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Oncology Boards > Adrenal/endocrine tumors > Flashcards

Adrenal/endocrine tumors Flashcards

1
Q

Perioperative mortality for dogs undergoing adrenalectomy with caudal vena cava venotomy (Knight Vet Surg 2019)

A

21%

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2
Q

Perioperative mortality for adrenalectomy and cavotomy for treatment of invasive adrenal tumors? (Mayhew Vet Surg 2019)

A

24% (died or euthanized)

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3
Q

MST for dogs surviving perioperative period after adrenalectomy and cavotomy for invasive adrenal tumors? (Mayhew 2019)

A

MST 547d

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4
Q

What increased the risk of death for dogs undergoing adrenalectomy and cavotomy for an invasive adrenal tumor? (Mayhew Vet Surg 2019)?

A

Post diaphragm thrombus termination location

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5
Q

What did the Utrecht score include for assessing prognosis of dogs with cortisol-secreting adrenocortical tumors? (Sanders VCO 2019)

A

Ki67 proliferation, clear/vacuolated cytoplasm, necrosis

Increasing score associated with shorter ST

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6
Q

Complications from percutaneous US-guided FNA of adrenal gland lesions? (Summer JSAP 2018)

A

9/19 tumors were pheos, only one developed complications that was ventricular tachycardia

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7
Q

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)

A

100% had objective responses

median 30% reduction in tumor volume

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8
Q

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)

A

OST 1000d

RT = 3-5fx, total 30-45gy

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9
Q

What were the clinical findgins for cats presenting with adrenal neoplasia? (Daniel JFMS 2016)

A

33 cats: weakness (12) respiratory signs (4) blindness (4) GI (3)

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10
Q

What were the lab findings in cats with adrenal gland tumors? (Daniel JFMS 2016)

A

Hypokalemia, alkalemia, elevated CK, azotemia

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11
Q

What was the most common functional adrenal tumor syndrome in 33 cats with adrenal neoplasia?

A

Hyperaldosteronism (16/25 cats tested)

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12
Q

What was the perioperative survival rate and survival time after adrenalectomy in cats? (Daniel JFMS 2016)

A

77% survive perioperative

ST ranged from 4-540 weeks

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13
Q

What was negatively associated with survival for cats undergoing adrenalectomy? (Daniel JFMS 2016)

A

Female

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14
Q

What was the sensitivity, specificity and accuracy of discriminating between malignant and benign adrenal tumors with contrast-enhanced ultrasound (CEUS) (Bargellini JAAHA 2016)

A

Sensitivity 100%

Specificity 80%

Accuracy 91.7%

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15
Q

What characteristic on CT was associated with pheochromocytomas in dogs? (Gregori VRU 2015)

A

Vascular invasions (characteristics overlapped so still need more than CT to dx specific adenal mass types)

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16
Q

What receptors were found to be lower in adrenal carcinomas and adenomas in dogs? (Kool, VetJ 2015)

A

Carcinoma: dopamine receptor DRD2 and somatostatin receptor (SSTR1)

Adenoma: Somatostatin receptor (SSTR1)

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17
Q

Increased expression of what receptor was found to be associated in recurrent adrenocortical tumors in dogs? (Kool, VetJ 2015)

A

Dopamine receptor (DRD1 - need to confirm 1 not 2)

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18
Q

Ultrasound showed what specificity and sensitivity for identifying adrenal gland lesions in dogs? What improved this? (Pagani BMC 2016)

A

High specificity (100%) low sensitivity (63.7%), improved with increasing lesion size

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19
Q

All AG lesions over _____ were histologically confirmed to be malignant on AUS. (Pagani BMC 2016)

A

20mm (all pheo and adenocarcinoma)

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20
Q

Vascular invasion was a ______ but not ______ predictor of malignancy on AUS for adrenal gland lesions in dogs (Pagani BMC 2016)

A

Specific but not sensitive

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21
Q

What shape was associated with a benign vs. malignant adrenal gland lesion in dogs on AUS? (Pagani BMC 2016)

A

Benign: nodular shape

Malignant: irregular enlargement

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22
Q

What was different between benign vs. malignant incidentally detected adrenal gland lesions on AUS in dogs? (Cook, JAVMA 2014)

A

All benign tumors <20mm, malignant tumors ranged in size from 20-46mm

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23
Q

What percentage of adrenal gland lesions were malignant in dogs with incidentally detected adrenal gland lesions on AUS (Cook JAVMA 2014)

A

30% - remember, all bigger than 20mm!

