Clinical, histological and immunohistochemical study of feline viral plaques and bowenoid in situ carcinomas

Canine and feline papillomaviruses: an update

Papillomaviruses are small viruses able to cause disease not only in mammalians, but also in birds and reptiles. In recent years, a rising number of papillomaviruses have been identified in dogs and cats, totaling 24 canine papillomavirus (CPV) and six feline papillomavirus (FcaPV). The canine and feline papillomaviruses (CPVs and FcaPVs, respectively) are responsible for multiple lesions in these domestic species but the potential pathological relevance of some recently identified types remains to be determined. CPVs are associated with oral papillomatosis, cutaneous papillomas and viral pigmented plaques, and have been rarely associated with the development of oral and cutaneous squamous cell carcinomas in their canine hosts. FcaPVs are associated with oral papillomas, viral plaques, and Bowenoid in situ carcinomas. The present review provides readers with the more recent advances on dog and cat papillomavirus research, bringing an update on this field to both veterinary practitioners and the virology community at large.

Papillomaviral skin diseases of humans, dogs, cats and horses: A comparative review. Part 2: Pre-neoplastic and neoplastic diseases

Papillomaviruses (PVs) are well recognized to cause pre-neoplastic and neoplastic diseases in humans. Similarly, there is increasing evidence that PVs play a significant role in the development of pre-neoplastic and neoplastic diseases of the haired skin of dogs and cats, and the mucosa of horses. As the mechanisms by which PVs cause neoplasia are well studied in humans, it is valuable to compare the PV-induced neoplasms of humans with similar PV-associated neoplasms in the companion animal species. In the second part of this comparative review, the pre-neoplastic and neoplastic diseases thought to be caused by PVs in humans, dogs, cats, and horses are described. This includes PV-induced cutaneous plaques, cutaneous squamous cell carcinomas (SCCs) and mucosal SCCs within the four species. The review concludes with a discussion about the potential use of vaccines to prevent PV-induced diseases of dogs, cats, and horses.

Infectious Causes of Neoplasia in the Domestic Cat

Simple Summary

Increasingly, cancers are being linked to infections with viruses, bacteria, and parasites in human medicine. This review summarises the current literature regarding neoplasia occurring in association with infectious diseases in domestic cats. To date, most studies have focused on the role of viruses, especially feline leukaemia virus and feline immunodeficiency virus in association with lymphoma, or the role of papillomavirus in cutaneous and oral neoplasms in cats. Recently, there has been a focus on a potential role of mouse mammary tumour virus in feline mammary carcinoma and lymphoma and studies assessing the potential role of gammaherpes virus and hepadnaviruses in feline neoplasia. Additionally, there has been some focus on potential bacterial and parasitic associations with neoplasia; including reports assessing potential associations between Helicobacter species and gastrointestinal neoplasms, and case reports of neoplasia in association with Platynosomum fastosum and Opisthorchis viverrini.

Abstract

In recent years, growing attention has been paid to the influence/role of infectious diseases in tumour development and progression. Investigations have demonstrated that some infectious organisms can have a direct role in the development of neoplasia, whereas others can predispose to neoplasia by alterations in the immune response, or by creating a pro-inflammatory environment. Feline leukaemia virus was one of the first infectious agents recognised as an oncogenic organism, and along with feline immunodeficiency virus has received the most attention. Since the discovery of this retrovirus, several other organisms have been associated with neoplastic processes in cats, these include gammaherpes virus, mouse mammary tumour virus, papillomaviruses, hepadnavirus, Helicobacter species, and the parasitic infections Platynosomum fastosum and Opisthorchis viverrini. This review summarises the findings to date.

Sublingual papillomas of cheetahs in southern Africa

Nine distinct papillomaviruses (Lambdapapillomavirus) have been described in domestic and nondomestic cats, but not in cheetahs. These viruses have been associated with cutaneous papillomas or plaques, bowenoid in situ carcinomas, feline cutaneous squamous cell carcinomas (SCC), feline sarcoids, and oral (often sublingual) papillomas. Fourteen cheetahs from the AfriCat foundation (Namibia) and one from the Ann van Dyk Cheetah center (South Africa) presented with sublingual lesions reminiscent of sublingual papillomas. Two animals were biopsied and the histopathology revealed benign proliferative epithelial lesions with prominent thickening of the overlying squamous epithelium. Throughout the squamous epithelial layers were cells with nuclear enlargement, irregularity of the nuclear membranes and cell contours, focal hyperchromasia of the nuclei, and perinuclear halos, reminiscent of a virus-associated process as seen in papillomavirus infections. Thirteen more cheetahs were sampled and the tissue snap frozen for molecular characterization. Amplification and sequencing of the papillomavirus L1, E6, E7, and E1 gene regions was achieved with modified primers. Maximum likelihood phylogenetic analyses revealed all 15 cheetah papilloma samples were 99.99% genetically similar and closely related to, but genetically distinct from any known felinepapillomaviruses. All cheetahs were FIV and FeLV negative. The results suggest the samples identified in this study can be considered a previously undescribed or novel feline papillomavirus and the authors propose "Acinonyx jubatus papillomavirus type 1" (AjPV-1), within the Lambdapapillomavirus 1 genus (Family: Papillomaviridae).

