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Module 17-Urinary, Endocrinology, Oncology > Approach to skin and soft tissue tumours > Flashcards

Approach to skin and soft tissue tumours Flashcards

1
Q

Diagnosis of skin tumours

A

Cystology for some tumour types
Histopathology for definitive diagnosis
(Excisional/Punch biopsy)

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2
Q

Where is the most common site of neoplasia for the dog and cat

A

Skin

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3
Q

What does TNM mean when staging skin tumours

A

T Primary lesion - size and extent

N Regional /Sentinel node - palpate, image, aspirate

M Distant metastases - Xray, AUS, bloods

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4
Q

Treatment for local skin tumours

A

Surgery

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5
Q

Treatment for local and region lymph nodes

A

Surgery +/or radiotherapy

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6
Q

Treatment for multifocal diffuses skin tumour

A

Chemotherapy

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7
Q

Suggest causes of multiple skin lesions

A

Primary Cutaneous lymphoma (T cell)
Disseminated mast cell tumours
Histiocytic skin conditions

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8
Q

Hystiocytic

A

A group of rare disorders in which too many histiocytes (a type of white blood cell) build up in certain tissues and organs, including the skin, bones, spleen, liver, lungs, and lymph nodes.

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9
Q

Differentiate between cutaneous and systemic REACTIVE histiocytosis

A

Cutaneous histiocytosis = skin only
Systemic histiocytosis = skin, lymph nodes & other organs

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10
Q

Give examples of neoplastic histiocytic skin conditions

A

Histiocytic sarcoma (Malignant histiocytosis)
Haemophagocytic histiocytic sarcoma

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11
Q

Treatment for Reactive histiocytosis

A

Some may respond to immunosuppressive drugs (high dose corticosteroids, cyclosporine, tetracycline/niacinamide)

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12
Q

Give examples of epidermal solitary skin tumours

A

Papilloma
Basal cell tumour (Trichoblastoma or solid-cystic ductular sweat gland adenoma)
Squamous cell carcinoma

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13
Q

Give examples of dermal solitary skin tumours

A

Sebaceous and sweat gland adenoma/ACA
Hair follicle tumours (pilomatricoma/trichoepithelioma/trichoblastoma)

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14
Q

Give examples of Mesenchymal / subcut connective tissue
solitary skin tumours

A

Fibrous tissue (fibroma/sarcoma)
Adipose tissue (lipoma/sarcoma)

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15
Q

Are basal cell tumors more common in cats or dogs

A

In cats

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16
Q

Cause of Squamous cell carcinoma

A

Chronic exposure to UV light in depigmented skin (white) areas

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17
Q

Squamous cell carcinoma treatment

A

Treatment wide local surgical resection

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18
Q

What is the most common skin tumour of old dogs

A

Sebaceous gland tumours (hyperplasia-warts, cysts, adenoma, epithelioma)

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19
Q

Canine cutaneous histiocytoma signalment

A

up to 10% of all skin tumours
Young dogs < 5 yrs,
50 % in dogs < 2 yrs

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20
Q

Are majority of melanocytic tumours slow growing and benign?

A

85% are slow growing and benign

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21
Q

Signalment for mast cell tumours

A

Middle aged - older dogs
No sex predisposition
Breeds:
Boxers, Staff BTs, Boston Terriers
Labradors,
Golden Retrievers*
Weimeraners
Pugs

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22
Q

What is the name of the two systems used to predict mass cell tumour

A

Patnaik system (1984) - low, intermed, high grades
Kiupel system (2011)- low and high grade

23
Q

Name mass cell tumour proliferation markers

A

Mitotic count (index)- no of mitoses/10 HPF
Ki67- nuclear stain for cells in cell cycle
AgNOR count- nuclear silver stain and PCNA (proliferating cell nuclear antigen)
cKI- Cell surface growth factor receptor with TK enzyme

24
Q

What is the number of Mitotic count (index)- no of mitoses/10 HPF for a bad prognosis

A

> 5 mitoses/10HPF has worse prognosis

25
Q

What is the percentage of Ki67 – nuclear stain for cells in cell cycle for a bad prognosis

A

1.8% of positive nuclei per total mast cells in field has a worse prognosis /decreased survival

26
Q

What do granules in mast cell tumour contain

A

Histamine
Heparin
Vasoactive amines

27
Q

What are the local effects of degranulation

A

Erythema
Swelling
Wheal formation- Raised, discolored blotch on the skin
‘Darier’s sign’- Urtication and erythematous halo that are produced in response to the rubbing or scratching of these lesions.

