Hemangiosarcoma

Question 1

HSA accounts for what % of canine tumors and % of canine splenic malignancies?

Answer 1

~2 % of all canine tumors and 45% to 51% of canine splenic malignancies

Question 2

__ % of cats examined at necropsy. __% of all feline neoplasms

Answer 2

0.5% of cats examined at necropsy. 2% of all feline neoplasms

Question 3

Age predilection for HSA?

Answer 3

Middle-age to older dogs

Question 4

What 3 dog breeds are overrepresented?

Answer 4

German shepherds, golden retrievers, Labrador retrievers and other large-breed dogs are overrepresented

Question 5

Gender predilection for canine HSA?

Answer 5

may be a slight male predisposition in dogs

Question 6

Where does cutaneous HSA occur in the skin?

Occurs secondary to what?

Answer 6

Ventral abdomen and conjunctiva in short-haired and lightly pigmentated breeds – reflecting the association w/ UV light exposure

Question 7

Etiology for canine HSA?

Answer 7

HSA may arise from bone marrow progenitor cells that undergo dysregulated maturation and subsequently move to peripheral vascular sites to form tumors

Question 8

Possible gene mutations in canine HSA?

Answer 8

p53 and Ras mutations are infrequent in canine HSA; however, > 50% PTEN inactivation in canine HSA samples

Question 9

Dysregulation of molecular pathways governing angiogenesis may be important in the pathogenesis of HSA

abundant expression of angiogenic growth factors such as vascular endothelial growth factor (VEGF), basic fibroblast growth factor (bFGF), and angiopoietins-1 and -2 (Ang-1 and -2) in HSA cells and tissues

Question 10

Increased level of ____ was documented in the plasma in the dogs w/ HSA as compared w/ healthy dogs

Answer 10

VEGF

Question 11

Primary site for canine HSA?

4 other sites for HSA?

Answer 11

spleen

other frequent sites - heart, skin and subcutis, and liver

Question 12

___% of dogs w/ splenic tumor had malignant disease and ____% of these malignancies were HSA

Answer 12

50%, 50-74%

Question 13

% of dogs with splenic masses presenting with non-traumatic hemoabdomen were HSA

Answer 13

63-70

Question 14

_____ is the 2nd most common primary sites for canine HSA and most common _____ neoplasm

Common location?

Answer 14

heart, cardiac

right atrium or auricle

Question 15

How does cutaneous HSA behave?

Visceral HSA?

Answer 15

skin – less aggressive

visceral forms – local infiltration and metastatic dissemination

Question 16

How does metastasis occur for canine HSA?

4 common sites of metastasis?

Answer 16

metastasis occurs either hematogenously or via intracavitary implantation after tumor rupture

liver, omentum, peritoneum, and lungs

Question 17

In dogs what is the most common tumor to met to the brain?

Answer 17

HSA

Question 18

In cats, what type of HSA is most common?

3 common locations for visceral HSA?

Answer 18

cutaneous and visceral

spleen, liver, intestine

Question 19

Metastatic rate for feline visceral HSA?

Answer 19

High

Question 20

2 common IHC markers for HSA?

Answer 20

IHC for von Willebrand’s factor (factor VIII–related antigen) or CD31/platelet endothelial cell-adhesion molecule (PECAM) can be used to demonstrate endothelial derivation – rule out other sarcomas

Question 21

Clincial sign asssociated with renal HSA?

Answer 21

hematuria

Question 22

Thrombocytopenia is observed ____ in of cases, ranging from mild to severe

Answer 22

75% to 97%

Question 23

What is the chemotherapy protocol for feline HSA?

Answer 23

DOX-based protocols for high risk of mets or advanced disease patients

Question 24

mixed killed bacterial vaccine following surgery and showed some improvement in survival time in dogs with splenic HSA

Question 25

adjuvant chemotherapy (DOX and CYC) combined w/ L- MTP-PE (liposome- encapsulated muramyl tripeptide-phosphatidylethanolamine) (an immunomodulator derived from mycobacterial cell walls that increases monocyte tumoricidal activity) had better MST (9.1 mo) than chemo alone (5.7 mo)

Question 26

cardiac HSA treated w/ hypoFx RT reduced the frequency of ___?

MST?

Answer 26

cardiac tamponade

MST of 2.5 mo

Question 27

Targeted Therapies

expression of receptor tyrosine kinase family members including PDGF receptor (PDFGR), VEGF receptor (VEGFR), and KIT has been documented in canine HSA

mastinib, imatinib and dasatinib have demonstrated growth inhibition and induction of apoptosis in canine HSA cell lines

administration of toceranib in dogs with stage I & II HSA after splenectomy and DOX therapy resulted in no apparent improvement in median DFI or MST

eBAT, a bispecific epidermal GF (EGF)-uro-kinase angiotoxin, was evaluated in dogs before standard DOX chemo – MST of 8.5 mo and 6 mo survival rate of 70%, which were significantly improved compared w/ a historical control group

Question 28

Yunnan Baiyao (YB) has been anecdotally used to control bleeding in dogs

led to dose- and time-dependent cell death via caspase-mediated apoptosis in 3 canine HSA cell lines

no benefit in time of recurrence of hemopericardium or ST in dogs w/ presumed cardiac HSA

Question 29

Prognosis for dogs w/ splenic HSA treated w/ Sx alone?

Answer 29

MST 19-86 days

Question 30

DOX-based chemo after Sx

Answer 30

MST 5-7 mo, 12 mo survival rate of <10%

Question 31

MST with stage 1 cnaine HSA?

MST with stage II?

Answer 31

stage I (nonruptured, nonmetastasis)- MST 239-355 d 8-12mo

stage II (ruptured) (MST 120-148 d) when post-op chemo is used

Question 32

MST with primary renal HSA?

Answer 32

primary renal HSA (MST 9 mo) may have more favorable outcome than other visceral HSA

Question 33

MST with retroperitoneal HSA?

Answer 33

retroperitoneal HSA carries a poorer prognosis – MST of 37.5 d

Question 34

MST for cutaneous HSA treated with Sx?

Answer 34

1570 d (4.3 yr)

Question 35

MST for cutaneous HSA with SQ invasion?

Answer 35

cutaneous tumor w/ SQ invasion had a higher chance of mets (relative rate of 2.04) and poorer survival (MST 539 d or 1.5 yr)

Question 36

HSAs originating in the SQ and intramuscular tissues are typically more aggressive than dermal HSA, w/ higher mets rate and shorter MST – thus, adjuvant chemo is recommended

Question 37

Prognosis for cardiac HSA w/o tx?

with surgical removal?

MST with adjuvant chemo after Sx?

MST with palliative pericardectomy?

DOX therapy?

Answer 37

the prognosis for cardiac HSA is poor – die within 2 wks w/o Tx

1-3 mo surgical removal

adjuvant chemo after Sx increased MST (175 d or 6 mo)

palliative pericardiectomy can be considered – reported MST of 2.7-4 mo

DOX therapy – 41% objective response rate and MST of almost 4 mo

Question 38

MST for feline visceral HSA?

MST for feline skin/SQ HSA?

Answer 38

visceral HAS is poor – most die from recurrence of primary tumor or mets, and MST are short (77-197 days) - 2.5-6.5 mo

skin/SQ HAS – tx w/ aggressive Sx: MST 9 mo-4 y