Cutaneous papilloma associated with a novel papillomavirus sequence in a cat

A 5-mm diameter mass developed on the nasal planum of a 4.5-y-old castrated male domestic shorthaired cat; the mass was raised ~2 mm above the surrounding skin. Histology revealed focal thickening of the epidermis with marked orthokeratosis. Many of the epidermal cells within the mass had prominent papillomavirus-induced changes. A diagnosis of a viral papilloma was made, and a DNA sequence from a novel papillomavirus type was amplified from the lesion. Although the sequence was most similar to other feline papillomavirus types, the low level of similarity was suggestive of a novel papillomavirus genus. There has been no recurrence of the mass or development of additional lesions in the 6 mo since the mass was removed. This is the third cutaneous papilloma reported in a cat; a putative feline papillomavirus type has not been identified previously within these lesions, to our knowledge. Our findings expand the range of lesions associated with papillomaviruses in cats and increase the number of papillomavirus types that infect cats.

In situ squamous cell carcinoma of the gingiva and nictitating membrane associated with Felis catus papillomavirus type 3 in a cat

Oral squamous cell carcinomas (OSCCs) are common cancers of cats. While papillomaviruses (PVs) are an important cause of human OSCCs, there is currently little evidence that PVs cause squamous cell carcinomas (SCCs) of the mouth or other mucosal surfaces in cats. In the present cat, in situ carcinomas developed on the gingiva and nictitating membrane. Neoplastic cells within both cancers contained prominent PV-induced cellular changes consistent with those caused by Felis catus PV3 (FcaPV3), and FcaPV3 DNA was amplified from both cancers. Neoplasms also contained intense nuclear and cytoplasmic p16CDKN2A protein (p16) immunolabeling, suggesting PV-induced degradation of retinoblastoma protein. The molecular and histological features strongly suggested the cancers were caused by FcaPV3 infection. This is the first report of an association between PV infection and the development of an in situ carcinoma of the mucosa of cats. The identification of these lesions suggests that PVs might cause a proportion of OSCCs, and SCCs from other mucosal surfaces, in cats.

Effectiveness of a fluralaner spot-on formulation in a case of feline demodicosis due to Demodex cati

Case summary

A 7-year-old male domestic shorthair cat was presented with a non-pruritic erythematous crusted nasal hypotrichosis along with bilateral ceruminous otitis externa. The cat was diagnosed with diabetes mellitus and was positive for feline immunodeficiency virus (FIV). Deep skin scraping, trichograms from lesional skin and ear canal parasitological examination were positive for Demodex cati. A 250 mg (55.5 mg/kg) fluralaner spot-on for medium-sized cats (Bravecto; MSD) was applied to the base of the cat’s head. Re-examinations were carried out on the fourth, sixth and eighth weeks after therapy. On the fourth week, the ceruminous otitis had resolved completely and the nasal lesions were markedly improved. One dead adult D cati was found in deep skin scrapings while other tests from the skin and both ear canals were negative. On the second re-examination only a mild hypotrichosis persisted on the nasal region and all parasitological examinations were negative. Eight weeks after the initial examination, the skin lesions had almost clinically resolved. On the 12th week, fluralaner spot-on was repeated. No recurrence was noted at the 6-month follow-up.

Relevance and novel information

The use of isoxazolines has been reported for only a few demodectic cats but was described to be safe and effective. This is the first report to evaluate the efficacy of a single spot-on fluralaner for the treatment of localised dermatitis and otodemodicosis due to D cati, and suggests it as an effective, safe and practical treatment.

Papillomaviruses in Domestic Cats

Papillomaviruses (PVs) are well established to cause hyperplastic papillomas (warts) in humans and animals. In addition, due to their ability to alter cell regulation, PVs are also recognized to cause approximately 5% of human cancers and these viruses have been associated with neoplasia in a number of animal species. In contrast to other domestic species, cats have traditionally been thought to less frequently develop disease due to PV infection. However, in the last 15 years, the number of viruses and the different lesions associated with PVs in cats have greatly expanded. In this review, the PV life cycle and the subsequent immune response is briefly discussed along with methods used to investigate a PV etiology of a lesion. The seven PV types that are currently known to infect cats are reviewed. The lesions that have been associated with PV infections in cats are then discussed and the review finishes with a brief discussion on the use of vaccines to prevent PV-induced disease in domestic cats.

Papillomavirus DNA is not Amplifiable from Bladder, Lung, or Mammary Gland Cancers in Dogs or Cats

Simple Summary

Papillomaviruses (PVs) are well established to cause genital and oral cancer in humans. Additionally, some evidence suggests that these viruses may also have a role in the development of human lung, breast, and bladder cancer. Recent studies have revealed that PVs can influence the development of some cancers in cats and, less frequently, in dogs. In the present study, 47 lung, mammary gland, and bladder cancers in dogs and 25 cancers in cats were evaluated for evidence of any role PVs may have in cancer development. Histology did not reveal any lesions suggestive of PV infection, and no PV DNA was amplified from any cancer. Therefore, these findings suggest that PVs do not frequently infect these tissues and are therefore unlikely to be significant factors in the development of lung, mammary gland, or bladder cancer in either dogs or cats.

