GI Tumors, Liver (+ some mammary) Flashcards
1
Q
Name three PNS seen with GI smooth muscle tumors.
A
hypoglycemia, nephrogenic DI, erythrocytosis
2
Q
What is the met rate for hepatic leiomyosarcomas?
A
100%
3
Q
What IHC markers differentiate leiomyosarcomas from GISTs?
A
Leiomyo: actin+, desmin+ (neg for c-kit, CD34, S-100)
GIST: cKIT+, CD34+ (variable reactivity to actin, desmin, S-100)
4
Q
What is the MST for GI leiomyosarcomas/GIST in patients that survive surgery?
A
37.4 months
5
Q
Aside from c-kit, what marker may be more sensitive/specific for canine GIST than c-kit? (Dailey 2015)
A
DOG1 (identified in 2 tumors that were c-kit negative, at minimum authors recommend combining with c-kit)
6
Q
What parasite is known to cause esophageal sarcomas?
A
Spirocerca lupi
7
Q
Which is not associated with Spirocerca lupi-induced sarcomas?
- neutrophilia
- hypertrophic osteopathy
- thoracic spondylitis
- microcytic hypochromic anemia
- hypoglycemia
A
hypoglycemia
8
Q
What is the most common canine gastric tumor?
A
adenocarcinoma
9
Q
What % of GISTs form in the stomach?
A
20%
10
Q
What is the MST for dogs undergoing pylorectomy and gastroduodenestomy?
A
33 days
11
Q
Pancreatic nodules larger than what size are suggestive of neoplasia in cats?
A
> 2cm
12
Q
What PNS is associated with pancreatic carcinoma in cats?
A
ventral glistening alopecia
13
Q
What compound can experimentally induce pancreatic duct adenocarcinoma?
A
N-ethyl-N’-nitro-N-nitrosoguanidine
14
Q
What is the MST for salivary gland carcinomas treated with sx +/- RT for dogs and cats?
A
550 days for dogs
516 days for cats
15
Q
What are the top 3 intestinal tumors in cats and dogs?
A
Cats: LSA, ACA, MST
Dogs: LSA, ACA, Leio/GIST
16
Q
What does the term carcinoid mean?
A
Tumors that arise from the diffuse endocrine system (enterochromaffin cells) rather than intestinal epithelium.
17
Q
Which IHC markers differentiate leiomyosarcomas from GISTs?
A
Leio: actin, desmin
GIST: cKIT, CD34 (DOG1)
18
Q
What is the MST for dogs with colorectal ACA treated with surgery?
A
2-4 years
survived 15 months with stool softeners alone
19
Q
What is the MST for cats with colonic ACA treated with surgery and DOX? (Withrow)
A
280d (9 months) vs. 56 days without
20
Q
What is the MST for dogs with intestinal ACA treated with surgery?
A
114 days, 7-10 months
21
Q
What is the MST for dogs with GI leiomyosarcoma or GIST treated with surgery?
A
1.1 - 2 years, 38 months
if they survive the preoperative period
22
Q
Diffuse cytoplasmic KIT staining detected in what % of GIST? (Takanosu 2016)
A
70% (and 30% stippled cytoplasmic staining)
also mutations in exon 11 of c-kit ID’s in 74% with RT-PCR
23
Q
Why can hypoglycemia occur with leiomyosarcoma?
A
Production of IGF
24
Q
Where are GISTs more likely to occur? Where are leiomyosarcomas more likely to occur? (Withrow p.414)
A
GIST - large intestine (specifically cecum)
Leio - stomach and small intestine
(note that in Hayes 2013, 67% of GISTs occurred in small intestine)
25
What is the metastatic rate and common locations for feline intestinal adenocarcinoma?
