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%
2
Q
What are some risk factors associated with STS in dogs (5)?
A
Trauma Foreign bodies Radiation therapy Orthopedic implants Parasites - Spirocerca lupi
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
4
Q
Which types of sarcomas are generally excluded from the term STS?
A
Tumors of hematopoietic orlymphoid origin HSA Chondrosarcoma Histiocytic sarcoma OSA
5
Q
What are the most common anatomic sites where STS occur?
A
Skin and SQ
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
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
8
Q
What are the atypical STS (6)?
A
- Leiomyosarcoma
- Rhabdomyosarcoma
- Synovial cell sarcoma
- Lymphangiosarcoma
- Oral fibrosarcoma
- BrachialPNSTs
9
Q
What things are evaluated when determining the grade of a ST
A
- Degree of differentiation
- Mitosis
- Necrosis
10
Q
Common locations for fibrosarcoma (3)? What is their cell of origin?
A
Skin, SQ, oral cavity
Malignant fibroblasts
11
Q
What breeds have been associated with fibrosarcomas?
A
Golden retrievers
Doberman pinscher
12
Q
What is a unique type of fibrosarcoma?
A
Hi-low fibrosarcoma
Histologically low grade and biologically high grade
13
Q
Metastasis can be seen in up to ___% of dogs with high-low oral fibrosarcoma.
A
20%
14
Q
What are the 3 types of PNST?
A
- Malignant Schwanomma
- Perivascular wall tumor/hemangiopericytoma
- Neurofibrosarcoma
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)
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
17
Q
What % of grade III PNST will invade the spinal cord?
A
50%
18
Q
What is the most common location for lipomas to occur?
A
SQ tissue
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.
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
21
Q
What is the most common complication seen with removal of intermuscular lipomas?
A
Seroma formation if a penrose drain is not used
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.
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
24
Q
What are liposarcomas?
A
Malignant tumors arising from adipoblasts
25
What are some locations for liposarcomas?
SQ locations along the ventrum and extremities
Can occur in bone and abdominal cavity
26
What is the metastatic potential of liposarcomas and what are the most common sites they metastasize to?
Low to moderate
Lungs, liver, spleen, and bone
27
What is the MST for liposarcomas with wide resection, marginal resection, and incisional biopsy?
MST 1200 days - wide surgical resection
MST 650 days - marginal resection
MST 180 - incisional biopsy
28
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?
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
29
Cell of origin for leiomyoma and leiomyosarcoma?
Smooth muscle cell
30
Most common location for leiomyoma? Any predisposition?
Leiomyosarcomas?
Leiomyoma - stomach; GI has a male predisposition
LSA - jejunum, cecum
31
Which type of STS can present with PNS seen?
Which are the PNS (3)?
```
Leiomyoma/leiomyosarcoma
PNS:
* Hypoglycemia
* Nephrogenic diabetes insipidus
* Secondary erythrocytosis
```
32
What is the tx of choice for leiomyomas of the vulva or vagina?
OVH as they are hormone-dependent
33
How do leiomyomas of the vagina and vulva usually look?
Pedunculated, may protrude from the vulva
34
What is the metastatic potential of leiomyosarcomas? On what does it depend?
Name 3 places and their metastatic rate.
Moderate; depends on the primary site of origin
Heptatic: 100%
Other intraabdoiminal sites: 50%
Dermal: 0% met rate
35
What are the most common sites of metastasis for leiomyosarcomas (3)?
Regional LN, liver, mesentery
36
What are the most common tumors of the GI tract in dogs and cats?
Dogs:
* Lymphoma
* Adenocarcinoma
* Leiomyosarcoma/GIST
Cats:
* Lymhoma
* Adenocarcinoma
* MCT
37
The vast majority of previously diagnosed GI leiomyomas and leiomyosarcomas have been reclassified as what type of tumor, based on IHC?
Gastrointestinal stromal tumors or GI stromal -ike tumors
38
What is the difference in IHC staining between leiomyosarcomas and GISTs?
What is the difference between GISTs and GI stromal-like tumors?
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
39
Is there a sex predisposition for infiltrative lipomas and leiomyomas?
Infiltrative lipomas - females
Leiomyomas - males; GI tract
40
Intestinal perforation is present in ___% of dogs with leiomyosarcomas.