Abstract

Papillomaviruses (PVs) cause around 5% of all human cancers, including most cervical cancers and around a quarter of all oral cancers. Additionally, some studies have suggested that PVs could cause a proportion of human lung, breast, and bladder cancers. As PVs have been associated with skin cancer in cats and, more rarely, dogs, it was hypothesized that these viruses could also contribute to epithelial cancers of the lung, mammary gland, and bladder of dogs and cats. Formalin-fixed paraffin-embedded samples of 47 canine and 25 feline cancers were examined histologically for evidence of PV infection. Additionally, three sets of consensus PCR primers were used to amplify PV DNA from the samples. No histological evidence of PV infection was visible in any of the cancers. DNA from a bovine PV type was amplified from one sample, while two different samples were found to contain human PV DNA. However, these were considered to be contaminants, and no canine or feline PV types were amplified from any of the cancers. These results suggest that PVs do not frequently infect the lung, mammary gland, or bladder of dogs and cats and therefore are unlikely to be significant factors in the development of cancers in these tissues.

Felis catus Papillomavirus Types 1, 2, 3, 4, and 5 in Feline Bowenoid in Situ Carcinoma: An In Situ Hybridization Study

Several studies based on histopathology or molecular investigations suggest a causal relation between Felis catus papillomavirus (FcaPV-2) infection and bowenoid in situ carcinoma (BISC) in cats. Nevertheless, data on distribution of viral DNA for different F. catus papillomavirus types (FcaPV-1, 2, 3, 4, 5) in precancerous skin lesions are lacking. In this study, incisional and excisional skin biopsies from 18 cats with BISC were investigated for the presence of FcaPV DNA by quantitative polymerase chain reaction (qPCR) and chromogenic in situ hybridization (CISH) using specific probes to detect each of the FcaPVs that have been identified so far. By qPCR analysis, 15 of 18 samples were positive for FcaPV-2, 2 were positive for FcaPV-4, and 1 sample was negative for all FcaPVs studied. Two cases were positive for FcaPV-5 by qPCR only. FcaPV-1 and FcaPV-3 were not detected by either method. CISH positivity for FcaPV-2 and FcaPV-4 was 100% concordant with qPCR. FcaPV-2 CISH signal was observed as nuclear dots within grouped neoplastic keratinocytes in 12 BISCs and in the perilesional skin of 9 biopsies. In 3 of these 9 cases, the signal was not observed within the BISC. FcaPV-4 CISH positivity was detected only within BISCs in 2 cases. The overall rate of concordance for FcaPV detection between PCR and CISH was 97.8%. This study suggests that CISH is a reliable method to detect FcaPV-2 and FcaPV-4 infection in cats and provides useful information on the type, rate, and localization of infected cells.

Use of fluorescence in situ hybridization to detect Felis catus papillomavirus type 2 in feline Bowenoid in situ carcinomas

OBJECTIVES

Papillomaviruses (PVs) are ubiquitous host- and site-specific viruses. PV infections in cats are associated with oral papillomas, viral plaques, Bowenoid in situ carcinomas (BISCs), squamous cell carcinomas and sarcoids; this association is primarily based on PCR detection of PV DNA within said lesions. PV DNA is frequently detectable on normal feline skin; thus, it is possible that some of the implicated DNA is commensal rather than associated with lesion formation. Therefore, the aim of the present study was to use fluorescence in situ hybridization (FISH) to localize PV DNA within feline BISCs, to provide additional evidence that PV infection may influence the development of these neoplasms.

METHODS

FISH probes targeting Felis catus papillomavirus type 2 (FcaPV2) DNA were used to localize FcaPV2 DNA within 42 BISCs from which FcaPV2 DNA had previously been amplified via PCR.

RESULTS

Fifteen of 42 BISC lesions (35.7%) demonstrated intralesional FcaPV2 using FISH. Probe annealing was predominantly located within the nuclei of koilocytes found in the upper strata of the epidermis. Probes were typically scattered multifocally within the lesions; most commonly this was near the periphery of the BISCs.

CONCLUSIONS AND RELEVANCE

These results confirm that a proportion of BISCs contain FcaPV2 DNA. These results further support a causative association between FcaPV2 and BISCs in cats.

Novel viruses: Update on the significance of papillomavirus infections in cats

PRACTICAL RELEVANCE

Prior to 1990 papillomaviruses (PVs) were not recognised to infect or cause disease in domestic cats. Since this time, the use of histology, immunohistochemistry and, more recently, molecular techniques has revealed that PVs almost certainly cause feline viral plaques and Bowenoid in situ carcinomas, oral papillomas and feline sarcoids. In addition, there is increasing evidence that PVs play a significant role in the development of feline cutaneous squamous cell carcinomas, one of the most common skin cancers of cats. Recent studies have also revealed that most cats are asymptomatically infected with PVs. This raises a critical question that is currently unanswered: why do only a small proportion of infected cats develop disease? In the future it may be possible to prevent PV-induced diseases by using a vaccine to prevent PV infection. Alternatively, novel therapies may be developed that prevent PVs from causing clinical disease by stimulating the host immune response.

CLINICAL CHALLENGES

A recognition of the skin diseases caused by PVs is important to more accurately predict disease progression. Unfortunately, there are currently no non-surgical treatments that have been proven to be beneficial in cats and clinical management of PV-induced skin disease in cats can be challenging.

