pISSN 1598-298XJ Vet Clin 31(4) : 319-321 (2014)

319

Epiphora by Non-viral Squamous Papilloma of the Conjunctiva in a Dog

Jury Kim*, Ul Soo Choi*, Caryn E. Plummer**, Dennis E. Brooks** and Min-Su Kim*,

**

*College of Veterinary Medicine, Chonbuk National University, Jeonju, 561-756, Korea

**Department of Small Animal Clinical Sciences, College of Veterinary Medicine,

University of Florida, Gainesville, Florida, 32608 USA

(Accepted: August 18, 2014)

Abstract : A 12-year-old mixed breed male dog was referred to Chonbuk National University Animal Medical Centerwith unilateral left epiphora. Magnified ophthalmic examination revealed a very small tissue mass on the palpebralconjunctiva of the left eye. The mass was surgically removed and microscopic examination confirmed moderate papillaryhyperplasia of the squamous epithelium without viral cytopathic effects. Based on the histology, the mass was diagnosedas a non-viral squamous papilloma. After removal of the mass, the epiphora was completely solved. This case reportdescribes the non-viral squamous papilloma arising from the conjunctiva in a dog with epiphora.

Key words : epiphora, conjunctiva, dog, non-viral squamous papilloma.

Introduction

Epiphora may frequently occur in dogs and cats and that is

a clinical feature of essential disease of the anatomical lacri-

mal gland (11,14). However, overproduction of tears is more

related to inflammation of the eye such as entropion, ectro-

pion, distichiasis, trichiasis, corneal and conjunctival inflam-

mation, and foreign bodies. In addition, disorders of naso-

lacrimal drainage system including malposition or absence of

the puncta, obstruction of the nasolacrimal duct are involved

(5,8,11). The treatment of epiphora is focused on the cure of

original problem. Although medical and surgical management

for tear overproduction is frequently documented and has a

good prognosis, which is not always satisfied for the patients

throughout their life unless an underlying cause can be

treated. Exact diagnosis is the most important to treat over-

production of tear.

Squamous papilloma is a common and generally benign

squamous epithelial tumor of the skin, oral cavity, eyelid and

conjunctiva (1,2). Papillomas in dogs less commonly affect

the ocular region, including the conjunctiva and cornea (9).

In the conjunctiva, papillomas are typically characterized by

finger-like projections that have a fibrovascular core in the

epithelium and stroma of the mucous membrane (3,6). The

etiology of the conjunctival papilloma in the dog remains

unclear. However, the majority of reported cases have been

virally induced by either solitary cutaneous papilloma produc-

ing virus or canine oral papilloma (COP) virus (9). In cases

with no evidence of viral origin, the proliferative masses are

considered to be non-viral squamous papilloma (2). The his-

tological changes associated with non-viral papilloma include

exophytic papillated projections of pleomorphic epithelium

which lack the characteristics of viral cytopathic effect (13).

This case report describes the epiphora result from very small

non-viral squamous papilloma of the conjunctiva in a dog.

Case

A 12-year-old intact female mixed breed dog was referred

with a history of unilateral epiphora and mild ocular dis-

charge from the left eye. Although the dog already had been

several medications including eye-drop from local animal

hospital, it had been suffered from moderate lacrimation for

approximately 12 month. No abnormalities were found on

routine physical and radiological examinations. Schirmer tear

test (STT-1) values were 35 mm wetting in the left eye, and

23 mm in the right eye during 60 seconds. The conjunctiva

1Corresponding author.E-mail : mskim@jbnu.ac.kr

Fig 1. Very small non-viral squamous papilloma in the left

lower palpebral conjunctiva.

320 Jury Kim, Ul Soo Choi, Caryn E. Plummer, Dennis E. Brooks and Min-Su Kim

and cornea were normal with no inflammatory reaction or

other signs of irritation. In addition, the cilia disorders includ-

ing distichiasis, trichiasis, or ectopic cilia were not found at

the left eyelid and no anatomical problems of nasolacrimal

drainage system and foreign bodies were found. Magnified

ophthalmic examination revealed a very small mass in the

left lower palpebral conjunctiva. The mass was pink less than

0.7 mm in diameter, and had a cauliflower-like appearance

(Fig 1). The differential diagnosis for the conjunctival mass

included squamous papilloma or squamous cell carcinoma.

At the owner’s request, the lesion was surgically removed.

Preoperative complete blood count and serum chemistry

were within the normal range. Under general anesthesia, the

conjunctival surfaces were cleaned with 0.5% povidone-

iodine solution and the mass was excised. It was placed in

10% phosphate buffered formalin for histological examina-

tion. After surgery, topical medications applied to the left eye

included artificial tears (Lacure; Samil Pharm., Seoul, Korea)

and ciprofloxacin (CF; Samcheondang Pharm., Seoul, Korea).

