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Onco Board Review 2 > Endocrine > Flashcards

Endocrine Flashcards

1
Q

What was the PR and SD of thyroid carcinoma to toceranib?

A

PR - 26.7%
SD - 53.5%
(clinical benefit 80%)

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2
Q

What is the most clinically important pituitary tumor in cats?

A

somatotroph adenoma

somatotropin cells release GH; corticotropic cells release POMC - precursor for ACTH, etc

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3
Q

What is meant by “secondary brain tumor?”

A

compressive or metastatic brain

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4
Q

T/F: It is more likely for a cat to have a metastatic lesion in an adrenal gland than a primary adrenal tumor.

A

True

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5
Q

What % of canine adrenocortical carcinomas invite the phrenicoabdominal vein?

A

20%

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6
Q

What is the metastatic rate for canine adrenalcortical carcinomas?

A

50%

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7
Q

What clinical findings are suggestive of Conn’s syndrome (hyperaldosteronism) in cats?

A

weakness, hypokalemia, hypertension

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8
Q

What is a paraganglioma?

A

an extra-adrenal pheochromocytoma

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9
Q

What % of canine pheochromocytoma invade the surrounding vasculature?

A

82%

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10
Q

What is the metastatic rate of canine pheochromocytoma?

A

up to 40%

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11
Q

What IHC stain can distinguish a pheo from an adrenocortical tumor?

A

chromogranin A

pheo is +

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12
Q

What is the mortality rate for dogs with pheos treated with phenoxybenzamine prior to surgery?

A

13%
(compared to 48% without prior treatment)
phenoxybenazmine is an alpha blocker

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13
Q

Name 3 prognostic factors for adrenal tumors treated with surgery.

A
  1. caval tumor thrombosis
  2. presence of metastasis
  3. tumor size >5cm
    (also whether they need ER surgery for adrenal bleeding)
    - also see JAVMA 2008 and JAVMA 2013
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14
Q

What IHC stains ID medullary thyroid carcinomas? (5)

A
  • calcitonin
  • calcitonin-related peptide
  • thyroid transcription factor-1
  • chromogranin A
  • neuron-specific enolase
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15
Q

Name 4 dog breeds predisposed to thyroid carcinomas.

A

Golden Retriever, Beagle, Boxer, Siberian Husky

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16
Q

What % of dogs with thyroid carcinomas have metastasis at the time of diagnosis?

A

35-40%

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17
Q

What % of dogs with thyroid carcinoma will eventually develop metastasis?

A

80%

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18
Q

What % of canine thyroid carcinomas are functional?

A

10%

30% are hypothyroid

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19
Q

Bilateral thyroid carcinomas are ___x more likely to metastasize.

A

16x

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20
Q

MST after thyroidectomy if mass is movable vs. more invasive?

A

moveable - 3 yrs

invasive - 6-12 months

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21
Q

What is the time to maximal tumor reduction after dRT for thyroid carcinomas?

A

8-22 months

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22
Q

What is the 3 year PFS rate for thyroid carcinomas treated with dRT?

A

72%

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23
Q

T/F: Dogs with hyperthyroidism have a longer MST after I-131 ablation?

A

False

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24
Q

What % of dogs with thyroid carcinoma treated with DOX or cisplatin have a response to therapy?

