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5: Skin and Reconstruction > Chapter 82 Specific Disorders of the Skin and SC Tissues > Flashcards

Chapter 82 Specific Disorders of the Skin and SC Tissues Flashcards

1
Q

What proportion of skin tumours are malignant in dogs?

And in cats?

A

21-37% malignant in dogs

60-65% malignant in cats

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2
Q

Whar are the definititions of

Incomplete margins

Close/narrow margins

Complete margins

A

Incomplete margins: neoplastic cells continuous with surgical margin

Close/narrow margins: neoplastic cells <3mm from surgical margin

Complete margins: neoplastic cels at least 3-5mm from surgical margin (depending on tumour type)

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3
Q

In what tumour types has FNA needle tract seeding been described in dogs?

A

TCC, pulmonary adenocarcinoma

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4
Q

Following surgical excision, what time interval is recommended before adjuvant radiation?

And vice versa re neoadjuvant radiation follwed by surgery?

A

1-3 weeks

wait 3-4 weeks beofre sx

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5
Q

List 4 tumour related factors that may cause complicated wound healing

A
  1. Residual tumour cells
  2. Tumour related cytokines/bioactive substances
  3. Cancer cachexia
  4. Paraneoplastic syndromes
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6
Q

What are the four tumour tissue origin types?

A
  • Epithelial
  • Mesenchymal
  • Round cell
  • Melanocytic
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7
Q

What is the WHO TNM classification for skin tumours

A
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8
Q

What tumour parameteres shoudl be described/assessed

A
  • Size
  • Location
  • Consistency
  • Colour
  • Fixation
  • Ulceration
  • Signs of inflammation
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9
Q

What is the accuracy of FNA for skin masses (cf histo)

A

90%

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10
Q

Wat is the typical route of metastasis for

Epithelial tumours

Mesenchymal tumours

A

Epithelial via lymphatics, mesenchymal via blood (e.g. most commom mets for STS are lung)

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11
Q

What are the two major functions of lymphatic system?

A

transport and immune reponse

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12
Q

What cell types predominate in the cortex, paracortex and medulla of lymph nodes?

A

Cortex: B-lymphocytes (and T-lymphoctes peripherally if antigenically challenged)

Paracortex: T-cells and macrophages (antigen presenting cells)

Medulla: Cords of lymphocytes, macrophages and plasma cells

Schematic representation of a lymph node. The left side illustrates how lymph enters through lymph vessels into the lymphatic sinuses to be drained centrally to the medulla, where it exits through efferent lymph vessels. The right side shows the vascular structures inside the lymph node.

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13
Q

In what cancer types is LN metastasis predicitive of prognosis?

A

canine mammary tumours, MCTs, SI tumours, canine primary lung tumours (+- more but these mentioned)

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14
Q

3 potential benefits of lymphdenectomy

A
  • Removal of potential source of further spread
  • Reduce signs of paraneoplastic disease
  • Palliation of signs due to enlarged LNs
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15
Q

What is the cause of lymhangitis?

An tx?

A

Usually infectious agents

Warm, moist compress + anti-microbial if indicated

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16
Q

What si the defnition of lymphoedema?

What causes lymphoedema?

What is the unusual, malignant transormation?

A

Reduced lymphatic transport capacity

Canbe primary (congenital malformations) or secondary (aquired disorders/iatrogenic damage e.g. neoplasia, trauma, radiation, parasitic infection, chronic lymphangitis)

Lymphangiosarcoma

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17
Q

How is lymphoedema diagnosed?

What is the treatment for lymphoedema?

A
  • Hx + c/s.
  • Rule out causes of high lymphatic load (e.g. cardiac dysfuntion, high venour pressure, hypoproteinaemia)
  • Lymphangiography or lymphoscintigraphy (delayed, asymmetric or absent visualisation of local LNs/lymphatic channels, collateral channels,visualisation of LNs in deep system, backflow)
  • Tx: Physio, compression garments, “coumarin” (=benzypyrones) (–> increased local proteolysis by cutaneous macrophages). NOT diuretics as not a primary water retention problem
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18
Q

Describe simple lymphography method:

A

sterile 5% patent blue injection sc between digits of affected limb.

