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Dermatology > Dermatology skin tumours and mast cell tumours > Flashcards

Dermatology skin tumours and mast cell tumours Flashcards

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Dermatology Board Prep flashcards
1
Q

What are the different types of epithelial tumours

A

Cutaneous papillomas; can see oral ones in dogs, these regress

Basal cell tumour: common

Squamous cell carcinoma

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2
Q

Characteristics of basal cell tumour

A

Middle aged animals
Head and neck typically
May be pigmented
Usually benign; cure via surgery

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3
Q

What is the most common pigmented mass on the head of a cat

A

Basal cell tumour NOT melanoma

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4
Q

Key difference between SCC on the nose vs other parts of body in dogs

A

Ones elsewhere don’t usually metastasise; local invasion more of an issue

In nasal planum SCCs in dogs = highly malignant as well as locally invasive
[cats not that malignant]

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5
Q

KEy difference in aetiology of SCC of nasal planum in dogs vs cats

A

In cats = related to UV light exposure
In dogs = genetic; see more in retrievers and collies; quite metastatic

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6
Q

What do SCC look like and where do they arise

A

Arise in lightly pigmented parst of body, assocaited with UV light exposure
Can look like cauliflower lesion or more like a non-healing ulcer

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7
Q

How can we treat superficial SCC of nasal planum in cats

A

Strontum brachytherapy

Could also try photodynamic therapy

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8
Q

How does SCC of nail bed present

A

Sore swollen toe; often misdiagnosed as a nail beg infection but antibiotics don’t work

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9
Q

Where might adnexal tumours come from

A

Sebaceous gland
Hair follicle
Perianal/hepatoid gland adenoma

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10
Q

What must be on our differential list for any epithelial lesion which is ulcerated or erosive

A

Squamous cell carcinoma

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11
Q

Characteristics of primary cutanoue lymphoma

A

T cell
PResents as multiple cutaneous nodules/plaqes
Aggressive with widespread disseminatino
Poor prognosis

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12
Q

PResentation of epitheliotrophic lymphoma

A

Can manifest in many ways
Often intesnse pruritis and scale
Can get nasal planum depigmentation

(there is also a muco-cutaneous form which looks like proliferating red velvet tissue through the mouth)

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13
Q

Treatment of epitheliotrophic lymphoma

A

Poor
Don’t respond to chemo
CAn give steroids to help pruritis
Mouth lesions can have radiotherapy and respond well

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14
Q

WHat is a plasmactyoma

A

Solitary skin tumour with benign behaviour; cure via sugerical excision

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15
Q

What is canine cutaneous histiocytoma

A

Common benign tumour of young dogs; see rapidly growing lesion on head mostly
Then spontaneous regression related to cytotoxic T lymphocte influx

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16
Q

How does reactive histiocytosis present

A

Can be skin only
Or systemic
INfiltration with histiocytes/antigen-presenting cells

Lesions wax and wane but slowly proress

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17
Q

What breeds are predisposed to disseminated histiocytic sarcoma and what is the prognosis like

A

Bernese mountain dogs
Retriever
Rottweiler

Very poor prognosis

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18
Q

BReed predisposition for histiocytic sarcoma

A

Flat coated retriever

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19
Q

What organism is associated with oesophageal sarcoma

A

Spirocerca lupi encysting there
Thought to be related to chronic inflammation aetiology

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20
Q

Feline injection site sarcoma characteristics

A

YOung animals
Very aggressive
High rate of local recurrenace so need huge margins

Must consider whenever we see a cat with mass betewen shoulders

21
Q

Why might soft tissue sarcomas feel like they are well encapsulated but don’t actually shell out well

A

This is just pseudoencapsulation due to compression of normal tissue around the tumour

22
Q

What soft tissue sarcomas are much more likely to metastasise

A

Haemangiosarcoma
Osteosarcoma

23
Q

Management options for soft tissue sarcoma

A

Radical surgical resection best
PLanned marginal debulking surgery can give good survival times e.g 1 year without recurrence for older dogs

Adding on radiotherapy can increase survival times a lot

24
Q

What grade are most soft tissue sarcomas and is local invasion or metastasis more of an issue

A

Most are low/intermediate grade
Local invasion more of an issue

25
Q

What breeds are predisposed to melanoma

A

Terriers
Cocker
NB: cutaneous melanome normally quite benign

26
Q

How do mast cell tumours present (what layers of skin)