50%
41
What is the tx of choice for leiomyoma, leiomyosarcomas, GISTs, and GI stromal like tumors?
Surgical resection
42
The reported MST for dogs with leiomyosarcoma and GISTs that survive the immediate post operative period is up to ___ months.
37 months (3 yrs)
Questionable whether metastasis at the time of sx affects MST or not
43
What is the MST of dogs with splenic leiomyosarcoma?
8 months
44
What is the cell of origin for rhabdomyosarcomas?
Myoblasts or primitive mesenchymal cells capable of differentiating into striated muscle cells
45
What are the most common sites for rhabdomyosarcomas in dogs (4)?
Skeletal muscle of the tongue, larynx, myocardium, and bladder
46
What is the metastatic potential of rhabdomyosarcomas and where do they tend to metastasize?
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.
47
What are the histologic classifications for rhabdomyosarcomas?
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
48
What are the IHC stains and criteria used to diagnose rhabdomyosarcomas? What are some skeletal muscle specific markers?
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
49
What are lymphangiosarcomas and were do they arise from? Signalment?
Rare tumors seen in young dogs and cats that arise from lymphatic endothelial cells.
50
How do lymphangiosarcomas look grossly?
Usually soft, cystic-like, and edematous.
Usually SQ tissue
Poorly demarcated margins.
51
Where do lymphangiosarcomas typically occur?
SQ tissue
52
What is the metastatic potential for lymphangiosarcomas, metastatic rate at diagnosis, and where do they typically metastasize to?
Moderate to high
40%
Lymph nodes
53
How do lymphangiosarcomas look histologically and with what tumor can it be confused?
What IHC markers can be used to clear up confusion?
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
54
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?
MST with sx - 490d
MST with sx, RT, chemo - 570d
9 months after complete remission with doxo
55
What are dermal hemangiomas and HSA associated with?
UV light exposure in short-haired dogs with poorly pigmented skin
56
What is one of the major complications associated with hemangiomas?
Severe anemia due to tumor associated blood loss
57
What is the treatment of choice for hemangiomas?
Surgical excision - usually curative
58
How are canine cutaneous HSA staged? What are the stages?
According to depth of involvement
Stage I - confined to dermis
Stage II - extending into SQ tissues (hypodermal)
Stage III - involving underlying muscle (hypodermal)
59
What is the treament of choice fore cutaneous HSA?
Wide surgical excision +/- doxo (if stage II or III)
60
What is the ORR of doxorubicin for cutaneous HSA in the gross dz setting? Median duration of response?
40%
| 50 days
61
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?
Stage I - 30%, MST 780 days (2yrs)
Stage II-III - 60%, MST 170-300d
RR - 77%
62
In dogs with SQ and IM HSAs treated with surgery, +/- radiation therapy, and doxorubicin, what is the median DFI and MST?
SQ - DFI 1550 days, MST 1190 days
IM - DFI 270 days, MST 270 days (9m)
63
In cats, where do cutaneous HSA usually occur? Metastatic behavior?
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
64
What is the local recurrence rate after surgical excision of feline dermal HSA?
What is the median time to tumor recurrence?
50-80%
420 days (14m)
65
The MST for cats with cutaneous HSA that are treated with wide surgical resection is ___ days vs no therapy ___ days.
MST w/tx >c4yrs
MST w/o 60 days
66
From where do synovial cell sarcomas arise?
Synoviocytes of the joint capsule and tendon sheath
67
What are the 2 different types of synoviocytes?
Type A - phagocytic and resemble macrophages
Type B - fibroblastic; produce glycosaminoglycan
68
From what type of synoviocytes do synovial cell sarcomas arise?
What about histiocytic sarcomas?
What is the exception?
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
69
What immmunohistochemical cell marker, utilized to dx histiocytic sarcomas, cannot differentiate between macrophages (type A synoviocytes) and dendritic antigen presenting cells?
CD18
70
IHC markers to differentiate between synovial cell sarcoma, histiocytic sarcoma, and malignant fibrous histiocytoma?
SCS; vimentin+, pancytokeratin +/- (small population)
Histiocytic sarcoma; vimentin+, CD18+
Malignant fibrous histiocytoma: vimentin+, SMA+
71
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.
Synovial cell sarcoma, synovial histiocytic sarcoma
72
How are synovial cell sarcomas graded (3 things) and what are the different grades? Is this grading system prognostic?
