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Acta Scientiae Veterinariae ISSN: 1678-0345 [email protected] Universidade Federal do Rio Grande do Sul Brasil Kiliç, Nuh; Toplu, Nihat; Epikmen, Erkmen Tugrul Surgical Treatment of Corneal Large Dermoid in a Simmental Calf Acta Scientiae Veterinariae, vol. 40, núm. 2, 2012, pp. 1-5 Universidade Federal do Rio Grande do Sul Porto Alegre, Brasil Available in: http://www.redalyc.org/articulo.oa?id=289023567015 How to cite Complete issue More information about this article Journal's homepage in redalyc.org Scientific Information System Network of Scientific Journals from Latin America, the Caribbean, Spain and Portugal Non-profit academic project, developed under the open access initiative

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Page 1: Treatment of Corneal Large Dermoid in a ... · PDF fileand Hereford-cross calves from one region of the ... The dermoid locations in that study were reported in decreasing order as

Acta Scientiae Veterinariae

ISSN: 1678-0345

[email protected]

Universidade Federal do Rio Grande do Sul

Brasil

Kiliç, Nuh; Toplu, Nihat; Epikmen, Erkmen Tugrul

Surgical Treatment of Corneal Large Dermoid in a Simmental Calf

Acta Scientiae Veterinariae, vol. 40, núm. 2, 2012, pp. 1-5

Universidade Federal do Rio Grande do Sul

Porto Alegre, Brasil

Available in: http://www.redalyc.org/articulo.oa?id=289023567015

How to cite

Complete issue

More information about this article

Journal's homepage in redalyc.org

Scientific Information System

Network of Scientific Journals from Latin America, the Caribbean, Spain and Portugal

Non-profit academic project, developed under the open access initiative

Page 2: Treatment of Corneal Large Dermoid in a ... · PDF fileand Hereford-cross calves from one region of the ... The dermoid locations in that study were reported in decreasing order as

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N. Kiliç, N. Toplu & E.T. Epikmen. 2012. Surgical Treatment of Corneal Large Dermoid in a Simmental Calf. Acta Scientiae Veterinariae. 40(2): 1041.

Acta Scientiae Veterinariae, 2012. 40(2): 1041.

CASE REPORTPub 1041

ISSN 1679-9216 (Online)

Surgical Treatment of Corneal Large Dermoid in a Simmental Calf

Nuh Kılıç1, Nihat Toplu2 & Erkmen Tugrul Epikmen2

ABSTRACT

Background: Ocular dermoid is a skin or skin-like appendage usually arising on the limbus, conjunctivae, and cornea. It can be unilateral or bilateral and may be associated with other ocular manifestation or with other malformations. Hair from the lesions is predominantly responsible for the associated irritation resulting in chronic inflammation of the conjunctivae and cornea and may cause visual impairment. Ocular dermoids are rare in cattle, with the prevalence estimated between 0.002% and 0. 4%.Case: A one-day-old Simmental calf presented for bilateral haired masses on the eyes and tumor-like growth since birth. The calf was admitted to the University of Adnan Menderes, Faculty of Veterinary Medicine 1 days after initial examination. The calf weighed 35 kg, was in good bodily condition and no further abnormalities were detected on physical examina-tion, complete blood count and serum chemistries. General anesthesia was induced and maintained with an intravenous detomidine-ketamine-midazolam combination. The corneal dermoids extended slightly beyond the inferonasal limbus and then merged with a second mass of lightly haired tissue within the inferonasal bulbar conjunctiva of both eyes. The dermoids were excised by superficial lamellar keratectomy that was extended into the inferonasal conjunctiva. The nasal masses were excised by electrocautery. All excised tissue was submitted for histopathology. Histopathology of the excised tissue confirmed bilateral corneoconjunctival dermoids with bilateral nasal hyperplastic tissue. Topical 1% atropine sulfate ointment was applied twice daily to both eyes for 5 days and bacitracin-neomycin-polymixin ophthalmic ointment applied twice daily to both eyes for 2 weeks postoperatively. Ocular and nasal healing was uneventful, with prominent corneocon-junctival granulation tissue 6 days postoperatively, which largely resolved by the 6-week follow-up examination. Bilateral large dermoids with nasal hyperplastic tissue have not been documented previously in Simmental cattle in Turkey.Discussion: The precise developmental mechanisms involved in the pathogenesis of ocular dermoids are not known. Metaplasia of mesenchyme (of primarily neural crest origin), resulting in abnormal differentiation of the surface ectoderm, is considered the most likely mechanism. Ocular dermoids may be associated with other congenital ocular or multiorgan abnormalities. The medial and lateral nasal processes, optic vesicle and first and second branchial arches are in close re-lationship on the lateral side of the embryonic head and might all be adversely influenced by the same stimulus. Ectopic lacrimal tissue may appear in combination with an ocular dermoid as in this case report and previously reported in cattle, or alone as an epibulbar choristoma. The ectopic lacrimal tissue in this calf may have represented misplacement of the nictitans gland or additional lacrimal tissue development. Superficial keratectomy is required to surgically excise a cor-neal dermoid although the depth of the dermoid within the cornea cannot be ascertained by ophthalmic examination until surgery is undertaken. In the case of large corneal dermoids, surgical excision should be performed early in the life of the patient to achieve optical improvement and allow functional development of the eye.

