Long-term treatment of
Equine Sarcoid in a mare
Elsa Kanner, St. George’s University
9 April 2014
Presented Feb 20, 2014
- 19 year old female intact Warmblood
- 13 years of treatment for severe sarcoids
- Problem list: sarcoids
Importance of equine
sarcoid for veterinarians
- Most common equine tumor
- Accounts for over half of all equine skin tumors
- No “one size fits all” treatment
http://balancedecosolutions.com/product/sarcoid-cleansing-salve
What are equine sarcoids?
-Locally invasive fibroblastic skin tumors
-Arise between ages 3-6
-Common locations: head, ventral abdomen, limbs
Dr. Hackett “Cutaneous Neoplasia” lecture
Causes of equine sarcoid cont
-3 requirements for sarcoid formation:
1) Exposure to Bovine Papillomavirus
2) Genetic predisposition
3) Skin infection/open wounds
bovine papillomavirus in a cow
6 types of equine sarcoid
http://www.wetherbyvets.co.uk/info/
Factsheets/Horse/24_269968.shtml
1) occult (flat)
4) fibroblastic
2) verrucous (wart-like)
3) nodular
5) mixed
6) malevolent
Differential diagnoses for equine sarcoid
-Infectious:
- papilloma (viral)
- pythiosis (fungal)
- habronemiasis “summer sores” (parasitic)
- staphylococcal folliculitis (bacterial)
http://veterinarynews.dvm360.com
pythiosis
http://info.mannapro.com/mannaproanimalcareblog/
equine papillomavirus
Differential diagnoses for equine sarcoid
-Inflammatory:
-granulation tissue
-granuloma
-Neoplastic:
-squamous cell carcinoma
(SCC)
-fibroma/fibrosarcoma
-cutaneous lymphoma
-mast cell tumor (MCT)
-melanoma
http://www.northfloridaequine.com/heel
-bulb-laceration/
granulation tissue
Diagnosis of equine sarcoid
-Presumptive diagnosis:
- clinical presentation
-Definitive diagnosis:
-histopathology
-consider exacerbation by
biopsy-induced trauma
Dr. Hackett “Cutaneous
Neoplasia” lecture
H&E stained photomicrograph of an equine sarcoid
Back to our case report...
- Sarcoids started in 2001, at approx age 3
- Initial lesions were occult (flat) in 2 spots on left flank
- Seen by RDVM, no treatment at that time
- During 2002 sarcoids became more aggressive and
patient was referred to CUHA
http://tailsfromprovence.com/2013/05/22/sarcoids-ugh/
Representative occult sarcoid,
no pictures of our patient until 2009
Treatments and results
date
treatment type
exact treatment
2003-2007
Surgical removal
Cautery + SMZ’s to control infection
2007-2009
Immunotherapy
EqStim
June 2009
Immunotherapy
Pythium
January 2010
Immunotherapy
BCG
January - April 2010
Chemotherapy #1
cyclophosphamide and doxorubicin
April 2010
Surgical removal #1
surgical debulking
Treatments and results cont.
