GI Tumours Flashcards
1
Q
What’s the most common canine oral tumours?
A
- MM
- SCC
- FSA
2
Q
What are the most common feline oral tumours?
A
- SCC
- FSA
3
Q
What’s the% of oral amelanotic melanoma?
A
38%
4
Q
Which IHCs are useful for diagnosis melanoma? What’s the sensitivity/ speficificity?
A
- Melan-A, TRP-1, TRP-2, PNL-2
- the specificity = 100% and sensitivity = 94%
5
Q
Describe the staging scheme for oral tumours.
A
6
Q
What’s the metastatic rate of canine oral melanoma?
A
up to 80%
- there is a small subset of well differentiated oral melanoma that’s less aggressive
7
Q
What’s the metastatic rate of canine oral SCC?
A
5-29%
- the metastatic rate increases as it goes mor caudally (ex. caudal tongue, tonsils –> high metastatic potential)
8
Q
What are some risk factors for the development of feline oral SCC?
A
- old generation flea collar (4x)
- canned food, specifically tuna (2x)
- 2nd hand smoke –> increases expression of p53
9
Q
What could be a physiologic reason for the extensive bony damage see with feline oral SCC?
A
the expression of PTHrP
10
Q
What’s the metastatic rate of canine oral fibrosarcoma?
A
<30% to the lymph nodes and lungs
11
Q
Which breeds appear to be at a higher risk of oral fibrosarcoma?
A
Goldens and Labs
12
Q
What’s the biological behaviour of peripheral odontogenic fibroma?
A
- benign
- does not invade bone
- intact epithelium
- predilection for maxillary arcade rostral to P3
13
Q
What’s the biological behaviour of acanthomatous ameloblastoma?
A
- benign
- but frequently invades bone
- Shelties, Old English Sheepdog, and Goldens are over-represented
- predilection sites (in descending order): rostral mandible, caudal mandible, rostral maxilla, and caudal maxilla
14
Q
What’s the accuracy of FNA and impression smear cytology for cat/dog oral tumours?
A
FNA
- accuracy = 98% in dogs, 96% in cats
Impression smear
- accuracy = 92% in dogs, 96% in cats
(mostly canine melanoma and feline SCC)
15
Q
How much cortical destruction is needed for it to be evident on x-rays?
A
40%
- so you can underestimate bony involvement in rads
- 30% vs 90% when using CT
16
Q
How does the size of the regional LN effect the metastatic status of canine oral melanoma?
A
- 40% of normal sized LN = metastatic
- 49% of enlarged LNs did NOT have metastasis
17
Q
What’s the LN FNA accuracy for diagnosing metastasis in dogs and cats?
A
77%
18
Q
How frequently is metastasis to mandibular LNs?
A
only 55% of cats/ dogs with regional LN metastasis had metastasis to the mandibular LNs
19
Q
How likely is permanent feeding tube needed for cats that undergoing mandibulectomy?
A
12%
20
Q
Which oral tumour should consider RT as the primary treatment?
A
acanthomatous ameloblastoma
21
Q
Generally, what’s the recurrence rate of oral tumours treated with surgery with complete or incomplete margins?
A
Complete: 15-22%
Incomplete: 62-65%
22
Q
What’s the most common cause of death for dogs with oral malignant melanoma?
A
Metastasis
14-67% will have lung metastasis
23
Q
What’s the MST untreated canine oral malignant melanoma?
A
MST = 65d
24
Q
What’s the overall recurrence with surgery for canine oral malignant melanoma?
A
up to 45%
- 22% with mandibulectomy
- 48% with maxillectomy
25
What's the MST for canine oral malignant melanoma treated with surgery only?
varies widely: 150 - 874 days (5-29m)
26
What are some known prognostic factors for canine oral malignant melanoma treated with surgery?
- age (< or > 12y)
- location
- size (< or > 3cm)
- clinical stage
27
What's the out come of well-differentiated melanocytic neoplasms that involved the mucous membranes of the lips and oral cavity treated with surgery only?
MST = 34m
- all dogs with recurrence (2) or died of tumour related causes (3) had the tumours in the oral cavity
28
What's the overall outcome for weekly RT for canine oral malignant melanoma?
RR = 81-100%
CR = up to 70%
MPFI = 139d (4.6m)
Recurrence rate = 15-26%
MST = 192 - 401d (6-13m)
29
What are some prognostic factors for dogs with oral malignant melanoma treated with RT?
- location (rostral is better)
- size (<2cm is good)
- microscopic disease
- no radiographic evidence of bone involvement
30
How does the risk factors (location, bone involvement, gross disease) influence the MST of dogs with oral malignant melanoma treated with radiation therapy?
- 0 risk factor, MST = 21m
- 1 risk factors, MST = 11m
- 2 risk factors, MST = 5m
- 3 risk factors, MST = 3m
31
What's the MST based on the size of canine oral malignant melanoma treated with radiation therapy?
T1 = 19m
T2 & T3 = <7m
(<2cm vs >2cm)
32
What's the MST based on the stage of canine oral malignant melanoma treated with radiation therapy?
Stage I = 758d (25m)
Stage 2 = 278d (9m)
Stage 3 = 163d (5m)
Stage 4 = 80d (~3m)
33
How does the addition of post-RT temozolomide influence the outcome of dogs with malignant oral melanoma?
- the response rate is similar at 80%
- PFI is significant longer in dogs treated with temozolomide
- but the MST is still similar
34
How do cats with oral melanoma respond to radiation therapy?
RR = 60%
MST = 146d (~5m)
35
How does the survival time differ between mandibular, maxillary, lingual, lip, hard palate and labial mucosa for canine melanoma?
- Mandibular/ maxillary: MST = 123 days (319 for maxillary in another study)
- Labial mucosa: MST = 310 days (10m)
- Lip: MST = 580d (1.5y)
- Tongue: MST = >551d (1.5y)
- hard palate: MST = 330d (11m)
All had a combo of Sx, RT, Chemo and immunotherapy
36
What's the outcome of well differentiated melanoma of the mucus membranes of the lips and oral cavities of the dogs?
only 5% that had surgery for the primary tumour died of melanoma.
MST = 34m (2.8y)
37
What's the general prognosis of canine oral SCC?
good, especially at a rostral location
general recurrence rate = 18-23%, better with complete excision
38
What's the metastatic rate of canine oral SCC?