Diffuse distribution = absence of intact lymphatic transport

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19
Q

What are the 3 most common skin tumours in dogs?

And in cats?

A

Dogs:

  1. MCT
  2. STS
  3. Perianal gland adenocarcinoma

Cats:

  1. SCC
  2. Basal cell tumour
  3. MCT
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20
Q

What is predisposin gfactor for SCC in cats? What does it cause?

A

UV light –> p53 tumour supressor gene mutation

(and possibly papilloma virus but not definitive)

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21
Q

What skin conditions are often pre-cursors to SCC in cats

A

Actinic keratosis

Bowenoid in situ carcinoma in cats

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22
Q

What is the risk factors of SCC in white cats vs pigmented?

A

x13 risk in white cats

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23
Q

List 7 treatment modalities for SCC

A
  • Surgery (recommend 5mm margins in feline, 2cm if canine. Mohs micrographic surgery if wide margins not possible)
  • Chemotherapy (not recommended as monotherapy. High cox-2 expression in dogs, not in cats)
  • Radiation
  • Cryosurgery (means no histo…recommend for <5mm superficial lesions only)
  • Plesiotherapy (= form of brachytherapy applied to the outside of body. Using strontium (90Sr))
  • Photodynamic therapy (=light sensitive drugs + laser e.g. 5-amino-levulinic acid, meta-chlorin, pyropheophorbide-α-hexyl ether. Efficacy decreases quickly with inrceasing lesion depth)
  • Immunomodulatory therapy (further research nec.)
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24
Q

What is noteworthy re basal cell cytology?

A

May seem poorly differentiated and can be mistaken for other tumours. May have high mitotic rat ebuut behave in benign fashion.

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25
Q

List 4 types of sebaceous gland tomour

A
  • Sebaceous adenoma
  • Sebaceous adenocarcinoma
  • Sebaceous hyperplasia
  • Sebaceous epithelioma
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26
Q

Sweat gland tumours may originate form which types of gland?

A

Apocrine and eccrine

Apocrine glands are widely distributed in dogs and cats, always associated with haired skin. Eccrine sweat glands, however, are present primarily in the non-haired skin of the footpads and nose.

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27
Q

What is the typical signalment for perianal hepatiod adenomas (modified sebaceous glands situated indermis of anus, tail base, prepuce - N.B. not present in cats!)

Tx?

A

Male entire, Cockers: primarily sex hormone dependent tumours (either stimulated by androgens of supressed by oestrogen)

Tx: Castration. Otherwise resection

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28
Q

In AGAAS, what is metastatic rate?

And percetnage with paraneoplastic hypercalcaemia (is a negative prognostic indicator)?

A

Mets in 36-96%

Hypercalcaemia in 27-53% (n.b. post-op hypocalcaemia reported - liekly due to long term supression of parathyroid glands)

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29
Q

For AGAAS, what are 3 negative prognositc factors? and 2 positive

A

Negative prognostic factors:

  • Stage
  • Hypercalcaemia
  • Lack of therapy

Positive prognostic factors:

  • Surgery
  • Lymphadenectomy
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30
Q

What was MST for AGAAS after various treatments?

What combo of tx reasulted in longest MST?

How does prognosis of cats compare?

A

16-18 months

Surgery, radiation, mitoxantronechemo (32 mo MST)

Few reports but poor prognosis in cats. MST 3mo

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31
Q

Which 6 tumour types make up the STS group

A
  • Fibrosarcoma
  • Liposarcoma
  • Myxosarcoma
  • Undifferentated sarcom
  • PNST (inc schwannoma, neurofibrosarcoma)
  • Perivascular wall tumour
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32
Q

What is the WHO TNM staging scheme for STSs?

