Miscellaneous Tumours Flashcards
1
Q
What’s the prevalence of thymoma in cats and dogs?
A
- uncommon
- but it’s the 2nd most common tumour in the cranial mediastinum
- usually in older patients (9,10 years old)
2
Q
What’s the most common type of thymoma in the cat?
A
cystic thymoma
3
Q
What’s the metastatic rate of thymoma in general?
A
low
4
Q
What’s the metastatic rate feline cystic thymoma?
A
up to 20%
5
Q
What are some differentials for cranial mediastinal mass?
A
- lymphoma
- thymoma
- ectopic thyroid
- brachial cysts
- rarely, sarcoma or metastatic disease
6
Q
Are thymomas benign of malignant?
A
they are considered carcinomas
7
Q
What are the most common signs of thymoma?
A
- regurgitation
- vomiting
- anorexia
- weight loss
- cough
- dyspnea
- tachypnea
8
Q
What are the most common paraneoplastic syndromes for thymoma in dogs? in cats?
A
Overall prevalence is up to 67% of dogs and cats.
Dogs:
- myasthenia gravis (40%)
- not as commonly found in cats
- up to 40% will have megaesophagus with concurrent aspiration pneumonia
Cats:
- exfoliative dermatitis
9
Q
When can paraneoplastic signs be present for thymoma?
A
- at the time of diagnosis
- some time later in the course of disease progression
- after tumour removal
10
Q
What % of dogs with thymoma will have a concurrent 2nd tumour?
A
up to 27%
11
Q
How common is hypercalcemia in patients with thymoma?
A
34% of dogs, and it’s also common in cats
- ddx: lymphoma
12
Q
How does thymoma cause hypercalcemia?
A
via PTHrP
13
Q
What ultrasound appearance would make thymoma significantly more likely?
A
cystic, heterogenous echogenicity
14
Q
What other cell types are commonly found in FNA of thymoma?
A
small mature lymphocytes
mast cells
15
Q
How often is neoplastic cells present on thymoma FNAs?
A
only in 61% of the time
16
Q
What’s an unique cytological features of thymoma?
A
Hassal’s corpuscles, but they are not usually seen with Wright’s Giemsa compare to biopsy samples
17
Q
How does flow cytometry help with thymoma diagnosis?
A
> 10% of cells will be CD4/CD8 double positive
(vs <2% for lymphoma)
18
Q
What’s the outcome of thymoma treated with surgery alone in dogs? in cats?
A
Dogs, MST = 635 - 790d (1.7-2.1y)
Cats, MST = 1825d (5y)
19
Q
What’s the outcome of canine thymoma without surgery/ treatment?
A
76 days
20
Q
What’s the outcome of dogs with thymoma treated with weekly hypofractionated RT?
A
RR = 50%
1y survival rate = 75%
21
Q
What’s the general outcome of RT for dogs and cats with thymoma?
A
RR = 75% (11/20 PR, 4/20 CR)
MST: dogs = 248d (8m)
MST: cats = 720d (~2y)
22
Q
What’s the role of chemotherapy in thymoma?
A
undefined
may end up targeting the non-neoplastic lymphocytes…
23
Q
What’s the general outcome of thymoma?
A
Good if non-invasive/ amendable for surgery
24
Q
What’s the mortality rate in dogs and cats undergoing surgical removal of the thymoma?
A
Dogs: 20-27%
Cats: 11-22%
25
What are some prognostic factors for thymoma?
- Amount of lymphocyte infiltration (higher = longer ST)
- dogs with Masaoka-koga stage I or II = significantly longer MST compared to >II
- age, invasiveness, and MC = NOT prognostic for ST
- in cats, cystic thymoma = better prognosis
26
Describe the Masaoka staging system.
Stage I: Tumor is grossly encapsulated and no capsular invasion is noted microscopically.
Stage II: Gross invasion occurs to surrounding fatty tissue or mediastinal pleura. Microscopic invasion of the capsule is noted.