LN ~ 10%
Lungs ~ 3-36%
but it's much higher for tonsils and base of the tongue --> up to 73% of dogs
39
What's the recurrence rate and outcome of maxillectomy for canine oral SCC?
Recurrence rate: 14-29%
MST = 10-39m (3.25y)
38% survival at 3y
40
What's the recurrence rate and outcome of mandibulectomy for canine oral SCC?
Recurrence rate: 0-10%
MST =19-43m (1.5-3.6y)
58% survival at 3y
41
How does stage influence the MST for surgically resected canine oral SCC?
Stage 1: MST not reached
Stage 2: MST = 420d (14m)
Stage 3: MST = 365d (12m)
Stage 4: MST = 50d (2m)
42
What's the general outcome for canine oral SCC treated with RT alone?
MST 15-16m, up to 34m if treated with Sx first
43
What are some reported prognostic factors for RT for canine oral SCC?
- maxillary location
- young age (<6y for orthovoltage; <9y for megavoltage) --> 39m vs 10m; 1080d (3y) vs 315d (10.5m)
- small size (T1 > 68m/5.5y; T2: 28m; T3: 8m)
- rostral location (28m vs 2-10m)
44
What's the outcome of piroxicam for bulky canine oral SCC?
RR = 17%, 1 CR
PFS = 180d if responding compared to 102d if stable disease
45
What's the outcome of piroxicam + cisplatin for bulky canine oral SCC?
RR = 56%
MST = 237d
but 41% had renal toxicity
46
What's the outcome of piroxicam + carboplatin for bulky canine oral SCC?
RR = 57% (4/7, CR)
all maintained for median 534d
47
What's the general outcome of feline oral SCC?
poor, but a rostral/mandibular location may be better
48
What's the outcome of mandibulectomy +/- RT for feline SCC?
- MST = 14m with RT, 86% had local failure between 3-36m
- Another study had a DFI of 340d
49
How does the location for mandibulectomy effect the MST of feline oral SCC?
- Rostral, MST = 911d
- hemimandibulectomy, MST = 217d
- >50% mandible resected = 192d
50
What's the general outcome of feline oral SCC treated with RT?
Response is not sustainable
RT is alone in generally considered ineffective
- gemcitabine too toxic (hematologic, and local)
- mitoxatrone may be promising (MST = 184d)
51
What's the outcome of hypofractionated/ palliative RT for feline oral SCC?
Daily 4.8Gy x 10:
- ORR = 81%, MST = 174d (grade II AE)
Weekly 8-10Gy x 3-4w:
- overall MST = 92d,
- sublingual = 135d
- mandibular = 80d
52
What's the outcome of SRT for feline oral SCC?
MST = 106d
RR = 39%
6/11 had mandibular fractures
53
What's the outcome of Palladia +/- NSAID for feline oral SCC?
RR = 57% --> 4% CR, 9% PR, and 43% SD
- MST = 123d
- if no Palladia, MST = 45d
- if responded:
PFS = 112d
MST = 202 d
54
What's the outcome of NSAID only for feline oral SCC?
MST = 169d
55
What's the role of bisphosphonates?
pamidronate (5 cats) with other treatment:
PFS = 71d
MST = 170d
56
What's the overall prognosis of canine oral fibrosarcoma?
guarded
57
What's the metastatic rate of canine oral fibrosarcoma?
LN: 19-22%
Lungs: up to 27%
58
What's the general recurrence rate and MST for canine oral fibrosarcoma treated with surgery?
- recurrence rate: 24-54%
- MST historically poor (<1y), more recent study = 743d (2y)
59
What's the outcome of feline oral fibrosarcoma treated with surgery?
for mandibulectomy, MST = 859d (2.4y)
60
What's the general outcome of oral fibrosarcoma with RT?
ineffective in gross disease setting
- MST =7m
- MST = 18-26m if microscopic
61
How does T stage effect RT outcome for oral fibrosacoma?
PFS:
T1 = 45m
T2 = 31m
T3 = 7m
62
What's the metastatic rate at presentation for canine oral osteosarcoma?
4%
but will eventually develop in 32-46% of dogs after definitive therapy
63
What's the recurrence and metastatic rate of dogs with oral osteosarcoma treated with maxillectomy?
RR = 58%
metastatic rate = 32%
MST = 5-10m
64
What's the recurrence and metastatic rate of dogs with oral osteosarcoma treated with mandibulectomy?
RR = 15-28%
metastatic rate = 35-58%
MST = 525d (17.5d)
65
What's the prognosis of peripheral odontogenic fibroma?
Good! May not need to remove bone
Recurrence rate = 0-17% without bone removal; 4% with bone removal
66
What's the RR of RT for POF?
3y PFS = 86%, but most commonly use Sx
67
What's the local recurrence rate for cats with multiple peripheral odontogenic fibroma?
high, 73% of 11 cats, 3m to 8y post-op
68
What's the outcome of acanthomatous ameloblastoma treated with Sx?
Really good with mandibulectomy or maxillectomy
- 91% will recur around 1m with marginal surgery
- local recurrence rate = 5%
69
What would be recommended surgical margin for AA based on % patient that achieved tumour free margin?
1cm = 67%
1.5cm = 75%
2cm = 100%
but even with incomplete margin, it may not recur
70
What's out of AA treated with RT?
good!
overall recurrence rate = 8-18%
T3 >T1 or T 2
71
What are some reported AE for RT for AA?
- 5-18% malignant transformation
- 6% had jaw necrosis
72
What's the role of intralesional bleomycin in AA?
CR possible, may take up to 5 treatments
prolonged DFS possible (>1y)
73
What's the metastatic rate of tonsillar SCC?
>90%
74
What's the most common tonsillar tumours and what are some differentials?
most common = SCC
- LSA, usually bilateral with peripheral lymphadenopathy
- melanoma can metastasize to the tonsils
75
How is tonsillar SCC treated?
if small/ non-invasive, can consider surgery
- should do bilateral (but only 6% incidence in a 2023 study)
- MST (multimodal tx) = 126d (4m)
- Sx + chemo seem to help
- small tumour, asymptomatic, and having Sx + chemo, NSAID = positive prognostic factors
76
What's the outcome of tonsillar SCC treated with RT?
75% locoregional control, but 1y survival is 10%
77
What's the cause of death for tonsillar SCC?
short-term = local disease
long-term = metastasis
78
What's the role of chemotherapy for tonsillar SCC?
many options tried (platins, anthracyclines, bleomycin) but all with limited response
79
What are the most common tongue tumours in the dog?
