HSA

Question 1

What is the staging scheme for cutaneous HSA?

Answer 1

Stage 1: confined to dermis
Stage 2: extends into SQ
Stage 3: extends into underlying muscle

Question 2

What is the difference in metastatic potential between stage I and stage II/III cutaneous HSA?

Answer 2

Stage 1: 30% rate with only dermal mets (maybe new primaries and not mets)
Stage 2 and 3: 60% met rate to lungs, LN, distant dermal mets

Question 3

Which IHC stains differentiate synovial cell sarcoma from histiocytic sarcoma?

Answer 3

Synovial: vimentin and cytokeratin
HS: CD18, CD204 (CD18 is sarcoma, CD204 specific among leukocytes for histolytic origin)

Question 4

How do VEGF levels of splenic tumors compare to healthy dogs? Is there a difference between dogs with HSA vs. hematoma? (Frenz 2014)

Answer 4

VEGF levels higher in dogs with splenic tumors; no difference between HSA and hematoma

Question 5

What % of canine splenic tumors are HSA?

Answer 5

45-51%

Question 6

What % of canine splenic masses are associated with non-traumatic hemoabdomen are HSA?

Answer 6

63-70%

Question 7

Which IHC markers identify HSA?

Answer 7

Factor VIII/vWF, CD31/PECAM

Question 8

What % of dogs with HSA have criteria for DIC?

Answer 8

47-50%

Question 9

Describe a T2 HSA.

Answer 9

tumor >/= 5cm or ruptured

invading SQ tissue

Question 10

What was the MST for dogs with HSA treated with surgery, L-MTP-PE, and chemo?

Answer 10

9. 1 months

5. 7 months with surgery and chemo alone

Question 11

What is the MST for splenic HSA with surgery alone?

Answer 11

19-86d

Question 12

Which visceral site HSA has the best prognosis?

Answer 12

Renal
MST 278d (9.3 months) with surgery and chemo

Question 13

T/F: Administration of DOX q2 weeks improves survival in HSA vs. 3 weeks.

Answer 13

False

Question 14

How does Yunnan Baiyao affect HSA cell lines? (Wirth 2016)

Answer 14

caspase-mediated apoptosis

Question 15

T/F: There was no significant difference to PFS/OST with addition of mCTX after DOX for HSA. (Matsayuma 2017)

Answer 15

True

Question 16

Does metronomic chemo added to DOX improve outcome?

Answer 16

No, several studies (Matsuyama 2017, Alexander 2018)

Finotello 2016 suggested that it did, but not reproduced in future studies.

Question 17

What histopath feature was associated with survival in multivariate analysis for HSA? (Moore JAVMA 2017)

Answer 17

mitotic index - MST was longer (292d) for dogs with mitotic score of 0 (< 11 mitoses/10 hpf)

Question 18

What % of small breed dogs that underwent splenectomy for splenomegaly had a malignant process? What breed may have had higher incidence of neoplasia? (Corbin 2017)

Answer 18

47%
(67% of these were HSA)
Wheaten terriers

Question 19

What were the results of single 12 Gy fraction for dogs with R atrial masses and hemorrhagic pericardial effusion? (Nolan 2017)

Answer 19

Decreased need for pericardiocentesis (did not improve overall MST)

Question 20

How does FDG-PET compare to conventional staging for HSA? (Borgatti 2017)

Answer 20

Abnormalities were found in 2 dogs that were not on conventional staging (R atrial mass and a hepatic nodule)

Question 21

What is eBAT? (Borgatti 2017)

Answer 21

biospecific angiotoxin that consists of truncated Pseudomonas exotoxin fused to EGF and the amino terminal of urokinase plasminogen activator

Question 22

How did eBAT affect survival in HSA dogs? (Borgatti 2017)

Answer 22

improved 6 month survival from < 40% in comparison population to ~70%
- eBAT also had less tox than traditional EGFR targeting

Question 23

What else was unique about survival in the eBAT study? (Borgatti 2017)

Answer 23

6 dogs survived > 450 days

Question 24

How did epirubicin compare to DOX for canine HSA (MST and toxicity)? (Kim 2007)

Answer 24

• MST similar to DOX (Stage I did have significantly better MST at 345d)
• 39% hospitalized for GI dox - higher incidence than DOX

Question 25

What was the response rate for DAV (DOX, DTIC, Vinc)? MST? (Dervisis 2011)

Answer 25

RR 47.4% | MST 125d

Question 26

What was the RR of VAC and MST? (Alvarez 2013)

Answer 26

RR 86% | MST stage III 195d (6.5 mo) same as stage I/II 189d

Question 27

What is the ORR for DOX for presumed cardiac HSA? (Mullin 2014)

Answer 27

41% | MST 116d

Question 28

What unusual nodal location of HSA has been reported in dogs and cats?

