Feline Lymphoplasmacytic Stomatitis: Report of Six Cases

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1 cjj ~flau~t J Chin Soc Vet Sci 27 (3) : Feline Lymphoplasmacytic Stomatitis: Report of Six Cases * Chen-Hsuan L1U, Victor Fei PANG, Lih-Seng YEH, Pen-Heng CHANG, Chian-Ren CHENG, and Fun-In WANG Department of Veterinary Medicine and Veterinary Hospital, National Taiwan University, Taipei 106, Taiwan (Received : March 27, Accepted: May 21, ) ABSTRACT Six cats, five male and one female, aging from 3 years to 9 years old were diagnosed with fel ine Iymphoplasmacytic stomatitis at our university veterinary hospital from July 1998 to May The major clinical signs of the sick cats were anorexia, difficulty in prehension of foods, pain, and ptyalism. Physical examination showed erythromatous, raised, ulcerative, and prol iferative lesions on the g ing iva, buccal mucosa, glossopalatine arches, and tongue. Microscopic examination revealed a marked and extensive infi lt ra t e of adm ixtures of mature plasma cells and lymphocytes associated w ith mucosal hyperplasia. The mature plasma cells w ith Russell's bodies, form ing intracytoplasmic globules and bulging from the cytoplasm, were frequently seen. Moderate edema and newly formed blood vessels were observed. In ulcerative areas, a number of neutrophils are accompanying w ith Iymphoplasmacyt ic infil t ra t e. ELISA for Feline leukemia virus (FeLV) ant igen and feline immunodific iency virus (FIV ) ant ibody was tested in one cat but with nega t ive result. Three affected cats had been received corticosteroid treatment. Symptoms were temporarily relieved, but recurred once treatment had ended. The definite d iagnosis is made on the basis of clinical s igns and characteristic histopathological findings. To our knowledge, the disease has not been reported in Taiwan, increased awareness of this disease will allow the veterinarians for making earlier diagnosis and more effective treatment. [. Liu CH, Pang VF, Yeh LS, Chang PH, Cheng CR and Wang F I. Feline Lymphoplasmacytic Stomatitis: Report of Six Cases. J Chin Soc Vet Sci 27(3) : , Corresponding author TEL : ext ext. 1401, FAX : ; chhsuliu@ccms. ntu,edu. twl Key words: Fel ine, Iymphoplasmacytic stomati t is INTRODUCTION Feline lymph oplasmacyt ic stomati tis in cats is a distinct form of stomatitis. There are seve ral synonyms including feline plasmacy tic stoma ti tis, feline gin givitis-stomatiti s-phar yngiti s complex, and plasma cell st omatitis-ph ar yngitis. The actual cause of th e disorder sti ll rem ains unknown, alt houg h bacter ia, calc ivirus, felin e leukemia virus (FeLV), feline immunodeficiency virus (F IV), herp esvirus, concurre nt systemic diseases, and immune-mediat - ed causes have been conside red as poss ible etiologies [ 1,2,3,5,6,8). Clinical exp ressions of th e affected cats usually s how anorexia, difficulty in prehension of foods, pain, and ptyalism. Typical gross lesions are manifest ed by red swelling, ulcerative and papillomatous prolif erat ion in th e oral cavity, parti cularl y involving th e gingiva, glosspalatine, and phar ynx, as we ll as subma ndibular lymphadenopat hy [1,3,8 ]. Cha racterist ic features of th e microscop ic find ings are a dense of admixtures of plasm a cells and lymphocytes w ith vary ing numbers of neu-

