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Small animal surgery I > Mammary diseases > Flashcards

Mammary diseases Flashcards

1
Q

Which dog breed might be predisposed to malignant mammary tumors?

A

German shepherds

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2
Q

What is the relative likelihood of malignant mammary tumors in dogs?

A
  • Most common neoplasm in intact female dogs
  • 70% of all tumors (benign and malignant)
  • 50% malignant in dogs
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3
Q

Do multiple tumors occur commonly?

A

Yes– > 60%

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4
Q

Why do all mammary tumors need to be removed?

A

Malignant transformation is possible

“Watch and wait” is NEVER appropriate

EVER

NEVER EVER

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5
Q

Why should each mammary tumor be tested histopathologically?

A
  • Different histologic subtypes in the same dog
  • Each mass should be submitted
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6
Q

What are some differences between hyperplasia and neoplasia?

A
  • Hyperplasia will regress on its own while neoplasia will not
  • Hyperplasia occurs after heat cycle due to progestin
  • ID by history and pattern of masses
    • More likely to see hyperplasia in young dogs than neoplasia
    • Multiple little tiny masses throughout chain indicative of hyperplasia
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7
Q

Which tests are indicated for work-up?

A
  • Minimum database (CBC/chem/UA)
  • 3 view thoracic rads
  • Abdominal U/S, CT, or MRI
  • Biopsy
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8
Q

Why is it necessary to include 3-way thoracic rads in the workup?

A
  • 25-50% of malignancies have metastasis at initial diagnosis
  • Presence of metastasis makes good prognosis unlikely
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9
Q

When is/isn’t abdominal US/CT/MRI indicated for the workup?

A
  • Especially for caudal mammary tumors
  • Drainage to the iliac LN
  • Not necessary for small, single masses
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10
Q

Why is a biopsy recommended for workup?

A
  • Only way to differentiate malignant vs. benign
  • Excisional biopsy usually diagnostic of choice
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11
Q

Is cytology valuable in the workup of mammary tumors?

A
  • Questionable value
  • Cannot definitely rule out malignancy
  • Treatment for benign tumors is identical
  • Differentiate mammary from other (e.g. mast cell tumor)
  • FNA of LN if palpable
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12
Q

What criteria is associated with malignancy in mammary tumors?

A
  • Rapid growth (history)
  • Size (> 0.5cm diameter)
  • Fixed to skin or underlying tissues/invasive
  • Poorly circumscribed
  • Ulceration or inflammation
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13
Q

T/F: Even single, small masses should always be removed

A

TRUE–NEVER WATCH AND WAIT

Benign masses can become malignant

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14
Q

What are the appropriate margins for wide excision of a potentially malignant tumor?

A

2-3cm margin circumference

If invasive: fascia and muscle plane deep

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15
Q

When is a lumpectomy indicated?

A

Only appropriate if no criteria of malignancy

Periphery of gland or between glands only

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16
Q

What is a simple mastectomy? When is it indicated?

A

Removal of single, entire mammary gland

Solitary mass within 1-2cm of gland

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17
Q

When is a regional mastectomy indicated?

A

For multiple tumors in adjacent glands

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18
Q

What are the indications for a chain mastectomy?

A
  • Multiple masses throughout the chain
  • Tumors in gland 3 with any COM–variable lymphatic drainage
  • Solitary masses anywhere with multiple COM
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19
Q

Explain the lumpectomy procedure

A
  • Mass removed with 1cm margins
  • Mass should be between glands or near periphery
  • Incision into gland–>leakage of lymph–>inflammation
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20
Q

Explain the procedure of a simple mastectomy

A
  • Elliptical incision includes entire mammary gland
  • If mass is in middle of gland this ensures 2-3cm margins
    • Ensures complete removal of malignancy
    • Elliptical incisions easier to close
21
Q

Explain the procedure of a regional mastectomy

A
  • “Regional” = same lymphatic/vessel drainage
  • Remove glands cranial and caudal to mass
  • Glands 1-3 for tumors in glands 1 & 2
  • Glands 3-5 for tumors in glands 4 & 5
  • Superficial inguinal node removed with gland 5
22
Q

What is special about gland 3 when performing regional mastectomy? When would you need to perform a chain mastectomy instead?

A
  • Gland 3 has unpredictable lymphatic drainage
  • If tumor is in gland 3 and simple masectomy is not indicated, must perform chain mastectomy
23
Q

What is a chain mastectomy? When should it not be performed?

A
  • Removal of the entire chain of mammary glands
  • Do not perform if animal has metastasis
    • ​Not worth the surgery/complications
24
Q

Why is regional mastectomy rarely used?

A

60% of dogs have recurrence on the same side

25
Q

How are bilateral chain mastectomies usually performed?