- SCC
- melanoma
- MCT
- HSA/Hemangioma
80
Which breeds are predisposed to:
SCC, MM, FSA, HSA, plasma cell tumour?
SCC = poodle, Lab, Samoyed
MM = Chow Chow, Shar-pei
FSA & HSA = Golden, border collie
Plasma cell tumour = cocker spaniel
81
What's the incidence of a 2nd primary tumour for dogs and people with a tongue tumour?
16% in dogs,
up to 29% in people
82
What's the treatment of choice for lingual tumours?
surgery
unless it's melanoma, then RT
83
What's the complication rate of glossectomy?
it's actually well tolerated
- post-op bleeding 10%
- tongue paralysis 2%
- dehiscence 2%
- none had long term prehension difficulties
- hypersalivation
- thermoregulation
- grooming (cats)
84
What's a prognostic factor for lingual tumours in dogs?
Size
>4cm = 10x more likely to recur and have distant mets, 19x more likely to die due to the tumour
MST = 818d if <2cm, vs 207d if > 2cm (>2y vs 7m)
85
What's the MST for benign lingual tumours?
1607d = 4.4y
86
What's the MST for metastatic lingual tumours?
MST = 241d vs 661d (if not mets) (8m vs 1.8y)
87
What's the outcome of lingual SCC with surgery based on grading?
Grade 1: 16m
Grade 2: 4m
Grade 3: 3m
88
What's the outcome of feline lingual SCC treated with surgery?
poor long term control
<25% survival at 1y
89
What's the metastatic rate and MST for canine lingual melanoma?
metastatic rate = 29-45%
MST = 222-551+ days (7m - 1.5y)
90
What's the MST of canine lingual hemangiosarcoma?
They tend to be small and rostral
MST = 553d (1.5y)
smaller and asymptomatic = 21m vs 5m
91
What's the outcome of lingual granular cell myoblastoma?
really good!
they can be removed with marginal resection (> 80% control) and though can recur, usually late
metastasis is rare
92
Describe undifferentiated malignancy in young dogs.
- <22m
- large breed
- rapid growing, undifferentiated histo
- likes hard palate, maxillary molars, maxilla, orbits
- majority present with regional LN and distant mets
- no effective treatment
- euthanized within 30d due to progressive disease
93
What's the outcome with papillary SCC in dogs?
- usually in young dogs
- rostral maxilla
- no recurrence or metastasis with complete margin
94
What's the recurrence rate of multilobular osteochondrosarcoma?
- 47-58%, depending on the surgical margin
DFI = 1332 vs 330d (3.6y vs 11m)
- grade also effects recurrence rate
Grade 1: 30%
Grade 2: 47%
Grade 3: 78%
95
What is the metastatic rate of MLO?
generally up to 58% of dogs
- depends on margin
25% rate for complete; 75% for incomplete
- also grade dependent
Grade 1 = 30%
Grade 2 = 60%
Grade 3 = 78%
though metastasis tend to occur late: 426-542d (14-18m)
96
What's the MST for MLO?
overall MST = 21m
- better if low grade: 50m vs 22m vs 11m
- mandible = 1487d (50m)
97
What is the most common odontogenic tumour in the cat?
inductive fibroameloblastoma
- typically in young cats
- by maxillary canines
- needs aggressive treatment but has good control rates and no mets reported
98
What are some common c/s of salivary neoplasia/ sialadenitis?
#1 = presence of mass
- halitosis
- anorexia
- weight loss
- dysphagia
- exophthalmos
- dysphonia
- Horner's
99
Which salivary gland is more likely to be affected in cats? dogs?
- mandibular for cats
- parotid for dogs
100
Which LNs would drain the salivary glands?
medial retropharyngeal LNs
101
What's the treatment for salivary carcinoma?
surgery!
watch for the facial nerve for parotid salivary glands
102
What's the prognosis for salivary carcinoma?
Dogs: MST = 550d (1.5y)
Cats: MST = 516d (1.4y)
Surgery +/- RT +/- chemo
103
What can cause esophageal sarcoma in dogs, especially in Israel?
Spirocerca lupi
104
What's the metastatic rate of spirocerca induced esophageal sarcoma? what are some other complicating factors?
5/11 dogs had metastasis on necropsy --> mostly to the lungs
- can also have megaesophagus
- hypertrophic osteopathy
these granuloma/ tumours tend to be in the caudal esophagus
105
What's the most common esophageal tumour in the cat? where is it located?
SCC,
in the middle 1/3, just caudal to the thoracic inlet
106
What's the diagnostic yield of intraluminal biopsy for smooth muscle tumours of the esophagus?
Not great as most do not penetrate the mucosa
107
What's the outcome of esophageal tumours?
Overall = poor, due to the extend of the disease/ presence of metastasis
- but if it's leiomyoma or leiomyosarcoma, can do better
108
What's the MST of spirocerca sarcoma in the esophagus?
MST = 267d (9m) with Sx and chemo
109
What's the MST of esophageal carcinoma?
poor as most of them are not resectable
110
What are the most common presenting complaints for exocrine pancreatic tumours?
- weight loss, anorexia (marked in cats)
- paraneoplastic alopecia in cats
- vomiting
- abdominal distension (mass or ascites)
- icterus
- lethargy
- rarely have diabetes mellitus
111
At what size would a pancreatic mass be more likely to be a carcinoma than hyperplasia in cats?
>2cm
112
Which IHC could potentially differentiate between well differentiated and poorly differentiated pancreatic carcinoma?
claudin 4 (tight junction protein)
113
How can contrast u/s help with diagnosis of pancreatic tumours?
it can differentiate between adenocarcinomas (hypoechoic and hypervascualr) and insulinoma (uniformly hypervascular)
114
What's the prognosis of cats with pancreatic carcinoma?
very poor
- tend to have metastasis on presentation
Overall MST = 97 d
- MST = 165d (5.5m; chemo or Sx)
- with abdominal effusion = 30 days
- NSAID = 26 days
115
What are the most common gastric tumours in the dogs?
#1 = gastric carcinoma
- leiomyoma/ leiomyosarcoma
- GIST
116
Which breeds are predisposed to gastric carcinoma?
Tervueren, Bourvier des Flandres, Groenendael, Collies, standard poodles, and Norwegian elkhounds/ lundehunds
117
What's the most common gastric tumour in cats?