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24
Q

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)

A

Intercostal better

MST 786d

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25
Q

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)

A

Vena cava invasion, extent of invasion, pheo, intraoperative transfusion, post-op complications (DIC, panc, etc.)

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26
Q

What was the strongest risk factor for short term survival after adrenalectomy in dogs? (Barrera JAVMA 2013)

A

extensive invasion - thrombus extension beyond hepatic hilus (did not affect long term survival)

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27
Q

What was the MST for dogs with non-cortisol secereting adrenal tumors that did not undergo adrenalectomy (2013 paper)

A

MST 17.8mo

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28
Q

What were prognostic factors for dogs with non-cortisol secreting adrenal tumors w/o adrenalectomy? (2013 paper)

A

Size and metastasis

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29
Q

What was the outcome for 11 cats treated with laproscopic adrenalectomy for unilateral noninvasive adrenocortical tumors?

A

4 needed conversion to laparotomy

10/11 discharged, MST 801d.

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30
Q

A Ki67 score greater than what % is predictive for adrenal carcinomas (vs. benign lesions)

A

2.4%

31
Q

Tumors that most commonly met to adrenal gland (LaBelle Vet Path 2005)?

A

Lung, mammary, prostate, gastric, panc, melanoma

32
Q

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)

A

No difference between mitotane and trilostane (survival 102-353d)

Metastasis decreased survival

33
Q

What was the overall MST for dogs undergoing coarse fractionated protocols for pituitary macroadenomas? Which protocol was better? (Marcinowska VRU 2015)

A

Overall MST 235 days

3.8Gyx10 MWF significantly better MST 961

12 weekly treatments for 5, total 38 Gy - MST = 182d

34
Q

What was significantly associated with MST for dogs undergoing coarse fx RT for pitutitary macroadenomas? (Marcinowska VRU 2015)

A

Clinical severity scores

35
Q

What was the MST for cats with acromegaly treated with SRT? (Wormhoudt JVIM 2018)

A

1072d

36
Q

What was the response to SRT in regard to insulin requirements for cats treated with SRT for acromegaly? (Wormhoudt JVIM 2018)

A

95% had decrease in insulin dose

32% had diabetic remission

Permanent remission in 62%, temorary in 38%

37
Q

What was the median duration to lowest insuline dose for cats treated with SRT for acromegaly? (Wormhoudt JVIM 2018)?

A

9.5mo

38
Q

What percentage of cats became hypothyroid and needed thyroid supplementation after SRT for acromegaly? (Wormhoudt JVIM 2018)

A

14%

39
Q

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)

A

MST 25mo

Rate of improvement 5/9 = better diabetes control, 2/2 imroved neuro signs

40
Q

What were perianesthetic complications for cats treated with hypophysectomy for acromegaly? (Neilson JFMS 2018)

A

hypothermia, hypotension, bradycardia, airway obstruction

41
Q

What was the mortality rate for cats at 24hrs post-hypophysectomy for acromegaly?

A

8%

42
Q

What two things were found related to anesthetic drugs for cats underoing hypophysectomy for acromegaly? (Neilson, JFMS 2018)

A
  1. use of alpha 2 agonists assoc. with lower incidence of hypotension (dexmed)
  2. fentanyl associated w/ high incidence of airway obstruction compared with remifentanil
43
Q

MST for dogs treated with SRT (1x15Gy or 3x8Gy) for imaging-dx pituitary tumors. What was significantly associated with MST? (VRU 2018)

A

MST 311d

Better for nonfnxl tumors (626d) compared to funxl tumors (245d)

44
Q

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)

A

No differences in lab values, ACTH stim at 3- or 6-mo

6mo 6/9 dogs had decreases in MRI-measurements, 3 had increases

45
Q

What is octreotide?

A

Somatostatin analog - reports of using for insulinoma

46
Q

What was the effect of ocreotide on insulin and glucose levels in dogs with insulinoma? (Robben ResVetSci 2006)

A

Insulin decreased, glucose increased

47
Q

What were the AEs reported secondary to streptozocin given q2wks to dogs with insulinoma? (Northrup JVIM 2013)

A

Diabetes in 8 dogs - 6 died or were euthanized

nephrotox in 2

increased ALT in 6

hypoglycemia in 2

48
Q

What was the median PFS and OST for dogs with insulinoma treated with streptozocin? (Northrup JVIM 2013)

A

PFS 196d

OSt 308d

49
Q

What was the outcome for a dog treated with pred and palladia after partial pancreatectomy? Flesner JAAHA 2019 **committee paper**

