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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
Q

What are the 3 stages (WHO staging scheme) for insulinoma?

A

Stage 1: involves pancreas only
Stage 2: LN involvement
Stage 3: distant metastasis

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26
Q

Name 2 prognostic factors for insulinoma

A

tumor size and Ki67 index

also stage

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27
Q

Describe the toxicity profile of streptozotocin

A

nephrotoxicity, emesis during administration, DM, mild hematologic changes

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28
Q

What % of dogs with stage 1 insulinoma treated with surgery are free of hypoglycemia at 14 months?

A

50%

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29
Q

What is Zollinger-Ellison syndrome?

A
  1. non-beta cell neuroendocrine tumor in the pancreas
  2. hypergastrinemia
  3. GI ulceration
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30
Q

What is the metastatic rate for gastrinomas?

31
Q

What was the MST for dogs with non-resectable thyroid carcinoma treated with hypofx RT? What was ORR? (Tsimbas 2018)

A

170d (5.6 months)

ORR was 25% (or 29% when you included only dogs who completed protocol)

32
Q

Is the expression of thyroid transcription factor-1 maintained in lung digit syndrome? (Finotello 2017)

A

Yes

but weakly to moderately positive?

33
Q

Can toceranib disrupt the hypothalamic-pituitary-thyroid axis? (Humes 2017)

A

Yes - hormones remained in reference ranges but FT4 went down and TSH went up (no thyroglobulin Abs in any dogs)

34
Q

Do guinea pigs get thyroid carcinomas?

A

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
Q

What was the prevalence of thyroid tumors found on CT? What % of these incidental lesions were malignant? (Bertolini VRU 2017)

A
  1. 12% (96/4520 dogs)

82. 3% were malignant

36
Q

What % of dogs developed hypoT4 after RT? What was the median time to development? (Amores-Fuster 2017)

A

47.6%
6 months
(21 total cases, 17 were post-op RT)

37
Q

Both thyroid glands are affected in what % of hyperthyroid cats?

38
Q

When should adrenalectomy be considered for incidental adrenal masses?

A

If they are functional, locally invasive, or larger than 2.5 cm

39
Q

What factors (in multivariate analysis) were associated with poor prognosis for dogs undergoing adrenalectomy? (Schwartz JAVMA 2008)

A

preoperative hypokalemia, preoperative increased BUN, concurrent nephrectomy

(other variables in univariate included weakness/lethargy, thrombocytopenia, increased PTT, increased AST, and intraoperative hemorrhage)

40
Q

What % of dogs with hypercalcemia had incidental thyroid nodule?

A

15%

22% of those were thyroid carcinoma

41
Q

What was sensitivity of palpation to rule out invasion of thyroid tumors? (Deitz JSAP 2014)

A

71%

Note that palpation was not predictive in Taeymans VRU 2013

42
Q

What was sens/spec of CT to rule out invasion of thyroid tumors? (Deitz JSAP 2014)

A

70%/100%

Also had 100% specificity in Taeymans VRU 2013

43
Q

What features were unique to dogs with sublingual ectopic thyroid neoplasia? What was MST? (Broome 2014)

A

They were younger and less likely to have metastatic disease

MST was 562d (18 months)

44
Q

What receptors were expressed in thyroid tumors as potential targets? (Campos 2014)

A

VEGF, COX-2, Pgp

sig higher in medullary than follicular; p53 was not expressed

45
Q

What pathway is overexpressed in canine thyroid carcinoma? (Campos 2014)

46
Q

What features of thyroid carcinoma are associated with having distant mets? (Campos JVIM 2014)

A

tumor diameter, tumor volume, bilateral location

47
Q

T/F: E-cadherin expression is associated with poor outcome in thyroid carcinoma.

