Hepatobiliary tumors

Question 1

What is the incidence of hepatobiliary tumors in dogs and cats?

Answer 1

1.5% of canine and 1-2.9% of feline tumors

Question 2

Is primary tumor or metastasis more common in dogs versus cats?

Answer 2

In dogs metastasis (liver, spleen, GI) 2.5X>primary tumors

Cats primary>metastasis

Question 3

____ tumors are more common in cats, ___ in dogs

Answer 3

Benign, malignant

Question 4

What are the 4 malignant categories for hepatobiliary tumors?

Answer 4

Hepatocellular

Bile duct

neuroendocrine

mesenchymal

Question 5

3 morphological types of hepatobiliary tumors?

Answer 5

Massive (solitary, larger, 1 lobule)

nodular (multifocal, several lobes)

diffuse (effaced)

Question 6

Reclassification according to hepatocytic or chalangiocytic lineages (based on keratin 19 IHC)

Answer 6

Well differentiated, poorly differentiated, and scirrhous

Question 7

What are the 3 hepatocellular tumors?

Answer 7

HCC (77% and #1 tumor in dogs, #2 in cats)

Hepatocellular adenoma - more commmon in cats

hepatoblastoma - rare

Question 8

Any etiology for hepatocellular tumors?

Morphologically, __% massive, ___ nodular, ___diffuse

Location in dogs and cats?

Metastatic rate

Answer 8

No viral or cirrhotic etiology, maybe like to vacuolar hepatopathy

34% scotties with VH had HCC

53-86% massive, 16-25% nodular, 19% diffuse

In dogs >2/3 left liver and anywhere in cats

0-37% for massive, 93-100% nodular or diffuse (LNs, peritoneum, lungs)

Question 9

Bile duct tumors

Most common in cats? Sex?

Most common primary malignant tumor in cats? In dogs?

Dog breed predisposition and sex predilection?

Morphological apperance?

Behaivour?

Answer 9

Biliary cystadenomas, mostly in males

Carcinoma (cholangiocarcinoma) in cats and #2 in dogs

Labs, and female dogs

37-46% massive, 54% nodular, 17-54% diffuse

Aggressive bhaivour (in dogs 88% metastasize to LNs, lungs/ in cats 67-80% develop carcinomatosis)

Question 10

Neuroendocrine tumors (carcinoids)

Age?

Location?

Morphologically?

Behaivour?

Answer 10

Rare tumors in dogs and cats (younger age)

Usually intrahepatic

67% diffuse and 33% nodular

Aggressive, diffue metastasize to regional LNs, pritoneum, lungs)

Question 11

Sarcomas

Most common primary?

Morphologically?

Behaivour?

Answer 11

HSA (#1 in cats, and 5% in dogs), leiomyosarcomas (#1 dogs) and FSA

nodular 64%, massive 36%

Agressive 86% mets to spleen, 100% to lungs

Question 12

Symptoms are reported in __ of cats and ___ of dogs

Clinical signs?

Most common signs?

Answer 12

50%, 75%

Related to mass effect and not hepatic insuficiency

inappetance, weight loss, lethagy, vomiting, PU/PD, and ascites

Question 13

Type of liver enzyme elevation can differentiate between primary (___ and ___ increase) vs. metastatic __ and ___

HCC and bile duct carcinoma

Answer 13

ALP and ALT

AST, Tbili

AST:ALT<1

AST:ALT>1

Question 14

Other chemistry abnormalities

Answer 14

hypoglycemia, hypoalbuminemia, hyperglobulinemia, increased BAs, azotemia in cats

a-fetoprotein in 75% HCC and 55% bile duct carcinomas in dogs

Question 15

Therapy for HCC

__ sided tumors have higher intra-op death

Answer 15

liver lobectomy

right sided

Question 16

Therapy for bile duct tumors

Answer 16

liver lobectomy for massive, none for nodular or diffuse forms

Question 17

Therapy for sarcomas

Answer 17

liver lobectomy

Question 18

MST for massic HCC treated with liver lobectomy?

MST with conservative management

Answer 18

1460-1836 days (4-5 yr) in dogs (2.4 years in cats)

270 days (9 mo) and 15.4x likelihood of tumor-related deaths

Question 19

Complete histological resection of HCC

RR?

Answer 19

RR=0-13% for dogs after liver lobectomy

37 dogs with mHCC underwent liver lobectomy, RR=12%, DFI=1000 and MST 1836 days for complete resection vessus RR=58%, DFI 521 and MST 765 days for incomplete

Incompletely resected HCC treated with Gemzar had MST 1339 days

Question 20

Prognosis for bile duct adenomas?

Answer 20

Very good after liver lobectomy

Question 21

Prognosis for cats and dogs with massive bile duct carcinomas after liver lobectomy?

Answer 21

Poor and patients die in 6 months due to local recurrence or metastatic disease

Question 22

Prognosis for neuroendocrine tumors

Metastasis

Answer 22

Poor not amenable to surgical resection

93%

Question 24

Prognosis for liver sarcomas

Answer 24

poor due to metastatic disease being present at time of diagnosis