Answer 28

cervical LN

Question 29

Positive prognostic factors for cutaneous HSA? (Szivek 2011)

Answer 29

predisposed breed, ventral abdomen, solar induced

Question 30

% of patients with cutaneous HSA recurrence? (Szivek 2011)

Answer 30

77%

Question 31

What % of incidentally detected splenic masses were malignant? (Cleveland 2016)

Answer 31

30% | 58% were cHSA

Question 32

What % of cardiac masses were successfully identified with FNA/cyto? (Pedro 2015)

Answer 32

6/6 - 100% | 5/6 neoplastic, 1 was inflammation (confirmed on histo?)

Question 33

What % of dogs with cardiac HSA had concurrent splenic HSA? (Boston 2011)

Answer 33

29% (and 42% had metastasis to another site)

Question 34

What % of dogs with splenic HSA had concurrent cardiac masses? (Boston 2011)

Answer 34

8.7% (is this different than what Withrow states?)

Question 35

What was MST for surgery alone for cHSA? How did chemo affect survival? (Wendelburg 2015)

Answer 35

surgery alone - 1.6 months any form of chemo extended survival (DOX, DOX + mCTX, mCTX alone all better than surgery alone) - initially not significantly different, but was after adjusting for stage and looking at early follow up period - concluded stage is important

Question 36

Does the use of Palladia after DOX prolong survival? (Gardner 2015)

Answer 36

No

Question 37

How did DOX/CTX compare to DOX/DTIC? (Finotello 2015)

Answer 37

TTM and MST longer with ADTIC (> 550 d vs. 100-150 d)

Question 38

What were the conclusions regarding IP Doxil? (Sorenmo 2008)

Answer 38

- IP administered doxil result in effective drug concentration and comparable clearance with IV - Did not effectively prevent intra-abdominal recurrence

Question 39

Concentrations of ___ were higher in dogs with splenic masses compared to healthy controls. (Frenz 2014)

Answer 39

VEGF | Didn't differentiate between malignant and benign, though.

Question 40

In dogs with confirmed splenic HSA, what % of dogs with grossly abnormal livers actually had HSA metastasis? (Clendaniel 2014)

Answer 40

50% (29/58) | Also noted that biopsy on liver that appeared normal was low yield

Question 41

The presence of a splenic mass > __ cm on AUS in cats is suggestive of malignancy. (Bertal 2017)

Answer 41

``` 1 cm (a moth-eaten appearance of the spleen does not necessarily reflect a LSA or other malignant neoplastic process on cyto) ```

Question 42

What was the median PFS/MST for dogs with lingual HSA? (Burton 2014)

Answer 42

PFS 524d, MST 553d (18 months) | all were low or intermediate grade; most small and on ventral surface

Question 43

What % of cats with visceral HSA had lung metastasis at dx? (Culp 2008)

Answer 43

33%

Question 44

What % of cats with visceral HSA had multifocal involvement at diagnosis? (Culp 2008)

Answer 44

77%

Question 45

What was MST for cats with visceral HSA? (Culp 2008)

Answer 45

Majority euth within 1 day of dx; rest was MST 77d

Question 46

RR of hypofractionated RT for non-splenic HSA? MST? (Hillers 2007)

Answer 46

90% MST 95d (3.2 months) 8 Gy x 3 or 6 Gy x 4

Question 47

RR of non-resectable SQ HSA to DOX? (Wiley 2007)

Answer 47

38.8%

Question 48

What are risk factors for perioperative death with splenectomy? (Wendelburg 2014)

Answer 48

- thrombocytopenia (for each 10,000 decrease in PLT odds of death increase 6%) - anemia (if PCV < 30%, odds of death 2x higher) - intraoperative arrhythmia (increased by 2x)

Question 49

What is MTP-PE? (Vail 1995)

Answer 49

Synthetic lipophilic derivative of MDP, a component of bacterial cell wall -- encapsulation within liposome greatly enhances endocytosis and tissue uptake.

Question 50

What cytokines were increased with L-MTP-PE treatment? (Vail 1995)

Answer 50

TNF-a, IL-6

Question 51

What % of dogs that received L-MTP-PE with DOX/CTX were disease free after 1 year? (Vail 1995)

Answer 51

37% | only 15% of placebo group

Question 52

Was there a significant difference in survival for dogs receiving L-MTP-PE vs. placebo? (Vail 1995)

Answer 52

There was for stage II, not stage I

Question 53

What was survival difference between stage I and II? (Vail 1995)

Answer 53

Stage I - 355 Stage II - 148 (this was statistically significant)

Question 54

How did masitinib affect HSA cell lines? (Lyles)

Answer 54

induced apoptosis in all lines via activation of caspase 3/7

Question 55

What IHC markers can distinguish lymphangiosarcoma from HSA?

Answer 55

PROX-1 | LYVE-1

Question 56

Which is FALSE regarding feline hemangiosarcoma? a. 77% of cats with visceral hemangiosarcoma have multifocal disease at diagnosis b. The liver is the most common location for visceral hemangiosarcoma c. A MI >3 is associated with a shorter survival time d. Visceral locations are more common than skin/subcutaneous locations

Answer 56

D. Visceral locations are more common than skin/SQ - FALSE