50% will spread to local LN; 30% to peritoneal cavity; 20% to lungs
26
What exon is c-kit mutation on for canine GIST?
exon 11
27
What gene is frequently mutated in human colorectal carcinoma and also noted to be mutated in dogs? (Youmans 2012)
APC (adenomatous polyposis coli)
28
What is the median DFI/MST for cats with colonic adenocarcinoma treated with subtotal colectomy and adjuvant carbo? (Arteaga 2012)
DFI 251d (8 months); MST 269d (9 months)
29
What was the complication rate for rectal pull-through surgery in dogs with rectal masses? MST? (Nucci 2014)
78.4% incontinence - permanent in 54.8%
MST was 1150d for all dogs and 726d for malignant rectal tumors
(conclude high complication rate but good outcome)
30
What cytokine may be important in pathogenesis of inflammatory colorectal polyps in mini-dachshunds? (Ohta 2013)
IL-17
| There are several papers looking at markers for this disease that I didn't include
31
What cells do GISTs originate from?
interstitial cells of Cajal
32
What % of GI leiomyosarcomas were reclassified as GIST? (Russell 2007 and Maas 2007)
58-67%
33
What features were associated with worse survival for GIST treated with Palladia (both microscopic and macroscopic? (Berger 2018)
```
High MI (did not give cut-off!) and metastasis at diagnosis
Could by type 1 error (false +)
```
34
What apoptotic marker was significantly higher in cats with GI LSA vs. IBD? (Swanson 2012)
Bcl-2
| but note that positive expression in both groups was pretty high
35
Do cats with GI LSA have gremlin mutation in MMR? (Aberdein 2012)
No
| evaluated due to MMR defect in HNPCC
36
Can cytology be used to diagnoses GI disease in dogs? (Maeda 2017)
Maybe, there was 81.4% agreement in this study looking at chronic enteritis vs. intestinal LSA in dogs.
(for enteritis vs. LSA - Sn was 98.6% but Sp only 73.5%)
37
When PARR was used for canine intestinal LSA, what % were accurately diagnosed? (Ohmura 2017)
76%
| correctly identified 22/29 cases; 85% were T cell
38
What % of cats with gastric LSA experienced remission? What was duration of first remission? (Gustafson 2014)
75% remission
| median remission 108d (3.6 months)
39
Is serum gastrin a reliable prognostic indicator for canine gastric carcinoma? (Seim-Wikse 2014)
No
| it is in humans
40
What cytologic features (on squash prep) are specific for malignancy in gastric ACA? (Riondato 2014)
signet rings and microvacuolation
41
What dose of radiation is recommended to treat recurrent sialoceles refractory to surgical management? (Poirier JVIM 2018)
Minimum total dose of 16 or 20 Gy in 4 Gy fractions appeared effective
42
What was ORR to radiation for sialoceles? (Poirier JVIM 2018)
100%
(54% CR, 45% PR)
Those that had progression had only received 12 Gy
43
What is the most common gastric neoplasia in horses? (Taylor JVIM 2009)
SCC (19/24 cases)
| MST was 4 weeks (all cases)
44
Which EMT factors are potential targets for canine mammary carcinoma? (Xavier 2018)
ZEB1 and ZEB2
45
How did medical therapy (toceranib/piroxicam/thalidomide) alone compare to medical therapy with hypofractionated RT for inflammatory mammary carcinoma? (Rossi 2018)
Improved response and survival
| ORR 100%, TTP 156d, MST 180d (vs. 34d and 109d)
46
Dogs with what characteristics may benefit from OHE at the time of mammary carcinoma removal? (Kristiansen 2016, randomized controlled trial)
grade 2
ER-positive tumors
increased peri-surgical serum E2 concentration
47
What were the results of combination iniparib and carboplatin to treat dogs with tumors? (Saba PLoS One 2016)
- iniparib developed as PARP inhibitor but MOA not understood, positive effects in human trials
- DLT included fever, anorexia, diarrhea, neutropenia, thrombocytopenia (attributed to carbo)
- Unable to identify MTD of iniparib but was tolerated
- No detectable drug/metabolites in the tumors themselves
48
What phenotype are tumor-associated macrophages?