GLOBAL IMPORTANCE

PVs have a worldwide distribution and negatively impact feline health and welfare globally.

AUDIENCE

This review is aimed at clinicians, especially those who regularly treat cats with skin disease. The review will also be useful to oncologists and researchers who have an interest in how cancer develops in cats.

EVIDENCE BASE

In producing this update the authors have drawn on recently published peer-reviewed literature.

Detection of Felis catus papillomavirus type 2 within multicentric basosquamous carcinoma in a domestic cat

A 12-year-old neutered male domestic shorthair cat was presented with a 3-year history of multiple nonpruritic, ulcerated, plaque-like skin lesions but no other clinical signs. A systemic examination revealed mild lymphadenopathy. Histopathologic analysis of the skin lesions revealed multicentric basosquamous carcinoma (BSC). Immunohistochemical analysis, PCR, and sequencing detected Felis catus papillomavirus type 2 (FcaPV-2) within the tumors. As BSC is rare in cats, clinical behavior has not been established. To our knowledge, this is the first case report to demonstrate detection of FcaPV-2 within a BSC in a domestic cat.

A study of multiple Felis catus papillomavirus types (1, 2, 3, 4) in cat skin lesions in Italy by quantitative PCR

Objectives The aim of the study was to investigate, by quantitative PCR (qPCR), the presence of papillomavirus in feline viral plaques (VPs), Bowenoid in situ carcinoma (BISC), squamous cell carcinoma (SCC) and actinic keratosis (AK). Methods Twenty-nine cases with previously established diagnoses of feline VPs, BISC, invasive SCC and AK were selected from a dermatopathological database. A critical re-evaluation of diagnosis was performed by defining clear criteria toward carcinomatous vs non-carcinomatous, in situ vs invasive (if carcinomatous) and viral vs actinic. Cases were evaluated for p16 immunolocalisation. The presence of the target viral genes for Felis catus papillomavirus (FcaPV)-1, FcaPV-2, FcaPV-3 and FcaPV-4 was determined by qPCR. The data generated ΔΔCq values, which represent a normalised measure of DNA viral quantity. Samples with a positive ΔΔCq value were submitted to sequence analysis. Results Four VPs, 19 BISCs, four SCCs and one case of AK were included. By ΔΔCq analysis we found that all VPs were positive for FcaPV-1 or FcaPV-2; eight BISCs were positive for FcaPV-1, FcaPV-2 and FcaPV-4. FcaPV-2 was the most prevalent among the group of VPs and BISCs. Conclusions and relevance Using the ΔΔCq method we report the first evidence of FcaPV-1, FcaPV-2 and FcaPV-4 in Italy. FcaPV-2 was the most frequently detected; to a lesser extent, FcaPV-1 and FcaPV-4 were detected in the examined samples. FcaPV-3 was never associated with viral-induced lesions by ΔΔCq investigation. Compared with conventional PCR the ΔΔCq method has the advantage of establishing a possible role of the virus in the outcome of infection.

Skin as a marker of general feline health: Cutaneous manifestations of infectious disease

Practical relevance: Infectious disease in feline patients often presents a diagnostic challenge. This article reviews the most relevant viral, bacterial and protozoal diseases and their cutaneous manifestations. Many of the diseases discussed have overlapping presentations or may mimic more common noninfectious disease processes. The purpose of the article is to reinforce knowledge of common and uncommon infectious diseases, help practitioners identify possible infectious dermatoses, create a comprehensive and prioritized differential list, and provide guidance for the diagnosis of these diseases. A working knowledge of these clinical syndromes is important if what is thought to be a case of a common disease does not respond to conventional management.

AUDIENCE

This review is aimed at veterinarians who treat cats and especially those with an interest in feline dermatology. Tables are included to allow the reader to formulate a concise list of differential diagnoses for clinically similar presentations. The diagnostic approach to a case of ulcerative facial dermatitis is reviewed in a Case Notes quiz. Evidence base: This article includes up-to-date information regarding dermatologic manifestations of less commonly encountered feline cutaneous infectious diseases. Information has been drawn from the published, peer-reviewed literature and the most recent textbook chapters with a particular aim of describing and differentiating clinical lesions and the diagnostic approach to cutaneous disease, especially in unusual cases.

Papillomaviruses in dogs and cats

Papillomaviruses (PVs) cause disease in both dogs and cats. In dogs, PVs are thought to cause oral papillomatosis, cutaneous papillomas and canine viral pigmented plaques, whereas PVs have been rarely associated with the development of oral and cutaneous squamous cell carcinomas in this species. In cats, PVs are currently thought to cause oral papillomas, feline viral plaques, Bowenoid in situ carcinomas and feline sarcoids. Furthermore, there is increasing evidence that PVs may also be a cause of cutaneous squamous cell carcinomas and basal cell carcinomas in cats. These diseases are discussed in this review. Additionally, there is a brief overview of PV biology, including how these viruses cause disease. Diagnostic techniques and possible methods to prevent PV infection are also discussed.

