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Chapter 21 - Soft Tissue Sarcomas Flashcards

1
Q

What percentage of skin and SQ tissues in dogs and cats are STS?

A

Dog 15%

Cat 7%

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2
Q

What are some risk factors associated with STS in dogs (5)?

A 
Trauma	
Foreign bodies	
Radiation therapy	
Orthopedic implants	
Parasites - Spirocerca lupi
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3
Q

What is the most common signalment of STS in dogs?

What are the two STS exceptions?

A

No breed or sex predilection
Middle to older aged dogs
Rhabdomyosarcoma in young dogs
Synovial cell sarcoma

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4
Q

Which types of sarcomas are generally excluded from the term STS?

A 
Tumors of hematopoietic orlymphoid origin
HSA
Chondrosarcoma
Histiocytic sarcoma
OSA
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5
Q

What are the most common anatomic sites where STS occur?

A

Skin and SQ

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6
Q

What are some common STS features with regard to their biologic behavior (7)?

A

Pseudoencapsulated and poorly defined histologic margins that infiltrate through fascial planes -locally invasive

Recurrence common after conservative sx

Metastasize hematogenously in 20% of cases

Regional LN metastasis is unusual (except for synovial cell sarcoma)

Histologic grade is predictive of metastasis

Resected tumor margins predict local recurrence

Tumors >5cm generally have a poor response to chemotherapy and RT

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7
Q

What are the classic/typical STS (7)?

A
  • Fibrosarcoma
  • Peripheral nerve sheath tumors (not brachial): malignant Schwanoma, Hemangiopericytoma/Perivascular wall tumor, and Neurofibrosarcoma
  • Liposarcoma
  • Myxosarcoma
  • Malignant mesenchymoma
  • Undifferentiated sarcoma
  • Malignant fibrous histiocytoma or pleomorphic sarcoma
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8
Q

What are the atypical STS (6)?

A
  • Leiomyosarcoma
  • Rhabdomyosarcoma
  • Synovial cell sarcoma
  • Lymphangiosarcoma
  • Oral fibrosarcoma
  • BrachialPNSTs
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9
Q

What things are evaluated when determining the grade of a ST

A
  • Degree of differentiation
  • Mitosis
  • Necrosis
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10
Q

Common locations for fibrosarcoma (3)? What is their cell of origin?

A

Skin, SQ, oral cavity

Malignant fibroblasts

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11
Q

What breeds have been associated with fibrosarcomas?

A

Golden retrievers

Doberman pinscher

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12
Q

What is a unique type of fibrosarcoma?

A

Hi-low fibrosarcoma

Histologically low grade and biologically high grade

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13
Q

Metastasis can be seen in up to ___% of dogs with high-low oral fibrosarcoma.

A

20%

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14
Q

What are the 3 types of PNST?

A
  • Malignant Schwanomma
  • Perivascular wall tumor/hemangiopericytoma
  • Neurofibrosarcoma
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15
Q

What are 2 stains that will help confirm a peripheral nerve sheath tumor?

A
  • S-100 - derived from cells of neural crest origin normally present in cells derived from the neural crest (Schwann cells, and melanocytes), chondrocytes, adipocytes, myoepithelial cells, macrophages, Langerhans cells, dendritic cells, and keratinocytes. Some FSA +.
  • Vimentin - protein expressed in mesenchymal cells (all sarcomas positive)
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16
Q

In which 3 locations can PNST occur and which one is more treatable?

A
  • Peripheral group - involving the nerves away from brain and spinal cord; most treatable
  • Root group - involving the nerves immediately adjacent to the brain or spinal cord
  • Plexus group - brachial or lumbosarcral plexus
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17
Q

What % of grade III PNST will invade the spinal cord?

A

50%

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18
Q

What is the most common location for lipomas to occur?

A

SQ tissue

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19
Q

What is the difference in histology between lipomas and liposarcomas?

A

Lipomas have indistinct nuclei and cytoplasm resembling normal fat, whereas liposarcomas are characterized by increased cellularity, distinct nuclei, and abundant cytoplasm with one or more droplets of fat. Morphologically, liposarcomas are usually firm.

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20
Q

Where are intermuscular lipomas usually located?

A

In the intermuscular region of the caudal thigh of dogs, particularly between the semitendinosus and semimembranosus muscles

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21
Q

What is the most common complication seen with removal of intermuscular lipomas?