A
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33
Q

What is the accuracy of FNA for STSs (vs histo)

A

63-69% do not exfoliate well

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34
Q

What is the overall average metastasis rate for STSs?

What about individually for

Grade 1

Grade 2

Grade 3

A

Overall 6-17%

Grade 1 <13%

Grade 2 <13%

Grade 3 41-44%

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35
Q

In STSs, what is the most important factor for local recurrence

A

Clean surgical margins

therefore recommend 2-3cm margins and a fascial plane

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36
Q

What is the MST for STS undergoing surgery, vs surgery and radiation?

A

Surgery alone 1400d (grade 3 230 - 850d)

Surgery + radiation 2270d

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37
Q

How does chemo fit into STS treatment?

A

Recommended for grade 3 as high rate of metastasis

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38
Q

What is noteworthy re canine oral fibrosarcomas

A

Biologically high grade, histologically low grade type!

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39
Q

What is the tissue of origin of perivascular wall tumours?

How does perivascular wall tumour metastasis compare with overall STS metastasis rate?

A

Cellular components of vascular wall except endothelial cells

0-2% so less than average for STS (6-17%)

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40
Q

What tissue type do PNST arise from?

A

Schwann cells or perineural fibroblasts (or both)

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41
Q

What 3 IHC stains can be used to identify PNST

A
  • S-100
  • Vimentin (only one consistently seen)
  • Glial fibrillary acidic protein
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42
Q

FISS related to administration of inactivated vaccines. What is the proportional risk of FISS after rabies vacc?

and FeLV vacc?

What other injections have been associated?

A

x2 for rabies vacc

x5 for FeLV

Also assoc with long acting penicillin, methylpred, cisplatin, melox, microchip, non-absorbable suture, skin staple, sc fluid port, retained swab.

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43
Q

How does FISS presentation differ from other STS?

A factor to bear inmind during work up.

What factor was associated wth shorter time to recurrence following sx?

A

FISS cats younger (8 yr, vs 11 for other STS)

Usually higher histologic grade (up to 70% grade 3)

Forelimb extended and caudally may improve evaluation.

  • Sx performed by GP (66d recurrence) vs specialist (270d recurrence)
  • Expression of aberrant cytoplasmic p53 expression
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44
Q

What was MST for cats undergoing radical (5cm) excision of FISS, with and without metastasis

What chemo woul you use?

A

With mets 388d

Without mets 1500d

Chemo = doxorubicin, or electrochemotherapy using bleomycin

45
Q

What are the recommendations for excision in masses in cats thought to be risk for FISS - When is surgery indicated?

A

Sx if:

  • present >3 months
  • significant size increase within 4 weeks
  • >2cm
46
Q

What is the usual signalment for infiltrative lipoma?

How is dx reached?

What is recurrence rate?

A

Female, labrador

dx by histo including surrounding infiltrated tissue

Recurrence 36-50%

47
Q

What is seen on cytology of liposarcoma?

What was MST with wide excision?

A

Very cellular, cells contain smal lipid vaculoles that stain strongly with ‘oil red O”

MST with wide excision 1200d (600 marginal, 180d intralesional)

48
Q

What proportion of feline haemagiosarcomas are cutaneous?

Asscociated with what ?environmental factor?

A

50-75% i.e. majority are cutaneous in cats

Assoc with UV light exposure

49
Q

How are canine cutaneous haemangiosarcomas staged?

What is overall metastatic rates?

How does this compare with feline cutaneous haemangiosarc

A

Stage 1: confined to dermis (2 year MST)

Stage 2: extending i nto sc tissue

Stage 3: invading muscle/fascia (<1 year MST)

Mets in 30-60% (depending on stage)

Feline MST after complete excision 1500d

50
Q

What is typical hx/signalment of feline fibropapilloma cats (i.e feline sarcoids)

A

Young (<5 yr), barn cats with exposure to cattle. Usually on face

51
Q

How many mammary glands do dogs have?