A

Most are in dermis
15% are in subcutis; must not mistake these for a lipoma

27
Q

General prognosis of cutaneous mast cell tumours

A

80% cured by simple surgery
Later stage disease has much poorer survival time

28
Q

Local and systemic effects of degranulation of mast cell tumours

A

Locally: get change in tumour size, bruising, wound breakdown

Systemically: vomiting/hyporexia, hypotension, oedema, collapse possible

29
Q

When is massive histamine/heparin release from mast cell granules more likely

A

With large tumours
Heavy handling of the mass
Self-trauma
Mastocytosis

30
Q

Which breeds are more likely to have low risk mast cell tumours vs intermediate risk

A

Pugs overrepresented; more so low risk
Boxers, goldies, labs: intermediate risk

Generally younger dogs have better prognosis

31
Q

Out of dermal and subcut mast cell tumours which has a better prognosis

A

Subcut
But don’t mistake with a lipoma

32
Q

Poor prongostic indicators of cutaneou s mast cell tumours

A

ulceration
Size >3cm
systemic effects
High patnaku/kiupel grade
Recurrence
Rapid growth
Lymphadenopathy

33
Q

What are the patnaik vs kiupel grades

A

Patnail = grades 1, 2, 3; using cell morphology and tissue/stromal involvement
Kiupel = high vs low grade just using cell morphology

34
Q

What are some problems with the official staging guide for mast cell tumours

A

Multiple dermal tumours called a stage 3 but actually these are generally de novo tumours NOT metastases so not that useful e/g in pugs often have multiple tumours but not poor prognosis

35
Q

What does staging of mast cell tumours involve

A

Sentinel/regional LN aspiration
ABdo ultrasound
Liver/spleen FNA
(could do thoracic xray but not that useful)

36
Q

Is mitotic count in mast cell tumours useful

A

Yes; correlates with grade. metastasis and survival
> or = 2 = high risk

37
Q

Treatment for mast cell tumours; medical and surgical

A

Medical: antihistamine H1 blocker CHLORPHENAMINE
Gastric protectants e.g omeprazole, H2 blockers

Surgical removal with proportionate lateral margin and 1 fascial deep planeH

38
Q

How to do a proportionate margin for mast cell tumour removal

A

Take diameter of mass as circumferential margin from centre out
But must have minimum margin 0.5cm and maximum 2cm

+ one deep fascial plane

This gives a very low recurence rate

39
Q

How can we downsize a bulky mast cell tumour before srugery

A

Use prednisolone for 10 days +/- chlorphenamine

40
Q

Why might we do a planned marginal resection of mast cell tumours

A

If the lateral margings needed would need radical surgery e.g in lower limb would require amputation
Or Where can’t get deep plane

Then send to hsitopath and wait
- If low grade probably won’t recur
- If high grade can follow up with radioation or revision surgeryW

41
Q

What adjuvant therapies might be used in mast cell management

A

Want local control with surgery
+ can add in vinblastine/prednisolone
Lomustine is cheaper but risk of liver damage/myelosuppression
Chlorambucil/prednisolone cheaper alternative to euthanasia

Coudl try tyrosine kinase inhibitors

42
Q

What are tyrosine kinase inhibitors and how might they be useful in mast cell mtumours management

A

= cytostatic drugs
Work because KIT often activated on mast cell causing survival, proliferation, migration

Masitinib
Toceranib

Can be used in face of metastatic disease or where
NB: expensive and toxicity risk; GI/haematological/hepatic/renal + slow onset anaemia/thrombocytoaeia

43
Q

What is stelfonta

A

Tigilanol tiglate
= novel intra-tumour therapeutic agent
Licensed for non-metastatic cutaneous/subcut MCT below elbow (since inoperable there)

Leaves skin deficit which heals by second intention

44
Q

How common are mast cell tumours incats

A

Not very
KIT mutations in most; could use tyrosine kinase inhibitors off label

45
Q

Forms of mast cell tumours in cats

A

Cutaneous; solitary dermal plaques or masses mostly on head/ears; pruritis
Often benign , esp siamese

May be atypical histiocytic in which case they spontaneously regress

Non-cutaneous form: weight loss, vomiting, abdo mass = poor prognosis

46
Q

Is grading useful in feline cutaneous mast cell tumour

A

No

47
Q

What age dogs are cutaneous histiocytomas seen in

A

young

48
Q

WHen is clinical staging of tumours indicated

A

Only if pretty certain it is malignant

49
Q
A

Dermatology (8 decks)

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