Lecture 8 Flashcards
signalment of hemangiosarc patients
–Large breed dogs- German shepherd, golden retriever and Labrador retriever overrepresented.
–Mean age 8-13 years, as young as 3 years
–Possible male predominance
locations of HSA
- Spleen, liver, right atrium- or multiple sites
* Kidney, subcutaneous tissues/muscle, oral cavity, urinary bladder, pericardium and peritoneum, bone.
biologic behavior of HSA
–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.
Dx of HSA
requires histopathology but many suggestive features can point to the diagnosis or give a high index of suspicion
suggestive features of HSA
–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
CBC of HSA
normocytic normochromic anemia, NRBC, fragmented red cells (schistocytes)
neutrophilic leukocytosis, thrombocytopenia
Thoracic rads of HSA
- 78% of metastasis that are present identified
* 47% of cardiac lesions present are identified
Treatment of HSA
•Surgical removal –spleens and some subcutaneous masses –right atrial mass •removal reported to extend survival but difficult to assess •pericardial window? Chemo
Chemo protocol for HSA
–Single agent doxorubicin (once every 2-3 weeks)
–Combination therapy
•Doxo + Vincristine+ Cyclophosphamide
•Doxo + DTIC
Antiangiogensis chemo therapy for HSA
–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
biological therapy for HSA
encapsulated muramyl tripeptide
predisposing factor to cutaneousHSA
- Light coat color, thin skin dog and cat disease
* Likely it is sunlight induced
paraneoplastic syndromes associated with MCT
–GI ulceration –impaired healing locally –coagulopathy –hypotensive shock- rare –urticaria –eosinophilia, basophilia
dog breeds predisposed to MCT
Boxer, Boston Terrier, Labrador Retrievers, Schnauzers, Beagles
cat breeds predisposed to MCT
siamese
age prediliction to MCT
•Any age in dog, tends to be older cats
presentation of MCT in dogs
- Most commonly have external skin masses
* Primary internal tumors are rare
presentation of MCT in cats
- Equal numbers of external and internal tumors
* Primary symptom is not always a skin mass
diagnostic tool required to grade MCT
histopath
Grading of MCTs
–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
evaluation of the mitotic index
–< 5 mitoses/10 hpf, less likely to recur or metastasize
–> 5 mitoses/10hpf, more likely to recur or metastasize
staging of mast cell tumors
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
symptomatic treatment of MCTs
–H1 blocker (diphenhydramine)
•Prevent bronchoconstriction, vasodialation
– H2 blocker (cimetidine,ranitidine,famotidine)
•Prevent gastric ulceration
–Prednisone
treatment for mcts (attempt to be curative)
–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
traditional chemo for MCT
–Prednisone, vinblastine, lomustine –Vinblastine and prednisone –Vinblastine, cyclophosphamide and prednisone –Hydroxyurea •WSU- Vinblastine and Lomustine or RTK inhibitors
prognosis for feline skin MCT
Skin MCT usually benign, cured with surgery
Two internal forms of feline MCT
•Lymphoreticular
•Gastrointestinal
present with vomiting
treatment of MCTs in cat
–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
