Ch 82 STS Flashcards

Question

What are the recommended margins for injection site sarcoma?

Answer 1

5cm lateral marings, 2 fascial planes deep

Answer 2

- may involve resection of spinous processes, partial scapulectomy, lateral body wall resection, and hemipelvectomy to achieve margins - latissimus dorsi or serratus ventralis muscle flaps may be required - survival times 576 to 608 days with surgery alone, significantly higher with radical margins - High recurrence rates > lead to larger margins - 4- to 5-cm, complete resections 95% of the tumors; 5% had tumor cells in the margins. Local tumor recurrence developed in 39%, distant metastasis 21%, and 51% of the cats were alive at 1 yr - 5cm/2 facial planes: overall median survival, 901 days - complete anatomic muscle compartment involved, recurence 14%, surivial >1000d

Answer 3

- In all cases of marginal excision, - increase disease-free interval and survival times comparable in some studies, with reported recurrences of up to 42% - complete excision + radioation also reported

Answer 4

A definitive role for chemotherapy in the treatment of feline injection site–associated sarcomas is still not established - several retrospective studies reported no significant improvement of outcomes of combining surgery + chemo - Doxorubicin possiby increase disease-free interval after surgery - Electrochemotherapy: disease-free interval of 12 months (intraoperative electrochemotherapy) and 19 months (postoperative electrochemotherapy) + following recurence

Answer 5

below the stifle or elbow, or on the tail if possible - removal of masses at injection sites that exist for more than 3 months after injection, that increase significantly in size within 4 weeks, and that are larger than 2 cm in diameter.

Answer 6

- Liposuction has been reported as an effective treatment for lipomas - Masses larger than 15 cm or in areas with increased movement had a higher risk for bruising and seroma formation.

Answer 7

- poorly defined, deep subcutaneous and intermuscular and intramuscular tumors composed of well-differentiated adipose cells - Labrador Retrievers were overrepresented in two reports - presence of infiltration of other tissues, typically muscle and fascia, and do not have a capsule. - locally aggressive and infiltrate surrounding tissue - Surgical resection is the main therapy, and aggressive treatment, including amputation, may be necessary - (MRI) or CT, to investigate invasiveness - nfiltration of important structures, including major nerves, often precludes complete excision. - Multiple surgeries, including liposuction techniques, may prolong life expectancy for years

Answer 8

36-50% Can follow with radiation therapy

Answer 9

neoplastic lipoblasts,266 is a rare tumor of older dogs - usually located subcutaneously and secondarily involve the dermis - 1% to 2% of feline injection site–associated sarcomas - poorly circumscribed, are locally invasive, and rarely metastasize. - FNA: lipid vacuoles that stain strongly with “oil red O" - good prognosis with appropriate surgical management. - Median survival times were 1188 days after wide excision, 649 days after marginal excision

Answer 10

DOGS - dermal hemangiosarcoma may be associated with (ultraviolet) solar exposure (ventrum, medial thigh, and inguinal region) but subcutaneous hemangiosarcoma is more often observed - staged according to tumor depth and invasion: superficial tumors confined to the dermis (stage I), tumors extending into subcutaneous tissues (stage II) tumors invading muscle and fascia (stage III) - stage I: Median survival was 780 days. - Stage II and III guarded prognosis: 23% complete resections because of large size and poor circumscription, 60% metastasis to the lungs, and a median survival of 172 to 307 days. - Other reported sites of metastasis include lymph nodes, spleen, liver, and heart - Completeness of excision was the most important prognostic factor - chemo may improve (high metastatic rate) CATS - more commonly in poorly pigmented skin, more often on the pinnae; nose and face; flank; and digits; and in the subcutis of the abdomen, inguinal region, and axilla. - Tumor site (dermis or subcutis), clean margins, and mitotic rate were prognostic for survival. - favorable disease-free intervals after complete resection and the relatively long survival after incomplete resection of hemangiosarcomas indicate that distant metastasis in cats is not as common

Answer 11

Prospective clinical study. Sample population: Fifty-three dogs with 52 MCT (50 low grade, 2 high grade) and 19 STS (12 grade I, 6 grade II, 1 grade III). followed up to 24mths. narrowest histologic tumor-free margins measured <1 mm in 21 of 52 (40%) MCT and 7 of 19 (37%) STS despite 2-3cm intraop margin (4%) low-grade MCT local recurrence (6%) low-grade MCT developed visceral metastasis One of 2 dogs with high-grade MCT developed local recurrence No local recurrence or metastasis was diagnosed after excision of 19 STS Local recurrence rates among predominantly low- to intermediategrade MCT and STS were low, despite a high prevalence of histologic tumor-free margins <1 mm. **limitations of histopathology in predicting outcomes**

Answer 12

Blinded clinical prospective study. Animals: Twenty-five dogs undergoing surgical excision of STS sensitivity and specificity were 88.2% and 92.8%, Use of OCT to accurately assess surgical margins after STS excision was associated with a high sensitivity and specificity potential utility for real-time surgical margin assessment in dogs Radial trimming methodology: surgical margin assessment from as few as four sections representing the short axis and long axis through the tumor specimen > represent assessment of <1% of the entire surgical margin Optical coherence tomography is a high-resolution, depth-resolved, cross-sectional, microscopic imaging technique > comparable to a lowmagnification histology image

Answer 13

retrospective descriptive study complications associated with postoperative brachytherapy were typically mild, although four cats developed more severe complications. The median time to progression for all cats was 619 days and disease-specific survival time for all cats was 1242 days local failure rate was 54.5% and the distant failure rate was 13.6% due to lung metastasis

Answer 14

positive stains: desmin (19%), vimentin (100%), S-100 protein (95.2%), c-KIT (19%) COX-2 (61.9%), FeLV viral particles (42.9%)

