Final Exam - Injection Site & Soft Tissue Sarcomas Flashcards
T/F: soft tissue sarcomas can arise from any anatomic site
true
what are the biological characteristics of soft tissue sarcomas?
pseudocapsule with poor histologic border
high local recurrence rate with conservative treatment
hematogenous metastasis
relatively resistant to chemo & radiation when gross disease
T/F: soft tissue sarcomas account for 10-15% of all cutaneous/subcutaneous tumors
true
what is the median age of diagnosis of soft tissue sarcomas?
10 years
where are most soft tissue sarcomas seen to arise from?
95% extremity & trunk
how should a needle core or tru cut biopsy be performed for a soft tissue sarcoma?
use a 14-16 G needle, get 4-6 samples, avoid penetrating tissue plane, can use image guidance, & squash preparation for cytology
how is an incisional biopsy performed for a soft tissue sarcoma?
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
what is the goal of surgical reconstruction for soft tissue sarcomas?
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
what is involved with surgical planning for soft tissue sarcomas in regards to gross surgical margin/surgical dose?
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)
quality of the pathologist’s opinion of your sample is directly related to what?
quality of the specimen & information that you send - make sure to include tissue inking & suturing deep fascial plane to skin to maintain orientation
grade of soft tissue sarcomas depend on what?
assigning scores to differentiation, degree, or necrosis & mitotic index
what are the most important aspects of outcomes for an animal with a soft tissue sarcoma?
histologic grade of the tumor & adequate resection with local control being most of the battle
T/F: 1/3-1/2 of soft tissue sarcomas will recur after conservative surgery
true
what are some factors that reduce chance of successful treatment of soft tissue sarcomas?
myxoid tumors/maybe fibrosarcoma
> 5cm
deep to fascial plane
age of patient
how is a soft tissue sarcoma staged?
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
how is a feline injection site sarcoma staged?
same as soft tissue sarcomas - but more likely to see metastasis, look for lymph node involvement
what are the treatment options for soft tissue sarcomas?
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
what are the treatment options for feline injection site sarcomas?
refer!!!!!!!! need presurgical planning & radiation therapy
complete excisional surgery!!!! need at least 5cm deep & 2 fascial planes for better outcomes
what is the importance of histologic grade in soft tissue sarcomas?
most are lower grade and have a low risk of metastasis
when would you refer a case of soft tissue sarcoma or feline injection site sarcomas in general practice?
high grade soft tissue sarcoma
suspicious FNA/incisional biopsy in a cat for feline injection site sarcoma
what are the different stages for soft tissue sarcomas?
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
if local control is adequate in soft tissue sarcomas, what is the average survival time?
4 years
what is the disease free interval for a high grade soft tissue sarcoma with adequate control with or without chemo?
740 days
what do you do if you have positive margins after surgical excision of a soft tissue sarcoma?
interpret it in light of grade - low grade has low rate of recurrence
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
true
what is a feline injection site sarcoma?
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
T/F: there is strong evidence between type, manufacturer, presence of adjuvant, & tumor development
false - no evidence
what tumors can potentially develop as a result of an injection in cats?
sarcoma, rhabdomyosarcoma, malignant fibrous histiocytoma, & chondrocytoma
what are the common biological themes of feline injection site sarcomas?
biological & histologically aggressive
peripheral inflammatory cell infiltrate & transition between inflammation & tumor
most are high grade tumors
what is the 3-2-1 rule for feline injection site sarcomas?
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
in practice, what are the only diagnostics you should do for a suspected feline injection site sarcoma?
FNA & narrow/deep incisional biopsy
why should you never do an excisional biopsy on your own on a suspected feline injection site sarcoma?
disease free interval is significantly decreased!!!!!
increased number of surgeries needed, surgery done by non-specialist, & surgery is planned without advanced imaging
what are the most important factors for outcome in soft tissue sarcomas?
histologic grade & adequacy of resection
what is the importance of histologic grade in soft tissue sarcomas?
grade significantly affects patient outcome - most are low grade, but high grade associated with higher mortality