Multiple viral plaques with sebaceous differentiation associated with an unclassified papillomavirus type in a cat

CASE HISTORY AND CLINICAL FINDINGS A 15-year-old neutered male domestic short-haired cat was presented due to multiple 0.5-2 cm-diameter crusting plaques in the left preauricular region, over the bridge of nose, and in the right periocular region. The plaques did not appear to cause discomfort. HISTOPATHOLOGICAL FINDINGS Biopsy samples of four plaques were examined histologically. Three plaques consisted of well-demarcated foci of mild epidermal hyperplasia overlying markedly hyperplastic sebaceous glands. Approximately 60% of the hyperplastic cells contained a large cytoplasmic vacuole that ranged from being clear to containing prominent grey-blue fibrillar material. The fourth plaque was composed solely of epidermal hyperplasia, consistent with previous descriptions of feline viral plaques. MOLECULAR BIOLOGY Papillomavirus DNA was amplified from all four plaques using PCR. A single DNA sequence was amplified from the plaques with sebaceous differentiation. This sequence was identical to the FdPV-MY sequence previously suggested to be from a putative unclassified papillomavirus type. Felis catus papillomavirus type 2 sequences were amplified from the plaque typical of feline viral plaques. Immunohistochemistry to detect p16^CDKN2A protein (p16) showed marked immunostaining throughout the hyperplastic epidermis and adnexal structures within the plaques with sebaceous differentiation. DIAGNOSIS Multiple feline viral plaques with variable sebaceous differentiation. CLINICAL RELEVANCE Feline viral plaques with sebaceous differentiation have not been previously reported in cats. The presence of unique cell changes within these lesions, the detection of an unclassified papillomavirus type, and the p16 immunostaining within these plaques suggest that they may have been caused by the papillomavirus that contains the FdPV-MY sequence.

Geno- and seroprevalence of Felis domesticus Papillomavirus type 2 (FdPV2) in dermatologically healthy cats

Background

Papillomaviruses can cause proliferative skin lesions ranging from benign hyperplasia to squamous cell carcinoma (SCC). However, asymptomatic infection is also possible. Several groups have detected Felis domesticus Papillomavirus type 2 (FdPV2) DNA in association with feline Bowenoid in situ carcinoma (BISC). Therefore, a causative connection has been suggested. However, the knowledge about FdPV2 epidemiology is limited. The aim of this study was to describe the genoprevalence and seroprevalence of FdPV2 in healthy cats.

For this purpose an FdPV2-specific quantitative (q)PCR assay was developed and used to analyse Cytobrush samples collected from 100 dermatologically healthy cats. Moreover, an ELISA was established to test the sera obtained from the same cats for antibodies against the major capsid protein (L1) of FdPV2.

Results

The genoprevalence of FdPV2 was to 98 %. Surprisingly, the quantities of viral DNA detected in some samples from the healthy cats exceeded the amounts detected in control samples from feline BISC lesions. The seroprevalence was much lower, amounting to 22 %. The concentrations of antibodies against FdPV2 were relatively low in healthy cats, whereas they were very high in control cats with BISC.

Conclusion

These observations suggest that FdPV2 is highly prevalent, even among healthy cats. However, cats that carry it on their skin mount in most instances no antibody response. It might be hypothesized that FdPV2 is only rarely productively replicating or its replication is only rarely exposed to the immune system.

Electronic supplementary material

The online version of this article (doi:10.1186/s12917-016-0776-7) contains supplementary material, which is available to authorized users.

The detection of Felis catus papillomavirus 3 DNA in a feline bowenoid in situ carcinoma with novel histologic features and benign clinical behavior

Bowenoid in situ carcinoma (BISC; papillomavirus-associated squamous cell carcinoma in situ) is an uncommon skin neoplasm of cats that can result in euthanasia because of the development of multiple lesions or because of progression to invasive squamous cell carcinoma. BISCs are currently thought to be caused by Felis catus papillomavirus 2 (FcaPV-2). The presently described cat developed a single 0.5 cm in diameter interscapular mass. Over the following 18 months, the mass doubled in size; no additional lesions developed. The mass was surgically excised and histologically diagnosed as a BISC. However, in contrast to previously reported BISCs, neither prominent thickening of the deep aspects of the follicular infundibula nor marked cell dysplasia were present. Furthermore, ~50% of the keratinocytes in the affected epidermis had prominent PV cytopathic changes that included shrunken angular nuclei and elongated basophilic cytoplasmic inclusions. As the histopathology was not typical for FcaPV-2 infection, polymerase chain reaction was performed and revealed only DNA sequences from Felis catus papillomavirus 3 (FcaPV-3). No further BISCs developed in this cat 6 months postremoval, hence surgical excision appeared to be curative. Results from this case suggest that, although FcaPV-2 appears to be the predominant cause of BISCs in cats, infection by FcaPV-3 can also cause these neoplasms. BISCs caused by FcaPV-3 appear to have unique histologic features that allow the causative PV type to be predicted. Results from this single case suggest that BISCs caused by FcaPV-3 may have a more benign clinical course than those caused by FcaPV-2.