28
Q

Systemic effects of hyperhistainaemia(paraneoplastic syndrome)

A

More likely with high grade tumour
Acts on H2 receptors in gastric parietal cells,leading to
- Increased acidity and motility
- Vomiting, anorexia, melaena
- Gastric ulceration

29
Q

Treatment for Hyperhistaminaemia

A

Supportive therapy - fluids
H2 antagonists- Cimetidine, ranitidine, famotidine
Gastric protectants- Sucralfate (Antepsin)
Proton pump inhibitor- Omeprazole
Remove /treat mast cell tumour to remove source of histamine

30
Q

Other biological effects of mass cell tumours

A

Hypotension
Coagulation problems– Localised haemorrhage
Delayed wound healing

31
Q

Difference between low grade and high grade mast cell tumour ‘s effects of the body

A

Low grade - may have local effects
High grade - more likely to have systemic effects
High serum histamine reported with all grades

32
Q

How do I diagnose a mass cell tumour

A

Do an FNA to confirm diagnosis (or biopsy)
Evaluate/FNA sentinel LN – for clinical stage

33
Q

Difference between treatment of clinical stage 1 and 2 mass cell tumours

A

If Clinical Stage I (solitary mass and no sentinel LN mets)
- Surgical excision only – wide local excision or
- Marginal excision and radiotherapy or
- Radiotherapy alone if not amenable to surgery at all

If Clinical Stage II (solitary mass plus LN mets)
- As above and also LN excision / Radiotherapy
- Metastasis to LN implies higher grade, so chemotherapy as well

34
Q

Give examples of drugs used in mass cell tumour chemotherapy

A

12 week Vinblastine/Pred protocol
Single agent Lomustine
Single agent TK inhibitor

35
Q

What is the most common skin tumour in cat

A

Mass cell tumour

36
Q

Signalment of feline mass cell tumours

A

Older cats (mean age 11years)
Siamese (Burmese, Russian Blue, Ragdoll) predisposed

37
Q

List low grade sarcomas

A

peripheral nerve sheath tumor, haemangiopericytoma (cancer of capillary wall)

38
Q

List medium grade sarcomas

A

Fibrosarcoma, myxosarcoma (neoplasm of connective tissue)

39
Q

List high grade sarcomas

A

Haemangiosarcoma (neoplasm originating from the endothelial cells of the blood vessels) , Feline injection-site sarcomas, Histiocytic sarcoma

40
Q

Outline sarcoma treatment

A

Chemotherapy as an adjunct to surgery for high grade tumours

41
Q

Name drug name for sarcoma treatment

A

Doxorubicin based protocol for most sarcomas eg HSA (need care in cats eg FISS)
Lomustine for histiocytic sarcomas

42
Q

What kind of tumour grades are FISS (Feline injection site sarcoma)

A

High grade

43
Q

Treatment for feline injection site sarcoma

A

Surgery +/- radiotherapy for primary tumour
Chemotherapy for metastasis

44
Q

Presentation of Haemangiosarcoma

A
  1. Superficial /soft tissue mass or haematoma
  2. Splenic Rupture- haemorrhage, collapse, abdominal distension, pale mmbs
  3. Cardiac signs- Muffled heart sounds, arrhythmias, Right sided Heart Failure
  4. Regenerative anaemia (blood loss, microangiopathic haemolysis), thrombocytopenia, neutrophilia, DIC
45
Q

Treatment of Haemangiosarcoma

A

Primary tumour
- Surgical excision of subcutaneous mass
- Radical excision / amputation
- Splenectomy
- Pericardectomy

Metastasis
- Adjunctive chemotherapy
- Doxorubicin
- VAC
-Metronomic therapy

46
Q

What is median survival time of splenic haemangiosarcoma

A

Surgery alone 1-3 months
Sx and Chemotherapy 5-7 months

47
Q

What is median survival time of Intramuscular haemangiosarcoma

A

6-9 months with chemo

48
Q

What is median survival time of skin haemangiosarcoma

A

Surgery alone
Dermal: 26-33 months (UV induced, thin coated dogs eg whippets, Pit Bulls
Subcutaneous: 7-10 months (39-40 mo in 1 study with adjuvant doxorubicin)

49
Q

What is median survival time of cardiac haemangiosarcoma

A

3-4 months with Doxorubicin vs 12 days with no treatment

50
Q

Outline the ‘T’ stage in TMN staging

A

Based off tumour diameter
T1-T4
T1: <2cm
T2: 2-5cm
T3: >5cm
T4: Invading muscle, bone etc

51
Q

Outline the ‘N’ stage in TMN staging

A

N1,2: Ipsilateral or contralateral/bilateral LN
N3: Fixed nodes

52
Q

Outline the ‘M’ stage in TMN staging

A

M1-Distant metastasis

53
Q

Outline the WHO criteria for MCT staging

A

0: Incompletely excised tumour from dermis with no LN involvement
1: Single tumour in dermis without LN involvement
2: Single tumour in dermis with LN involvement
3: Multiple dermal tumours/ Large infiltrating tumours ± LN involvement
4: Any tumour with distant metastasis, blood or BM involvement

Module 17-Urinary, Endocrinology, Oncology (28 decks)

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