Adrenal/endocrine tumors Flashcards
Perioperative mortality for dogs undergoing adrenalectomy with caudal vena cava venotomy (Knight Vet Surg 2019)
21%
Perioperative mortality for adrenalectomy and cavotomy for treatment of invasive adrenal tumors? (Mayhew Vet Surg 2019)
24% (died or euthanized)
MST for dogs surviving perioperative period after adrenalectomy and cavotomy for invasive adrenal tumors? (Mayhew 2019)
MST 547d
What increased the risk of death for dogs undergoing adrenalectomy and cavotomy for an invasive adrenal tumor? (Mayhew Vet Surg 2019)?
Post diaphragm thrombus termination location
What did the Utrecht score include for assessing prognosis of dogs with cortisol-secreting adrenocortical tumors? (Sanders VCO 2019)
Ki67 proliferation, clear/vacuolated cytoplasm, necrosis
Increasing score associated with shorter ST
Complications from percutaneous US-guided FNA of adrenal gland lesions? (Summer JSAP 2018)
9/19 tumors were pheos, only one developed complications that was ventricular tachycardia
Objective responses rate/ mediain reduction in tumor volume for dogs treated with voumetric-modulated arc stereotactic RT for adrenocortical tumors with vascular invasion? (Dolera, JSAP 2016)
100% had objective responses
median 30% reduction in tumor volume
OST for dogs treated for adrenocortical tumors with vascular invasion with volumetric-modulated arc stereotactic RT? What was the protocol for RT? (Dolera JSAP 2016)
OST 1000d
RT = 3-5fx, total 30-45gy
What were the clinical findgins for cats presenting with adrenal neoplasia? (Daniel JFMS 2016)
33 cats: weakness (12) respiratory signs (4) blindness (4) GI (3)
What were the lab findings in cats with adrenal gland tumors? (Daniel JFMS 2016)
Hypokalemia, alkalemia, elevated CK, azotemia
What was the most common functional adrenal tumor syndrome in 33 cats with adrenal neoplasia?
Hyperaldosteronism (16/25 cats tested)
What was the perioperative survival rate and survival time after adrenalectomy in cats? (Daniel JFMS 2016)
77% survive perioperative
ST ranged from 4-540 weeks
What was negatively associated with survival for cats undergoing adrenalectomy? (Daniel JFMS 2016)
Female
What was the sensitivity, specificity and accuracy of discriminating between malignant and benign adrenal tumors with contrast-enhanced ultrasound (CEUS) (Bargellini JAAHA 2016)
Sensitivity 100%
Specificity 80%
Accuracy 91.7%
What characteristic on CT was associated with pheochromocytomas in dogs? (Gregori VRU 2015)
Vascular invasions (characteristics overlapped so still need more than CT to dx specific adenal mass types)
What receptors were found to be lower in adrenal carcinomas and adenomas in dogs? (Kool, VetJ 2015)
Carcinoma: dopamine receptor DRD2 and somatostatin receptor (SSTR1)
Adenoma: Somatostatin receptor (SSTR1)
Increased expression of what receptor was found to be associated in recurrent adrenocortical tumors in dogs? (Kool, VetJ 2015)
Dopamine receptor (DRD1 - need to confirm 1 not 2)
Ultrasound showed what specificity and sensitivity for identifying adrenal gland lesions in dogs? What improved this? (Pagani BMC 2016)
High specificity (100%) low sensitivity (63.7%), improved with increasing lesion size
All AG lesions over _____ were histologically confirmed to be malignant on AUS. (Pagani BMC 2016)
20mm (all pheo and adenocarcinoma)
Vascular invasion was a ______ but not ______ predictor of malignancy on AUS for adrenal gland lesions in dogs (Pagani BMC 2016)
Specific but not sensitive
What shape was associated with a benign vs. malignant adrenal gland lesion in dogs on AUS? (Pagani BMC 2016)
Benign: nodular shape
Malignant: irregular enlargement
What was different between benign vs. malignant incidentally detected adrenal gland lesions on AUS in dogs? (Cook, JAVMA 2014)
All benign tumors <20mm, malignant tumors ranged in size from 20-46mm
What percentage of adrenal gland lesions were malignant in dogs with incidentally detected adrenal gland lesions on AUS (Cook JAVMA 2014)
30% - remember, all bigger than 20mm!
Is an intercostal or paracostal surgical approach better for exposure for R-sided adrenalectomy? What was MST for dogs in this study? (Andrade Vet Surg 2014)
Intercostal better
MST 786d
What were risk factors associated with post-op death w/in 14 days identified for dogs undergoing adrenalectomy w/ or w/o invasion of CVC (5)? (Barrera JAVMA 2013)
Vena cava invasion, extent of invasion, pheo, intraoperative transfusion, post-op complications (DIC, panc, etc.)