And cats?

A

Dogs 5 pairs (cr and cd thoracic, cr and cd abdominal and inguinal)

Cats 4 pairs

52
Q

What is the blood supply to mammary glands?

A
  • Lateral and internal thoracic arteries (–> cranial superficial epigastric)
  • External pudendal arteries (–> caudal superficial epigastric)
53
Q

What is the typical lymphatic drainage of canine mammary glands?

And cats?

A

Glands 1 and 2 to axillary (can be superficial cervical and sternal)

Glands 3 and 4: axillary or inguinal (sometimes medial iliac and popliteal)

Gland 5: inguinal, medial iliac (sometimes popliteal).

Most cranial gland drains into axillary in cats, rest inguinal (gland 2 may be axillary also)

54
Q

How do mammary lymphatic communications differ in dogs and cats

A

Contralateral and ipsilateral anasomoses present in dogs, not in cats

55
Q

What dog breed is predisposed to malignant mammary tumours?

A

GSD

56
Q

What is the risk for benign canine mammary tumours vs malignant?

A

x2-5 more likely benign

57
Q

Respective of the risk in entire females what is the risk of developing mamary tumours in dogs spayed:

Before 1st oestrus

Before 2nd oestrus

After 2nd oestrus but <2 years old

A

Before 1st oestrus 0.5%

Before 2nd oestrus 8%

After 2nd oestrus but <2 years old 26%

Obesity before 1year also risk factor for mammary tumours

58
Q

How does oestrogen and progesterone receptor expression differ between benign and malignant tumours?

A

expressed in >90% benign tumours, approx 50% of malignant (inc oestrogen receptors correlated with lower ki-67 proliferation marker i.e. lose hormane receptor expression as become more malignant

59
Q

List 4 genes associated with mammary tumorigenesis

A
  • c-erbB-2
  • p53
  • BRCA1 and BRCA2
  • RAD51
60
Q

How does cox-2 expression differ between banign and malignant mammary tumours

A

Higher in mammary tumours

61
Q

Describe WHO TNM classification for canine mammary tumours

A
62
Q

List 3 specific sub types of malignant, benign and unclassified canine mammary tumours

A
63
Q

What percentage of canien mammary tumours are inflammatory carcinoma?

What glands are most commonly affected?

What is met rate?

What is MST?

A

8% of mammary tumours

Most commonly glands 4 or 5

Met rate 8-100%

MST 25-60d

64
Q

For canine mammary tumurs, when is each f the following indicated?

Lumpectomy

Simple mastectomy

Regional mastectomy

Chain mastectomy

A

Lumpectomy: <0.5cm masses

Simple mastectomy: centrally located mass with 2-3 cm margins

Regional mastectomy: rest

Chain mastectomy: multiple nodules, 3rd gland masses, >1cm masses with fixation, other suspiscion of malignancy

65
Q

What was recurrency of mammary tumour with lymphatic/vascular invasion on histo?

A

97%

66
Q

What factors are prognostic in canine mammary masses?

A
  • Histologic type (esp grade and invasiveness, proliferation markers ki-67 and AgNORs)
  • Tumour size
  • LN metastasis

Chemo improved survival

67
Q

What % of mammary tumours in cats are malignant?

What is met percentage?

A

85%

80% met (at necropsy)

68
Q

What proliferatioon markers are negatively associated with survival in feline mammary tumours?

A

HER-2

Ki-67

VEGF

69
Q

What is the name of the hormonally driven condition causing massive enlargement of feline mammary glands (think case we saw at RSPCA)

What is tx?

A

Fibroadenomatous hyperplasia, usually cats <2 years old

Tx = remove hormonal influence i.e. spay (progesterone blocking drug aglepristone –> full remisison but abortion)

70
Q

What is MST for feline mammary tumours?