#1 = lymphoma
carcinoma = rare @ 5%
118
What's the most common c/s for gastric tumours?
vomiting
119
What's the diagnostic yield of squash prep cytology for gastric tumours?
sensitivity and specificity = 94% for gastric carcinoma
120
What's the agreement between FNA and biopsy of gastric tumours in cats and dogs?
poor (50%)
121
How can imaging characteristics differentiate between carcinoma and sarcoma for canine gastric tumours?
Carcinoma = broad based
Sarcoma = pedunculated/ focal
122
What's the treatment for gastric tumours?
surgical removal!
gastrojejunostomy (Billlroth II) --> guarded outcome due to persistent vomiting, poor appetite, and progressive disease --> MST = 4-5 weeks
123
Which mutation is commonly expressed in gastric carcnoma?
HER2
124
What's the general prognosis of gastric carcinoma?
poor, due to difficulty with surgery for the local disease and moderate-high metastatic risk
- generally <6m
125
What's the prognosis for GIST, leiomyosarcoma and undifferentiated sarcoma treated with surgery?
MST:
- GIST = 37.4m 3=(3y)
- leiomyosarcoma = 8-12m
- undifferentiated sarcoma = 2.9m
126
What's the outcome of gastric leiomyoma?
most dogs = cured
127
What's the MST of gastric MCT in dogs? in cats?
Dogs = <1m
Cats = 531d (1.45y)
128
What's more common, primary hepatic or secondary hepatic tumours in dogs/ cats?
Dogs - secondary hepatic tumours are more common than primary
Cats - primary is mor common than secondary
129
What's the distribution of the 4 categories of primary liver tumours and 3 morphological types in dogs?
130
Are malignant tumours in the liver more common in dogs or cats?
dogs = more likely to be malignant
131
What's the general prognosis of liver tumours in dogs and cats?
dogs - good if it's massive hepatocellular carcinoma
- all malignant tumours in cats are bad
- all nodular/ diffuse tumorus are bad
132
Which is the most common hepatocellular tumour in the cat?
hepatocellular adenoma
133
What's the more common laterality in dogs/ cats with hepatocellular carcicnoma?
Dogs - left is more common (including the papillary process of the caudate lobe)
Cats - equal distribution between left and right
134
What's the metastatic rate of canine hepatocellular carcinoma?
Massive: 0-37%
Nodular/ diffuse: 93-100%
135
Which are the common metastatic sites for hepatocellular carcinoma?
- regional LNs, peritoneum, lungs
136
Describe biliary cystadenoma.
- >50% of cats with liver tumour = bile duct adenoma
- usually doesn't cause an issue until it gets too big and compress on adjacent organs
137
What's the most common malignant hepatic tumour in cats?
bile duct carcinoma (cholangiocarcinoma)
- this is 2nd most common in dogs
138
Where is the most common location of bile duct carcinoma?
Dogs: intrahepatic
Cats: equal between intra- and extra-hepatic
Within the gallbladder is rare in both cats and dogs
139
What's the metastatic rate of bile duct carcinoma in dogs and cats?
Dogs: up to 88% with metastasis to regional LNs and lungs
Cats: 67-80% with diffuse intraperitoneal metastasis and carcinomatosis
140
What's the frequency of hepatic neuroendocrine tumour in dogs/ cats?
rare
141
How can you distinguish neuroendocrine vs carcinoma in the liver histologically?
using silver stain
142
What's the metastatic rate of hepatic neuroendocrine tumours?
Frequent --> LNs, lungs, peritoneum
143
Though primary sarcoma in the liver is rare what is the most common hepatic sarcoma in dogs and cats?
Dogs - leiomyosarcoma
Cats - hemangiosarcoma
144
What's the metastatic rate of hepatic sarcoma in dogs?
86-100% have metastasis to spleen and lungs
145
How often are hepatocellular tumours clinical in dogs and cats?
75% of dogs and 50% o cats
146
What are some common clinical signs of massive HCC?
more to do with the physical presence rather than systemic illness
- anorexia, weight loss, vomiting, lethargy, PU/PD, ascites
- paraneoplastic hyperglycemia
- icterus more common with extrahepatic bile duct carcinoma and diffuse neuroendocrine tumours
147
What's the significance of AST:ALT ratio?
>1: more likely to be neuroendocrine/ or sarcoma
< 1: more likely to be carcinoma
148
Which liver tumour can have paraneoplastic hypoglycemia?
hepatic adenoma
149
Which biochem change is most common in cats with liver tumour?
azotemia!
150
What's the significance of hyperferritinemia?
- it' common in IMHA and dogs with histiocytic sarcoma
- so once IMHA is ruled out, hyperferritinemia can be helpful in ddx HS from other liver disease
151
What's the diagnostic yield of FNA and needle-core biopsies for hepatic tumours?
60% for FNA
90% for needle core biopsies
152
Can triple phase CT distinguish between different hepatic tumours?
it can distinguish between benign and malignant masses (>90% accurate), but cannot distinguish between the histotypes of malignant tumours
153
What's the intra-op mortality and complication rate of canine HCC?
intra-op mortality = 4.8%
complication rate = 28.6%
- hemorrhage
- vascular compromise to adjacent liver lobes
- transient hypoglycemia
- reduced liver function
154
What's the general location recurrence rate for canine HCC treated with surgery?
generally 0-13%
- complete excision = 12%
- incomplete = 58%
155
What's the MST for HCC after liver lobectomy in dogs and cats?
Dogs: MST = 1460-1836 days (4-5y)
Cats: 2.4y (n=6)
156
What's the MST for dogs with HCC treated with conservative management?
270d (9m)
157
What are some prognostic factors for canine HCC?
- surgical treatment
- laterality (R is trickier)
- ALT, AST
- ALT:AST / AST:ALT
- completeness of excision: 1836d vs 1000+ days (5y vs 2.7y)
158
What are some treatment options for nodular or diffuse HCC?
- bland embolization and chemoembolization
(moderate success for palliation)
- microwave ablation
159
What's the outcome of 3DCRT of 6-10Gy x 1-2fx / week to 18-42Gy for non ressectable canine HCC?
5/6 dogs had PR, MST = 567d (1.5d)
160
Which chemotherapy has shown some promise for canine HCC?
gemcitabine 350-400 mg/m3 weekly x 5 weeks
MST = 197d (6.5m) for nonresectable
MST = 1339d (3.6y) for incompletely excised HCC and nodular HCC
The addition of chemo really didn't improve survival times...