A

Seroma formation if a penrose drain is not used

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22
Q

What are infiltrative lipomas?

A

Uncommon tumors composed of well-differentiated adipose cells without evidence of anaplasia. Cannot be differentiated from simple lipomas. Considerd benign and do not metastasize. Commonly invade adjacent muscle, fascia, nerve, myocardium, joint capsule, and even bone. Aggressive treatment such as amputation may be needed.

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23
Q

What is a diagnostic challenge seen when using CT to evaluate infiltrative lipomas?

A

It cannot be distinguished from normal fat and do not contrast enhance

Liposarcomas, however, DO contrast enhance

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24
Q

What are liposarcomas?

A

Malignant tumors arising from adipoblasts

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25
Q

What are some locations for liposarcomas?

A

SQ locations along the ventrum and extremities

Can occur in bone and abdominal cavity

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26
Q

What is the metastatic potential of liposarcomas and what are the most common sites they metastasize to?

A

Low to moderate

Lungs, liver, spleen, and bone

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27
Q

What is the MST for liposarcomas with wide resection, marginal resection, and incisional biopsy?

A

MST 1200 days - wide surgical resection
MST 650 days - marginal resection
MST 180 - incisional biopsy

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28
Q

What are the 5 histologic subtypes of liposarcomas?

Is the histologic subtype a prognostic indicator?

Which type metastasizes more common?

Most common one to metastasize to extrapulmonary soft tissue structures?

A

Histologic subtypes:

  • Myxoid - more likely to met to extrapulmonary sites
  • Well-differentiated
  • Dedifferentiated
  • Poorly differentiated (round cell)
  • Pleomorphic - METS MORE COMMON

Prognosis not affected by subtype

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29
Q

Cell of origin for leiomyoma and leiomyosarcoma?

A

Smooth muscle cell

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30
Q

Most common location for leiomyoma? Any predisposition?

Leiomyosarcomas?

A

Leiomyoma - stomach; GI has a male predisposition

LSA - jejunum, cecum

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31
Q

Which type of STS can present with PNS seen?

Which are the PNS (3)?

A 
Leiomyoma/leiomyosarcoma
PNS:	
* Hypoglycemia	
* Nephrogenic diabetes insipidus	
* Secondary erythrocytosis
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32
Q

What is the tx of choice for leiomyomas of the vulva or vagina?

A

OVH as they are hormone-dependent

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33
Q

How do leiomyomas of the vagina and vulva usually look?

A

Pedunculated, may protrude from the vulva

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34
Q

What is the metastatic potential of leiomyosarcomas? On what does it depend?

Name 3 places and their metastatic rate.

A

Moderate; depends on the primary site of origin

Heptatic: 100%
Other intraabdoiminal sites: 50%
Dermal: 0% met rate

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35
Q

What are the most common sites of metastasis for leiomyosarcomas (3)?

A

Regional LN, liver, mesentery

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36
Q

What are the most common tumors of the GI tract in dogs and cats?

A

Dogs:

  • Lymphoma
  • Adenocarcinoma
  • Leiomyosarcoma/GIST

Cats:

  • Lymhoma
  • Adenocarcinoma
  • MCT
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37
Q

The vast majority of previously diagnosed GI leiomyomas and leiomyosarcomas have been reclassified as what type of tumor, based on IHC?

A

Gastrointestinal stromal tumors or GI stromal -ike tumors

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38
Q

What is the difference in IHC staining between leiomyosarcomas and GISTs?

What is the difference between GISTs and GI stromal-like tumors?

A

Leiomyosarcomas: SMA+, desmin+

GIST: c-kit+, CD34+, vimentin+, and +/- SMA, desmin, s-100

GI-stromal like : no c-kit staining, rest same as GIST

Tissue microarrays:
100% specific for SMA, desmin, CD117
100% sensitive for CD117

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39
Q

Is there a sex predisposition for infiltrative lipomas and leiomyomas?

A

Infiltrative lipomas - females

Leiomyomas - males; GI tract

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40
Q

Intestinal perforation is present in ___% of dogs with leiomyosarcomas.

A

50%

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41
Q

What is the tx of choice for leiomyoma,leiomyosarcomas, GISTs, and GI stromal like tumors?

A

Surgical resection

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42
Q

The reported MST for dogs with leiomyosarcoma and GISTs that survive the immediate post operative period is up to ___ months.