What was the strongest risk factor for short term survival after adrenalectomy in dogs? (Barrera JAVMA 2013)
extensive invasion - thrombus extension beyond hepatic hilus (did not affect long term survival)
What was the MST for dogs with non-cortisol secereting adrenal tumors that did not undergo adrenalectomy (2013 paper)
MST 17.8mo
What were prognostic factors for dogs with non-cortisol secreting adrenal tumors w/o adrenalectomy? (2013 paper)
Size and metastasis
What was the outcome for 11 cats treated with laproscopic adrenalectomy for unilateral noninvasive adrenocortical tumors?
4 needed conversion to laparotomy
10/11 discharged, MST 801d.
A Ki67 score greater than what % is predictive for adrenal carcinomas (vs. benign lesions)
2.4%
Tumors that most commonly met to adrenal gland (LaBelle Vet Path 2005)?
Lung, mammary, prostate, gastric, panc, melanoma
What was the survival time for dogs with adrenal dependent HAC treated with mitotane or trilostane? What was associated with decreased survival? (Helm JVIM 2011)
No difference between mitotane and trilostane (survival 102-353d)
Metastasis decreased survival
What was the overall MST for dogs undergoing coarse fractionated protocols for pituitary macroadenomas? Which protocol was better? (Marcinowska VRU 2015)
Overall MST 235 days
3.8Gyx10 MWF significantly better MST 961
12 weekly treatments for 5, total 38 Gy - MST = 182d
What was significantly associated with MST for dogs undergoing coarse fx RT for pitutitary macroadenomas? (Marcinowska VRU 2015)
Clinical severity scores
What was the MST for cats with acromegaly treated with SRT? (Wormhoudt JVIM 2018)
1072d
What was the response to SRT in regard to insulin requirements for cats treated with SRT for acromegaly? (Wormhoudt JVIM 2018)
95% had decrease in insulin dose
32% had diabetic remission
Permanent remission in 62%, temorary in 38%
What was the median duration to lowest insuline dose for cats treated with SRT for acromegaly? (Wormhoudt JVIM 2018)?
9.5mo
What percentage of cats became hypothyroid and needed thyroid supplementation after SRT for acromegaly? (Wormhoudt JVIM 2018)
14%
What was the MST for cats with acromegaly treated with SRS (15-20Gy in 1-3 treatments). What was the rate of clinical improvement? (Sellon JVIM 2009)
MST 25mo
Rate of improvement 5/9 = better diabetes control, 2/2 imroved neuro signs
What were perianesthetic complications for cats treated with hypophysectomy for acromegaly? (Neilson JFMS 2018)
hypothermia, hypotension, bradycardia, airway obstruction
What was the mortality rate for cats at 24hrs post-hypophysectomy for acromegaly?
8%
What two things were found related to anesthetic drugs for cats underoing hypophysectomy for acromegaly? (Neilson, JFMS 2018)
- use of alpha 2 agonists assoc. with lower incidence of hypotension (dexmed)
- fentanyl associated w/ high incidence of airway obstruction compared with remifentanil
MST for dogs treated with SRT (1x15Gy or 3x8Gy) for imaging-dx pituitary tumors. What was significantly associated with MST? (VRU 2018)
MST 311d
Better for nonfnxl tumors (626d) compared to funxl tumors (245d)
What was the outcome at 3- and 6-mo for dogs treated with pasireotide in addition to tradiational medical treatment for pituitary HAC? (Lottati JAVMA 2018)
No differences in lab values, ACTH stim at 3- or 6-mo
6mo 6/9 dogs had decreases in MRI-measurements, 3 had increases
What is octreotide?
Somatostatin analog - reports of using for insulinoma
What was the effect of ocreotide on insulin and glucose levels in dogs with insulinoma? (Robben ResVetSci 2006)
Insulin decreased, glucose increased
What were the AEs reported secondary to streptozocin given q2wks to dogs with insulinoma? (Northrup JVIM 2013)
Diabetes in 8 dogs - 6 died or were euthanized
nephrotox in 2
increased ALT in 6
hypoglycemia in 2
What was the median PFS and OST for dogs with insulinoma treated with streptozocin? (Northrup JVIM 2013)
PFS 196d
OSt 308d
What was the outcome for a dog treated with pred and palladia after partial pancreatectomy? Flesner JAAHA 2019 **committee paper**
ong term glycemic control, ST > 24mo
What are the imaging features of insulinomas on contrast enahanced ultrasound? (Vanderperren JSAP 2014)
uniformly hypervascular lesions
What were the contrast ultrasound features of pancreatic adenocarcinomas? (Vanderperren JSAP 2014)
Hypoechoic and hypovascular
What IHC is feline insulinoma positive for? (Jackson JVIM 2009)
insulin, chromogranin A, somatostatin
only looked at one tumor
Results of study examining vessel sealing device (VSD) compared to conventional surgery for dogs undergoing thyroidectomy (Lorange, JAVMA 2019)
Significantly shorter surgery times for VSD (28) vs. conventional (41 min) No differences in complication rate or duration of hospital stay No dogs in VSD group had bleeding, 2 in conventional group did
Complication rate for dogs undergoing unilateral thyroidectomy (Reagan JAVMA 2019)
Perioperative: 19.9% (most common = hemorrhage in 7.7%) Post op - most common = aspiration pneumonia in 3.2% Odds for developing complications high for fixed masses and additional days in hospital
Outcomes for dogs undergoing unilateral thyroidectomy? (Reagan JAVMA 2019)
Local Recurrence: 18 dogs Metastatic disease: 13 (lung in 8) MST 911 days Mitotic index assoc with decreased PFS and MST
What is MEN type I and what spp has it been described in?