2 Felin e lymphoplasrnacyiic stomatit is I 6 troph ils infilt rating th e oral mucosa and submucosa [ 1.3.8]. The purpose of this report is because th e disease has not been reported in T aiwan and the lesions sha re some degrees of similarities with tumor growths and other chro nic oral inflammations. increase d awa reness will allow th e vete rina rians for making earlier diagnosis and effective treatment.. MATERIALS AND METHODS Six cats with main clini cal manifest ati ons of anorexia, diffi culty in prehens ion of foods, and pt yalism were referred to Nati onal T aiwan University Veterin ar y Hospital (NTUVH) for further examina tion. Ph ysical exam ina tion in all six cats revealed variable stomatitis, gingivitis, and phar yngitis, which displ ayed a lichenoid or papill omatous appearance. Biopsies were int er vened and pieces of tissues from th e lesions immediately we re imm ersed in 10% neut ral buff er ed formalin solution and routinely processed for histological exami na tion. RESULTS Fig. 1 Gross findings of fel ine Iymphoplasmacytic stomatitis revealing red swe lling, raised, ulcerative and papillomatous prol iferation on bilatera l glosspa lat ine. sive to an ti-inflamma tory the rapy. Three other cats had been received ora l predn isolone (1 mg / kg) and revealed remarked imp rovemen t. However. the clinical sig ns and lesions recurred once prednisolone treatment had ended. Clinical observation T he pati en ts were 5 male (2 neut ered ) and 1 female (spayed) ca ts with a mean age of 5.8 years (range, 3 year s - 9 years). Breeds includ ed mixed (n =5) and Persian (n = 1). Chronic stomatitis, gingivitis and phar yngiti s associated with anorexia, pain and ptyalism were th e most common clinical diagnosis and signs. One of the affected cats showed bilateral swelling of submandibular lymph nodes and face. Physical examination revealed ery thromatous, raised. ulcerative, and proliferative lesions (F ig. 1) on the gingiva in 4 cats, buccal mucosa in 4 cats, glossopa latine arches in 1 cat. and tongue in 1 cat. Complete blood count and blood chemistry panel in all cats we re within normal limit. On one cat exami ned with Fe LV and F IV E LI A tests ( Snap Combo FeLV Ag/ F IV Ab test, IDEX X), the results we re negative. Anti histamine ( chlorphen iramine maleat e, I mg/kg, by mou th ). antibiotics (gen tami cin, 5 mg/kg, or cephalex in 10 mg/ kg, by int ram uscular injection ) and lysozyme (20 mg/kg, by mouth ) had been given to 2 cats for one week, whi ch were non-respon- Histopathological examination H istological examination from the 6 affected cats s howed the similar lesions, but varied in scale and sever ity. Microscopic exam ination revealed a mark ed and extensive inflammati on composed main ly of admixt ures of mature plasma cells and variable amounts of lym phocyt es in th e submucosa ( Fig. 2 and 3 ). The mature plasma cells with Russell 's bodies, forming intracytopl asm ic globul es and bulgin g from the cytoplasm, wer e frequently see n. Moder at e edema an d newly formed blood vessels as evide nced by an extensive capi llary network we re obse rved. The lesion was cove red by an intact hyper plast ic mucosa or ulce rated surface. In ulcerat ive areas, interspe rsed wit h neutrophils is abunda nt in assoc iation wi th an infil trate of plasma cells and lymp hocytes. DISCUSSION Inflammator y conditions of the feline oral cavity are commonly encountered in the small anima l practice. Although th e majority of causes can be at-

3 187 Chen -Hsuan LI U et al. Fig. 2 Low-power photomicrography of Feline Iy mphoplas macy t ic stomat i t is showing marked and extens ive admi x ture s of mature plas ma cel ls and lymphocytes in associa t ion w it h mucosol hyperplasia. No te scatte red or aggregated neutrophils a mong the lesions. H&E stain, 246X Fig. 3 Hig h-pow er of Feline Iym pho plasm acytic stomat it is showing maj ority of mature pl asma cel ls rich in Russell ' s bod i es ( arro w s), Forming in tracytoplasmic g lob ules and bulging From the cytoplasm. H&E slain, 492X tributed to th e dental disord ers. however. a sma ll perc entage may be du e to immune associated diseases. eosinophilic g ranu loma. neoplasia, and other misce llaneous syndromes [1.8]. Here we report ed six cats with lyrnphoplasm acyti c stomatitis identified by clinic al pr esentat ions and pathological features. T o our knowl edg e. no such or similar disease has ever been reported in Taiwan. On average, th e diagn osis of th e affected cats in our report cam e at about age of 5.8 yea rs ( 3 yea rs to 9 yea rs) and ma les (5 males and 1 female) pre dominantly. As indicated in a series of 40 cases reported previously, th e mean age was 7. 1 years (4 months to 17 years) and males slightly appeared to be more commonly affected [8]. T hese findings indicat ed th at th e disease mainly occurr ed in middleaged adults and gend er ratio might only reflect hospit al population. Often t he disease develops prog ress ively and most frequent clini cal signs are halitosis, ptyalism. dysphagia, pain and weight loss in severe condition [1,3,7,8]. some of which sh ares sim ilar signs as th e pr esent report. Gross and histopathological findings in our six cats were also sim ilar to th ose described in pr evious reports of lymphopla smacyti c stoma titis [ 1, ]. The causes of lymphoplasmacytic stomatitis in cats are uncertain and may be associated wit h infections of some bact eria, calcivirus, retrovirus (FeLV. FIV). herpesvirus 1. concurrent odontoclastic reso rpt ion. concurrent diabetes me llitus, chronic int erstitial nephritis. malnutrition and immune-mediat ed disorder [1, ]. Cats infect ed with FeL V or F IV were associated wi th immunosuppression th at may pr edispose to lymphoplasmacyti c stomati tis clinic ally [8]. In our study, ELISA test for FeL V and F IV infect ion was perform ed on ly in one of the 6 affect ed cats but negative. However, in most cases of lyrnphoplasmacytic sto ma titis, th e evidences of an immune related cause had been described in associat ion wit h a high perc entage of plasm a cells with Russell's bodies. hyperprot ein emia/hyperglobulinemi a. and monoclon al gammopathy/bence-jon es proteinuria [6,8]. The previous and present studies indicated tha t corticost eroid tr eatment would alleviate the symptoms. This may further support immune-mediated et iology rather th an a sim ple bacter ial infection. Differential diagn osis of inflammation, tumor or concurre nt condition should be made in any oral raised lesions in cat s. thus, to ma ke diag nosis should obtain complete histor y. oral examinati on. and exclude conc urre nt system ic diseases. Define diagnosis is primaril y on th e basis of pat hologica l find ings. w hich arc cha racte rized by an exte nsive infiltrat e of plasma cells rich in Rus sell's body. lymphocyt es. and mucosal hyp er plasia. Treatment sho uld exclude kn own causes and concur rent syste mic disease. and is pr imari ly aimed