161
What's the prognosis of bile duct adenoma?
very good with liver lobectomy (either massive or multiple confined to 2 lobes)
- no reports of local recurrence or malignant transformation
162
What's the prognosis of bile duct carcinoma?
if massive, treat with liver lobectomy but survival <6m due to recurrence/ metastasis
- not much options for nodular or diffuse ones
163
What's the prognosis of liver carcinoids?
poor, usually not surgical
- metastasis occurs in 93% of dogs early on --> regional LNs, peritoneum, and lungs
- more likely to be diffuse
164
What's the prognosis of hepatic sarcoma?
poor, due to high metastatic rate
165
What are the most common intestinal tumours in dogs and cats?
#1 = lymphoma in both cats and dogs
#2 = adenocarcinoma in both cats and dogs
Cats #3 = MCT
Dogs #3 = leiomyosarcoma or GIST
166
Is there a sex predisposition for intestinal tumours?
maybe a male predominance
167
Has a viral etiology been demonstrated in dogs and cats with liver tumours?
No, only woodchucks
168
What are the common metastatic sites for intestinal tumours?
In decreasing frequency:
- LNs (esp carcinoma)
- liver (esp leiomyosarcoma)
- mesentery, omentum
- spleen, kidney, bone
- peritoneum (carcinomatosis)
- lungs
169
How common is other systemic involvement for dogs/ cats with intestinal lymphoma?
25% of dogs and 80% of cats will have concurrent involvement of other organs
170
Where is the common sites for intestinal lymphoma in cats and dogs?
Cats: small intestines
Dogs: stomach and small intestines in equal frequency
171
Where is the common sites for intestinal carcinoma in cats and dogs?
Cats: small intestines
Dogs: colon, rectum
172
What's the immunophenotype of canine primary colorectal lymphoma?
B cell, high grade
173
What's the outcome of canine primary colorectal lymphoma?
Good with chemo. Additional local therapy didn't improve outcome.
- hematochezia = longer PFS
- median PFS = 1318d (3.6y)
- MST = 1845d (5y)
174
Where is the common sites for intestinal polyps in cats and dogs?
Cats: duodenum, obstruction possible
Dogs: colon, rectum.
- can have multiple small polyps --> inflammatory polyp
175
Where is the site of predilection for GIST?
intestine (rather than stomach), likely more in the large intestines but there are also reports in the small intestines
176
What ICH can be used to differentiate between leiomyosarcoma and GIST?
most important = KIT (CD117) positive = GIST
Leiomyosarcoma: smooth muscle actin (+), desmin (+) KIT (-)
GIST: vimentin (+), majority smooth muscle actin (-), KIT (+)
177
What's the cell origin of GIST?
- likely multipotential stem cell like cells of Cajal
- can differentiate to smooth muscles cells if lacking KIT
178
What's the metastatic potential of GIST?
historically low @ 7%, more recent (2013) reported 28%: liver, LNS, and omentum
179
Which cells to intestintal neuroendocrine tumours originate from?
- the diffuse endocrine system / enterochromaffin cells
180
What types of secretory granules can be found in carcinoids?
- serotonin
- secretin (pancreatic bicarb)
- somatostatin
- gastrin (stimulate gastric acid secretion)
181
What's the typical behaviour of intestinal carcinoids?
aggressive and debilitating
182
What's the prevalence of OSA in the intestines in cats?
- 3/55 extraskeletal and total of 145 cases
- can liver ~1y with surgery
183
Where is the mutation most likely to occur for GIST?
exon 11 (just like people, and canine MCT)
- exon 9 possible (minority in people, 1 reported in the dog)
184
How often is COX-2 expressed in intestinal tumours?
The utility for COX-2 inhibitors is questionable
- expression level can be quite variable
- Adenocarcionoma: rare positivity (2006 study); 47% positive (2002 study)
- TCC: more strongly positive (2006 study)
In cats (2003 study):
- 37% TCC (+)
- 9% oral SCC (+)
- 0% in cutaneous SCC, adenocarcinoma (including intestinal), LSA, and FISS
185
How likely if perforation with GIST?
25-32%
186
Name some paraneoplastic syndromes documented for instestinal tumours.
- Cheyltiella infection - 1 dog with abdominal carcinomatosis
- Neutrophilic inflammation - dogs with rectal tumours
- hypoglycemia - intestinal smooth muscle tumour
- eosinophilia - intestinal T-cell LSA, likely due to IL-5 stimulation
- hyperviscosity syndrome = EMP
- erythrocytosis - in 1 dog with cecal leiomyosarcoma
- alopecia - 1 cat with colonic carcinoma
- nephrogenic diabetes insipidus - 1 dog with intestinal leiomyosarcoma
187
How often can abdominal mass be palpable in dogs and cats?
- 20-40% dogs with lymphoma
- 20-50% dogs with non-lymphomatous tumours
- most cats
188
What's the most common CBC abnormalities for intestinal tumours?
- anemia
- leukocytosis
189
What's the most common biochemistry abnormalities for intestinal tumours?
- hypoproteinemia
- increased in BUN
- increased in ALP
- hypoglycemia
-
190
How often in abdominal mass visible on x-rays?
~40%, but may be higher for large solid masses
- can see obstructive pattern in 10-75% of cases
191
How often can sonographic evidence be absent in dogs with GI LSA?
26%
192
Which part of the intestinal wall is common affected in cats with GI lymphoma?
muscularis propria
193
What features are noted for feline intestinal adenocarcinoma on utlrasound?
mixed echopgenicity and asymmetric
194
What's the hallmark of carcinomatosis in cats on ultraound?
presence of masses in the doublet sheet portion of the peritoneum and that connect the visceral and parietal portions
195
What's the diagnostic yield of CXR on initial presentation for intestinal tumours?
low,
2/14 cats in one study, and none in another
196
What's the risk of dehiscence after GI biopsies?
low!
1% in dogs, <3% in cats
197
Is carcinomatosis always a poor outcome?
No, 2 cats that had surgical removal of the primary mass lived for 4.5 and 28m
198
What's the peri-op mortality rate for intestinal tumours?
30-50%
- sepsis, peritonitis
- owner decision
199
What's overall prognosis for intestinal solid tumours?
1y survival rate 40% in dogs
- metastasis may happen later on
200
What's the metastatic rate/ site for intestinal tumours?