Nuclear pleomorphism, mitotic figures, necrosis
Grade I, II, and III
Yes
73
What is the metastatic potential of synovial cell sarcomas? What are the most common metastatic sites?
Moderate to high (higher risk vs STS)
| Regional LN, lungs
74
Up to ___ % of dogs with synovial cell sarcomas have evidence of metastasis at the time of diagnosis and ___ % by the time of euthanasia.
30% at the time of diagnosis
55% at the time of euthanasia
75
How common are synovial cell sarcomas in cats? How do they behave?
Rare.
Histologic appearance, biologic behavior, distribution of mets same as dogs. Exception: rare bone involvement.
76
What is the typical signalment for synovial cell sarcomas in dogs? Where do they most commonly occur?
Large breeds
Flat-coated and Golden retrievers commonly affected
No sex predilection
Common locations: larger joints - stifle, elbow, shoulder
77
What is the most common presenting complaint in dogs with synovial cell sarcomas?
Lameness
78
What are some radiographic features of synovial cell sarcomas in dogs?
How are these be different from OSA?
How do these differ in cats?
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
What is the treatment of choice? Why?
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
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)?
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
What are some prognostic factors in dogs with synovial cell sarcomas (4)?
Stage/presence of metastasis, histologic grade, extent of surgical treatment, +cytokeratin IHC
82
What is the MST in dogs with synovial cell sarcoma with metastasis vs without?
W/o mets >36m
| With mets <6m
83
What is the MST in dogs with synovial cell sarcoma when treated with amputation vs marginal resection?
Amputation - MST 850d (~30m)
| Marginal resection - MST 455d
84
What is the MST for the different grades of canine synovial cell sarcoma?
> 48m - grade I
> 36m - grade II
7m - grade III
85
What is the MST and metastatic rate for dogs with synovial myxoma, histiocytic sarcoma, and other types of synovial tumors?
Synovial myxoma - MST 30m, metastatic rate 0%
Histiocytic sarcoma - MST 5m, metastatic rate 90%
Other types - MST 3.5 months, metastatic rate 100%
86
A diagnosis of sarcoma is obtained via FNA in ___% of the cases?
65%
87
What biopsy technique is not recommended for diagnosing a STS?
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
What is considered a superficial and deep STS?
Superficial - above the fascial plane, not invading the fascia
Deep - located deep to the fascia, invades tha fascia, or both
89
What is the most important tx for management of STS?
Surgery!
90
What are the recommended surgical margins for STS?
3cm lateral margins
| 1 fascial plane deep
91
What is considered close surgical margins?
1-3mm
92
For which grade of STS should adjuvant chemotherapy be recommended?
Grade III
93
What is the recurrence rate for grade I, II, and III STS after marginal resection?
Grade I - 7%
Grade II - 35%
Grade III - 75%
94
What is the treatment of choice for incompletely resected grade III STS?
RT, 2nd surgery, adjuvant chemo
95
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?
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
Approximately what % of dogs with STS have their tumor incompletely excised?
22%
97
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.
10%,
28%
98
What is the metastatic rate for grade I, II, and III STS in dogs?
What is the median time to metastasis?
Grade I - II: 8 to 15%
Grade III - 41 to 44%
Median time to mets 1 year
99
In a 2004 study of 35 dogs that underwent marginal excision for STS of the extremities the recurrence rate was ___%.
11%
100
What is the treatment of choice for incompletely excised STS?
A second surgery is preferred over RT because local tumor control is better.
101
How long after surgery for removal of a STS can RT be implemented?
>7 days after - to minimize sx complications such as dehiscence and delayed healing
102
Although the optimal fractionation and total dose schemes for canine STS have not been determined, doses greater than ___Gy are recommended.
Doses higher than 50 Gy
103
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.
Median time to recurrence 700 > 800 days
5-30% by 1-year
15-60% in the long term
104
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?
MST 2270 (6yrs)
Control rates: 1 yr 80-95%, 2 yrs 70-90%
Survival rates: 3-yrs 68%, 5-yrs 76%
105
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?
30-50%
300-500d
Extremities
Metronomic chemo - longer OST, but PFI the same
106
The median duration of local control in dogs with STS when treated with RT plus local hyperthermia is ___ days.