M2
49
What is one of the most highly recurrent amplified genes in canine mammary carcinoma? (Borge PLoS One 2015)
MYC
50
What was significant about overweight dogs and mammary tumors? (Lim Vet Path 2015)
proportion of grade 3 tumors and aromatase expression
51
How did ulceration influence survival of mammary carcinoma? (Tran 2016)
MST 118d if present and 443d if absent
52
How did surgical margins influence survival of mammary carcinoma? (Tran 2016)
MST 70d if incomplete, 872d if complete
53
What was the effect of OHE at the time of tumor removal in dogs with benign mammary tumors? (Kristiansen 2013)
OHE at time of tumor removal can reduce risk of new tumor development by 50%
(new mammary tumors developed in 64% of intact dogs and 36% of spayed)
54
What gene was identified that may play a role in MGT in English sprinter spaniels? (Borge 2013)
ESR1 (estrogen receptor 1 gene)
55
Overexpression of what protein, which is normally restricted to testis and ovaries, was identified in 82% of oral melanomas, 100% of nasal tumors, and 100% TVT? (Chen 2013)
MAGE-A
56
What two factors were identified as independent prognostic markers of canine malignant mammary tumors? (Santos 2013)
MMP-9, Ki67
57
What breed had the highest proportion of malignant MGTs and over-expression of BRCA-1? (Im 2013)
Shih Tzus
Cytoplasmic and membranous expression of BRCA1 was associated with ER/PR negative and triple negative (ER/PR/HER2) phenotypes and basal-like molecular structure in Shih Tzu dogs.
58
1. What cytokine was associated with negative prognosis in cats with HER2-over expressing mammary tumors? 2. Which cytokine was expressed in more primary tumors than metastatic? (Marques 2018)
1. CXCL12
| 2. CXCR4
59
What was the complication rate for cats undergoing staged bilateral mastectomy vs. single session bilateral mastectomy? What was the complication rate for unilateral mastectomy? (Gemignani JAVMA 2018)
bilateral staged = 35.7% vs. bilateral single session = 40.6%
unilateral = 19.7%
60
What was the PFS for unilateral mastectomy vs. bilateral? (Gemignani JAVMA 2018)
289d (9.6 months) for unilateral vs. 542d (18 months) for bilateral
61
What were 4 significant risk factors for disease progression in cats with mammary carcinoma (Gemignani JAVMA 2018)
unilateral mastectomy, tumor ulceration, LN metastasis, tumors arising from fourth mammary gland
(LN mets and distant mets were significant for disease-specific survival)
62
What Ki67 cutoff was determined to be reasonable for feline mammary cancer? (Soares 2016)
14%
63
What are 3 independent prognostic factors for feline mammary carcinoma used for grading? (Mills Vet Path 2015)
lymphovascular invasion, nuclear form, MI
64
COX2 was over expressed in what percentage of canine and feline mammary carcinomas? (Millanta VCO 2016)
83% canine, 81% feline
65
What was the conclusion about feline mammary tumors and ER/PR/HER2 and BRCA expression? (Wiese/Kiupel 2013)
Commonly triple negative but BRCA mutations are uncommon
66
What factors were associated with shorter survival for intestinal LSA (univariate)? What was MST? (Sogame 2018)
anorexia, sepsis
| MST 62d
67
T/F: Dogs with intestinal LSA treated with a CCNU-based protocol did better than CHOP. (Sogame 2018)
False - no difference in this study
68
A cranial mediastinal mass accounts for what % of acquired myasthenia gravis in cats? (Hague 2015)
52%
69
How does sonographic appearance of thymoma differ from lymphoma? (Patterson 2014)
cystic (57%) and heterogenous (94%) in comparison to lymphoma
(LSA more likely to be solid and split 50/50 between homogenous and heterogenous)
70
T/F: Thyroid transcription factor-1 is a specific marker of benign but not malignant feline lung tumors.