A

37 months (3 yrs)

Questionable whether metastasis at the time of sx affects MST or not

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43
Q

What is the MST of dogs with splenic leiomyosarcoma?

A

8 months

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44
Q

What is the cell of origin for rhabdomyosarcomas?

A

Myoblasts or primitive mesenchymal cells capable of differentiating into striated muscle cells

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45
Q

What are the most common sites for rhabdomyosarcomas in dogs (4)?

A

Skeletal muscle of the tongue, larynx, myocardium, and bladder

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46
Q

What is the metastatic potential of rhabdomyosarcomas and where do they tend to metastasize?

A

Low to moderate met potential

Lungs, liver, spleen, kidneys, adrenal glands

Metastatic potential and prognosis in dogs has not been identified because these tumors are rare and rarely treated with curative intent.

Sx with or w/o RT can be encouraging.

In humans, multimodal therapy (sx, RT, chemo) has significantly improved survival times.

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47
Q

What are the histologic classifications for rhabdomyosarcomas?

A

Embryonal - head and neck region of older dogs

Botryoid - urinary bladder of young, female large breed dogs; St. Bernard overrepresented, grape-like appearance

Alveolar

Pleomorphic

In humans, histologic classificcation influences prognosis, botryoid good, embryonal intermediate, alveolar poor

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48
Q

What are the IHC stains and criteria used to diagnose rhabdomyosarcomas? What are some skeletal muscle specific markers?

A

At least 1 muscle specific marker and absence of smooth muscle markers is needed

  • Src-actin
  • Myoglobin
  • Myogenin
  • Myogenic differentiation (MyoD)

All are vimentin and desmin positive

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49
Q

What are lymphangiosarcomas and were do they arise from? Signalment?

A

Rare tumors seen in young dogs and cats that arise from lymphatic endothelial cells.

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50
Q

How do lymphangiosarcomas look grossly?

A

Usually soft, cystic-like, and edematous.

Usually SQ tissue

Poorly demarcated margins.

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51
Q

Where do lymphangiosarcomas typically occur?

A

SQ tissue

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52
Q

What is the metastatic potential for lymphangiosarcomas, metastatic rate at diagnosis, and where do they typically metastasize to?

A

Moderate to high
40%
Lymph nodes

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53
Q

How do lymphangiosarcomas look histologically and with what tumor can it be confused?

What IHC markers can be used to clear up confusion?

A

They resemble normal endothelial cells.

May be confused with HSA because of the vascular channels, however, RBC are not seen within channels.

Lymphatic and endothelial cells - both positive for factor VIII-RA

Lymphatic endothelial cells: PROX-1, LYVE -1

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54
Q

MST for canine lymphangiosarcoma when tx with surgery vs sx, RT, and chemo?

A single case report of a CR to which chemo drug exists?

A

MST with sx - 490d

MST with sx, RT, chemo - 570d

9 months after complete remission with doxo

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55
Q

What are dermal hemangiomas and HSA associated with?

A

UV light exposure in short-haired dogs with poorly pigmented skin

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56
Q

What is one of the major complications associated with hemangiomas?

A

Severe anemia due to tumor associated blood loss

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57
Q

What is the treatment of choice for hemangiomas?

A

Surgical excision - usually curative

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58
Q

How are canine cutaneous HSA staged? What are the stages?

A

According to depth of involvement

Stage I - confined to dermis

Stage II - extending into SQ tissues (hypodermal)

Stage III - involving underlying muscle(hypodermal)

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59
Q

What is the treament of choice fore cutaneous HSA?

A

Wide surgical excision +/- doxo (if stage II or III)

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60
Q

What is the ORR of doxorubicin for cutaneous HSA in the gross dz setting? Median duration of response?

A

40%

50 days

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61
Q

What is the metastatic rate and MST in dogs with stage I, II, and III dermal HSA when treated with surgery.

Overall locoregional recurrence rate?

A

Stage I - 30%, MST 780 days (2yrs)

Stage II-III - 60%, MST 170-300d

RR - 77%

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62
Q

In dogs with SQ and IM HSAs treated with surgery, +/- radiation therapy,and doxorubicin, what is the median DFI and MST?

A

SQ - DFI 1550 days, MST 1190 days

IM - DFI 270 days, MST 270 days (9m)

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63
Q

In cats, where do cutaneous HSA usually occur? Metastatic behavior?