Keywords: calf, large dermoid, nasal hyperplastic tissue, surgery.

Received: December 2011 www.ufrgs.br/actavet Accepted: January 2012

1Department of Veterinary Surgery, 2Department of Veterinary Pathology, Faculty of Veterinary Medicine, Adnan Menderes University, Aydin, Turkey. CORRESPONDENCE: N. Kılıç [[email protected] - Fax: 0090 256-247-07-20]. Department of Veterinary Surgery, Faculty of Veterinary Medicine, Adnan Menderes University. 09016 - Isikli, Aydin, Turkey.

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N. Kiliç, N. Toplu & E.T. Epikmen. 2012. Surgical Treatment of Corneal Large Dermoid in a Simmental Calf. Acta Scientiae Veterinariae. 40(2): 1041.

INTRODUCTION

Ocular dermoid is a skin or skin-like append-age usually arising on the limbus, conjunctivae, and cornea. It can be unilateral or bilateral and may be as-sociated with other ocular manifestation or with other malformations. Hair from the lesions is predominantly responsible for the associated irritation resulting in chronic inflammation of the conjunctivae and cornea and may cause visual impairment [1,12,18]. Dermoids may affect the eyelids, conjunctiva, nictitans, sclera and cornea [14] and most commonly present unilat-erally. Bilateral ocular dermoids have been reported in cattle [1,2,6,9,20], sheep [8], and a camel [18]. Ocular dermoids are rare in cattle, with the prevalence estimated between 0.002% and 0. 4% [20]. This paper reports a case of bilateral large dermoids in a calf.

CASE REPORT

A one-day-old Simmental heifer calf was pre-sented with an abnormal appearance of both eyes since birth. Ocular findings were similar in both eyes. A large fleshy mass was attached to the cornea and sclera with a large number of temporally and superiorly directed hairs arising from the surface of the mass (Figure 1). The calf exhibited moderate blepharospasm and watery discharge of both eyes. Superficial corneal ulceration was present in the inferotemporal cornea of both eyes as a result of trichiasis. The nictitans of each eye ap-peared to be displaced anteriorly by its respective cor-neal mass, but the inferior extent of the corneal masses could not be determined without general anesthesia. A firm nodule was present in the left and right side of the dorsomedial nasolabial planum. No other ocular

abnormalities were detected in either eye (Figure 2). The clinical diagnosis was bilateral corneal dermoids and nasal hyperplastic tissue.

The calf was admitted to the University of Adnan Menderes, Faculty of Veterinary Medicine 1 days after initial examination. The calf weighed 35 kg, was in good bodily condition and no further ab-normalities were detected on physical examination, complete blood count and serum chemistries. General anesthesia was induced and maintained with an intra-venous detomidine-ketamine-midazolam combination [13]. The corneal dermoids extended slightly beyond the inferonasal limbus and then merged with a second mass of lightly haired tissue within the inferonasal bulbar conjunctiva of both eyes. The dermoids were excised by superficial lamellar keratectomy that was extended into the inferonasal conjunctiva (Figure 3). The nasal masses were excised by electrocautery. All excised tissue was submitted for histopathology. Topical 1% atropine sulfate ointment1 was applied

Figure 1. Initial presentation. (a) Left eye. Note the long hairs protruding from the corneal dermoid.

Figure 2: Tumor-like growth on the nasolabial planum.

Figure 3. Corneal large dermoid of left eye just after the surgery.

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N. Kiliç, N. Toplu & E.T. Epikmen. 2012. Surgical Treatment of Corneal Large Dermoid in a Simmental Calf. Acta Scientiae Veterinariae. 40(2): 1041.

twice daily to both eyes for 5 days and bacitracin-neomycin-polymixin ophthalmic ointment2 applied twice daily to both eyes for 2 weeks postoperatively. Ocular and nasal healing was uneventful, with promi-nent corneoconjunctival granulation tissue 6 days postoperatively, which largely resolved by the 6-week follow-up examination.

Histopathology was similar for the tissue excised from both eyes. The corneal lesion exhibited a moderately well delineated but nonencapsulated raised mass comprised of moderately hyperplastic, keratinizing stratified squamous epithelium overly-ing a thick collagenous stroma, which merged with conjunctival tissue containing submucosal glandular tissue. The corneal mass contained numerous, large, well-developed hair follicles and adnexal structures superficially. A band of abortive hair follicles and ad-nexa was identified as haphazardly arranged clusters of epithelium, in the absence of hair bulbs, intermingled with tortuous lumina of apocrine glands beneath the productive follicles (Figure 4).

and mesenchymal elements (fibrous tissue, fat and cartilage) combined in different proportions [11].