A

4mo - >3 years (depending on tumour size, presence of mets).

N.B. chemo not shown to be beneficial. Radiation not investigated

71
Q

What are the precursor cells for mast cells?

A

CD34+ progenitor cells in bone marrow

72
Q

What do mast cell granules stain with?

A

Cationic dyes

73
Q

which 2 breeds represent majority of MCT cases?

A

Boxer + Boston terrier

74
Q

List 5 extra-cutaneous MCT sites

A
  • Conjunctiva
  • Trachea
  • Oral cavity
  • Salivary gland
  • Larynx
  • Nasopharynx
  • GI tract
  • Ureter
  • Spine
  • (Viceral/systemic mastocytosis)
75
Q

What two tumours does cd117 stain for?

A

MCT and GIST

76
Q

What is the name of this sgn re MCTs:

A

Darier sign = oedema, erythema, inflammation

77
Q

What is the order of metastasis in MCTs

A

Local Ln –> liver and spleen

78
Q

Briefly explain the two grading systems for MCT

A

Patnaik

  • Grade 1 (differentiated) , 2 (intermediate) or 3 (undifferentiated).

3 downsides to Patnaik (–> alternative scheme):

  1. Assumes tumour is originating in dermis
  2. Doesnt account for v variable behaviour of grade 2 tumours
  3. Inconsistent grading re 1 vs 2 among pathologists.

Kiupel

Low vs high grade

79
Q

What % MCTs can be diagnosed vis FNA with use of stains?

What type of stains?

A

96%

Romanovsky type stains (includes diff-quik)

80
Q

In canine MCT, list 5 factors associated with survival

A
  • LN metastasis
  • Mitotic index
  • Special stains (ki-67, AgNORs, PCNA)
  • Kiupel grade
  • Patnaik grade
  • Mucous membrane location (except conjunctiva!)
  • Darier sign/systemic signs
  • Location (prepucial and scrotal + care re perineal/inguinal)
81
Q

Mast cells are present in normal LNs. List 3 factors that would be considered as neoplastic population

A
  • Clusters/sheets
  • Increased numbers in >2 hpf
  • Large number of atypical mast cells
82
Q

What is the MST for low vs high grade canine MCTs?

A

Low grade 2-4 years

High grade 100-200d

83
Q

Breifly outline MCT tumour tx:

A
  • Sx with 2-3cm margins + 1 fascial plane + metastatic LN excision
  • If incomplete margins ideally re-cut (most effective), otherwise radiation
  • Consider chemo in grade 3 and high risk grade 2
84
Q

What is the initial chemo choice in MCTs?

A

Lomustine

85
Q

Aside form chemo and radiation, list 2 other adjuctive methods used for MCT tx

A

Electrochemotherpay

Hypotonic shock

86
Q

List the two ytological types of feline MCT and typical presentation.

A

Mastocytic MCT (differentiated vs poorly differentiated)

Histiocytic MCT (Siamese cats, 2-3 years old), regress without tx

87
Q

Aside form cutaneois list 2 feline MCT sites + MST with tx

A

Spleen. Splenectomy –> MST 12-20 months

GIT. MST 2 months (but longer reported)

88
Q

What are the three most common GIT tumours in cats?

A
  1. Lymphoma
  2. Adenocarcinoma
  3. MCT
89
Q

Is MCT grade prognostic in cats?

A

No

Mitotic index most effective prognostic factor

90
Q

What cells cause histiocytomas?

Tx?

A

Langerhans cells

No tx necessary, usually regress. Steroids contraindicated (because regression is characterised by lymphocyte infiltration)

91
Q

What is IHC stain for histiocytic tumours?

What is first line chemo agent?

A

CD18

Lomustine

92
Q

What haematological change may be seen with extramedullay plasmacytoma?

