Ch 72 - Musculoskeletal Neoplasia and Limb Sparing Surgery Flashcards

1
Q

What % of skeletal neoplasia is OSA?
What are the two reported peaks in age of onset?

A

85%
- Small peak at 18-24m
- Larger peak at 10yr

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2
Q

What are the 2 most common sites of OSA in dogs?
What is the MST with aggressive local and systemis treatment?

A

Distal radius and proximal humerus
MST 10-12m

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3
Q

What is the accuracy rate of a bone biopsy and of an FNA?

A
  • Bone biopsy 80-90%
  • FNA 71% overall, increases to 92% for neoplastic processes
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4
Q

What can be used to increase the diagnostic accuracy of FNA cytology for an OSA?

A

Staining with ALP

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5
Q

What is the rate of gross metastasis at time of diagnosis of OSA?
What sized thoracic mets can be seen on rads and on CT?

A

15% gross metastasis
- Nodules 7-9mm in diameter seen on rads
- 1mm seen on CT

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6
Q

When can bone lesions be seen on radiographs?

A

When there is over 30% bone loss and the lesion is over 2cm

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7
Q

What was the overall rate of bone mets when assessed with rads, nuclear scintigraphy (technetium 99m) and CT scan?

A

27%
Should not do an amuptation in a dog with bone mets in another limb….

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8
Q

What is the reported MST for dogs with LN mets vs not

A
  • MST with LN mets 59 days vs 318 days
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9
Q

What parameter on biochemistry has been shown to be a negative prognostic indicator?

A

Elevated ALP

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10
Q

What are some hypothesised causes of fracture-associated OSA and TPLO-associated OSA?

A
  • Comminuted fracture with complicated healing, implant loosening +/- infection
  • Implant corrosion (Jonas pins, early TPLO)
  • Chronic inflammation
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11
Q

What are the characteristics of a good candidate for a partial scapulectomy?

A
  • Proximal scapula effected
  • Has not extended into surrounding soft tissues
  • Can be removed with a 2-3cm distal margin with preservation of the shoulder joint
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12
Q

What are the 4 historic classifications of hemipelvectomies?

A
  • Total hemipelvectomy
  • Mid to caudal hemipelvectomy
  • Mid to cranial hemipelvectomy
  • Caudal hemipelvectomy
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13
Q

What can be used to reconstruct an abdominal wall defect after hemipelvectomy?

A
  • The sartorius muscle
  • Synthetic mesh
  • Medial thigh musculature (gracilus, adductor)
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14
Q

How much of the sacrum can be removed while retaining normal function of contralateral limb?

A

30%

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15
Q

What are the main options for limb sparing surgery for distal radial OSA?

A
  • Cortical allograft (out of favour)
  • Endoprosthesis
  • Pasteurised Autograft (65C for 40min)
  • Vascularised Ulnar Transposition
  • Bone transport osteogenesis (Distraction osteogenesis)
  • Irradiated Autograft (not recommended)
  • Stereotactic Radiosurgery (high risk of fracture 63%)

Overall complications are very high with post-op infection 40-75% with high risk of recurrence (25%) and implant failure (40%) also concerns

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16
Q

What are the main endoprosthesis implant options?

A
  • VOI
  • BioMedtrix tantalum radial endoprosthesis
  • Fitzpatrick Referrals
17
Q

What modification of the vascularised ulnar transposition has been reported?

A

Lateral manus translation

18
Q

What are the chemotherapy options for OSA?

A
  • Doxorubicin
  • cisplatin/carboplatin
  • combo

MST with amputation alone19.2wk compared to 10-12m with chemo

19
Q

What are bisphosphonates?
What are the two options?

A
  • Osteoclast inhibitors
  • Pamidronate
  • Zoledronate
20
Q

What is the metastatic rate of OSA in cats?
What is the recommended Tx?

A

10%
Recommend amputation without chemotherapy as prolonged survival can be expected is wide or radical excision is achieved

21
Q

What staining can be used for synovial cell sarcoma?
What IHC marker can be used for histiocytic sarcoma?

A

Cytokeratin
CD18

22
Q

What breeds are predisposed to histiocytic sarcoma and synovial myxoma?

A

Histiocytic sarcoma - Rottweilers, Bernese Mt Dog
Synovial myxoma - Doberman Pinschers

23
Q

Between which muscles is the most common site of intermuscular lipoma?

A

Semimembranosus and semitendinosus

24
Q

What is the local recurrence rate after radical excision of infiltrative lipoma?

A

36%
Adjunctive radiation therapy recommended

25
Q

What location of digit SCC has a better prognosis?

A
  • Subungual (1yr survival of 95% vs 60%)