Infection and cancer in multicellular organisms

Evolutionary considerations suggest that oncogenic infections should be pervasive among animal species. Infection-associated cancers are well documented in humans and domestic animals, less commonly reported in undomesticated captive animals, and rarely documented in nature. In this paper, we review the literature associating infectious agents with cancer to evaluate the reasons for this pattern. Non-malignant infectious neoplasms occur pervasively in multicellular life, but oncogenic progression to malignancy is often uncertain. Evidence from humans and domestic animals shows that non-malignant infectious neoplasms can develop into cancer, although generally with low frequency. Malignant neoplasms could be difficult to find in nature because of a low frequency of oncogenic transformation, short survival after malignancy and reduced survival prior to malignancy. Moreover, the evaluation of malignancy can be ambiguous in nature, because criteria for malignancy may be difficult to apply consistently across species. The information available in the literature therefore does not allow for a definitive assessment of the pervasiveness of infectious cancers in nature, but the presence of infectious neoplasias and knowledge about the progression of benign neoplasias to cancer is consistent with a widespread but largely undetected occurrence.

Pododermatitis in Captive and Free-Ranging Greater Flamingos (Phoenicopterus roseus)

Pododermatitis is frequent in captive flamingos worldwide, but little is known about the associated histopathologic lesions. Involvement of a papillomavirus or herpesvirus has been suspected. Histopathologic evaluation and viral assessment of biopsies from 19 live and 10 dead captive greater flamingos were performed. Selected samples were further examined by transmission electron microscopy and immunohistochemistry. Feet from 10 dead free-ranging greater flamingos were also evaluated. The histologic appearance of lesions of flamingos of increasing age was interpreted as the progression of pododermatitis. Mild histologic lesions were seen in a 3-week-old flamingo chick with no macroscopic lesions, and these were characterized by Micrococcus-like bacteria in the stratum corneum associated with exocytosis of heterophils. The inflammation associated with these bacteria may lead to further histologic changes: irregular columnar proliferations, papillary squirting, and dyskeratosis. In more chronic lesions, hydropic degeneration of keratinocytes, epidermal hyperplasia, and dyskeratosis were seen at the epidermis, as well as proliferation of new blood vessels and increased intercellular matrix in the dermis. Papillomavirus DNA was not identified in any of the samples, while herpesvirus DNA was seen only in a few cases; therefore, these viruses were not thought to be the cause of the lesions. Poor skin health through suboptimal husbandry may weaken the epidermal barrier and predispose the skin to invasion of Micrococcus-like bacteria. Histologic lesions were identified in very young flamingos with no macroscopic lesions; this is likely to be an early stage lesion that may progress to macroscopic lesions.

Feline Viral Papillomatosis

Overview:

Papillomaviruses are epitheliotropic and cause cutaneous lesions in man and several animal species, including cats.

Infection:

Cats most likely become infected through lesions or abrasions of the skin. Species-specific viruses have been detected but human and bovine related sequences have also been found, suggesting cross-species transmission.

Clinical signs:

In cats, papillomaviruses are associated with four different skin lesions: hyperkeratotic plaques, which can progress into Bowenoid in situ carcinomas (BISCs) and further to invasive squamous cell carcinomas (ISCCs); cutaneous fibropapillomas or feline sarcoids; and cutaneous papillomas. However, papillomaviruses have also been found in normal skin.

Diagnosis:

Papillomavirus-induced skin lesions can be diagnosed by demonstration of papillomavirus antigen in biopsies of skin lesions, or detection of papillomavirus-like particles by electron microscopy and papillomavirus DNA by polymerase chain reaction (PCR).

Treatment:

Spontaneous regression might be expected. In cases of ISCC, complete excision should be considered if possible.

Loss of Retinoblastoma Protein, But Not p53, Is Associated With the Presence of Papillomaviral DNA in Feline Viral Plaques, Bowenoid In Situ Carcinomas, and Squamous Cell Carcinomas

Although papillomaviral (PV) DNA is frequently present in feline cutaneous squamous cell carcinomas (SCCs), a causative association cannot be proven. Oncogenic human PVs cause neoplastic transformation by inhibiting retinoblastoma (pRb) and p53 activity. Therefore, absence of pRb and p53 immunostaining, along with increased p16 immunostaining, indicates a PV cause in some human SCCs. If PVs cause cutaneous feline SCCs, it was hypothesized that a similar immunohistochemistry profile, along with PV DNA, would be detectable. This was investigated using 5 feline viral plaques, 10 Bowenoid in situ carcinomas, 19 SCCs from ultraviolet-exposed (UV-exposed) skin, and 11 SCCs from UV-protected skin. Papillomaviral DNA was amplified by polymerase chain reaction from 30 of 45 lesions. Reduced pRb immunostaining was present in 26 of 45; increased p16 immunostaining was in 30; and p53 immunostaining was in 19. Both reduced pRb immunostaining and increased p16 immunostaining were more frequent in lesions containing PV DNA. In contrast, no association was observed between p53 immunostaining and the presence of PV DNA. SCCs from UV-protected skin more frequently contained PV DNA, reduced pRb, and increased p16 than UV-exposed SCCs. UV exposure was not associated with p53 immunostaining within the SCCs. These results suggest that feline PVs alter cell regulation by degrading pRb. Unlike oncogenic human PVs, there was no evidence that feline PVs degrade p53. These results provide further evidence that PVs may cause feline cutaneous SCCs, especially those in UV-protected skin, and they suggest a possible mechanism of this oncogenic action.