A

Poorly pigmented skin, particularly skin of pinna, head, and ventral abdomen and SQ tissue of the inguinal region

Mets can occur, but less frequently reported

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64
Q

What is the local recurrence rate after surgical excision of feline dermal HSA?

What is the median time to tumor recurrence?

A

50-80%

420 days(14m)

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65
Q

The MST for cats with cutaneous HSA that are treated with wide surgical resection is ___ days vs no therapy ___ days.

A

MST w/tx >c4yrs

MST w/o 60 days

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66
Q

From where do synovial cell sarcomas arise?

A

Synoviocytes of the joint capsule and tendon sheath

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67
Q

What are the 2 different types of synoviocytes?

A

Type A - phagocytic and resemble macrophages

Type B - fibroblastic; produce glycosaminoglycan

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68
Q

From what type of synoviocytes do synovial cell sarcomas arise?

What about histiocytic sarcomas?

What is the exception?

A

Synovial cell sarcomas - Type B (fibroblastic)

Histiocytic sarcoma - Type A (phagocytic macrophage resemblance)

Periarticular histiocytic sarcoma - arises from dendritic cells; cannot use CD18 to differentiate between DC and type A macrophages

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69
Q

What immmunohistochemical cell marker, utilized to dx histiocytic sarcomas, cannot differentiate between macrophages (type A synoviocytes)and dendritic antigen presenting cells?

A

CD18

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70
Q

IHC markers to differentiate between synovial cell sarcoma, histiocytic sarcoma, and malignant fibrous histiocytoma?

A

SCS; vimentin+, pancytokeratin +/- (small population)

Histiocytic sarcoma; vimentin+, CD18+

Malignant fibrous histiocytoma: vimentin+, SMA+

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71
Q

Even though ____ is the most common synovial tumor in dogs, a study evaluating synovial tumors in 35 dogs found that ____ was more common within the population of the study.

A

Synovial cell sarcoma, synovial histiocytic sarcoma

72
Q

How are synovial cell sarcomas graded (3 things) and what are the different grades? Is this grading system prognostic?

A

Nuclear pleomorphism, mitotic figures, necrosis

Grade I, II, and III

Yes

73
Q

What is the metastatic potential of synovial cell sarcomas? What are the most common metastatic sites?

A

Moderate to high (higher risk vs STS)

Regional LN, lungs

74
Q

Up to ___ % of dogs with synovial cell sarcomas have evidence of metastasis at the time of diagnosis and ___ % by the time of euthanasia.

A

30% at the time of diagnosis

55% at the time of euthanasia

75
Q

How common are synovial cell sarcomas in cats? How do they behave?

A

Rare.

Histologic appearance, biologic behavior, distribution of mets same as dogs. Exception: rare bone involvement.

76
Q

What is the typical signalment for synovial cell sarcomas in dogs? Where do they most commonly occur?

A

Large breeds
Flat-coated and Golden retrievers commonly affected
No sex predilection

Common locations: larger joints - stifle, elbow, shoulder

77
Q

What is the most common presenting complaint in dogs with synovial cell sarcomas?

A

Lameness

78
Q

What are some radiographic features of synovial cell sarcomas in dogs?
How are these be different from OSA?
How do these differ in cats?

A

Periarticular soft tissue swelling, bone invasion manifested as ill-defined periosteal reaction and/or multifocal punctate osteolyitic lesions, can involve sites on either side of the joint.

Cats - bone involvement is rare in cats

79
Q

What is the treatment of choice? Why?

A

Limb amputation

Local recurrence is common and MST is better (850d vs 450 if marginal resection)

Forequarter amputation, hemipelvectomy or coxofemoral diasrticulation - as much as possible

80
Q

When is systemic chemotherapy warranted for synovial cell sarcomas?

What do we know about the chemotherapy response in humans?

What chemo drugs are used (2)?

A

Grade III non-metastatic synovial cell sarcomas

In humans, tend to me more responsive vs other STS

Anthracyclines (doxo) and ifosfamide are used

Benefit unknkown, but may be warranted

81
Q

What are some prognostic factors in dogs with synovial cell sarcomas (4)?

A

Stage/presence of metastasis, histologic grade, extent of surgical treatment, +cytokeratin IHC

82
Q

What is the MST in dogs with synovial cell sarcoma with metastasis vs without?