Stage III: Gross invasion into neighboring organs (pericardium, great vessels, lungs)
Stage IVa: Pleural or pericardial dissemination
Stage IVb: Lymphatic or hematogenous metastasis
27
What's the natural behavioral of TVT?
- develop within 2-6m of mating
- can be grow slowly and unpredictably for years, or
- grow invasively and become malignant and metastasize
28
What's the metastatic rate of TVT?
5-17%
29
What's a unique arrangement of TVT that's used as a primer for PCR?
LINE-c-myc gene sequence
30
What are the 3 phases of TVT?
1. progressive: grow for the first 3-6m
2. stationary phase: last months to years!
3. regression phase: usually starts within 3m, but rarely if the tumour is present for >9m --> need immunocompetent host
31
What does TVT do in the progressive phase to allow for growth?
mostly due to immunoavoidance
- down regulates MHC class I and II expression --> evade T cell cytotoxicity
- secretion TGF-beta --> inhibits MHC antigen expression and NK cell activity (inhibits IFN-gamma)
- can also target and damage dendritic cells
32
What's a major determine factor for a switch into the regression phase?
IL-6 concentration
- IL-6 = pro-inflammatory
- acts synergestic with host IFN-gamma, and will overcome the tumour TGF-beta effects, and restores NK cell activity and MHC expression up to 40% of tumour cells
(but a 2022 paper by do Prado et al did not find evidence of immune-induced complete spontaneous regression)
33
What other hose immune defense is available for TVT?
humoral immune response --> antibody production
34
What's the treatment of choice for TVT?
chemotherapy
- vincristine single agent weekly for 3-6 treatments = 90-95% CR
- combination protocol not as good
- can use doxorubicin in vincristine resistant cases
35
What's the outcome of TVT treated with RT?
can have up to 100% durable CR
36
What's the outcome of TVT treated with surgery?
recurrence rate is 30-75%
37
What's the overall general prognosis of TVT?
very good to excellent
38
What are the 2 most common primary cardiac tumour in the dog?
1. hemangiosarcoma
2. aortic body tumour (chemodectomas, paragangliomas)
39
What's the most common cardiac tumour in the cat?
- Lymphoma (both primary and metastatic)
- aortic body tumour can occur, with hemangiosarcoma = rare
40
How common is cardiac tumour in dogs and cats?
rare
41
What's the predominant location for malignant cardiac tumours in the dog?
Right auricle/ right atrium
42
What's are clinical signs of cats with cardiac tumours?
- tachypnea
- dyspnea
- anorexia
- weight loss
- lethargy
- acute collapse = less common than dogs
43
How good is chest radiographs at identifying cardiac tumours?
Sensitivity = 47% (of cardiac hemangiosarcoma)
- but can often see the secondary changes such as cardiac tamponade and effusions
44
What's the sensitivity/ specificity of diagnosing cardiac tumours with echocardiogram?
Specificity = 100%
Sensitivity = 82%
- higher for right atrium/auricle masses (99% spec, 82% sensitivity) vs
- heart base tumours (98% spec, 74% sensitivity)
45
How common is pericardial effusion in dogs with echo diagnosed cardiac tumours?
42%
(it's 84% for those with hemangiosarcoma)
46
What's the diagnostic yield of cytology of the pericardial effusion?
8%, it's better (~20%) if the PCV is < 10%
47
How is cardiac troponin I used in diagnosis of cardiac tumours in dogs?
It can help with hemnagiosarcoma diagnosis.
- can use the pericardial effusion (>0.25ng/mL) or peripheral blood (2.45 ng/mL)
- can help with false-positive on echocardiogram
48
What's the % of dogs with cardiac hemangiosarcoma having splenic involvement?
What's the % of dogs with splenic hemangiosarcoma with cardiac involvment?
- 29% of cardiac hemangiosarcoma has splenic involvement,
- but only 8% of splenic hemangiosarcoma has cardiac involvement (older literature = 24%)
- 42% of cardiac hemangiosarcoma has metastasis elsewhere than spleen
49
What's the benefit of pericardial window in the treatment of cardiac tumours?