Consistent Detection of Felis Domesticus Papillomavirus 2 DNA Sequences Within Feline Viral Plaques

Viral plaques are well recognized skin lesions of cats. They are thought to be caused by papillomavirus infection; however, the causative papillomavirus is uncertain. In the current study, polymerase chain reaction using 2 consensus primer sets and 1 primer set specific for Felis domesticus papillomavirus 2 (FdPV-2) was used to amplify DNA from a series of 14 feline viral plaques. The FdPV-2 sequences were detected in all 14 viral plaques by the specific primers but in only 1 of 14 feline cutaneous trichoblastomas. Papillomavirus DNA was amplified from 8 plaques using the consensus primers. Sequences from FdPV-2 were amplified using the consensus primers from 4 plaques. In addition, 3 plaques contained papillomavirus DNA sequences from Felis domesticus papillomavirus sequence MY1, and a previously unreported papillomavirus DNA sequence was amplified from 1 plaque. As FdPV-2 was consistently present within the plaques, this suggests that this papillomavirus is the likely etiologic agent. Feline viral plaques can undergo neoplastic transformation to Bowenoid in situ carcinomas (BISCs). As FdPV-2 DNA is frequently present within BISCs, this suggests that FdPV-2 induces viral plaque formation and then remains detectible after neoplastic transformation.

Increased p16CDKN2A Protein Within Feline Cutaneous Viral Plaques, Bowenoid In Situ Carcinomas, and a Subset of Invasive Squamous Cell Carcinomas

Cutaneous viral plaques and bowenoid in situ carcinomas (BISCs) in cats are thought to be caused by papillomavirus (PV) infection. There is evidence that PVs may also cause some feline invasive squamous cell carcinomas (ISCCs). Human oncogenic PVs degrade retinoblastoma (RB) protein, impairing cell cycle control. Loss of RB function also increases p16CDKN2A protein (p16), and increased p16 immunoreactivity within a human oral ISCC indicates that the neoplasm was caused by PV infection. In the present study, p16 immunoreactivity was evaluated in 14 feline viral plaques, 14 BISCs, 7 non–solar-induced ISCCs, 11 solar-induced ISCCs, and 14 trichoblastomas. Increased p16 was present within all viral plaques, BISCs, and non–solar-induced ISCCs. In contrast, little p16 immunoreactivity was visible in the solar-induced ISCCs or trichoblastomas. PV DNA was consistently amplified from viral plaques, BISCs, and non–solar-induced ISCCs. However, just 5 solar-induced ISCCs and 1 trichoblastoma contained PV DNA. Given that both increased p16 immunoreactivity and PV DNA were present within viral plaques, BISCs, and non–solar-induced ISCCs, all 3 may be caused by PV infection. This suggests that feline non–solar-induced ISCCs may develop as a result of neoplastic progression from viral plaques and BISCs. Whether PVs promote this progression is unknown; however, evidence from this study suggests the PV that is associated with viral plaques and BISCs is able to disrupt the p16–RB pathway and therefore could have oncogenic potential. Immunohistochemical detection of p16 appears to be a useful technique to investigate the role of PVs in feline skin disease.

Multicentric Squamous Cell Carcinoma In Situ Associated With Papillomavirus in a Ferret

A 6-year-old castrated male ferret presented with multiple black and tan proliferative skin lesions. Histologically, the lesions were characterized by multifocal plaques of irregular epidermal hyperplasia and full-thickness dysplasia, with loss of normal epithelial stratification, loss of nuclear polarity, and rare eosinophilic intranuclear inclusion bodies in the superficial layers of the epidermis. Immunohistochemical staining with a monoclonal antibody against papillomaviruses was strongly immunoreactive. Ultrastructurally, large numbers of hexagonal viral particles approximately 50 nm were observed within the nuclei of dysplastic superficial keratinocytes. To the authors' knowledge, this is the first report of a ferret multicentric squamous cell carcinoma in situ associated with papillomavirus.

Papillomavirus-Associated Cutaneous Neoplasia in Mammals

For humans, strong evidence indicates that some mucosal papillomavirus (PV) types cause genital and oral neoplasia, and weaker evidence suggests that some cutaneous PVs may cause cutaneous squamous cell carcinomas (SCC). For nonhuman species, strong evidence supports a causal role of PVs in the development of feline and equine sarcoids. Likewise, PVs are believed to cause cutaneous SCCs in rabbits, western barred bandicoots, and some rodents. Furthermore, some evidence suggests that PVs may influence the development of both feline and canine cutaneous SCCs. This review discusses the evidence that PVs cause human cutaneous SCCs and the proposed mechanisms for this action. It then reviews preneoplastic and neoplastic skin diseases that are associated with PV infection in nonhuman mammals.

Detection of two different papillomaviruses within a feline cutaneous squamous cell carcinoma: case report and review of the literature

CASE HISTORY

A 15-year-old, brown-and-white cat was presented to a veterinary clinic with an ulcerated, reddened 1-cm diameter lesion on the nasal planum.

CLINICAL FINDINGS AND DIAGNOSIS

Histology of a biopsy sample confirmed the lesion was a squamous cell carcinoma (SCC). PCR amplified DNA sequences from two different papillomaviruses. One sequence was from FdPV-2, which has previously been amplified from feline cutaneous SCC. However, the other sequence has not previously been reported, suggesting a novel feline papillomavirus.