A

W/o mets >36m

With mets <6m

83
Q

What is the MST in dogs with synovial cell sarcoma when treated with amputation vs marginal resection?

A

Amputation - MST 850d (~30m)

Marginal resection - MST 455d

84
Q

What is the MST for the different grades of canine synovial cell sarcoma?

A

> 48m - grade I
36m - grade II
7m - grade III

85
Q

What is the MST and metastatic rate for dogs with synovial myxoma, histiocytic sarcoma, and other types of synovial tumors?

A

Synovial myxoma - MST 30m, metastatic rate 0%

Histiocytic sarcoma - MST 5m, metastaticrate 90%

Other types - MST 3.5 months, metastatic rate 100%

86
Q

A diagnosis of sarcoma is obtained via FNA in ___% of the cases?

A

65%

87
Q

What biopsy technique is not recommended for diagnosing a STS?

A

Excisional biopsy - rarely curative and subsequent surgery required to achieve complete margins is usually more aggressive, resulting in additional morbidity and costs.

Further attempts at resection have a negative impact on survival time.

88
Q

What is considered a superficial and deep STS?

A

Superficial - above the fascial plane, not invading the fascia

Deep - located deep to the fascia, invades tha fascia, or both

89
Q

What is the most important tx for management of STS?

A

Surgery!

90
Q

What are the recommended surgical margins for STS?

A

3cm lateral margins

1 fascial plane deep

91
Q

What is considered close surgical margins?

A

1-3mm

92
Q

For which grade of STS should adjuvant chemotherapy be recommended?

A

Grade III

93
Q

What is the recurrence rate for grade I, II, and III STS after marginal resection?

A

Grade I - 7%
Grade II - 35%
Grade III - 75%

94
Q

What is the treatment of choice for incompletely resected grade III STS?

A

RT, 2nd surgery, adjuvant chemo

95
Q

Metronomic chemotherapy for incompletely excised STS are ideally recommended in which cases?

How do Tregs and MVD change after metronomic chemotherapy? Doses?

What is the median DFI in dogs treated with metronomic chemotherapy vs those not treated?

A

Grade I and II; probably just grade II as grade I only has a 7% chance of recurrence

Has been shown to prolong disease free interval time

A 15.0mg/m2/day dose resulted in decreased # and % Tregs along with decreased tumor MVD

A 12.5mg/m2/day decreased Treg # only; no change in % Tregs or MVD

DFI > 410d in treated dogs vs 210

96
Q

Approximately what % of dogs with STS have their tumor incompletely excised?

A

22%

97
Q

In a study of 104 dogs with STS managed with sx alone in non-referral practices, fewer than ___% were excised with 3cm margins and local tumor recurrence was reported in ___% of dogs.

A

10%,

28%

98
Q

What is the metastatic rate for grade I, II, and III STS in dogs?

What is the median time to metastasis?

A

Grade I - II: 8 to 15%
Grade III - 41 to 44%

Median time to mets 1 year

99
Q

In a 2004 study of 35 dogs that underwent marginal excision for STS of the extremities the recurrence rate was ___%.

A

11%

100
Q

What is the treatment of choice for incompletely excised STS?

A

A second surgery is preferred over RT because local tumor control is better.

101
Q

How long after surgery for removal of a STS can RT be implemented?

A

> 7 days after - to minimize sx complications such as dehiscence and delayed healing

102
Q

Although the optimal fractionation and total dose schemes for canine STS have not been determined, doses greater than ___Gy are recommended.

A

Doses higher than 50 Gy

103
Q

Local tumor control and survival time for incompletely resected STS treated with post operative RT.

The median time to local recurrence is ___ to > ___ days.

Local tumor recurrence is reported in ___ to ___ % of dogs by 1-yr and ___ to ___% in the long term.

A

Median time to recurrence 700 > 800 days

5-30% by 1-year

15-60% in the long term

104
Q

What is the overall MST in dogs with incompletely resected non-oral STS when treated with definitive RT?

Control rates at 1 and 2 years?

Survival rate at 3 and 5 years?

A

MST 2270 (6yrs)

Control rates: 1 yr 80-95%, 2 yrs 70-90%

Survival rates: 3-yrs 68%, 5-yrs 76%

105
Q

What % of dogs with measurable STS respond to RT?
MST?

Dogs with tumors in which locations may have longer PFI/MST?

What other therapies have been shown to enhance ST?