- can improve survival time in aortic body tumours and mesothelioma
- didn't show to improve outcome in dogs with hemangiosarcoma
50
What chemotherapy can be considered with cardiac tumours?
- doxorubicin based, mono or combination therapy for hemangiosarcoma
- Palladia for aortic body tumours in dogs (not proven in cats)
- feline lymphoma = CHOP/ COP
51
What's the outcome of RT for aortic body tumours?
- in a small study (8 dogs) using 3D-CRT (weekly), all dogs have gradual reduction of tumour size
- SRT: (23 dogs) - MST = 404 days (1.1y), with 25% PR and 60% SD for median of 333d (10m)
- in the SRT study, arrhythmia, clinical signs, locoregional LN enlargement = reduced ST
52
What's the outcome of Palladia for canine chemodectoma?
RR = 89%
MST = 478 days, which was not significantly different than dogs treated with additional therapy (521 days)
53
What's the outcome of IMRT with adjuvant vinblastine and propranolol for canine right atrial tumours?
- MST = 326d (~10m)
- 1/7 (14%) CR, 4/7 (57%) PR, 2 (28%) SD
- weekly vinblastine (2.6 mg/m2 IV) and daily propranolol (0.5 mg/kg PO TID, increased to 1 mg/kg PO TID after 1 week).
54
What's the outcome of surgery vs surgery + adjuvant doxorubicin for dogs with cardiac hemangiosarcoma?
Surgery only: MST = 16d to 4m
With doxorubicin post-op: MST = 175d (~6m)
55
What's the outcome of doxorubicin alone for canine cardiac hemangiosarcoma?
Response rate = 41%
median PFS = 66 days
MST = 116-140d (3-4.5m)
56
What's the outcome of canine aortic body tumour with pericardiectomy vs no pericardiectomy?
Pericardiectomy MST = 661 -730d (22-24m)
No pericardiectomy MST = 42-129d (1-4m)
57
What's the outcome of cats with cardiac tumours?
generally poor
58
What's the most common presenting sign of mesothelioma?
effusion (pericardial, thoracic, abdominal) due to impaired lymphatic drainage
59
Vomiting and urinary signs could be a symptoms of which type of tumour?
Sclerosing mesothelioma
- more so in males, German Shepherds
- thick fibrous linings
- restrictions around organs
60
What's the sensitivity of detecting cardiac mesothelioma with echocardiogram for dogs with pericardial effusion?
5/15 dogs
61
What tests can be run with effusions to rule out malignancy?
fibronectin
- mesothelioma can be ruled out if fibronectin is not increased
62
What's the MST of cardiac mesothelioma treated with pericardiectomy?
MST = 4-9m
if followed up with chemo, MST = 10-27m
63
Is there a difference in out in dogs with pericardial effusion due to mesothelioma treated with pericardial window vs subtotal pericardiectomy?
no, MST 3-4m
64
What's a chemotherapy option for intracavity infusion due to mesothelioma?
intracavity chemo! but only penetrates 2-3mm
65
What are histiocytes?
They are dendritic or macrophage lineage
66
Which stem cells do histiocyte differentiate from?
CD34+
67
Define intraepithelial, interstitial, interdigitating, and migratory dendritic cells.
- Intrepithelial = Langerhans cells
- Interstitial = those in perivascular location. Ex. dermal DCs
- Interdigitating = found in LNs, spleen
- migratory = part of interdigitating DCs
68
Which cytokines/ growth factors can influence blood monocyte differentiation into macrophage vs dendritic cells?
Monocyte --> macrophage = M-CSF
Monocyte --> DC = granulocyte-macrophage-CSF and IL-4
69
Which cells are the most potent antigen presenting cells?
dendritic cells
70
In cutaneous and systemic histiocytosis, which type of dendric cells are predominately responsible?
interstitial DCs
71
In histiocytic sarcoma, which type of dendric cells are predominately responsible?
it's due to the migratory potential of the interstitial DCs --> rapidly disseminate
72
Which IHCs are important for differentiating the different dendritic diseases?