date
treatment type
exact treatment
May 2010
Chemotherapy #2
cyclophosphamide and vincristine
January 2011
Surgical removal #2 + immunotherapy
surgical debulking + Xterra
November 2011
Surgical removal #3
surgical debulking
September 2012
Surgical removal #4
surgical debulking
July 2013
Surgical removal #5 + immunotherapy
surgical debulking + autologous
implantation
February 2014
Surgical removal #6 + chemotherapy
surgical debulking + intralesional
cisplatin & carboplatin
2007-2009: EqStim
-Mechanism of action: Injections with P. Acnes to stimulate immune
system
-Result: moderate control of tumors during this time period, but
became ineffective and was discontinued
back
June 2009: Pythium immunotherapy
-Mechanism of action: Vaccinate with Pythium Insidiosum to
stimulate immune system
-Result: worked for 3 months (June - September 2009), but became
ineffective and was discontinued
lesions in June
back
January 2010: BCG
-Mechanism of action of BCG (Bacille de Calmette et Guérin) :
human TB vaccine used to stimulate immune system
- Results: ineffective, stopped after 1 month (February 2010)
January
February
back
Jan – April 2010: First systemic chemotherapy
-Mechanism of action of chemotherapy: target tumor cells
systemically with cyclophosphamide and doxorubicin
- Results:
- Slight improvement in tumor surfaces, no reduction in size
http://www.indiamart.com/asterpharma
/oncology-anti-cancer.html
http://www.indiamart.com/asterpharma
/oncology-anti-cancer.html
back
April 2010: first surgical debulking
-Mechanism of action: remove necrotic tissue/large tumors for
comfort of the patient
- Result: temporary reduction in tumor size
April before surgery
April during surgery
April post surgery
back
May 2010: Systemic chemotherapy #2
- Mechanism of action: target tumor cells systemically with
cyclophosphamide and vincristine
- Result: tumors growing aggressively, protocol discontinued
http://www.indiamart.com
May
June
www.hospira.com
back
January 2011: Xxterra + surgical debulking # 2
-Mechanism of action of Xxterra: Bloodroot powder + zinc chloride to stimulate
the immune system locally at the tumor site
- Results of Xxterra: successful on small tumors, but painful, so discontinued
January pre surgery
January during surgery
back
July 2013: Autologous implantation
-Mechanism of action: Pieces of sarcoid removed, frozen, and
surgically re-implanted to stimulate immune system
- Result: temporary reduction in tumor size
http://liquidnitrogentank.com/CT20_Tank.php
liquid nitrogen tank to freeze pieces of sarcoid before implantation
back
February 2014: surgical debulking # 6 + first
intralesional chemotherapy
-Mechanism of action of intralesional chemotherapy: target tumors more
locally with Cisplatin and Carboplatin
- Result: temporary reduction in tumor size
February pre surgery
February during surgery
http://www.indiamart.coml
next
Costs, prognosis, questions
-Current CUHA bill: > $14,000.00
- Prognosis:
- Poor for resolution of lesions
-Questions:
-Quality of life?
Conclusions
- Treatments did not work in our patient
- Related to her immune system?
- More research needed about this
disease & treatments
http://www.ourdailyjourney.org
Resources
1- Larson, Erica. "Evidence-Based Equine Sarcoid Treatments Reviewed." The Horse 19
Apr. 2012: n. pag. Print.
2- Rohrbach, Barton W., VMD, MPH, DACVPM, et al. Effects of adjunctive treatment with
intravenously administered Propionibacterium acnes on reproductive performance in
mares with persistent endometritis. Journal of the American Veterinary Medical
Association. Volume 231, Number 1, July 1 2007, pp. 107-13.
3- Mendoza, Alberto L., Robert L. Glass, and Richard D. Hansen. Pythium
Immunotherapy. Board of Trustees, Michigan State University, assignee. Patent
12/647,971. 30 June 2011. Print.
4- United States. Centers for Disease Control and Prevention. Division of Tuberculosis
Elimination. World Health Organization. Issues Relating to the Use of BCG in
Immunization Programmes - A Discussion Document. N.p.: n.p., 1999. Print.
5 - Larson, Ken. "Xxterra." Larson Laboratories. Vetline, Inc., n.d. Web. 5 Apr. 2014.
6 - Espy, Benjamin M.K. "How to Treat Equine Sarcoids by Autologous Implantation."
AAEP Proceedings 54 (2008): 68-73. Print.
7 - Taylor, S., and G. Haldorson. “A Review of Equine Sarcoid.” Equine Veterinary
Education 25.4 (2013): 210-16. Print.
Acknowledgements
Thank you to:
Dr. Richard Hackett
Dr. Hayley Lang
Students & faculty of Cornell University for being so
welcoming to St. George’s and Ross students.
Questions?