A

False (Campos JVIM 2014 - not associated with outcome)

48
Q

What % of dogs with bilateral thyroidectomy developed hypocalcemia? (Tuohy JAVMA 2012)

A

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
Q

What was MST following bilateral thyroidectomy for thyroid carcinoma? (Tuohy JAVMA 2012)

A

38.3 months, some dogs had adjuvant chemo

50
Q

In a case series of 19 dogs, how many had complications associated with FNA of adrenal masses? (Sumner JSAP 2018)

A

1/19 – Vtach after sampling (tumor was a pheo)

9/19 diagnosed as pheo (histopath was not available for all cases)

51
Q

What factors affected MST for cats undergoing unilateral adrenalectomy for primary hyperaldosteronism? (Lo 2014)

A

anesthesia time >4h

52
Q

What % of laparoscopic adrenalectomies needed to be converted to laparotomy? (Mitchell 2017)

53
Q

What was the clinical benefit of toceranib for pheochromocytoma? (Musser 2018)

A

5 dogs - 1 PR, 4 SD (retrospective so inconsistent re-staging)

54
Q

What was the survival time for dogs with non-cortisol secreting adrenal tumors NOT treated with surgery? (Arenas Vet Rec 2013)

A

17.8 months

55
Q

What gene was increased in adrenal cortisol-secreting tumors in comparison to adenomas? (Kool JVIM 2015)

A

ERBB2

Conclusion: PI3K activation in carcinomas but not adenomas based on target gene expression.

56
Q

Mutations in _____ have been associated with metastatic disease of pheos/paragangliomas in humans and has been described in dogs. (Galac VCO Review 2017)

A

succinate dehydrogenase subunit B

57
Q

What was the prevalence of incidental adrenal masses found in dogs on abdominal CT? (Baum 2016)

A

9.3% (25/270)

58
Q

In 9 dogs undergoing bilateral adrenalectomy, how many died perioperatively? (Oblak 2016)

A

1/9

Those who survived to discharge - MST was 525d

59
Q

T/F: Pheochromocytoma associated cardiomyopathy is reported in humans and also occurs in dogs.

A

True (Edmondson 2015)

60
Q

What variable was associated with poor outcome in a series of 33 cats with adrenal neoplasia? (Daniel 2016)

A

female sex

61
Q

Is urine or plasma superior to measure normetanephrine for diagnosis of pheochromocytoma? (Salesov JVIMA 2015)

62
Q

Undetectable ____ in a neutered dog with an adrenal tumor is highly suggestive of a pheo. (Bromel JVIM 2013)

A

inhibin

expression noted in other adrenal tumors but not pheos

63
Q

What % of dogs with incidental adrenal tumors had non-adrenal cancers? (Cook 2014)

A

29%

Conclusions: more common in older dogs, IAGL are probably malignant if > 2cm

64
Q

What characteristic on CT makes pheo more likely? (Gregori 2014)

A

Vascular invasion

65
Q

What was the accuracy of cytology in diagnosing adrenal tumors? (Bertazzolo 2014)

66
Q

What was MST for adrenocortical carcinomas and pheos? (Barrera 2013)

A

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
Q

Pheochromocytoma was diagnosed in ___ % of horses presenting for necropsy and was suspected to contribute to ___% of the cases’ clinical findings.

A

0.95%

19% – multiple endocrine neoplasms were frequently seen

68
Q

What % of canine insulinoma cases have mets at dx?

69
Q

What tumor reduction was seen with SRT for canine adrenal tumors with vascular invasion? (Dolera JSAP 2017)

70
Q

What is the main cause of non-islet cell tumor hypoglycemia?

A

secretion of IGF2

vs. islet cell tumors secreting insulin

71
Q

What risk is associated with streptozotocin in dogs? What is needed for safe administration?

A

Nephrotoxicity

Can be safely administered with aggressive saline diuresis

72
Q

How does octeeotide help insulinoma?

A

Somatostatin analog

Inhibits production of insulin and growth hormone

73
Q

What TKs are expressed by neuroendocrine tumors?

A

VEGFR

PDGFR

74
Q

What was gross disease response rate to 5-FU and carbo for carcinomas? (Retrospective, Flesner on study)

Onco Board Review 2 (20 decks)

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