- Iba-1: macrophages and dendritic cells
- CD163 & CD 204: class A scavenger receptors --> expressed on macrophages and normal tissues
- CD18: CD11/CD18 = beta-integrins (adhesion molecules), expression is highly regulated in normal macrophages and DCs
- CD11b = macrophages
- CD 11c = Langerhans cells and interstitial cells
- CD80/CD86: expressed on antigen presenting cells --> ligand for T cell co-stimulation
73
What is reactive histiocytosis?
these include the cutaneous histiocytosis and systemic histiocytosis
74
Describe the pathophysiology of cutaneous histiocytoma.
- usually solitary, pink, raised mass in the a young dog/ cranial portion of the body
- rapid onset (1-4 weeks), regresses in 1-2 months
- CD8+ infiltration thought to help with regression
- will express E-cadherin = unique to cutaneous histiocytoma (can be used to differentiate from reactive histiocytosis)
75
Describe the pathophysiology of cutaneous Langerhans cell histiocytosis
- very similar to cutaneous histiocytoma but involve multiple masses or diffuse skin involvement
- can also spread to LNs and internal organs
- spontaneous regression may happen in about 50% of dogs, may be delayed up to 10m
- prognosis is poor with diffuse presentation
- can try CCNU or Griseofulvin
- if solitary with LN mets, surgery can have good outcome (1-4 y)
76
What's the typical signalment for dogs with cutaneous histiocytosis?
- tend to be young dogs
- Golden, Great Dane, Bouvier may be predisposed
- most dogs have previous derm issues
77
What's the distribution pattern for cutaneous histiocytosis?
- restricted to skin, subcutis
- head, ear, nose, limbs, scrotum
- benign condition
78
Which IHC markers are helpful for cutaneous histiocytosis?
- E-cadherin negative (positive with cutaneous histiocytoma)
- Thy-4 and CD4 = activated interstitial dendritic cells
- CD1a, CD1b, CD11c, MHC II
79
What's the treatment for cutaneous histiocytosis?
- spontaneous regression is still possible
- usually with prednisone (partial response in most dogs)/ immuno-suppressants
- long term maintenance may be required
80
How can one distinguish between cutaneous histiocytosis and systemic histiocytosis?
- the IHC markers are the same
- will have same distribution patterns for the peripheral lesions
- but, will also involve other sites like LN, internal organs, eyes, bone marrow, etc
81
Which breeds are over-represented in systemic histiocytosis?
- Bernese mountain dogs (may be familial)
- Golden, Rottie and Irish Wolfhound
82
What are some common clinical signs of systemic histiocytosis?
- depression
- weight loss/ anorexia
- conjunctivitis
- harsh respiration
83
What are some common CBC abnormalities for dogs with systemic histiocytosis?
- monocytosis
- lymphopenia
- anemia
occasionally see hypercalcemia
84
What's the treatment for systemic histiocytosis?
- tend not to spontaneous regress
- steroids alone may not be enough
- immunosuppressants: azathioprine, cyclosporine A, leflunomide
85
What's the prognosis of systemic histiocytosis?
- treatment can often have episodes of response then recrudescence
- euthanasia generally due to repeated relapses or failure to respond to tx
86
Which breeds are predisposed to histiocytic sarcoma?
- Bernese mountain dog
- Flat coated retriever
- Rottie, mini Schnauzer
- Corgis in Japan
87
Which gene mutations have been identified for dogs with histiocytic sarcoma?
- CDKN2A/B, RB1, PTEN
- PTPN11
88
What could be a predisposing factor for periarticular histiocytic sarcoma in Berners?
previous injury to the joints
89
What are some differences in the histiocytic sarcoma in Berners vs. flat-coated retrivers?
