Feline Lymphoma Flashcards
What is the reported percent of feline renal transplant patients that develop lymphoma?
a. 3%
b. 9%
c. 18%
d. 22%
b.
You perform an abdominal ultrasound on a cat with gastrointestinal signs, which reveals diffuse intestinal thickening with distortion of all wall layers. PARR reveals a monoclonal population of T-cells. What is the expected survival time?
a. 2 months
b. 6 months
c. 8 months
d. 1 year
e. 2 years
a.
T-cell GI lymphoma is more common than B-cell (83% and 17%, respectively). Transmural T-cell GI lymphoma is associated with an MST of 1.5 months. In Moore et al 2012, about half of the cats with transmural T-cell had LGL. Other survival times are as follows:
- Mucosal T-cell (sparing the submucosa): MST of 29 months.
- B-cell transmural (95% of B-cell GI lymphomas): MST of 3.5 months.
- B-cell transmural: MST not reported.
What percent of cats with inflammatory bowel disease will have ultrasonographic evidence of lymphadenopathy?
a. 14%
b. 17%
c. 23%
d. 26%
e. 31%
b.
A 13-year-old, spayed female, Domestic shorthaired cat presents with a 2 month history of vomiting and diarrhea. Ultrasonography reveals mesenteric lymphadenopathy and muscularis thickening. It is elected to pursue full thickness biopsies. The histopathology report is as follows:
In section of jejunum and duodenum, there is diffuse infiltration of the lamina propria with small round cells that expand the lamina propria, replaces normal mucosal architecture, and shortens and fuses villi. These cells are also present in clusters within the mucosal epithelium. Multifocally, these cells infiltrate the submucosa and connective tissues of the interstitium of the muscular tunic. All cells are positively labeled for CD3 whereas minimal numbers of cells have CD20 positive labeling.
What is the correct diagnosis for this patient?
a. inflammatory bowel disease b. lymphoplasmocytic duodenitis c. large, B-cell intestinal lymphoma d. small, T-cell intestinal lymphoma e. small, B-cell intestinal lymphoma
d.
“As previously discussed, histologic features that help differentiate intestinal lymphoma from IBD include lymphoid infiltration of the intestinal wall beyond the mucosa, epitheliotropism (especially intraepithelial nest and plaques), heterogeneity, and nuclear size of lymphocytes.”
What is the median survival time of a cat with small T cell intestinal LSA treated with chlorambucil and prednisone?
a. 3 months b. 6 months c. 12 months d. 18 months e. 24+ months
e.
Which of the following tests would further enhance the sensitivity for histopathology on a cat suspected to have small T cell intestinal LSA?
a. vimentin immunohistochemistry b. CD3 immunohistochemistry c. PARR d. flow cytometry on paraffin embedded tissue e. CD4 immunohistochemistry
c.
- H&E alone (Sp = 99%, Se = 72%)
- IHC (Sp = 99%, Se = 78%)
- PARR (Sp = 99%, Se = 83%)
In regards to the characteristics associated with the different anatomic forms of lymphoma in cats, choose the most correct answer. Note that common stands for > 50% of clinical presentations and rare stands for
a.
Feline CNS lymphoma may be primary; however what percentage of feline CNS lymphoma may represent a multicentric process? Also, identify which anatomic locations are most commonly involved with CNS lymphoma as part of this multicentric process. (choose one answer for percentage and one answer for locations)
i. 30%
ii. 75%
iii. 80%
iv. Liver and mesentery
v. Renal and bone marrow
vi. Stomach and bladder
a. i, vi
b. iii, iv
c. iii, v
d. ii, vi
e. ii, v
c.
Feline CNS lymphoma may be primary but more commonly, approximately 80%, represents a multicentric process (especially renal or bone marrow).