A

30-50%

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25
What are the 3 stages (WHO staging scheme) for insulinoma?
Stage 1: involves pancreas only Stage 2: LN involvement Stage 3: distant metastasis
26
Name 2 prognostic factors for insulinoma
tumor size and Ki67 index | also stage
27
Describe the toxicity profile of streptozotocin
nephrotoxicity, emesis during administration, DM, mild hematologic changes
28
What % of dogs with stage 1 insulinoma treated with surgery are free of hypoglycemia at 14 months?
50%
29
What is Zollinger-Ellison syndrome?
1. non-beta cell neuroendocrine tumor in the pancreas 2. hypergastrinemia 3. GI ulceration
30
What is the metastatic rate for gastrinomas?
85%
31
What was the MST for dogs with non-resectable thyroid carcinoma treated with hypofx RT? What was ORR? (Tsimbas 2018)
170d (5.6 months) | ORR was 25% (or 29% when you included only dogs who completed protocol)
32
Is the expression of thyroid transcription factor-1 maintained in lung digit syndrome? (Finotello 2017)
Yes | but weakly to moderately positive?
33
Can toceranib disrupt the hypothalamic-pituitary-thyroid axis? (Humes 2017)
Yes - hormones remained in reference ranges but FT4 went down and TSH went up (no thyroglobulin Abs in any dogs)
34
Do guinea pigs get thyroid carcinomas?
Yes Majority of thyroid neoplasms were benign (8 adenomas, 1 cystadenoma, 3 papillary thyroid adenomas) but some were malignant (5 follicular carcinomas, 1 follicular-compact carcinoma, 1 small cell thyroid carcinoma)
35
What was the prevalence of thyroid tumors found on CT? What % of these incidental lesions were malignant? (Bertolini VRU 2017)
2. 12% (96/4520 dogs) | 82. 3% were malignant
36
What % of dogs developed hypoT4 after RT? What was the median time to development? (Amores-Fuster 2017)
47.6% 6 months (21 total cases, 17 were post-op RT)
37
Both thyroid glands are affected in what % of hyperthyroid cats?
70-90%
38
When should adrenalectomy be considered for incidental adrenal masses?
If they are functional, locally invasive, or larger than 2.5 cm
39
What factors (in multivariate analysis) were associated with poor prognosis for dogs undergoing adrenalectomy? (Schwartz JAVMA 2008)
preoperative hypokalemia, preoperative increased BUN, concurrent nephrectomy (other variables in univariate included weakness/lethargy, thrombocytopenia, increased PTT, increased AST, and intraoperative hemorrhage)
40
What % of dogs with hypercalcemia had incidental thyroid nodule?
15% | 22% of those were thyroid carcinoma
41
What was sensitivity of palpation to rule out invasion of thyroid tumors? (Deitz JSAP 2014)
71% | Note that palpation was not predictive in Taeymans VRU 2013
42
What was sens/spec of CT to rule out invasion of thyroid tumors? (Deitz JSAP 2014)
70%/100% | Also had 100% specificity in Taeymans VRU 2013
43
What features were unique to dogs with sublingual ectopic thyroid neoplasia? What was MST? (Broome 2014)
They were younger and less likely to have metastatic disease | MST was 562d (18 months)
44
What receptors were expressed in thyroid tumors as potential targets? (Campos 2014)
VEGF, COX-2, Pgp | sig higher in medullary than follicular; p53 was not expressed
45
What pathway is overexpressed in canine thyroid carcinoma? (Campos 2014)
PI3K/Akt
46
What features of thyroid carcinoma are associated with having distant mets? (Campos JVIM 2014)
tumor diameter, tumor volume, bilateral location
47
T/F: E-cadherin expression is associated with poor outcome in thyroid carcinoma.
False (Campos JVIM 2014 - not associated with outcome)
48
What % of dogs with bilateral thyroidectomy developed hypocalcemia? (Tuohy JAVMA 2012)
73%, all were successfully corrected, 8 dogs needed longterm soloxine Conclusions: successful outcome can be had, even when surgeon can't preserve parathyroid tissue
49
What was MST following bilateral thyroidectomy for thyroid carcinoma? (Tuohy JAVMA 2012)
38.3 months, some dogs had adjuvant chemo
50
In a case series of 19 dogs, how many had complications associated with FNA of adrenal masses? (Sumner JSAP 2018)
1/19 -- Vtach after sampling (tumor was a pheo) | 9/19 diagnosed as pheo (histopath was not available for all cases)
51
What factors affected MST for cats undergoing unilateral adrenalectomy for primary hyperaldosteronism? (Lo 2014)
anesthesia time >4h
52
What % of laparoscopic adrenalectomies needed to be converted to laparotomy? (Mitchell 2017)
36%
53
What was the clinical benefit of toceranib for pheochromocytoma? (Musser 2018)
5 dogs - 1 PR, 4 SD (retrospective so inconsistent re-staging)
54
What was the survival time for dogs with non-cortisol secreting adrenal tumors NOT treated with surgery? (Arenas Vet Rec 2013)
17.8 months
55
What gene was increased in adrenal cortisol-secreting tumors in comparison to adenomas? (Kool JVIM 2015)
ERBB2 | Conclusion: PI3K activation in carcinomas but not adenomas based on target gene expression.
56
Mutations in _____ have been associated with metastatic disease of pheos/paragangliomas in humans and has been described in dogs. (Galac VCO Review 2017)
succinate dehydrogenase subunit B
57
What was the prevalence of incidental adrenal masses found in dogs on abdominal CT? (Baum 2016)
9.3% (25/270)
58
In 9 dogs undergoing bilateral adrenalectomy, how many died perioperatively? (Oblak 2016)
1/9 | Those who survived to discharge - MST was 525d
59
T/F: Pheochromocytoma associated cardiomyopathy is reported in humans and also occurs in dogs.
True (Edmondson 2015)
60
What variable was associated with poor outcome in a series of 33 cats with adrenal neoplasia? (Daniel 2016)
female sex
61
Is urine or plasma superior to measure normetanephrine for diagnosis of pheochromocytoma? (Salesov JVIMA 2015)
urine
62
Undetectable ____ in a neutered dog with an adrenal tumor is highly suggestive of a pheo. (Bromel JVIM 2013)
inhibin | expression noted in other adrenal tumors but not pheos
63
What % of dogs with incidental adrenal tumors had non-adrenal cancers? (Cook 2014)
29% | Conclusions: more common in older dogs, IAGL are probably malignant if > 2cm
64
What characteristic on CT makes pheo more likely? (Gregori 2014)
Vascular invasion
65
What was the accuracy of cytology in diagnosing adrenal tumors? (Bertazzolo 2014)
90-100%
66
What was MST for adrenocortical carcinomas and pheos? (Barrera 2013)
Adrenocortical carcinomas - 48 months Pheo - MST not reached (1 yr survival 83%, 3 yr 60%) Basically if they can survive surgery they can do well.
67
Pheochromocytoma was diagnosed in ___ % of horses presenting for necropsy and was suspected to contribute to ___% of the cases' clinical findings.
0.95% | 19% -- multiple endocrine neoplasms were frequently seen
68
What % of canine insulinoma cases have mets at dx?
50%
69
What tumor reduction was seen with SRT for canine adrenal tumors with vascular invasion? (Dolera JSAP 2017)
~30%
70
What is the main cause of non-islet cell tumor hypoglycemia?
secretion of IGF2 | vs. islet cell tumors secreting insulin
71
What risk is associated with streptozotocin in dogs? What is needed for safe administration?
Nephrotoxicity | Can be safely administered with aggressive saline diuresis
72
How does octeeotide help insulinoma?
Somatostatin analog | Inhibits production of insulin and growth hormone
73
What TKs are expressed by neuroendocrine tumors?
VEGFR | PDGFR
74
What was gross disease response rate to 5-FU and carbo for carcinomas? (Retrospective, Flesner on study)
43%

Onco Board Review 2 (20 decks)

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