True
71
What was the response rate of thymomas to hypo fractionated RT? (Goto 2017)
50%, median time to response was 22d
| tx with 48-49 Gy in 6-7 fractions
72
What are two recently evaluated markers, aside from TTF-1, that may help identify lung tumors? (Beck 2017)
surfactant protein-A and napsin A
73
Which TK receptor showed increased expression in lung tumors? (Mariotti 2014)
PDGFR-alpha
74
What were the most common clinical signs associated with HO? (Withers 2015)
leg swelling, ocular discharge and/or episcleral injection, lameness, lethargy
75
What were the most common laboratory findings associated with HO? (Withers 2015)
anemia, neutrophilia, elevated ALP
76
Which breeds appeared to be over-represented with cartilaginous tumors of the larynx and trachea? (Ramirez 2015)
Arctic breeds (Alaskan Malamute and Siberian Husky)
77
T/F: Hypercalcemia and myasthenia gravis/megaesophagus at the time of diagnosis of thymoma are associated with a worse outcome.
False (Robat 2013)
78
What features were associated with poor prognosis for thymoma? (Robat 2013)
presence of another tumor at diagnosis, lack of surgical excision, higher pathological stage
79
What % of dogs had recurrence after surgery for thymoma? (Robat 2013)
17%
80
What % of dogs with thymoma were hypercalcemic? (Robat 2013)
34%
81
What is the MST for thymoma with surgery vs. without? (Robat 2013)
635d with surgery (21 months)
| 76d without surgery (2.5 months)
82
T/F: Primary hepatobiliary tumors are more common than metastatic tumors in cats.
True
83
T/F: Most canine primary liver tumors are benign.
False
84
Most common liver tumor in dog?
Hepatocellular carcinoma
| usually massive
85
What is the etiology of HCC in woodchucks? What gene does this affect?
Woodchuck hepatitis virus (affects c-myc)
| also viral link in humans
86
What is the metastatic rate for diffuse HCC in dogs?
93-100%
87
What is the most common hepatobiliary tumor in cats?
bile duct adenoma
88
What % of bile duct carcinomas metastasize to RLN/lungs in dogs?
88%
89
What is the most common primary liver sarcoma in the dog?
leiomyosarcoma
(also HSA and FSA)
metastasis 86-100% to spleen, lungs
90
What is a benign liver tumor in cats thought to be associated with chronic hypoxia?
myelolipoma
91
What is the reported intraoperative mortality rate for HCCs treated with surgery?
4.8%
92
Name 3 prognostic factors for massive HCC.
1. surgical treatment (+)
2. R sided mass (-) - worse due to intraop death
3. increased ALT and AST (-)
93
What is the MST for massive HCC treated with surgery?
1460d (4 years)
94
What is the MST for dogs that do not receive surgery for HCC?
270d (9 months)
95
What was the objective response to 3D-CRT for inoperable massive HCC in dogs? (Mori 2015)
5/6 dogs (83%)
RT induced liver dz in 1 dog, rest well tolerated
Total dose ranged from 18-42 Gy
96
Most common liver tumor in cats?
benign biliary cystadenoma
97
Dog breed that may be overrepresented with HCC?
miniature schnauzer
98
How do bile duct carcinomas differ between cats and dogs?
Dog - intrahepatic more common
| Cat - extrahepatic more common
99
Metastatic rate of liver carcinoids?
93%
| typically nodular/diffuse, younger age
100
Does gemcitabine provide benefit for HCC? (Elpiner 2011)
no obvious benefit, survival similar to other reports
101
What % of liver masses were correctly localized on ultrasound? (Wormser 2016)
51.8%
| correct localization 3.2x more likely with R or L compared to central
102
What % of cats had increased ALT activity with CCNU? (Musser 2012)
6.8%