Cats with adenocarcinoma:
- 50% to LNs, 30% to peritoneal cavity (carcinomatosis), <20% to lungs
Dogs (carcinoma, leiomyosarcoma):
- 50% to LNs, followed by liver
201
What's the prognosis of canine small intestinal carcinoma?
- no treatment = 12 days
- with surgery: 114 days (3m) to 7-10m
202
What's the prognosis of canine small intestinal leiomyosarcoma?
MST
- 8m
- 1.1 to almost 2y
203
What's the prognosis of canine small intestinal GIST?
MST = 38m
if counting perio-op mortality = 1y
204
What's the prognosis for canine small intestinal MCT?
- not good with surgery: 2/49 lived >180d, majority died within the 1st month
- doesn't respond to prednisone
205
What's the outcome of cats with small intestinal tumours?
- there is a high peri-op mortality rate: reported 50% or 100% died within 2 weeks post-op
- 4/11 that survived over 2 weeks died within 2 months due to complications
- those that survived can lived for 15m. though MST as low as 2.5 also reported
206
What are some complications of rectal pull through?
- fecal incontinence (57% total, 40% permanent)
- diarrhea (43%)
- tenesmus (31%)
- stricture (21%)
- bleeding (11%)
- dehiscence (8%)
- infection (5%)
207
What's the outcome of colorectal carcinoma in dogs?
MST with resection: 2-4+y
- with stool softeners only = 15m
208
What's the recurrence rate and rate of malignant transformation for dogs with rectal polyps/ carcinoma in situ?
- recurrence up to 41%
- 18% malignant transformation
209
What's the MST for colorectal EMP and polyp in dogs?
EMP = 2y
polyp = 2+ years
210
What's the outcome for feline intestinal lymphoma, MCT, and adenocarcinoma treated with surgery only?
LSA = 3.5m
MCT = 6.5m
adenocarcinoma (subtotal colectomy)= 4.5m, with doxorubicin = 7m; with mets = 49d
211
What's the role of chemotherapy in treating intestinal tumours?
- feline adenocarcinoma with surgery +/- doxorubicin: MST = 280d vs 56d
- feline adenocarcinoma with surgery + carboplatin MST = 269d (7m)
- Distant met (200 vs 345d) and LN mets (178d vs 328d)
212
What's the response of GIST to TKI?
with imatinib
- metastatic disease: >140d
- nonresectable: >9m
- recurrent: >4y
213
What's the response to imatinib for canine MCT?
strong PR but short duration
214
What's the response of NSAID to rectal polyp in dogs?
piroxicam --> reduction in size and symptoms
215
How does gross appearance of rectal mass in dogs influence the outcome?
MST = 1.6m if it's obstructive/ annular mass
MST = 12-32m for nodular/ pedunculated/ cobblestone lesions
216
What are some prognostic factors in canine nonlymphomatous small intestinal tumours?
Presence of metastasis at surgery
- negative prognostic factor: MST = 3m vs 15m; overall 10m
- but might be fine with leiomyosarcoma: around 21m either way
217
What treatments are recommended for cats with colonic adenocarcinoma?
- subtotal colectomy and doxorubicin
- if just mass excision, MST = 68d, vs subtotal colectomy = 138d (2m vs 4.5m)
- LN (+) MST = 49d vs LN (-) = 259d (1.5m vs 8.6m)
218
Which gene is mutated in familial polyposis?
APC gene
also documented in dogs
219
How do human do with COX inhibitors for colorectal cancer?
- can reduce the incidence and and mortality by 40-50%
220
What's the typical signlament for perianal adenoma in dogs?
- older intact male dogs (>10y)
- or spayed female
221
What's the influence of hormone on the development of perianal adenoma?
- testosterone promotes growth
- estrogen inhibits growth
- possible for hyperadrenocorticism to induce perianal adenoma in females
- concurrent interstitial testicular tumours are common
222
What's the frequency of perianal adenocarcinoma?
much less frequent: 3-21% of all tumours in that region
223
What's the metastatic rate of perianal adenocarcinoma? where are the most common sites?
- <15% at diagnosis
- most common = regional LNs
- distant met can happen (lungs, kidneys, liver, bone), but rare
224
What are some molecular markers for perianal tumours?
- p53?
- VEGF, growth hormone
- no androgen receptors though
- Mdm2 (seen in both adnoma and adenocarcinoma)
- PCNA and ki67 = increases with malignancy
225
Can cytology reliably distinguish between perianal adenoma and perianal adenocarcinoma?
No, degree of invasion and etc is important to know as well
226
What's the outcome of ECT for perianal adenoma?
- can be an alternative to surgery
- over 90% RR, with 65% CR
- intralesional chemo + ECT
- AE: focal necrosis, erythema, and inflammation --> more likely in larger tumours (>5cm)
227
What's the outcome of ECT for perianal adenocarcinoma?
4/3 had CR! the other one had PR
228
What's the prognosis of perianal adenocarcinoma?
- depends on tumour size
- T2 (<5cm) has a 2y control rate of >60%
- metastasis is a negative prognostic factor --> MST = 7m (but 5/6 didn't have aggressive treatment)
229
Which breeds are at an increased risk of AGASACA?
Spaniels (English cocker), German Shepherds, Alaskan malamute, dachshund
230
How common is AGASACA in cats?
rare, 0.5% of all feline skin/ subcutaneous tumours
231
What's the incidence of bilateral AGASACA?
20% (2024 study)
- none of the bilateral patients had evidence of bilateral disease despite a complete work-up
232
What's the complication rate of bilateral anal sacculectomy?
- 9% intraop
- 14% post-op
overall not that different than single sacculectomy
233
What's the metastatic rate to iliosacral LNs for AGASACA?
23.4 - 83% on presentation
(26-89% in Withrow)
234
What's the distanace metastatic rate for AGASACA?
2.1-3.1%
(0-42% in Withrow)
235
What's the % of hypercalcemia on presentation for AGASACA
16-53%
236
Which histological parameters are associated with nodal metastasis?
- tumour invasion
- lymphatic invasion
- solid pattern
but not necrosis and mitotic index
237
Which receptor expressions demonstrated effectiveness for toceranib?
- VEGFR
- PDGFR
- KIT
though not all tumours expressed KIT
238
What's the prognosis of anal sac melanoma?