In a study of 63 cats diagnosed histopathologically with gastrointestinal lymphoma or IBD, the specificity was around 99% and sensitivity was 72%. How did the addition of immunophenotype and PARR analysis enhance the sensitivity for the diagnosis of lymphoma? (identify the sensitivity for each test)
a. Immunophenotype 83%, PARR 72%
b. Immunophenotype 75%, PARR 93%
c. Immunophenotype 80%, PARR 83%
d. Immunophenotype 90%, PARR 99%
e. Immunophenotype 78%, PARR 83%
e.
Kiepel’s study of 63 cats with either LSA of IBD found that, although standard histopath was highly specific for LSA (99% specific, 72% sensitive), sensitivity was enhanced by the addition of immunophenotypic analysis (99% specific, 78% sensitive) and further enhanced by PARR analysis (99% specific, 83% sensitive).
A 9 year old female spayed DSH presents with history of anorexia, weight loss, and vomiting. A 4cm small intestinal mass, abdominal lymphadenomegaly, and abdominal effusion are observed with ultrasound. Cytology of the intestinal mass and lymph nodes show large lymphocytes with basophilic cytoplasm with vacuoles and magenta granules. Felv/FIV testing is negative. What is the reported median survival for cats with this cancer treated with chemotherapy? A. 17 days B. 57 days C. 107 days D. 350 days E. 535 days
b.
- 45 cats in study; 23 cats received chemotherapy
- 1 CR and 6 PR when treated with chemo (Overall response rate of 30%)
An 11 year old male, neutered Maine Coon is referred to you after a nasal biopsy is consistent with large cell lymphoma. There are 5 mitoses per HPF and the neoplastic cells are CD79a+/CD3-. What is the risk of distant metastasis/relapse in this patient? A. 80% B. 63% C. 32% D. 20% E. 3%
d.
Staging tests including thoracic radiographs, abdominal ultrasound, liver and spleen cytology, and bone marrow cytology are performed on a cat with nasal LSA. No evidence of distant metastasis is found. What therapy provides the longest median survival time? A. Radiation therapy – 3Gy x 18 B. CHOP based chemotherapy protocol C. Chlorambucil/Prednisone D. COP based chemotherapy E. Prednisone alone
a.
MST for all therapies regardless modality – 537d
No difference in survival for RT alone vs RT + chemo vs chemo alone
Which statement is true of Elspar therapy in cats compared to dogs?
a. The duration of response is shorter but the percentage response rate is the same.
b. The duration of response is the same but the percentage response rate is lower.
c. The duration of response is longer but the percentage response rate is shorter.
d. The duration of response is shorter and the percentage response rate is lower.
d.
A 12 year old male neutered cat presents with a three month history of bilateral mucopurulent nasal discharge. Following a CT scan and nasal biopsies, the patient is diagnosed with nasal lymphoma. Labwork (CBC, chemistry, urinalysis, T4, retroviral testing) is unremarkable and thoracic radiographs and abdominal ultrasound reveal no evidence of lymphoma. Cytology of liver, spleen, and bone marrow are also clear of lymphoma. There are no radiation therapy facilities near you, and the owner’s schedule does not allow travel for treatment. You discuss using a CHOP-based chemotherapy protocol as an alternative treatment. Which answer best represents the expected outcome?
a. 90% complete response, 3 year median survival time
b. 40% complete response, 1.5 year median survival time
c. 60% complete response, 1 year median survival time
d. 75% complete response, 2 year median survival time
d.
Choose the most correct statement regarding feline lymphoma in the kidney, GI tract, and liver:
a. FIV-associated lymphoma is more likely to have B cell immunophenotype; FeLV-associated lymphoma is more likely to have T cell immunophenotype
b. FIV-associated lymphoma is more likely to have T cell immunophenotype; FeLV-associated lymphoma is more likely to have B cell immunophenotype
c. Both FIV and FeLV-associated lymphoma are more likely to have T cell immunophenotype.
d. FIV and FeLV-associated lymphoma do not have a strong immunophenotype predisposition.
a.