A

Monoclonal gammopathy

93
Q

What is noteable re TVT genetic makeup

A

TVT tumour karyotype has 59 chromosomes (dogs have 78)

94
Q

What is TVT tx

A

Vinccristine, weekly, 0.5 - 0.75 mg/m2

95
Q

What are 5 most common oral tumours in dogs:

And 3 most common in cats

A

Dogs:

  1. Malignant melanoma
  2. SCC
  3. Fibrosarcoma
  4. /5. Osteosarc, acanthomatous ameloblastoma

Cats:

  1. SCC
  2. Fibrosarc
  3. Malignant melanoma
96
Q

What IHC stains are used for amelanocyic melanoma?

A

S-100 and NSE

97
Q

How does malanocytic tumour type differ with location.

A

Pigmented skin mainly benign, oral cavity and nail ned more commonly malignant

malignany: Ocular > oral cavity > nail bed > skin

98
Q

Adjunct therapy advice for malignant melanoma?

A

Systemic tx warranted given high met rate

(chemo, immune modulators)

99
Q

List immune modulators developed for use in malignant melanoma

A

“Melanoma vaccines”

  • Human tyrosinase DNA vaccine (also reported safe (?effective) in cats)
  • Human CSPG4-DNA vaccine (Chondroitin-sulphate proteoglycan 4 is a tumour progression marker. Highly expressed in 60% of canine melanomas)
  • Local suicide gene therapy + cytokine enhanced tumour vaccine (6 and 9 year MST not reached in dogs with surgery followed by this!! vs 100d with sx only)
100
Q

What are 5 most common canine nail bed tumours?

A
  1. SCC
  2. Malignant melanoma
  3. STS
  4. MCT
  5. Osteosarc
101
Q

What is the metastatic rate of canine nail bed tumours

A

low, 5-29%

(worse for melanoma, 40-60%)

102
Q

What is the MST for canine toe osteosarc?

A

over 2 years reported

103
Q

What are the three most common nail bed tumours in cats (no order)?

A

SCC, fibrosarcoma or metastatic (bronchiolar adenocarcinoma, SCC, Apocrine gland adenocarcinoma)

Lung digit syndrome often affects several digits so x-ray all.

104
Q

There are 4 main digital arteries - name them

A

Axial and abaxial dorsal arteries and palmar proper arteries.

105
Q

What is a pilonidal sinus?

How to work up?

When is sx indicated?

A
  • Incomplete separation of ectodermal and neural tissue during embryogenesis (a tubular skin structure that extends from skin to underlying ST). Extensive ones communicate with spinal dura mater. Lined by skin (i.e. squamous epithelium). Usually cervical or cranial thoracic (LS and sacrococcygeal noted).
  • Advanced imaging to assess spinal involvement
  • Sx if chronic derm signs or neuro signs (may require DSP excison, or if attached to dura dorsal laminectomy and dura mater resection)
106
Q

What is this?

How is it managed?

A

Nasal dermoid cyst

During embryologic development, a canal called the foramen cecum develops in the frontal bone and allows an outpouching of meninges into the prenasal space and into contact with somatic ectoderm. With maturation the canal normally closes. Persistence of the canal results in a draining sinus in the dorsal midline of the nasal bone that perforates through an incomplete suture line in the nasal septum. Communication with the meninges has been reported in humans but not in dogs. Clinical signs of nasal dermoid sinus cysts include drainage and crusting around the affected area. Obstructed sinuses may result in perisinus swelling, abscessation, and infection. Treatment is surgical resection, including the affected portion of the nasal septum in some cases. Resection is facilitated by catheterization of the sinus

107
Q

What infectious agents have been associated with aquired sinus tracts due to primary infection?

A
  • Nocardia
  • Sporothrix
  • Botryomycosis
  • Mycobacterium
  • Pythium
108
Q

What is the sens/spec of positive contrast sinography (fistulography) for ID of FBs

In what % of cases was US able to identify FB

A

Sensitivity 87%

Specificity 100%

82% i.e. fistulography better

5: Skin and Reconstruction (8 decks)

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