A

30-50%

300-500d

Extremities

Metronomic chemo - longer OST, but PFI the same

106
Q

The median duration of local control in dogs with STS when treated with RT plus local hyperthermia is ___ days.

A

750 days

107
Q

What are some negative side effects that can be seen with whole body hyperthermia and RT?

A

Does not improve response rate when compared to RT, increased risk of metastasis

108
Q

In dogs with STS treated with sx and RT, a mitotic rate of >__/10 HPF is associated with increased risk for local recurrence and shorter survival times.

A

9/10HPF

109
Q

Doses lower than ___Gy are recommended for preoperative RT indogs STS to reduce surgical complications. What is the goal of preoperative RT?

A

<50 Gy

Eradication of the microscopic cells at the peripheral margin

110
Q

What are indications for chemotherapy in dogs with STS (4)?

A

Grade III tumors
Metastatic disease
Intra-abdominal STS (leiomyosarcoma, splenic sarcoma)
Histologic types with higher rates of metastasis (HS, hypodermal HSA, SCS, rhabdos, LAS)s

111
Q

Doxorubicin based protocols for canine STS, either alone or in combination with cyclophosphamide, have shown an overall response rate of ___% in the gross disease setting.

A

23%

112
Q

ORR of mitoxantrone in dogs with measurableSTS (range)?

A

0-33%

113
Q

A complete response rate of ___% has been seen with ifosfamide in dogs with STS.

A

15%

114
Q

What are the two most common chemo drugs used for the treatment of STS in humans? What is the response rate for both?

A

Doxorubicin and ifosfamide, <30%

It does however, prolong disease free interval times

115
Q

What was the main finding in a 2005 study that compared the outcome of dogs with high-grade STS when treated with and without adjuvant doxorubicin?

A

No significant overall survival time compared to surgery alone

116
Q

What are some poor prognostic factors when it comes to STS (6)?

A 
Large tumor size; >5cm3
Incomplete surgical margins
High histologic grade
High MI
% of necrosis
local recurrence
117
Q

When tumors have a MI of ___ or more, metastasis is ___x more likely and the risk of tumor related deaths is ___x more likely.

Tumor related deaths are also ___x more likely when there is > than ___% of necrosis.

A

20 or >

Metastasis 5x more likely

Tumor related deaths 2.6x more likely

Necrosis >10%, tumor death 2.8x more likely

118
Q

The MST for dogs with STS ranges from ___ days when treated with surgery alone to ___ days with surgery and adjunctive RT.

A

4yrs

6 yrs

119
Q

Overall, what % of dogs with STS eventually due of tumor related causes?

A

33%

120
Q

To which vaccines have feline vaccine induced sarcomas been linked to?

What other 3 things have also been associated with injection site sarcomas?

A

Killed rabies and killedFeLV (has been proven that its not related)

Microchips, lufenuron, aluminum

Aluminum - may contribute to tumor initiation and promotion in the absence of an inflammatory response, induces fibroblast proliferation

Adjuvant containing vaccines* most likely the cause
Anadjuvantis a substance that is added to avaccine to increase the body’s immune response to thevaccine

Vaccine associated sarcoma = injection site sarcoma

121
Q

What is the reported time to tumor development after vaccination?

A

4 weeks to 10 years after vaccination

122
Q

What is the theory behind vaccine associated sarcomas?

A

Post vaccination inflammatory reactions that lead to uncontrolled fibroblast and myofibroblast proliferation and eventual tumor formation, either alone or with immunologic factors.

This is supported by histologic transition zones of inflammation to sarcoma within histopathology nd because of microscopic foci of sarcoma located in areas of granulomatous inflammation.

Lymphocytes secrete PDGF, recruit macrophages, and lead to fibroblast proliferation

123
Q

How can intraocular sarcomas develop in cats?

A

Trauma or chronic uveitis

So more or less the same as injection site sarcomas, secondary to inflammation

124
Q

What are cells that can be seen in association with injection site sarcomas, adjaent to neoplastic tissue (4)?

A

Lymphocytes
Macrophages
Fibroblasts
Myofibroblasts

125
Q

The volume of tumor seen on CT is approximately ___ the volume of what is measured using calipers.

A

2x

126
Q

The vaccine associated feline sarcoma task force recommends treatment for masses after vaccination based on what?