750 days
107
What are some negative side effects that can be seen with whole body hyperthermia and RT?
Does not improve response rate when compared to RT, increased risk of metastasis
108
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.
9/10HPF
109
Doses lower than ___Gy are recommended for preoperative RT in dogs STS to reduce surgical complications. What is the goal of preoperative RT?
<50 Gy
Eradication of the microscopic cells at the peripheral margin
110
What are indications for chemotherapy in dogs with STS (4)?
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
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.
23%
112
ORR of mitoxantrone in dogs with measurableSTS (range)?
0-33%
113
A complete response rate of ___% has been seen with ifosfamide in dogs with STS.
15%
114
What are the two most common chemo drugs used for the treatment of STS in humans? What is the response rate for both?
Doxorubicin and ifosfamide, <30%
It does however, prolong disease free interval times
115
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?
No significant overall survival time compared to surgery alone
116
What are some poor prognostic factors when it comes to STS (6)?
```
Large tumor size; >5cm3
Incomplete surgical margins
High histologic grade
High MI
% of necrosis
local recurrence
```
117
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.
20 or >
Metastasis 5x more likely
Tumor related deaths 2.6x more likely
Necrosis >10%, tumor death 2.8x more likely
118
The MST for dogs with STS ranges from ___ days when treated with surgery alone to ___ days with surgery and adjunctive RT.
4yrs
6 yrs
119
Overall, what % of dogs with STS eventually due of tumor related causes?
33%
120
To which vaccines have feline vaccine induced sarcomas been linked to?
What other 3 things have also been associated with injection site sarcomas?
Killed rabies and killed FeLV (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
An adjuvant is a substance that is added to a vaccine to increase the body's immune response to the vaccine
Vaccine associated sarcoma = injection site sarcoma
121
What is the reported time to tumor development after vaccination?
4 weeks to 10 years after vaccination
122
What is the theory behind vaccine associated sarcomas?
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
How can intraocular sarcomas develop in cats?
Trauma or chronic uveitis
So more or less the same as injection site sarcomas, secondary to inflammation
124
What are cells that can be seen in association with injection site sarcomas, adjaent to neoplastic tissue (4)?
Lymphocytes
Macrophages
Fibroblasts
Myofibroblasts
125
The volume of tumor seen on CT is approximately ___ the volume of what is measured using calipers.
2x
126
The vaccine associated feline sarcoma task force recommends treatment for masses after vaccination based on what?
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
What are some negative prognostic indicators for DFI and MST in cats with ISS treated with sx (3)?
Marginal resection
Increased # of surgeries
Surgery performed by a non-specialist
128
VAFS Task Force recommends what minimal margins? Problem with this? Best margin recommendations?
Minimal: 2cm lateral and 2cm deep
Problem: <50% completely excised
5cm lateral and 2 fascial planes deep
129
What is the median time to tumor recurrance for FVAS after marginal, wide, and radical surgical resection?
Marginal - 80 days
Wide - 325 days
Radical - 420 days
130
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.
66 days GP vs 270 days referral institution
131
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.
<50%
132
Median DFI and survival time are both greater than ___ months when complete histologic resection is achieved.
MST in incompletely excised?
>16 months
200d (6.6m)
133
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?
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
On mutlivariate analysis, what factors of the STS grading scheme have been stastically associated with prognosis and how?
Mitotic index - metastasis, local recurrence, MST
| Tumor necrosis - survival after sx
135
What is the reported agreement between pathologists on STS grade? Which factor is most reliably reported?
90%
| Mitotic index
136
Perivascular wall tumors/hemangiopericytomas have a higher serum concentration of what 2 growth factors?
VEGF
| PDGF-B
137
What type of STS is less likely to recur post-operatively? What is the recurrence rate for this tumor?
Perivascular wall tumors
9%
138
What is the median PFS and MST in dogs with oral fibrosarcomas when treated with surgery and other treatment modalities, like RT?
PFS 300-650d (10m to ~2yrs)
| MST 500-750d (1.5 to 2yrs)
139
What are some identified prognostic indicators in dogs with oral FSA (6)?
```
Grade
Location
Tumor size
Type of surgery performed
Margins obtained
RT post sx
```
140
As opposed to perivascular wall tumors, PNST are more commonly positive for which 2 IHC markers?