- location: Berners = systemic, Flat-coated = periarticular (7x more likely to have localized HS)
- age: Berners are younger than Flat-coated retrievers at diagnosis
- histological differences also reported
90
Which IHC can be used to differentiate between periarticular histiocytic sarcoma and synovial cell sarcoma?
- CD18, cytokeratin, smooth muscle actin
91
What are some useful markers for diagnosing histiocytic sarcoma?
CD204, IBA-1
There is a CADET histiocytic malignancy assay --> sensitivity = 78%, specificity = 98%
92
What CBC abnormalities are common in dogs with histiocytic sarcoma?
- anemia, often regenerative
- thrombocytopenia
- leukocytosis
it's this 2nd most common cause of pancytopenia
93
What biochem abnormalities are common in dogs with histiocytic sarcoma?
- hypocholesteremia
- hypoalbuminemia
- increased liver values
- hypercalcemia has been reported
94
How does ferritin level play a role in diagnosis of histiocytic sarcoma?
- Hyperferritinemia is common in dogs with HS (89%)
- but not so good as a screening tool
95
What diagnostic test can be used to differentiate between neoplastic and non-neoplastic cause of hemophagocytosis?
based on the scatter plot of flow cytometry
96
What type of lung pattern can be noted on CXR for histiocytic sarcoma?
- diffuse/ infiltrative
- patchy consolidated area
- focal/ multifocal masses
Right middle lung lobe!
97
What's the general outcome of histiocytic sarcoma?
- poor
- localized/ periarticular have significantly better MST (391d vs 128d [1y vs 4m])
- even metastatic PAHS can do well, but if no mets on presentation, MST = 980d (2.7y) vs 253d (8m)
98
What's the outcome of histiocytic sarcoma treated with CCNU?
- RR = 46% in gross disease setting
- median remission duration = 85d (3m)
- if responded, MST = 175d (8m), if not response, MST = 60d (2m)
99
What's the response rate of doxorubicin alternating with CCNU very 2 weeks?
RR = 58%, median time to progrsesion = 185d (6m)
100
What are some rescue protocols reported for histiocytic sarscoma?
- dacarbazine, RR = 18%, event-free survival = 70d (2m)
- Epirubicin, RR = 29%
101
What are some outcome of metronomic chemotherapy for histiocytic sarcoma?
Lomustine: 2 cases, PR
Chlorambucil: 2 cases, 1 PR 1 SD
102
What's the role of RT in histiocytic saromca?
HS = radioresponsive
- mostly used for periarticular histiocytic sarcoma
- MST 182d (6m)
- with CCNU = 208d (7m)
103
What cytological features can increase suspicion of hemophagocytic histiocytic sarcoma?
- atypical macrophages in the spleen with phagocytosis
104
What's the outcome of hemophagocytic histiocytic sarcoma?
there is no effective therapy - euthanasia in 1-2 days
105
What bloodwork abnormalities are common in hemophagocytic histiocytic sarcoma?
- regenerative anemia (94%)
- thrombocytopenia (88%)
- hypoalbuminemia (94%)
- hypocholesterolemia (69%)
106
What are the 3 distinct forms of feline histiocytic disease?
- feline progression histiocytosis
- feline histiocytic sarcoma
- pulmonary Langerhans cell histiocytosis
107
Describe feline histiocytic sarcoma.
- both dendritic and macrophage origin have been described
- solitary lesions = rare; mostly multifocal or disseminated
- bone marrow involvement is common
- no effective treatment; use of CCNU. masitinib, and RT has been reported
108
Describe feline progressive histiocytosis.
- dendritic cell
- multifocal to coalescing skin nodules
- predilection to head, feet, and legs
- indolent, but progressive --> eventually go to LNs, lungs, and abdominal viscera
- doesn't respond to steroids
- may spontaneously regress
- may respond to CCNU, masitinib
109
Describe pulmonary Langerhans cell histiocytosis.
