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Understanding Retrobulbar Neoplasia in Dogs: A Comprehensive Case Study and Diagnostic Guide

This case study discusses an 8-year-old female spayed Beagle presenting with lethargy, nasal discharge, seizures, exophthalmos, and ocular pain. Diagnostics reveal retrobulbar neoplasia, potentially carcinoma, causing these symptoms. The case emphasizes the importance of imaging, including ultrasound and MRI, alongside FNA for diagnosis. It also outlines treatment options like anti-epileptics, steroids, and the consideration of radiation therapy. The complexities of retrobulbar tumors, including differential diagnoses and prognosis, are thoroughly explored.

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Understanding Retrobulbar Neoplasia in Dogs: A Comprehensive Case Study and Diagnostic Guide

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  1. Behind the eye… Trisha Oura, DVM March 29, 2010

  2. Peanut SeymourAcc # 131024, 131064 • 8 yo FS beagle • 1 week lethargy, clear nasal discharge • New onset seizure • Now yellow/orange nasal discharge and exopthalmos (OU) • Physical exam: • Exopthalmos (OD>OS), decreased retropulsion OD • Pain associated with OD • Slight right head tilt, mild decreased hopping RF

  3. Diagnostics for seizure/exopthalmos • Bloodwork: normal • UA: mild proteinuria • Ophthalmology consult: decreased/painful retropulsion OD, lateral strabismus, bilateral retinal hemorrhage, cataracts OU, optical neuritis OU • Imaging: • Thoracic radiographs: mild inflammatory airway disease • Abdominal US: WNL • Ocular US: • MRI:

  4. Ultrasound

  5. Normal m = extraocular muscle f = fat

  6. MRI

  7. MRI (cont.)

  8. FNA of retrobulbar mass: • Consistent with carcinoma and chronic suppurative inflammation • Plan: • anti-epileptics, steroids (reduce associated edema), consider radiation therapy +/- chemotherapy

  9. RetrobulbarNeoplasia • What lives there? • Optic nerve, extraocular muscles, lacrimal gland, zygomatic salivary gland, vessels, orbital bones, fat, masticatory muscles • Adjacent structures too (dental, nasal/sinus) • Clinical signs: • Exophthalmos, conjunctival hyperemia, third eyelid protrusion, keratitis, abnormal fundic exam • Uncommon (~4% of tumors in dogs/cats) • Dogs vs. cats • Malignant, primary (D) • Malignant, metastatic or adjacent (C)

  10. Differentials for retrobulbar disease • It’s not just cancer! • Mucocele • Abscesses • Cellulitis • FB • ….but it usually IS cancer

  11. Diagnosis? • Image! • Skull radiographs (difficult to position/interpret) • US (good first choice: inexpensive, no anesthesia) • CT • MR • US guided FNA • Exenteration with histopathology • Thoracic radiographs to look for metastases

  12. US findings in 50 dogs with retrobulbar disease • Visualization of 86% of lesions • Most that were not visualized = inflammatory • 26/50 = neoplasia • Median age = 9 yo • Carcinoma (16), sarcoma (6), lymphoma (2), MCT (2) • 46% = primary • Most neoplasia located medially on US

  13. US findings in 50 dogs with retrobulbar disease

  14. Retrospective of 23 canine cases • Possible female predilection • Mean age = 8 years • 11 different tumor types; >90% malignant • >70% = primary neoplasia • ≥50% euthanized/died as direct consequence • Grave prognosis: 3/23 survived > 3 years

  15. Retrospective of 25 cases • No breed, sex predilection (possibly larger breeds?) • Mean age of diagnosis = 8.7y (D),12.5y (C) • ~ 50% had FNA, ~ 45% of FNAs resulted in diagnosis • Treatment: surgery, chemotherapy, radiation therapy • Mean survival: • - 10 months (D), 1 month (C) • Multiple tumor types: • Dogs • Adenocarcinoma • Osteosarcoma • Rhabdomyosarcoma • Fibrohistocytoma • Neurofibrosarcoma • Fibroma • Retinoblastoma • Cats • SCC • LSA • Carcinoma • Fibrosarcoma • Osteosarcoma • Meningioma

  16. References • Haak CE, MA Breshears, PA Lackner. What is your diagnosis? Retrobulbarneoplasia. J Am Vet Assoc 2007;231:863-4. • Attali-Soussay K, J Jegou, B Clerc. Retrobulbar tumors in dogs and cats:25 cases. Vet Ophth 2001;4:19-27. • Kern TJ. Orbital neoplasia in 23 dogs. J Am Vet Assoc 1985;186:489-91. • Mason DR, CR Lamb, GJ McLellan. Ultrasonographic finings in 50 dogs with retrobulbar disease. J Am Anim Hosp Assoc 2001;37:557-562.

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