NGFR
| Olig2
141
What % of perivascular wall tumors highly expresses COX-2?
35%
142
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?
Recurrence 30%
Good limb function in 63%
MST 1300d (3.5yrs)
Margin status; incomplete MST 500d, complete MST 6yr
143
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?
2 years
Protocol: 8 Gy x 3 daily or EOD
144
MDM2 expression has been shown to correlate with which STS type?
Grade 1 liposarcomas - highly expressed
145
Liposarcomas infrequently express immunopositivity to muscle antigens (desmin, SMA, myogenin), but are commonly positive for what?
UCPI - a fat marker
Also expressed in skeletal muscle
146
What is the correlation between expression of FGF2 and PDFGR-B and MI in dogs with liposarcoma?
High FGF2 - low MI (negative correlation)
| High PDGFR-B - high MI (positive correlation)
147
How can lipomas be differentiated from liposarcomas on CT?
Lipomas: do not usually contrast enhance, lack hyperattenuation, are well defined
Liposarcomas: heterogenously contrast enhance, are irregular, can have mineralization
148
What is the MST in dogs with splenic liposarcomas?
Negative PI (2)?
620d (1.7 yrs)
Metastatic dz at the time of surgery; MST 45d
Grade 2 or 3 tumors; MST 200d and 70d, respectively
149
MST of dogs with metastatic splenic liposarcoma?
45d
150
PNS are most commonly seen with which form of leiomyoma/leiomyosarcoma?
GI
151
What % of dogs with GI leiomyosarcoma can have intestinal perforation with localized to diffuse peritonitis?
50%
152
Identified prognostic factors in dogs with dermal HSA (2)?
Tumor location
| Solar-induced changes; more benign (MST 1550d vs 550d)
153
Most common tumor of the canine joint/synovium?
Synovial cell sarcoma - type B synoviocytes
154
What growth factor is elevated in serum of dogs with STS but decreases after surgical resection?
VEGF
155
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?
60% agreement
30% underestimate
12% overestimate
156
What is the sensitivity and specificity of pre-treatment biopsies for high grade STS in dogs?
95% specific
33% sensitive
-You can believe a high grade result, but not a low grade
157
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?
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
MST for dogs with oral STS treated with sx and RT?
540d (1.5 yrs)
159
Mutations or loss of which gene/protein have been associated to cats wtih injection site sarcomas?
p53
160
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)?
60 to 80%; LOH most common
Cytoplasmic staining in 44% of tumors
Shorter time to recurrence and ST
161
Although Withrow states that FeLV has not been detected in ISS, a newer study found viral particles in ___% of the cases
43%
162
What % of ISS are grade III and I.
III - 60%
| 1- 5%
163
What is the reported mortality rate in cats with interscapular or body wall ISS that often require body wall resection?
4%
164
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.
Surgical time
40% of cats with truncal ISS
165
Recurrence rate in incompletely excised ISS?
Up to 76%
166
How long after sx should RT be initiated for cats with incompletely excised ISS? Why (2)?
10 to 14 days
| Longer wait times decreases DFI and MST
167
Recurrence rate post RT for ISS (range)?
30 to 40%
168
MST in cats with incompletely excised ISS treated with definitive RT (range)?
1, 2, 3 yr survival rates?
600 to 1300d
1 - 86%
2- up to 71%
3, up to 68%
169
Metastatic rate in cats with ISS? Median time to metastasis?
0-25%
260-300d (8.5 to 10m)
170
ORR of doxorubicin and +/- cyclophosphamide in cats with ISS?
MST in responders vs non responders?
40-50%
Responders 8m vs 80d in non responders
171
MST for sx, RT, and doxo vs sx and RT alone?
Sx, RT, chemo - 29m (2.4 yrs)
| Sx and RT - 5m
172
MST in cats with interscapular tumors tx with neoadjuvant epirubicin, followed by sx, and 2 more doses of chemo? Recurrence rate?
MST not reached, 80% alive or censored due to death from other causes
14% local recurrence
173
Ifosfamide ORR in cats with ISS?
40%
174
CCNU ORR, PFS, and duration of response in cats with ISS?
ORR 25%, 1CR, 6PR
Median PFS 2m (60d)
Medaian duration of response 2.6m (80d)
175
Palladia response for ISS?
No response