Ocular dermoids in cattle are not common, with an estimated prevalence of 0.002%–0.4% [3,7]. Ocular dermoids have been reported in cattle of many breeds worldwide, with a similar low prevalence in all breeds other than the Hereford [20]. The apparent predisposition in Herefords is largely based on a report by Barkyoumb and Leipold [1] of 74 affected Hereford and Hereford-cross calves from one region of the USA, the majority of calves being bilaterally affected. The dermoid locations in that study were reported in decreasing order as limbus, third eyelid, canthus, eyelid and conjunctiva [18]. There are otherwise few reports of bilateral ocular dermoids in calves, each describing single or low numbers of animals [6,20], and only one reporting a nasal tumor-like growth [12]. Of these bilateral cases, inferonasal corneoconjunctival dermoids were most commonly reported, followed by nasal canthal dermoids [6,20].

Ocular dermoids may be associated with other congenital ocular or multiorgan abnormalities [3,4,6]. The medial and lateral nasal processes, optic vesicle and first and second branchial arches are in close relationship on the lateral side of the embryonic head and might all be adversely influenced by the same stimulus [16]. Ectopic lacrimal tissue may appear in combination with an ocular dermoid as in this case report and previously reported in cattle [9], or alone as an epibulbar choristoma [15]. The ectopic lacrimal tissue in this calf may have represented misplacement of the nictitans gland or additional lacrimal tissue development.

The primitive adnexal units situated beneath the productive hair follicles in the deeper connective tissue frequently failed to show luminal development, resulting in a band of abortive hair follicles that has not been previously described in dermoids. Also not previously reported in cattle was the prominent mi-totic activity noted in the glandular tissue of the nasal choristomas, suggesting ongoing proliferative activity. Choristomas are known to grow, with the rate acceler-ated by trauma, irritation or puberty, in humans [6]. Malignant degeneration is rare in ocular choristomas but transformation of ectopic lacrimal tissue into adenocarcinoma and pleomorphic adenoma has been reported in humans [6].

Congenital heart disease has been reported in association with bilateral corneal and nasal canthal der-

Figure 4. Corneo-conjunctival dermoid. Within the deeper portions of the corneal dermoid, there is a parallel arrangement of abortive hair follicular development characterized by the presence of a hair bulb (arrow) and an associated apocrine gland (arrowhead). H&E. [bar = 25 µm].

DISCUSSION

The precise developmental mechanisms in-volved in the pathogenesis of ocular dermoids are not known [10,12,20]. Metaplasia of mesenchyme (of primarily neural crest origin), resulting in abnormal differentiation of the surface ectoderm, is considered the most likely mechanism [4, 5]. The resulting der-moid consists of ectodermal elements (keratinized epithelium, hairs, sebaceous and apocrine glands),

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N. Kiliç, N. Toplu & E.T. Epikmen. 2012. Surgical Treatment of Corneal Large Dermoid in a Simmental Calf. Acta Scientiae Veterinariae. 40(2): 1041.

moid in a Guernsey calf [6]. Barkyoumb and Leipold [1] described cardiac defects (Tetralogy of Fallot and patent ductus arteriosus), polycystic kidney disease and small tissue masses protruding into the external nares in some of 74 calves reported with ocular der-moids, although they did not specify the number of calves affected and whether calves showed one or a combination of the three abnormalities. Bhatt et al. reported a tumor-like growth at the entrance of the left nasal passage in association with bilateral corneal and eyelid dermoids in a Rathi calf [2]. Histopathologic examination was not performed on the nasal masses in either of these two reports.

The combination of congenital ocular and nasal abnormalities in this calf is compatible with the intimate early developmental origin of the optic and nasal regions and a common abnormality in neural crest migration [17]; whether this abnormality has a genetic basis or not is less clear. Characteristics of both autosomal recessive and polygenic inheritance were found by Barkyoumb and Leipold [1] in their analysis

of Hereford cattle with ocular dermoids. Breed predis-positions for ocular dermoids are reported in Birman cats, Dachshund, Dalmatian, Dobermann, Golden Retriever, German shepherd and Saint Bernard dogs, and Quarterhorses [19,20].

Superficial keratectomy is required to surgi-cally excise a corneal dermoid [2] although the depth of the dermoid within the cornea cannot be ascertained by ophthalmic examination until surgery is undertaken [2,11]. In the case of large corneal dermoids, surgi-cal excision should be performed early in the life of the patient to achieve optical improvement and allow functional development of the eye.

SOURCES AND MANUFACTURERS1Atropine sulfate ophthalmic ointment USP 1%, Abdi İbrahim, İIstanbul, Turkey.

2Trioptic-P, Altanta Inc., Melville, NY, USA.

Declaration of interest. The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.

REFERENCES

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Pub. 1041www.ufrgs.br/actavet

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18 Moore C.P., Shaner J.B., Halenda R.M., Rosenfeld C.S. & Suedmeyer W.K. 1999. Congenital ocular anomalies and ventricular septal defect in a dromedary camel (Camelus dromedarius). Journal of Zoo and Wildlife Medicine. 30 (3): 423-430.

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20 Yeruham I., Perl S. & Liberboim M. 2002. Ocular dermoid in dairy cattle - 12 years survey. Revue de Médecine Véterinaire. 153(2): 91-92.