4 Feline lymphoplasmacytic stomatitis 188 at maintaining good ora l hygiene and following anti bioti cs, fluoride, corticosteroid, and imm unosuppressive drugs (e. g. Gold salts, aza t hiop rine). T he rapy op tions may also include per iodontal treatme nt, extraction of all premo lars and molars, and CO 2 laser therapy, cryo therapy, levamisole and pain contro l. In most cases, signs may be on ly temporarily released with th ese treatme nts. T he prognosis is generally poor [7,8]. ACKNOWLEDGEMENT We wo uld like to thank Drs. CM Chang an d TR Lai for referring cases and Miss MI C hen at Depar tm ent of Veterinary Medicine, NTU for technical assistance. REFERENCES 1. Diehl K, Rosychuk RA. Feline gingivitis-stomatitis-pharyngitis. Vet Clin North Am Small Anim Pract 23: , Hargis AM, Ginn PE. Feline herpesvirus 1- assoc iated facial and nasal dermatitis and stomatitis in cats. Vet Clin North Am Small Anim Pract 29 : , Johnessee JS, Hurvitz AI. Feline plasma cell gingivitispharyngitis. J Am Anim Hosp Assoc 19 : , KnowlesJO. Gaskell RM, Gaskell CJ, Harvey CEo Lutz H. Prevalence of feline calicivirus, feline leukemia virus and antibodies to FIV in ca ts with chronic stomatitis. Vet Rec 124 : , Knowles JO, McArdle F, Dawson S, Carter SD, Gaskell CJ, Gaskell RM. Studies on the role of feline calicivirus in chronic stoma titis in cats. Vet Microbiol 27 : , Lyon KF. Feline Iymphoplasmacytic stomatitis assoc iated with monoclonal gammopathy and Bence-Jones prot einuria. J Vet Dent 11: 25-27, Smith MM. Oral and salivary gland diso rders. In : Etting er SJ, Feldman EC, ed. Textbook of veterinary internal medicine 5~ ed. WB Saunders Co, Philadelphia, , White SD, Rosychuk RA, Janik TA, Denerolle P, Schultheiss P. Plasma cell stoma titis-pharyngitis in cats : 40 cases ( ). J Am Vet Med Assoc 200: , 1992.

5 IH9 Chen-Hsuan LIU et al 貓淋巴細胞一漿細胞性口炎 : 六個病例報告 J1 振軒龐飛葉力森張本恆鄭謙仁王汎癸 國立台灣大學農學院獸醫學系及農學院附設動物醫院台北市 ( 收稿日期 : 叩年 3 月 27 日 接受日期 : 90 年 5 月 2 1 日 ) ; 高要自 年七月至 2 0 五月, 有六隻貓, 五公母, 年齡由三歲至九歲經台灣大學農學院附設動物 醫院診斷為貓淋巴細胞 - 漿細胞性口炎 病貓的臨床特徵包括食慾不振及流澀, 口腔內齒齡 頰部 舌頡弓 及舌表面有腫瘤樣團塊或苔蘇樣紅色凸起生長物, 經生檢採樣進行病理學檢查 在光學顯微鏡下, 黏膜增生 或潰虜, 黏膜下層組織出現大量成熟漿細胞 淋巴球及 R u s se l l ' s bodies, 此外, 水腫及血管增生情形亦可 見 在表面潰虜病例, 多量嗜中性球夾雜於漿細胞 淋巴球及黏膜層 其中一隻以 E LI SA 方法檢測貓白血 病病毒 ( F e LV ) 抗原及貓免疫不全病毒 ( F I V ) 抗體, 均呈陰性反應 三隻病貓對類固醇藥物治療, 可暫時緩 解疾病, 但是停藥後, 又再復發 本病在台灣地區未有正式文獻報告, 而且易與腫瘤及其它慢性口腔內炎症 混淆, 報告這些病例, 希望有助於獸醫師對本病的了解, 以便早期診斷並給予適當治療 [. 劉振軒 龐飛 葉力森 張本恆 鄭謙仁 王汎焚 貓淋巴細胞 - 漿細胞性口炎 : 六個病例報告 中華獸醫誌 27 (3): , 聯絡人 TE L : ext ext. 1401, FAX: ; chhsuliu@ccms. ntu. edu. tw I 錚錚 J 聲, 謝 E 御慮一黨御增世 3 克