A

Staged 4-6 weeks

If not, it will be extremely difficult to close the skin after surgery

26
Q

Is the prognosis for a benign mammary mass good or bad?

A

Good with complete resection of mass

27
Q

T/F: Masses < 4cm are more likely to be benign

A

FALSE– < 3cm are more likely to be benign

28
Q

What is the median survival time for malignant disease?

A

1-2 years if no metastasis

29
Q

What does prognosis of mammary neoplasia depend on?

A
  • Tumor factors
    • Tumor subtype
    • Tumor size (smaller = longer MST)
      • True for malignant tumors as well
30
Q

What is the prognosis for dogs with metastatic disease?

A

Poor

LN metastasis = 80% recurrence

Distand metastasis: MST = 5mo

31
Q

What is the influence of OHE/OE prior to the first heat on risk of mammary tumor development in dogs?

A
  • OHE before 2yrs of age reduces risk
    • 0.5% risk if spayed before first estrus
    • 8% risk if spayed between 1st and 2nd cycle
    • 26% if spayed after 2nd cycle but before 2yrs of age
32
Q

T/F: Performing an OHE on a patient older than 2yrs will still slightly reduce the risk of developing mammary tumors

A

FALSE–OHE after 2yrs has no effect

33
Q

Is an OHE recommended at the time of mastectomy?

A

YES

  • Do OHE before mastectomy
    • Avoid seeding tumor into abdomen
    • Same anesthetic episode as CMT surgery
34
Q

How do you differentiate inflammatory carcinoma from standard mammary tumors?

A
  • Masses are inflamed so palpation is painful
  • Lots of inflammation and reddening of the area
  • Can tell difference by rapidity of progression and clinical signs
35
Q

T/F: Inflammatory carcinomas are rapidly progressive and highly metastatic

A

TRUE

36
Q

What is the prognosis of inflammatory carcinoma?

A

Poor

37
Q

What treatment is not usually recommended for inflammatory carcinoma?

A

Surgical treatment is not recommended

Will not usually be successful. Can put patient on NSAIDs to make their remaining time more comfortable, but not much else can be done

38
Q

What is the relative likelihood of malignant mammary tumors in cats?

A

Less common in cats than dogs, but 85-90% of mammary tumors are malignant

80% are adenocarcinomas and there are multiple subtypes

39
Q

Is the effect of OHE for prevention of mammary tumors in cats similar to that in dogs?

A

Yes

Prior to 6mo = 10% risk of intact cats

Prior to 1yr = 15% risk of intact cats

40
Q

Which tests are recommended for mammary neoplasia workup in cats?

A
  • Pre-op workup similar to that in dogs
    • CBC/chem/UA
    • Rads for metastasis
    • U/S recommended due to risk of malignancy
41
Q

What are the indications for surgery in a cat with mammary neoplasia?

A

Surgery is recommended if there is no indication of malignancy

42
Q

When removing mammary tumors in cats, which surgical procedure is typically selected?

A
  • Chain mastectomy on effected side
    • Regardless of tumor number/size
  • Wide excision with underlying fascia
  • Remove muscle if attached to fascia
  • Stage bilateral procedures as for dogs
  • No evidence that simultaneous OHE improves survival
43
Q

T/F: Adjunctive therapy following mammary tumor removal in cats is only recommended if high indication of malignancy

A

FALSE–adjunctive therapy is ALWAYS recommended

44
Q

What are the factors that predict prognosis in cats with mammary tumors?

A
  • Size
    • < 2cm–MST > 3yrs
    • > 3cm–MST ~6mo
  • Surgery
    • More aggressive = better survival
  • Histologic grade
    • Less invasive/more differentiated = better survival
  • Some studies include adjunctive therapy
45
Q

How do you differentiate fibroadenomatous hyperplasia from mammary neoplasia?

A
  • Benign lesion
  • Mammary tumors are much smaller whereas hyperplasia has a very large characteristic appearance
  • Diagnosis by history and clinical signs
46
Q

What is the signalment associated with fibroadenomatous hyperplasia?

A
  • Usually occurs in cats < 2yrs old
  • Has been reported in older and male cats
    • Probably triggered by hormonal therapy
47
Q

What hormone influences fibroadenomatous hyperplasia? What condition is it associated with?

A
  • Progesterone-dependent
    • During first estrus cycle
  • Associated with pregnancy/pseudopregnancy
48
Q

What surgical procedure is used to treat fibroadenomatous hyperplasia?

A

OVH/OHE

49
Q

Which approach is preferred when treating fibroadenomatous hyperplasia?

A

Flank approach

Don’t want to be cutting through highly inflamed hyperplastic tissue to do your spay

Small animal surgery I (25 decks)

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