A

ong term glycemic control, ST > 24mo

50
Q

What are the imaging features of insulinomas on contrast enahanced ultrasound? (Vanderperren JSAP 2014)

A

uniformly hypervascular lesions

51
Q

What were the contrast ultrasound features of pancreatic adenocarcinomas? (Vanderperren JSAP 2014)

A

Hypoechoic and hypovascular

52
Q

What IHC is feline insulinoma positive for? (Jackson JVIM 2009)

A

insulin, chromogranin A, somatostatin

only looked at one tumor

53
Q

Results of study examining vessel sealing device (VSD) compared to conventional surgery for dogs undergoing thyroidectomy (Lorange, JAVMA 2019)

A

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

54
Q

Complication rate for dogs undergoing unilateral thyroidectomy (Reagan JAVMA 2019)

A

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

55
Q

Outcomes for dogs undergoing unilateral thyroidectomy? (Reagan JAVMA 2019)

A

Local Recurrence: 18 dogs Metastatic disease: 13 (lung in 8) MST 911 days Mitotic index assoc with decreased PFS and MST

56
Q

What is MEN type I and what spp has it been described in?

A

pituitary, panc, parathyroid

cat

side bar - MEN1 can also include gastrinomas and adrenal tumors…caused by mutation in menin gene in people (and cats)

57
Q

MEN type 2 (A and B) is caused by what gene mutation

A

Ret

58
Q

What was the outcome for dogs with paraythroid carcinoma treated with surgery? (Sawyer VCO 2011)

A

Good - 18/19 had resolved hypercal w/in 4d

one dog died due to intractable hypocal

no dogs had recurrent or metastatic disease

59
Q

What was the rate of clinical benefit for dogs with pheo’s treated with Palladia? (Musser BMC 2018)

A

5/5 had benefit, 1 PR, 4 SD

60
Q

What was the PFI for dogs with inoperable, metastatic or recurrent pheos treated with palladia? (Musser BMC 2018)

A

1 dog with PR = 61wks

2 dogs with SD 36 and 28wks

2 dogs with stable metastatic disease = 11 and 18 wks

61
Q

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)

A

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

62
Q

What was the rate of incidentally detected thyroid nodules on cervical ultrasound? (Pollard VRU 2015)

A

15% (33% of the ones removed were thyroid carcinoma - recommend fna or removal!)

63
Q

What breeds are at an increased risk of thyroid ca? (Wucherer JAAHA 2010)

A

Goldens and Siberian Huskies

64
Q

What age group is at an increased risk for thyroid carcinoma? Gender? (Wucherer JAAHA 2010)

A

older dogs higher risk - 10-15yrs

no gender associations

65
Q

What % of thyroid tumors are carcinomas vs. adenocarcinomas?

A

90% carcinomas, 9.3% adenomas

66
Q

What thyroid pathologic changes increased with disease duration in cats with hyperT4 (cats were referred for radioiodine therapy)? (Peterson JFMS 2016)

A
  • 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

67
Q

What was the outcome for dogs treated with i131 for nonresectable thyroid tumors (Turrel JAVMA 2006)

A

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%)

68
Q

What IHC markers were higher in thyroid carcinoma vs. normal thyroid tissue? (Pessina VCO 2016)

A

Fibroblast growth factor-2

thryoid transcription factor-1

PCNA

VEGF

69
Q

What IHC markers are used to identify follicular cell vs. cell cell thyroid tumors? (Vara J Comp Path 2016)

A

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)

70
Q

What was the MST for dogs undergoing unilateral thyroidectomy for thyroid ca? What was associated with a shorter PFI or ST?

A

MST 911d (30.3mo = 2.5yr)

shorter PFI: MI and tumor size

ST: MI and perioperative complications

71
Q

What factors have been associated with risk of distant metstasis in dogs with thyroid ca? (Campos JVIM 2014)

A

sumor diameter, volume, bilateral location

72
Q

What has been shown to be a negative predictor of disease free survival for dogs with thyroid ca undergoing surgery? (Campos JVIM 2014)

A

vascular invasion

73
Q

Does ectopic sublingual thyroid carcinoma have a more or less biologic behavior regular thyroid ca? (Broome JVIM 2014

A

less aggressive (yonger dogs and less likely to have mets (15% vs. 30%)

MST 562d (most surgery and/or radioiodine)

74
Q

What was the rate of hypothyroidism in dogs after treated with RT for thyroid carcinoma? (Amores-Fuster VCO 2015)

A

21 dogs, 17 had RT post-op

10 developed hypothyroidism (47.6%) at a median time of 6mo

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