Answer 15

3cm lateral margins + full thickness body wall resection or minimum 2 fascial planes - mDFI 21m, MST 24m - operations for recurrent tumours more likely to result in tumour-related death - local tumour recurrence 38.1% - reoperation for recurrence associated with higher risk of another recurrence (55% vs 33%) - tumour bed biopsies negative for tumour → lower recurrence rate (30.5% vs 76.2%) - 3.8% perioperative mortality

Answer 16

adjuvant radiotherapy for non-injection-site STS in 18 cats - tumour recurrence in 8/18 (44.4%) - 3/8 (37.5%) hypofractionated, 5/10 (50%) conventional - median PFI – overall 2748d, 164d in cats with recurrence - hypofractionated 164d, conventional 2748d – not statistically significant

Answer 17

assessment of histological margins for ‘planned narrow excision’ of MCT and STS using the residual tumour classification scheme (R scheme) - R scheme: R1 (tumour on ink) = incomplete, all other margins R0 (complete) – objective - planned narrow excision = surgeon intention to resect outside gross visible tumour <10mm lateral margins + deep fascial plane - MCT: 6-10mm measured lateral margins → 7% R1, 0-5mm → 55% R1 - no association between histologic grade and R1 margins (no high grade in study) - STS: 6-10mm measured lateral margins → 43% R1, 0-5mm → 41% R1 - wider lateral margins recommended for STS - no association between histologic grade and R1 margins (1 high-grade in study) - R scheme → greater %agreement planned narrow excision (PNE): removing as much tissue as possible within the constraints of the anatomical location and the need for primary wound closure (as healing by second intention would preclude/delay some adjuvant therapies). definition of what entails an “incomplete histological excision” varies between different studies (eg, tumor cells ≤1 mm,5,7,17 2 mm,23 or 3 mm,12 from the inked surgical margin), meaning direct comparisons cannot be performed. The residual tumor classification (“R”) scheme is an objective measure of histopathological margin reporting, with a definition of “tumor on ink” to define an incomplete histological margin (R1), and all other margin lengths being designated as complete (R0).

Answer 18

limb tumors: One strategy to manage these tumors is marginal excision (ME): removing macroscopic disease, followed by active surveillance and/or adjunctive therapy, been shown to have good long-term clinical outcomes in veterinary patients1

Answer 19

24 dogs, retrspec for gross (18) or microscopic (8) infiltrative lipomas he estimated median overall survival (OS) after completing radiotherapy was 4.8 years This study demonstrates lengthy survivals with radiotherapy, even with gross disease, for dogs with infiltrative lipomas

Answer 20

single 20-Gy fraction of radiation in combination with a liquid fiducial marker to treat marginally or incompletely resected STS in the absence of gross disease resulted in similar OST and DFI compared to other previously reported radiation protocols.

Answer 21

15 dogs with recurrent cutaneous/subcutaneous STS and 5 dogs with recurrent cutaneous MCT 46.7%) dogs with recurrent STS had grade shift > 50% higher or lower the **heterogeneity of the tumor** resulted in the assignment of a different grade. This has been demonstrated in studies comparing grade between incisional and excisional biopsies of the same tumors, where grade has been reported to be different in 41% of canine STS and up to 10% of canine MCT. Mitotic activity and necrosis contribute significantly to grade and can be variable throughout the tumor. Variability between pathologists in STS grading is common and should be considered as a potential source of alteration in tumor grades Validated grading schemes that minimize the potential role of intra- and inter-observer variability and account for tumor heterogeneity are needed in companion animals. need more study to dertermine prognostic significance of grade shift

Answer 22

>5cm, 39 dogs >Tumours were removed by at least a narrow margin excision (≥1 cm) and deep fascial plane in all cases. Histological margins were deemed complete in 15/39, close (1–3 mm) in 8/39, incomplete in 4/39, and unknown in 12/39. Minor complications occurred in 10/39 and major complications requiring surgical intervention occurred in 5/39. median 1064 days) reported good postoperative function, with owner reported local recurrence in 2/39. morbidity associated with skin flap reconstruction, case selection should be based on establishing a preoperative diagnosis from incisional biopsy, supported by CT findings, with important consideration given to reconstruction options

Answer 23

These data provide preliminary evidence that excision of cutaneous or subcutaneous STS with CO2 surgical laser is comparable to non-laser methods for the measured outcomes. 98% of the laser energy produced by a CO2 laser is absorbed within 0.1 mm of its target tissue, thermal damage to the surrounding tissue is minimal, ranging from <0.1–0.5 mm cut, coagulate, and seal blood vessels up to 0.5 mm in diameter Laser vaporisation seals small lymphatic vessels and small nerve endings reducing postoperative swelling and pain sensation vaporises bacterial organisms in the tissue, reducing intraoperative wound contamination and risk of postoperative infection (

Answer 24

subcutaneous STS infiltrated into the skin overlying the tumour - incidence higher with higher grade sSTS (100% of Gr2 and 3) (36% of Gr1) - less aggressive cutaneous excision, but still with a local curative intent, as only the skin directly in contact with the sSTS has been proven to be tumor-infiltrated

Answer 25

ECT associates the systemic administration of chemotherapy agents with the delivery of permeabilizing electric pulses with specific amplitude, duration, and waveforms increase the efficacy of lipophobic drugs but minimizing patient toxicoses while maintaining adequate anticancer efficacy in STSs, ECT used in an adjuvant modality since these neoplasms show a limited response to ECT alone studies evidenced a clear clinical gain in terms of local control. In all these adjuvant studies, side effects were limited to local inflammation and occasional wound dehiscence The overall response rate was 95% (21 out of 22 patients) with a mean time to recurrence of 730 days.