Appears to be aggressive
- majority have nodal metastasis (4/11, 36%)
- 1 had lung metastasis (9%)
- all were unilateral
- median MC = 50 / 10 hpf
- 10/11 died due to tumour progression (90%)
239
What's the prognosis of anal sac SCC?
local control may be more of a concern
- 0/9 had metastasis on presentation
- 4/5 recurred after surgical excision
- NSAID only ~7m
- 1 dog with carbo and PRT achieved CR >1y
240
What's the behaviour of feline AGASACA?
it's locally invasive
- moderate-high recurrence rate
- nodal metastasis = 20%
- paraneoplastic hypercalcemia = 11%
241
How often is AGASACA incidentally found?
47%
242
What's the most common clinical signs of feline AGASACA?
- perianal discharge / ulceration (85%)
ddx: anal sac abscess
243
What's the result of sentinel lymph node mapping for canine AGASACA?
8/12 = ipsilateral
4/12 = contralateral
LNs = medial iliac > sacral > internal iliac
- can have multiple affected
244
What are the most common complications for anal sacculectomy and what's the compication rate?
Complication rate: 5-24%
- dehiscence
- rectal perforation
- rectocutaneous fistula
- fecal incontinence --> worse in older studies with more aggressive surgery (60% permanent, 40% transient)
245
What are 4 prognostic factors for AGASACA going for anal sacculectomy?
- lack of therapy
- distant metastasis
- nodal metastasis
- size of primary mass (>2.5cm)
246
Does LN removal improve prognosis?
yes, regional nodal metastasis should be surgically removed
247
Which chemotherapy has shown responsiveness in gross disease setting in AGASACA?
carboplatin, cisplatin, and actinomycin D
(platinum drugs = PR, MST = 6m)
248
Is there evidence to support adjuvant chemotherapy for AGASACA?
controversial
- one study with 133 dogs showed MST of 500d (sx) and 540d (sx + chemo) (16m vs 18m)
249
What are some reported outcome of AGASACA treated with chemo?
250
What's the general outcome of gross disease AGASACA treated with Palladia?
PR ~ 20-25%
SD ~48-62.5%
MST ~ 350-356
251
What's the control rate of RT in the gross disease setting for AGASACA?
38-75%
252
What's the role of RT in post-op setting?
less defined, but did found the longest MST (956d/32m/2.6y)
253
What's the outcome of fractionated RT for gross AGASACA?
Can be favorable (MST ~ 447d / 15m)
- but at >3Gy / fraction, can have significant late AE
- rectal stricture, perforation, and chronic colitis
254
What's the outcome of palliative RT for gross AGASACA?
- improvement in clinical signs noted in up to 63% of patients
- hypercalcemia resolved in 31%; increased up to 46% with prednisone and bisphosphonates
- AE = mild
- late AE more likely with >5Gy/ fraction
255
Does completeness of surgical margin influence recurrence rate for AGASACA?
no
256
What's the general recurrence rate of AGASACA treated with surgery?
5-44%
257
What's the DFI of AGASACA treated with surgery?
262-433d (8.7-14m)
with or without adjuvant chemo
DFI shorter if nodal metastasis is present at diagnosis (134-197d vs 529-760d [4-6.5m vs 17.6-25m)
258
What's the metastatic rate to LNs and distant mets after surgery?
nodal mets: 31-69%
distant mets: 14-18%
259
What's the outcome of 2nd surgery after recurrence/ nodal metastasis of AGASACA?
- MST 374d (after 2nd surgery) vs. 47d (if no further treatment)
- another study found 283d
260
What's the overall MST of AGASACA treated with surgery +/- chemo?
MST: 386-960d (1-2.6y)
261
What's the overall MST for dogs with or without nodal metastasis for AGASACA treated with surgery?
MST = 293-448d with mets (10-15m)
MST = 529-925d (17.6-30m)
262
In AGASACA, for LNs larger than 4.5cm, is Sx or RT better?
RT!
- PFI = 347d
- MST = 447d (~15m)
Sx
- PFI = 159dd
- MST = 182d
263
Is hypercalcemia a negative prognostic factor for AGASACA?
not shown in all studies
hypercalcemic MST = 256d vs. 548d without hypercalcemia (8.5m vs 18m)
264
What tumour size has shown to have worse outcome in AGASACA?
2.5cm or 4cm or 10cm2
- 10cm2: 584d vs 292d (19 vs 9.7d)
- 2.5cm: 722 vs 1205d (24 - 40m)
- 4cm: 433 vs. 773d (14-25m)
265
How does clinical signs play a role in prognosis for AGASACA?
those with clinical signs will do worse, and they tend to be associated with larger tumour
266
What's the MST of dogs with AGASACA with distant metastasis?
MST 71-82 days, one also reported 219d
267
What histological features are associated with worse prognosis?
- being solid pattern = bad
- more E-cadeherin (>75%) = MST 1169d (39m) vs. <75% MST = 448d (15m)
268
What's the outcome of anal sac melanoma?
MST 3.5m
269
What's the MST of feline AGASACA?
MST = 260d (8.7m)
270
What are some negative prognostic factors for feline AGASACA?
- tumour recurrence
- high nuclear pleomorphic score: score 2 = 909d, score 3 = 187d (30m vs 6m)
271
What's the outcome of 4Gy x 5 daily PRT for AGASACA?
MST of RT alone = 384d
MST for RT plus other = 628d (20m)
272
What's the outcome of autologous vaccine for canine oral melanoma?
- limited efficacy
- median PFI = 48d
- 3/10 dogs had anaphylaxis and 3/10 had mildly altered appetite
273
What paraneoplastic syndrome can be seen with salivary carcinoma?
hypercalcemia! reproted in a dog
274
What's the outcome of SRT for mandibular and maxillary OSA?
Mandibular MST = 144d (~5m)
Maxillary MST = 232d (7.7m)
275
What's the outcome of SRT (7-7.5Gy x 3) for canine HCC?
- 3/9 had PR and clinical response
- 5/9 SD
- MST = 164d (5.5m)
Previously reported dogs with no surgery MST = 270d (LIptak et al 2004)
276
What's the outcome of SRT for AGASACA?
1/4 = CR, 1/4= PR, 2/4 SD
minimal acute AE
In a 2021 study, MST 991d = 2.7y, most were post-op, some had LN irradiation
277
Does the needle gauge effect diagnostic yield for FNA liver/ spleen in dogs?
No difference between 22-, 23-, 25-
but more blood contamination with 22
278
279
What's the general outcome of feline hepatocellular tumours, bile duct carcinomas with or without surgery?
