffuse hyperpigmen­ tation. A combination of cell types was found, leading Figure 11 - Iris anterior surface showing normal feline iris the authors to speculate that this cell makeup may pigment cells and the invading overgrowth of melanocytes (H. represent a progression of characteristics from iris & E. stain 40X). freckle to diffuse melanoma.1 A diffuse iris melanoma is a malignancy that can Early diagnosis of an iris melanoma with vary in hyperpigmentation from localized to multi­ enucleation is recommended to prevent the neoplasia focal to generalized. The globe may even become from metastasizing. All enucleated globes should be histologically evaluated to help understand the char­ acteristics of malignancy more fully and predict the prognosis of the animal. The debate over when an eye should be enucleated will always exist. For many owners it is hard to justify the loss of a cat's visual eye because of a pigment change on the iris. Ophthalmologists generally agree that these pigmented spots, without thickening or distortion of the iris and no associated inflammation, should be serially monitored instead of enucleated. The evaluations should include measurement of the pigmented areas, photographs, biomicroscopic and gonioscopic examinations of the hyperpigmented Figure 10 - Iris tip with melanosis of iris stroma and surface. Rapid color change caused concern, so the eye was enucleated areas every 3 to 6 months. (II. & E. stain 4X). 5 ophthalmologist should consider the long-term studies on 49 cats with anterior uveal melanoma that docu­ ments a known or suspected metastasis in 53 percent to 66 percent of the cats.4 The value of early enucleation to decrease the long-term rate of metastasis is unknown. A controlled prospective clinical study that compares the three- to five-year survival rates of cats receiving early and late enucleation will help answer the existing controversy. Additional studies of the clinical, histopathological, and cytological risk factors associated with metastasis of the feline iris melanoma Figure 12 - Note the epithelioid melanocytic cells on the surface are warranted.5,6 ■ of this rapidly changing nevi. These cells are characteristic of cells grown in culture media. The anterior chamber provides an R eferences ideal environment for those conditions (II. & E. stain 100X). 1 Dubielzig RR, Lindley DM. Transition of iris freckle to diffuse iris melanomas of cats. Histological study. Proc Am Coll Vet Ophthalmol 24:56, 1993. Baseline values of the cat’s general condition should be obtained. Tests can include a complete 2 Duncan DE, Peiffer RL: Morphology and prognostic blood count, serum chemistry panel, and thoracic and indicators of anterior uveal melanomas in cats. Prog Vet abdominal radiographs. If the periodic evaluation Comp Ophthalmol 1:25-32, 1991. documents a change in the iris pigmentation and 3 Dubielzig RR, Everitt J, Shadduck JA, et al.: Feline ocular character, a more definitive answer may be obtained melanoma and post-traumatic sarcoma. Proc Am Coll Vet by submiting an iris biopsy or cytology from a freckle Ophthalmol 17:436, 1986. by using the surface vacuum technique. Both “Patnaik AK, Mooney S: Feline melanoma: a comparative techniques have positive and negative implications. study of ocular, oral, and dermal neoplasms. Vet Pathol An iris biopsy may result in enough trauma to release 25:105-112, 1988. neoplastic cells for metastasis or cause hemorrhage. ’Zimmerman LE, McLean IW: An evaluation of enucleation Although needle aspiration of the surface cells is a in the management of uveal melanomas. Am J Ophthalmol safer technique, it may not yield enough cells to 87:741-757, 1979.
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