pituitary, panc, parathyroid
cat
side bar - MEN1 can also include gastrinomas and adrenal tumors…caused by mutation in menin gene in people (and cats)
MEN type 2 (A and B) is caused by what gene mutation
Ret
What was the outcome for dogs with paraythroid carcinoma treated with surgery? (Sawyer VCO 2011)
Good - 18/19 had resolved hypercal w/in 4d
one dog died due to intractable hypocal
no dogs had recurrent or metastatic disease
What was the rate of clinical benefit for dogs with pheo’s treated with Palladia? (Musser BMC 2018)
5/5 had benefit, 1 PR, 4 SD
What was the PFI for dogs with inoperable, metastatic or recurrent pheos treated with palladia? (Musser BMC 2018)
1 dog with PR = 61wks
2 dogs with SD 36 and 28wks
2 dogs with stable metastatic disease = 11 and 18 wks
What was the difference in plasma free metanephrine (fMN) and plasma free normetanephrine (fNMN) in dogs with pheos vs. dogs with nonadrenal disease vs. healthy dogs (Gostelow JVIM 2013)
fMN higher in pheo vs. healthy but no difference b/w pheo and nonadrenal disease
fNMN higher in dogs with pheo compared to both healthy and nonadrenal disease
What was the rate of incidentally detected thyroid nodules on cervical ultrasound? (Pollard VRU 2015)
15% (33% of the ones removed were thyroid carcinoma - recommend fna or removal!)
What breeds are at an increased risk of thyroid ca? (Wucherer JAAHA 2010)
Goldens and Siberian Huskies
What age group is at an increased risk for thyroid carcinoma? Gender? (Wucherer JAAHA 2010)
older dogs higher risk - 10-15yrs
no gender associations
What % of thyroid tumors are carcinomas vs. adenocarcinomas?
90% carcinomas, 9.3% adenomas
What thyroid pathologic changes increased with disease duration in cats with hyperT4 (cats were referred for radioiodine therapy)? (Peterson JFMS 2016)
- Tumor size/volume (1.6cm3 —> 6.4cm3)
- Degree of hyper T4 (100—>315)
- Chance of multifocal disease
- Prevalence of intrathoracic tumor tissue (3% –> 32%)
- Prevalence of suspected thyroid carcinoma (0.4% –> 19%)
All values compared between cats diagnosed for <1yr to those diagnosed for >4yrs
What was the outcome for dogs treated with i131 for nonresectable thyroid tumors (Turrel JAVMA 2006)
local or regional tumors (stage II or III) did better (839d) than those with mets (366d)
3 dogs died due to radioiodine-associated myelosuppression w/in 3mo (3/39 = 7.7%)
What IHC markers were higher in thyroid carcinoma vs. normal thyroid tissue? (Pessina VCO 2016)
Fibroblast growth factor-2
thryoid transcription factor-1
PCNA
VEGF
What IHC markers are used to identify follicular cell vs. cell cell thyroid tumors? (Vara J Comp Path 2016)
All thyroid tumors: TTF1
Follicular cell: Thyroglobulin
C-cell: calcitonin
Pax8 (follicular) and Napsin A (c-cell) had some cross reactivity between tumor types but are generally thyroid specific (w/ exception of renal cell carcinoma for both and pulmonary adca for napsin A)
What was the MST for dogs undergoing unilateral thyroidectomy for thyroid ca? What was associated with a shorter PFI or ST?
MST 911d (30.3mo = 2.5yr)
shorter PFI: MI and tumor size
ST: MI and perioperative complications
What factors have been associated with risk of distant metstasis in dogs with thyroid ca? (Campos JVIM 2014)
sumor diameter, volume, bilateral location
What has been shown to be a negative predictor of disease free survival for dogs with thyroid ca undergoing surgery? (Campos JVIM 2014)
vascular invasion
Does ectopic sublingual thyroid carcinoma have a more or less biologic behavior regular thyroid ca? (Broome JVIM 2014
less aggressive (yonger dogs and less likely to have mets (15% vs. 30%)
MST 562d (most surgery and/or radioiodine)
What was the rate of hypothyroidism in dogs after treated with RT for thyroid carcinoma? (Amores-Fuster VCO 2015)
21 dogs, 17 had RT post-op
10 developed hypothyroidism (47.6%) at a median time of 6mo