Hepatocellular tumours MST = 868d (2.4y)
Bile duct carcinoma = 270d (9m)
if no Sx, overall MST = 16d
280
How does the size of the primary AGASACA effect the nodal metastatic rate?
Overall nodal metastasis = 46%
<2cm : 20%
>3cm = 63%
281
With oral extramedullary plasmacytoma, what's the overall prognosis?
overall MST = 973d (2.7y)
1/3 had progression of plasma cell disease
282
What are some prognostic factors for canine tonsillar SCC?
asymptomatic patients, patients treated with surgery and adjuvant chemotherapy, and those receiving NSAIDs may have a better prognosis than untreated dogs or symptomatic patients
- OST 126d
- no mets MST = 381 days
283
Which IHC would be good for feline exocrine pancreatic carcinoma?
cytokeratin 7 and 20
284
What's the time to recurrence for canine colorectal polyps treated with surgery?
Not reached at 2000d
estimated MST = 1640d
West Highland White Terriers --> shorter time to recurrence
285
What's the otucome of transcatheter arterial emoblization for canine hepatocellular masses?
MST = 419d (14m)
- negative prognostic factors = intra-abdominal bleeding, large tumour size
(Kawamura et al 2023)
286
What's the outcome of canine salivary carcinoma treated with surgery?
good!
- MST = 1886d (5y! much better than previously reported)
- overall DFI = 191d
- time to nodal mets = 299d, found in 22/69 (31.9%) of dogs
(Bush et al 2023)
287
What's a CT feature that can differentiate between GI LSA and GI adenocarcinoma in cats?
- layer enhancement was noted in al lcats with adenocarcinoma (only 7% of LSA)
- LSA cats had lymphadenopathy and increased wall thickness compared to adenocarcinoma
(Tanaka et al 2022)
288
What's the outcome of 3DCRT for microscopic AGASACA (20 x 2.5Gy)?
MST = 771d (~2y; most also had carbo)
AE: transient grade III dermatitis, resolved within 4 weeks
289
What was the metastatic rate of canine AGASACA staged with CT?
- 71% with iliosacral lymphadenopathy
- 11% with lung nodules (Sutton et al 2022)
290
What's the outcome of u/s guided microwave ablation of HCC in dogs?
- in 4 dogs
- still alive with follow-up 39-649d
(Locatelli et al 2022)
291
What's the prognosis of juvenile (<2y) dogs with oral SCC treated with surgery?
great!
- median follow-up time = 1556d (4.3y) and all but 1 died (due to DCM)
- none had metastasis on presentation
- all had partial maxillary or mandibulectomy
292
What's the outcome of drug-eluting bead chemoembolization for nonresectable canine HCC?
MST = 337d
RR = 85%: 62% SD, 23% PR
11% major complication including death
293
What's the outcome of accelerated hypofractionated RT with chemo for feline oral SCC?
overall MST = 89d
grade III mucositis noted
Irradiated MST = 136d vs no RT = 38d
(Marconato et al 2020)
294
What's the outcome of ECT with IV bleomycin for canine non-tonsillar SCC?
RR = 90.9%, 1-2cm masses achieved CT without recurrence
- MST = 831d (27m) if not recurred
- MST = 110d (3.6m) if died with tumour
295
296
What's the complication rate of u/s guided percutaneous sampling of canine liver?
- 85.3% of dogs with no or mild coag abnormalities had a decrease in PCV
- 42.2% had >6% change in PCV (major hemorrhage)
- 1.9% had complications
297
What's the outcome of Sx + Palladia for AGASACA?
OST = 827d (2.2y)
(Heaton et al 2020)
298
What's the outcome of multi-modal treatment with Oncept vaccine for canine oral melanoma?
dogs treated with surgery and/or RT
MST - 510d (17m)
median time to progression = 304d (10m)
(Turek et al 2020)
299
What's the outcome of intracavitary carboplatin for cats with carcinomatosis?
in the 8 cats, all died within 5-16d due to recurrent effusions or poor general health
300
Which tumour is most likely in cats with honeycomb appearance in the spleen?
Lymphoma
15/33 = lymphoid hyperplasia
8/33 = LSA: 4 B cell, 3 T cell, 1 large granular
1/33 = Histiocytic sarcoma
remainder = benign changes
301
What's the yield of of metastasis or a major finding with prognostic significance for dogs >15yo with oral tumours staged with head CT, LN FNA, thoracic and abdominal imaging?
27.8%
302
What's the outcome of surgery for dogs with >5cm AGASACA?
OST = 671d
-local recurrence = 37%
-nodal met at presentation = decreased PFI but not OST
- adjuvant therapy was not associated with outcome
(Griffin et al 2023)
303
What's the agreement between liver FNA and biopsy?
The overall sensitivity was 60%, and the specificity was 68.6%
Agreement was 22.9%, for neoplastic lesions = 18.9%
(Cray et al 2023)
304
What's the outcome of surgery +/- Palladia for intrahepatic bile duce carcinoma?
liver lobectomy, all completely removed, 2/6 received Palladia
- MST = 894d (~2.5y)
- 2 dogs had local recurrence / distant metastasis around 1y post surgery
305
What's the outcome of canine combined hepatocellular cholangiocarcinoma?
MST = 700d (~2y) with surgery
306
What factor cause hypoglycemia in HCC and leiomyosarcoma?
insulin like growth factor -2
307
What the outcome of dogs with hepatic tumours with hemoabdomen?
MST:
HCC = 897d (30m)
benign = 905d
HSA = 45d
other neoplasia = 109
Interesting, elevated ALT was associated with a better prognosis (MST = 644 vs 63d) -- none of the HSA had elevated ALT
(Reist et al 2022)
308
What's the outcome of dogs with pancreatic carcinoma treated with Palladia?
clinical benefit in 75% (1PR, 2SD, 1PD)
MST = 89.5d
(Musser et al 2021)
309
What's the complication rate for patients going for mandibular or maxillectomy pre-treated with RT or chemo?
the odds of dehiscence or oral fistula increased by 3x
- overall complication rate = 37.3%
(Cray et al 2021)
310
What's the relationship between size of canine oral melanoma and lymphatic invasion?
if tumour <6.5mm = 100% sensitivity to rule out
if tumour >24.5mm = 100% specificity to rule in
(Carroll et al 2020)
311
What would be a useful marker to differentiate between canine oral SCC and acanthomatous ameloblastoma?
-ki67 labelling index
- MI was not useful
(Peralta et al 2019)