A

3-2-1 rule

If mass is still evident 3 months after vaccination

If the mass is larger than 2cm in diameter

If the mass increases in size 1 month after vaccination

127
Q

What are some negative prognostic indicators for DFI and MST in cats with ISS treated with sx (3)?

A

Marginal resection
Increased # of surgeries
Surgery performed by a non-specialist

128
Q

VAFS Task Force recommends what minimal margins? Problem with this? Best margin recommendations?

A

Minimal: 2cm lateral and 2cm deep
Problem: <50% completely excised
5cm lateral and 2 fascial planes deep

129
Q

What is the median time to tumor recurrance for FVAS after marginal, wide, and radical surgical resection?

A

Marginal - 80 days
Wide - 325 days
Radical - 420 days

130
Q

When surgery for removal of FVAS is performed at a non referral institution, the time to tumor recurrence is ___ days, compared to ___ days, when performed at a referral institution.

A

66 days GP vs 270 days referral institution

131
Q

Despite treatment with curative intent surgery, using 2 to 3cm margins and one fascial plane deep resection, complete resection is achieved in less than ___% of cats.

A

<50%

132
Q

Median DFI and survival time are both greater than ___ months when complete histologic resection is achieved.

MST in incompletely excised?

A

> 16 months

200d (6.6m)

133
Q

Answer the following questions for cats with ISS treated with 5cm lateral margins and 2 fascial plane deep for surgery.

Completely excised in what %?

Local tumor recurrence in what %?

Major complications in what %?

What was the overall MST?

What 2 factors were associated negatively with survival time?

A

97% complete excision rate

14% recurrence rate

11% major complications; dehiscence in interscapular tumors most common

11% metastatic rate

MST 907 days (2.4 yrs)

134
Q

On mutlivariate analysis, what factors of the STS grading scheme have been stastically associated with prognosis and how?

A

Mitotic index - metastasis, local recurrence, MST

Tumor necrosis - survival after sx

135
Q

What is the reported agreement between pathologists on STSgrade?Which factor is most reliably reported?

A

90%

Mitotic index

136
Q

Perivascular wall tumors/hemangiopericytomas have a higher serum concentration of what 2 growth factors?

A

VEGF

PDGF-B

137
Q

What type of STS is less likely to recur post-operatively? What is the recurrence rate for this tumor?

A

Perivascular wall tumors

9%

138
Q

What is the median PFS and MST in dogs with oral fibrosarcomas when treated with surgery and other treatment modalities, like RT?

A

PFS 300-650d (10m to ~2yrs)

MST 500-750d (1.5 to 2yrs)

139
Q

What are some identified prognostic indicators in dogs with oral FSA (6)?

A 
Grade
Location
Tumor size
Type of surgery performed
Margins obtained
RT post sx
140
Q

As opposed to perivascular wall tumors, PNST are more commonly positive for which 2 IHC markers?

A

NGFR

Olig2

141
Q

What % of perivascular wall tumors highly expresses COX-2?

A

35%

142
Q

Compartmental resection of PNST for limb preservation.
Tumor recurrence in what % of cases?

Limb function was good in what % of dogs?

MST?

Prognostic factors identified and how did it affect MST?

A

Recurrence 30%

Good limb function in 63%

MST 1300d (3.5yrs)

Margin status; incomplete MST 500d, complete MST 6yr

143
Q

Stereotactic RT in dogs with PNST of the intracranial trigeminal nerve results in a median-disease specific ST of how much?

What was the SRT protocol used?

A

2 years

Protocol: 8 Gy x 3 daily or EOD

144
Q

MDM2 expression has been shown to correlate with which STS type?

A

Grade 1 liposarcomas - highly expressed

145
Q

Liposarcomas infrequently express immunopositivity to muscle antigens (desmin, SMA, myogenin), but are commonly positive for what?

A

UCPI - a fat marker

Also expressed in skeletal muscle

146
Q

What is the correlation between expression of FGF2 and PDFGR-B and MI in dogs with liposarcoma?

A

High FGF2 - low MI (negative correlation)

High PDGFR-B - high MI (positive correlation)

147
Q

How can lipomas be differentiated from liposarcomas on CT?

A

Lipomas: do not usually contrast enhance, lack hyperattenuation, are well defined

Liposarcomas: heterogenously contrast enhance, are irregular, can have mineralization

148
Q

What is the MST in dogs with splenic liposarcomas?

Negative PI (2)?

