section name header

Basics

Outline


BASICS

Overview!!navigator!!

  • Tumors of the respiratory system are most commonly located in the thoracic or sinusal/parasinusal structures
  • Incidence is very low—thoracic cavity neoplasia was reported in 35 of 5629 necropsies. Primary lung tumors—7.9% of thoracic neoplasia
  • The most frequent primary lung tumor is the granular cell tumor (or myoblastoma). They may be accompanied by osteoproliferative abnormalities of carpal, tarsal, and fetlock joints
  • Lung is a relative frequent site for secondary metastases from other organs
  • 50–68% of nasal passage tumors are malignant with SCC being the most frequent. SCC originates from mucosal or alveolar teeth epithelium and starts invading locally before metastasizing regionally

Signalment!!navigator!!

  • Nasal/paranasal tumors—SCC (most frequent); mature adults, more frequent in aged horses. Mean age 8–12.4 years
  • Primary pulmonary tumors—>7 years. Pulmonary granular cell tumor (most frequent); mean age 13 years, range 8–22 years
  • Lung metastases from distant primary tumors—mean age 8 years, range 3 months to 14 years
  • Sex predilection—majority of females for pulmonary granular cell tumors and males for intrathoracic metastatic adenocarcinoma.

Signs!!navigator!!

Historical Findings

  • Weight loss
  • Dullness
  • Exercise intolerance
  • Intermittent fever

Physical Examination Findings

  • Thoracic respiratory tumors;
    • Underweight
    • Signs of pleural effusion and ventral edema
    • Tachypnea
    • Coughing
    • Dyspnea
    • Hemoptysis
    • Abnormal lung auscultation sounds
    • Pallor, icterus, and intermittent epistaxis in cases of hemangiosarcoma
    • Proliferative osteopathy of carpal, tarsal, fetlock joints rarely seen
  • Nasal/parasinusal tumors:
    • Nasal discharge (frequent); foul smelling
    • Facial deformity for large tumors

Causes and Risk Factors!!navigator!!

Undetermined

Diagnosis

Outline


DIAGNOSIS

Differential Diagnosis!!navigator!!

  • Thoracic respiratory tumors—equine asthma and inflammatory conditions, equine multinodular fibrosis, other neoplasia, idiopathic pleuritis, mycotic pneumonia
  • Nasal/paranasal tumors; primary sinusitis, nasal inflammatory polyps, progressive ethmoidal hematoma

CBC/Biochemistry/Urinalysis!!navigator!!

  • CBC—results depend on the invasiveness of the primary tumor: often an inflammatory hemogram is present
  • Chemistry—no abnormalities unless a specific organ is showing functional insufficiency

Other Laboratory Tests!!navigator!!

  • Thoracocentesis—neoplastic cells can be observed in the pleural fluid
  • Lung biopsy—preferentially US-guided to sample a mass, or through an endoscope if a mass is visible in the airways
  • Transtracheal aspiration cytology may reveal neoplastic cells
  • For nasal/paranasal tumors—biopsy samples obtained deep within the mass. Superficial samples obtained by endoscopy are often nondiagnostic

Imaging!!navigator!!

  • Head radiography—nasal/paranasal SCC; dorsoventral view is useful to assess sinuses
  • Thorax radiography—pulmonary tumors; single or several soft tissue density
  • Thorax US—pleural effusion, masses in the lung parenchyma
  • Upper/lower airway endoscopy (including sinusoscopy)—nasal/paranasal SCC; often ulcerated. Pulmonary tumor; masses in the main bronchi occasionally seen

Other Diagnostic Procedures!!navigator!!

Thoracoscopy—to visualize and biopsy masses affecting the lung surface.

Pathologic Findings!!navigator!!

  • Nasal/paranasal SCC—classified as well, moderately, or poorly differentiated. Degrees of differentiation not correlated with the presence of metastasis
  • Pulmonary granular cell tumor—most frequent primary pulmonary tumor. Usually unilateral. Local metastases frequently reported
  • Pulmonary carcinoma—usually unilateral, caudal lung. Pleomorphic epithelial cells. Rarely metastasize
  • Metastatic hemangiosarcoma—primary tumor more frequently in skeletal muscle or skin
  • Metastatic SCC—primary tumor more frequently in the stomach, but also penis, vulva, and eye

Treatment

TREATMENT

  • Lung neoplasm—mass and lung resection have been attempted
  • Granular cell tumor removal by transendoscopic electrosurgery and ablation with a diode laser have been described. Nasal/paranasal mass removal—often malignant with risks of recurrence and metastasis

Medications

MEDICATIONS

None

Follow-up

Outline


FOLLOW-UP

Patient Monitoring!!navigator!!

Improvement in attitude, clinical signs, and weight gain can be observed when nasal/paranasal mass is removed successfully.

Expected Course and Prognosis!!navigator!!

Grave for lung tumors and malignant nasal passage tumors; short life expectancy after diagnosis.

Miscellaneous

Outline


MISCELLANEOUS

Associated Conditions!!navigator!!

  • Primary neoplasms when lung metastases are present
  • Rare cases of proliferative osteopathy of carpal, tarsal, fetlock joints

Abbreviations!!navigator!!

  • SCC = squamous cell carcinoma
  • US = ultrasonography, ultrasound

Suggested Reading

Scarratt KW, Crisman MV. Neoplasia of the respiratory tract. Vet Clin North Am Equine Pract 1998;143:451473.

Sweeney CR, Gillette DM. Thoracic neoplasia in equids: 35 cases (1967-1987). J Am Vet Med Assoc 1989;195:374377.

Author(s)

Author: Renaud Leguillette

Consulting Editors: Daniel Jean and Mathilde Leclère