Microscopically, there was a single tiny fragment of conjunc-

tival tissue demonstrating moderate papillary hyperplasia of

the lining stratified squamous epithelium. A small portion of

the superficial submucosa contained confluent marked lym-

phoplasmacytic stromal inflammation (Fig 2). Based on the

histology, a diagnosis of non-viral squamous papilloma with

focal marked lymphoplasmacytic conjunctivitis was made.

Three weeks after removal of the mass, the STT valves were

18 mm in the left eye and 19 mm in the right. The epiphora

was completely resolved.

Discussion

Epiphora as clinical sign rather than specific disease is

most commonly associated with insufficient drainage or an

overproduction of the tear in small breed dogs (11). Although

it is not life threatening disease, epiphora results in some

problems such as inflammation, skin problem, and patient

discomfort. The causes of epiphora are varied, and much care-

ful examination has been focused on various pathological

considerations (5). Generally, it may be caused either by ana-

tomical disorders including nasolacrimal duct, cilia and eyelid

abnormalities or secondary by chronic irritation/inflammation

of the cornea, conjunctiva, or lacrimal sac (5,8,11). For treat-

ment of epiphora if the cause is related to another eye prob-

lem, the primary cause is directly cured (8). If a specific

cause should not be recognized, the patient is focused on cos-

metic part in nature that its vision or comport is not threat-

ened. In this case, the owner could not find a specific problem

which caused the epiphora. In addition, the squamous papil-

loma as foreign body could not be easy to find without mag-

nified ophthalmic device due to very small size and the

tumor location at lower bulbar conjunctiva near the fornix.

Squamous papilloma is one of two types of papilloma clas-

sified as non-neoplastic epithermal papillated mass (2). It is

slow growing, with demarcated lesions of papillomatous con-

figuration occurring at the squamous epithelium (4). Squa-

mous papillomas frequently occur at the ocular region in

animals. In the dog, mucosal squamous papilloma has been

described on the eyelids, the cornea, the conjunctiva and

adjacent structures (2). Conjunctival papillomas are the most

commonly acquired epithelial lesions of the conjunctiva, and

usually involve multiple lesions with a cauliflower-like appear-

ance. These papillomas may have an exophytic growth pat-

tern and are typically white pink in color (12). In this case,

the mass was a tiny, pink, cauliflower-like lesion. Based on

the histological appearance of the mass, the conjunctival pap-

illoma can be classified as having either viral or non-viral eti-

ology (2,13). In humans, conjunctival papillomas associated

with Human Papilloma Virus (HPV) have a characteristic

frond-like appearance (6,7). In dogs, skin lesions are caused

by a cutaneous papilloma-producing virus and the oral lesions

by a COP virus (8). However, non-viral squamous papillo-

mas, in which viral cytopathic effects are not evident, occur

rarely in dogs. Non-viral papillomas are delicate, papillated

masses that may be pedunculated and are generally smaller

than viral warts, like the lesion in the present case (13). In

this case, a reactive non-neoplastic papillary proliferative

response to ongoing inflammation or trauma cannot be ruled

out. However, there were no demonstrated clinical signs of

chronic conjunctivitis, such as erythema or chemosis. Viral

proteins could also be evidenced by polymerase chain reac-

tion (PCR) or immunohistochemistry, but unfortunately in

this case the unstained sections were too small to perform

immunohistochemistry (IHC) for the detection of papilloma

virus. However, the mass is consistent with a benign non-viral

squamous papilloma based on the histological findings. In

this case, foreign body like acting of squamous papilloma

might induce the epiphora. The mass was successfully

Fig 2. Papillary hyperplasia of the lining stratified squamous epithelium with lymphoplasmacytic stromal inflammation in the super-

ficial submucosa.

Epiphora by Non-viral Squamous Papilloma of the Conjunctiva in a Dog 321

removed, and the epiphora was simply cured in the dog.

In conclusion, this case report describes the treatment and

histological analysis of non-viral squamous papilloma of the

conjunctiva result in epiphora.

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개 결막의 비바이러스성 편평세포 유두종에 의한 유루증 증례

김주리*·최을수*·Caryn E. Plummer**·Dennis E. Brooks**·김민수*,

**

*전북대학교 수의과 대학, **플로리다 대학교 수의과 대학

요 약 : 12년령 접종 수컷 개가 전북대학교 수의과 대학에 왼쪽 편측성의 유루증으로 내원하였다. 확대경을 통한 안

검사에서 왼쪽 안검 결막에 매우 작은 덩어리가 있는 것이 발견되었다. 이 조직을 외과적으로 제거하여 조직검사를 실

시한 결과 편평상피 세포에 바이러스성 변화가 없는 중등도의 유두세포 증식이 관찰되었다. 조직 검사를 바탕으로 비

바이러스성 편평세포 유두종으로 진단하였다. 조직 제거 후에 환자의 유루증은 완전히 해결되었다. 본 증례는 개에서

결막의 비바이러스성 편평세포 유두종에 의해 발생한 유루증을 치료한 것이다.

주요어 :유루증, 결막, 개, 비바이러스성 편평세포유두종