A

620d (1.7 yrs)

Metastatic dz at the time of surgery; MST 45d
Grade 2 or 3 tumors; MST 200d and 70d, respectively

149
Q

MST of dogs with metastatic splenic liposarcoma?

A

45d

150
Q

PNS are most commonly seen with which form of leiomyoma/leiomyosarcoma?

A

GI

151
Q

What % of dogs with GI leiomyosarcoma can have intestinal perforation with localized to diffuse peritonitis?

A

50%

152
Q

Identified prognostic factors in dogs with dermal HSA (2)?

A

Tumor location

Solar-induced changes; more benign (MST 1550d vs 550d)

153
Q

Most common tumor of the canine joint/synovium?

A

Synovial cell sarcoma - type B synoviocytes

154
Q

What growth factor is elevated in serum of dogs with STS but decreases after surgical resection?

A

VEGF

155
Q

What is the % of agreement for tumor grade between pre-treatment biopsies and excisional biopsies in dogs with STS?

What % of pre-treatment biopsies underestimate the grade vs overestimate it?

A

60% agreement

30% underestimate

12% overestimate

156
Q

What is the sensitivity and specificity of pre-treatment biopsies for high grade STS in dogs?

A

95% specific
33% sensitive

-You can believe a high grade result, but not a low grade

157
Q

What is the recurrence rate and median DFI of dogs with STS that have it excised (mostly marginally/narrowly) in GP practices? The majority are what grade?

What were prognostic indicators for recurrence (1) and reduced survival (3) in this study?

A

Recurrence - 20%
DFI - not reached
I or II; only 6.6% high grade

Recurrence: tumor grade; high grade tumors 5.8x more likely to recur

Reduced survival: firmly attached tumors, necrosis extent, mitosis

158
Q

MST for dogs with oral STS treated with sx and RT?

A

540d (1.5 yrs)

159
Q

Mutations or loss of which gene/protein have been associated to cats wtih injection site sarcomas?

A

p53

160
Q

p53 mutations/alterations have been identified in up to ___ to ___% of cats with VAS.

What staining pattern is consistent with VAS? In what % of tumors does it occur?

How do p53 alterations affect prognosis (2)?

A

60 to 80%; LOH most common

Cytoplasmic staining in 44% of tumors

Shorter time to recurrence and ST

161
Q

Although Withrow states that FeLV has not been detected in ISS, a newer study found viral particles in ___% of the cases

A

43%

162
Q

What % of ISS are grade III and I.

A

III - 60%

1- 5%

163
Q

What is the reported mortality rate in cats with interscapular or body wall ISS that often require body wall resection?

A

4%

164
Q

Identified risk factor (1) for wound healing complications in cats with ISS after wide resection?

Wound healing complications can occur in up to ___% of cats undergoing wide surgical resection.

A

Surgical time

40% of cats with truncal ISS

165
Q

Recurrence rate in incompletely excised ISS?

A

Up to 76%

166
Q

How long after sx should RT be initiated for cats with incompletely excised ISS? Why (2)?

A

10 to 14 days

Longer wait times decreases DFI and MST

167
Q

Recurrence rate post RT for ISS (range)?

A

30 to 40%

168
Q

MST in cats with incompletely excised ISS treated with definitive RT (range)?
1, 2, 3 yr survival rates?

A

600 to 1300d
1 - 86%
2- up to 71%
3, up to 68%

169
Q

Metastatic rate in cats with ISS? Median time to metastasis?

A

0-25%

260-300d (8.5 to 10m)

170
Q

ORR of doxorubicin and +/- cyclophosphamide in cats with ISS?

MST in responders vs non responders?

A

40-50%

Responders 8m vs 80d in non responders

171
Q

MST for sx, RT, and doxo vs sx and RT alone?

A

Sx, RT, chemo - 29m (2.4 yrs)

Sx and RT - 5m

172
Q

MST in cats with interscapular tumors tx with neoadjuvant epirubicin, followed by sx, and 2 more doses of chemo? Recurrence rate?

A

MST not reached, 80% alive or censored due to death from other causes

14% local recurrence

173
Q

Ifosfamide ORR in cats with ISS?

A

40%

174
Q

CCNU ORR, PFS, and duration of response in cats with ISS?

A

ORR 25%, 1CR, 6PR

Median PFS 2m (60d)

Medaian duration of response 2.6m (80d)

175
Q

Palladia response for ISS?

A

No response

Withrow (13 decks)

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