CLINICAL RELEVANCE

There is evidence that papillomaviruses promote the development of SCC on sun-exposed skin in humans. This is the first report in a cat of a papillomavirus other than FdPV-2 and the first time that multiple papillomaviruses have been detected within a single neoplasm in this species. Whether the papillomaviruses influenced the development and behaviour of this SCC is currently uncertain, but this case provides additional evidence of the association between papillomaviruses and feline cutaneous SCC. If papillomaviruses are found to influence the development of SCC this may allow novel strategies to prevent these common neoplasms in cats.

Clinical, Histologic, and Immunohistochemical Analyses of Feline Squamous Cell Carcinoma In Situ

Actinic keratosis (AK) and Bowenoid in situ carcinoma (BISC) are two distinct forms of in situ squamous cell carcinoma in felines. They usually occur on different locations and present with specific clinical and histologic features. However, in some cases, these diseases cannot be distinguished either clinically or histopathologically. The aim of the present study was to determine the accuracy of diagnosis based on clinical or histologic criteria alone, and whether immunohistochemistry for papillomavirus or p53 can improve the accuracy of diagnosis. A series of in situ squamous cell carcinoma cases ( n = 45) were selected according to their location and initial histologic classification and subsequently classified as AK ( n = 22) or BISC ( n = 23) according to the clinical criteria and were reevaluated histologically by 2 dermatopathologists. All BISC cases and most of the AK cases ( n = 15) were confirmed histologically. In 7 cases clinically classified as AK, this diagnosis was not unanimously confirmed histologically because of the presence of overlapping features. P53 immunoreactivity was observed in 11/14 (79%) confirmed AK cases and in 4/22 (18%) BISC cases, while papillomavirus antigen was not detected in any confirmed AK case but was detected in 11/23 (48%) BISC cases. It was concluded that BISC can usually be reliably diagnosed histologically. The histologic diagnosis of lesions clinically suggestive of AK might sometimes be difficult. Results of immunohistochemistry for p53 and papillomavirus antigen were supportive for a role of sun exposure and papillomavirus in the pathogenesis of AK and BISC, respectively.

Feline cutaneous viral papilloma associated with human papillomavirus type 9

A 12-year-old domestic Shorthaired cat developed a multinodular exophytic mass on the dorsal surface of the nose. The skin surrounding the mass was nonpigmented, and actinic keratosis had been diagnosed in this area 3 years previously. Histologic examination revealed hyperkeratosis, epidermal hyperplasia, papillomatosis, koilocytosis, and possible intranuclear viral inclusions. Polymerase chain reaction amplified papillomaviral deoxyribonucleic acid from formalin-fixed samples of the lesion. Sequencing of the amplicon revealed 98% similarity to human papillomavirus (HPV) type 9. To the authors' knowledge, this is only the second reported feline cutaneous viral papilloma. In addition, this is the first report of a feline papilloma being associated with an HPV.

Proliferative and necrotizing otitis externa in four cats

Proliferative and necrotizing feline otitis externa is a rare disorder of unknown aetiology. This condition was diagnosed by skin biopsy in three adult domestic shorthair cats (3-5 years old) and one kitten (6 months old). The affected cats had large tan to dark brown-black coalescing plaques covering the concave surface of the pinnae and external ear canals. Friable material from the plaques and a thick exudate occluded the ear canals. The cats had a secondary bacterial and/or yeast otitis. Prior to the histopathological diagnosis, all cats received numerous otic preparations as well as oral antibiotics and corticosteroids without resolution. Histologically, all cases had strikingly similar changes; acanthosis with pronounced hair follicle outer root sheath hyperplasia and neutrophilic luminal folliculitis, follicular keratosis and individually necrotic keratinocytes in the outer root sheath of hair follicles. One case was documented via skin biopsy to have persisted for 4 years. The adult cats were treated with topical 0.1% tacrolimus and all showed marked improvement although one cat was lost to follow up. The lesions completely resolved with topical tacrolimus alone in one cat and topical tacrolimus in addition to oral prednisolone in another cat.

Detection of papillomaviral sequences in feline Bowenoid in situ carcinoma using consensus primers

Feline Bowenoid in situ carcinoma (BISC) is a rare disease that presents as multiple discrete plaques of epidermal hyperplasia and dysplasia. Two studies using immunohistochemistry revealed papillomaviral antigens in 11% and 47% of BISCs. Additionally, a recent study detected papillomaviral DNA in 24% of BISC lesions. To further investigate the association between papillomaviruses and BISC, polymerase chain reaction using consensus primers was used to detect papillomaviral DNA in 18 formalin-fixed samples of BISC. Papillomaviral DNA was amplified from 11 of the samples but from none of the controls. Six amplicons were sequenced; one was homologous with a papillomavirus from a human patient with multiple cutaneous squamous cell carcinomas and the other five showed weak homology to human papillomavirus type 17. These five sequences were > 96% homologous over a 235 bp sequence, indicating the presence in all five BISCs of one papillomavirus type distinct from any previously sequenced and more closely related to human than animal papillomaviruses. The results confirm an association between BISC and papillomaviruses, and as all six papillomavirus sequences identified are closely related to human papillomaviruses, it is possible that the virus is transmitted from humans to cats or vice versa.