Lecture 8

Question 1

signalment of hemangiosarc patients

Answer 1

–Large breed dogs- German shepherd, golden retriever and Labrador retriever overrepresented.
–Mean age 8-13 years, as young as 3 years
–Possible male predominance

Question 2

locations of HSA

Answer 2

• Spleen, liver, right atrium- or multiple sites

* Kidney, subcutaneous tissues/muscle, oral cavity, urinary bladder, pericardium and peritoneum, bone.

Question 3

biologic behavior of HSA

Answer 3

–Extremely aggressive tumor that has a high rate of early development of metastasis
–Endothelial cells can go anywhere they want to and can arise in multiple sites simultaneously.

Question 4

Dx of HSA

Answer 4

requires histopathology but many suggestive features can point to the diagnosis or give a high index of suspicion

Question 5

suggestive features of HSA

Answer 5

–Splenic lesions
•2/3 are malignant, and 2/3 of those are hemangiosarcoma
•Evidence of splenic bleeding or rupture (submit entire spleen for analysis so tumor is not missed).
–Right atrial masses with pericardial hemorrhage
–Ultrasound appearance of cellular fluid filled masses- any location.
–Aspiration for cytology, or biopsy yielding only blood.
–Evidence of DIC- elevated coags or D-dimers or FDP’s
–Plasma troponin 1 concentration high in pericardial fluid

Question 6

CBC of HSA

Answer 6

normocytic normochromic anemia, NRBC, fragmented red cells (schistocytes)
neutrophilic leukocytosis, thrombocytopenia

Question 7

Thoracic rads of HSA

Answer 7

• 78% of metastasis that are present identified

* 47% of cardiac lesions present are identified

Question 8

Treatment of HSA

Answer 8

•Surgical removal
–spleens and some subcutaneous masses
–right atrial mass
•removal reported to extend survival but difficult to assess
•pericardial window?
Chemo

Question 9

Chemo protocol for HSA

Answer 9

–Single agent doxorubicin (once every 2-3 weeks)
–Combination therapy
•Doxo + Vincristine+ Cyclophosphamide
•Doxo + DTIC

Question 10

Antiangiogensis chemo therapy for HSA

Answer 10

–Minocycline
–Low dose chemotherapy / metronomic therapy
•Cyclophosphamide daily or cyclophosphamide and etoposide
•Lomustine daily
•Chlorambucil daily
–NSAID’s
–Tyrosine Kinase inhibitors- so far Palladia has not been shown to help

Question 11

biological therapy for HSA

Answer 11

encapsulated muramyl tripeptide

Question 12

predisposing factor to cutaneousHSA

Answer 12

• Light coat color, thin skin dog and cat disease

* Likely it is sunlight induced

Question 13

paraneoplastic syndromes associated with MCT

Answer 13

–GI ulceration
–impaired healing locally
–coagulopathy
–hypotensive shock- rare
–urticaria
–eosinophilia, basophilia

Question 14

dog breeds predisposed to MCT

Answer 14

Boxer, Boston Terrier, Labrador Retrievers, Schnauzers, Beagles

Question 15

cat breeds predisposed to MCT

Answer 15

siamese

Question 16

age prediliction to MCT

Answer 16

•Any age in dog, tends to be older cats

Question 17

presentation of MCT in dogs

Answer 17

• Most commonly have external skin masses

* Primary internal tumors are rare

Question 18

presentation of MCT in cats

Answer 18

• Equal numbers of external and internal tumors

* Primary symptom is not always a skin mass

Question 19

diagnostic tool required to grade MCT

Answer 19

histopath

Question 20

Grading of MCTs

Answer 20

–Grade 1 
•Well differentiated, superficial
•Prognosis nearly always good
–Grade 2 
•Well to medium differentiation, SQ involvement
•Variable prognosis
–Grade 3 
•Poorly differentiated
•Prognosis nearly always very poor

Question 21

evaluation of the mitotic index

Answer 21

–< 5 mitoses/10 hpf, less likely to recur or metastasize

–> 5 mitoses/10hpf, more likely to recur or metastasize

Question 22

staging of mast cell tumors

Answer 22

0: one tumor, already excised from dermis
I: one tumor
II: one tumor, with regional lymph node involvement
III: multiple dermal tumors, large infiltrating tumors, with or without lymph node involvement
IV: any tumor with distant metastasis or recurrence with metastasis

Question 23

symptomatic treatment of MCTs

Answer 23

–H1 blocker (diphenhydramine)
•Prevent bronchoconstriction, vasodialation
– H2 blocker (cimetidine,ranitidine,famotidine)
•Prevent gastric ulceration
–Prednisone

Question 24

treatment for mcts (attempt to be curative)

Answer 24

–Surgery- 3 cm margins in all directions
–Electrochemotherapy
•Great for small low grade tumors
–Radiation therapy
•Very good for local disease
•Best if minimal disease present
–Traditional Chemotherapy
•Used only for high stage / systemic disease (all grade 3)
•Minimally effective alone

Question 25

traditional chemo for MCT

Answer 25

–Prednisone, vinblastine, lomustine
–Vinblastine and prednisone
–Vinblastine, cyclophosphamide and prednisone
–Hydroxyurea
•WSU- Vinblastine and Lomustine
or RTK inhibitors

Question 26

prognosis for feline skin MCT

Answer 26

Skin MCT usually benign, cured with surgery

Question 27

Two internal forms of feline MCT

Answer 27

•Lymphoreticular
•Gastrointestinal
present with vomiting

Question 28

treatment of MCTs in cat

Answer 28

–Symptomatic treatment important
•Corticosteroids, H1 and H2 blockers
•Splenic form- stop therapy after surgery?
•Intestinal form may require therapy for life
–Remove tumor- spleen or intestine
–Tyrosine Kinase inhibitors shown to be beneficial but not often necessary