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SA DX & TX I > Final Exam - Injection Site & Soft Tissue Sarcomas > Flashcards

Final Exam - Injection Site & Soft Tissue Sarcomas Flashcards

1
Q

T/F: soft tissue sarcomas can arise from any anatomic site

A

true

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2
Q

what are the biological characteristics of soft tissue sarcomas?

A

pseudocapsule with poor histologic border

high local recurrence rate with conservative treatment

hematogenous metastasis

relatively resistant to chemo & radiation when gross disease

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3
Q

T/F: soft tissue sarcomas account for 10-15% of all cutaneous/subcutaneous tumors

A

true

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4
Q

what is the median age of diagnosis of soft tissue sarcomas?

A

10 years

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5
Q

where are most soft tissue sarcomas seen to arise from?

A

95% extremity & trunk

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6
Q

how should a needle core or tru cut biopsy be performed for a soft tissue sarcoma?

A

use a 14-16 G needle, get 4-6 samples, avoid penetrating tissue plane, can use image guidance, & squash preparation for cytology

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7
Q

how is an incisional biopsy performed for a soft tissue sarcoma?

A

can do this under sedation & local anesthesia - ensure the animal is deep enough

get adequate hemostasis, suture subcutis & capsule - want a narrow cut for better healing

if in mouth, ensure correctly recorded & take a picture

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8
Q

what is the goal of surgical reconstruction for soft tissue sarcomas?

A

surgical oncology principles are very important - aim for simplest reconstruction & consider a fall back plan - wide margin with 2nd intent

balance between oncologic control & morbidity/function/quality of life

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9
Q

what is involved with surgical planning for soft tissue sarcomas in regards to gross surgical margin/surgical dose?

A

extent of surgery doesn’t affect the outcome

want quality & quantity - 2 to 3 cm & deep uninterrupted fascial plane

grade likely has an impact (pushing vs. infiltrative)

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10
Q

quality of the pathologist’s opinion of your sample is directly related to what?

A

quality of the specimen & information that you send - make sure to include tissue inking & suturing deep fascial plane to skin to maintain orientation

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11
Q

grade of soft tissue sarcomas depend on what?

A

assigning scores to differentiation, degree, or necrosis & mitotic index

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12
Q

what are the most important aspects of outcomes for an animal with a soft tissue sarcoma?

A

histologic grade of the tumor & adequate resection with local control being most of the battle

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13
Q

T/F: 1/3-1/2 of soft tissue sarcomas will recur after conservative surgery

A

true

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14
Q

what are some factors that reduce chance of successful treatment of soft tissue sarcomas?

A

myxoid tumors/maybe fibrosarcoma

> 5cm

deep to fascial plane

age of patient

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15
Q

how is a soft tissue sarcoma staged?

A

T1 - <5cm
T2 - >5cm, type a is superficial & type b is deep

N0 - no lymph node involvement
N1 - lymph node involvement

M0 - no metastasis
M1 - distant metastasis present

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16
Q

how is a feline injection site sarcoma staged?

A

same as soft tissue sarcomas - but more likely to see metastasis, look for lymph node involvement

17
Q

what are the treatment options for soft tissue sarcomas?

A

low grade tumors can be managed at general practices because they have lower rates of metastasis

surgery - 2-3cm deep & 1 deep uninterrupted fascial plane

18
Q

what are the treatment options for feline injection site sarcomas?

A

refer!!!!!!!! need presurgical planning & radiation therapy

complete excisional surgery!!!! need at least 5cm deep & 2 fascial planes for better outcomes

19
Q

what is the importance of histologic grade in soft tissue sarcomas?

A

most are lower grade and have a low risk of metastasis

20
Q

when would you refer a case of soft tissue sarcoma or feline injection site sarcomas in general practice?

A

high grade soft tissue sarcoma

suspicious FNA/incisional biopsy in a cat for feline injection site sarcoma

21
Q

what are the different stages for soft tissue sarcomas?

A

stage 1 - any T, N0, M0 grade I/II

stage 2 - T1 or T2a, N0, M0: grade III

stage 3 - T2b, N0, M0, grade III

stage 4 - any T, any N, M1

22
Q

if local control is adequate in soft tissue sarcomas, what is the average survival time?

A

4 years

23
Q

what is the disease free interval for a high grade soft tissue sarcoma with adequate control with or without chemo?

A

740 days

24
Q

what do you do if you have positive margins after surgical excision of a soft tissue sarcoma?

A

interpret it in light of grade - low grade has low rate of recurrence

25
Q

T/F: adjuvant radiation therapy provides up to 85% long term disease control with R1 disease in soft tissue sarcomas after positive margins post-op surgery

A

true

26
Q

what is a feline injection site sarcoma?

A

associated with robust inflammation that cats mount - uncontrolled fibroblast & myofibroblast proliferation & eventual tumor formation, similar phenomenon with ocular trauma & sarcomas in cats

upregulation of PDGF, EGF, TGF-B

27
Q

T/F: there is strong evidence between type, manufacturer, presence of adjuvant, & tumor development

A

false - no evidence

28
Q

what tumors can potentially develop as a result of an injection in cats?

A

sarcoma, rhabdomyosarcoma, malignant fibrous histiocytoma, & chondrocytoma

29
Q

what are the common biological themes of feline injection site sarcomas?

A

biological & histologically aggressive

peripheral inflammatory cell infiltrate & transition between inflammation & tumor

most are high grade tumors

30
Q

what is the 3-2-1 rule for feline injection site sarcomas?

A

all of these are warning signs of FISS & should be investigated

mass that has been there for more than 3 months after an injection

mass that is bigger than 2cm

mass that has increased in size more than 1 month after a vaccine/injection

31
Q

in practice, what are the only diagnostics you should do for a suspected feline injection site sarcoma?

A

FNA & narrow/deep incisional biopsy

32
Q

why should you never do an excisional biopsy on your own on a suspected feline injection site sarcoma?

A

disease free interval is significantly decreased!!!!!

increased number of surgeries needed, surgery done by non-specialist, & surgery is planned without advanced imaging

33
Q

what are the most important factors for outcome in soft tissue sarcomas?

A

histologic grade & adequacy of resection

34
Q

what is the importance of histologic grade in soft tissue sarcomas?

A

grade significantly affects patient outcome - most are low grade, but high grade associated with higher mortality

SA DX & TX I (59 decks)

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