Small case series of 3 cats
- all presented from respiratory compromise/ distress
- CXR: diffuse, severe broncho interstitial lung pattern with diffuse/ miliary nodules in all lung lobes
- needed extensive IHC for diagnosis (necropsy)
- all had metastasis to pancreas, kidneys, liver, LNs
110
What % of splenic tumours = hemangiosarcoma in dogs?
45-51%;
111
Which breeds are overrepresented for hemangiosarcoma?
Goldens, Labs, German Shepherds
-large breeds
112
Which mutation is commonly found in canine hemangiosarcoma?
PTEN
- also dysregulation of angiogenic pathways
113
What's the likelihood of splenic hemangiosarcoma for dogs presenting with nontraumatic hemoabdomen?
63-70%
114
On necropsy, what % of canine splenic tumours are malignant and what % are hemangiosarcoma?
50% are malignant
50-74% are hemangiosarcoma
115
What's the most common cardiac tumour in dogs?
hemangiosarcoma (the 2nd most common site in dogs = heart)
116
Which tumour is the most common secondary tumour to the brain in dogs?
hemangiosarcoma
117
Where are the most common sites for feline hemangiosarcoma?
skin, and visceral (spleen, liver, and intestines)
118
What are some common metastatic sites for feline hemangiosarcoma?
liver, omentum, lungs
119
Which IHC can be used for hemangiosarcoma?
- factor VIII, (von Willebrand's factor)
- CD31/ platelet endothelial cell-adhesion molecule
120
How often is thrombocytopenia in dogs with visceral hemangiosarcoma?
75-97%
121
What coagulation parameters can be abnormal in dogs with visceral hemangiosarcoma?
seen in 50% of affected patients
- secondary coagulation parameters
- prolonged PT, PTT
- increased fibrin degradation product, fibrinogen, D-dimers
DIC!
122
What paraneoplastic syndrome can be noted on CBC of dogs with hemangiosarcoma?
- neutrophilia!
can also be due to tumour necrosis
123
What bio chem abnormalities can be found in cats with visceral hemangiosarcoma?
50% will have elevated AST
124
Describe the staging scheme for canine hemangiosarcoma.
125
What are some biomarkers used for diagnosis of hemangiosarcoma?
- cardiac tropnin 1
- VEGF, urine bFGF
- thymidine kinase
- serum collagen XXVII --> can be used for monitoring!
126
How often are multiple and/or dark red/ black lesions in the liver actually been benign in dogs with visceral hemangiosarcoima?
- 50%!
- almost 60% of histologically benign lesions were obtained from grossly abnormal livers
127
What are some single agent chemo that has shown effectiveness in hemangiosarcoma?
#1 = doxorubicin
- ifosfamide
- epirubicin
- liposomal-encapsulated DOX
128
What's the outcome of metronomic chemotherapy for hemangiosarcoma?
- can be used in post-op or as maintenance after MTD
- likely no survival advantage
- one study had thalidomide and that significantly increased the ST
129
How responsive is immunotherapy for canine hemangiosarcoma?
- mixed killed bacteria vaccine + doxorubicin had some improvement (no significant difference)
- allergenic cell lysate vaccine didn't show difference
(vaccine post-op is better than Sx alone - MST 142d; Lucroy et al 2020)
- adjuvant chemo + liposome-encapsulated muramyl tripeptide-phosphatidylethanolamine (L-MTP-PE) had MST of 9.1m - but not commercially available
130
What's the role of RT in hemangiosarcoma?
- can palliate cardiac hemangiosarcoma --> reduces the incidence of pericardial effusion
- they are radioresponsive, but not shown to have a significant improvement
131
What's the outcome of RT for retroperitoneal hemangiosasrcoma?
~ 400d (1y)
132
How effective is tyrosine kinase inhibitors for hemangiosarcoma?
imatinib, masitinib, dasatinib:
- they have demonstrated in vitro effectiveness, but the concentration needed for in vivo benefit would be too high (too toxic)
Toceranib
- tried in combi with doxorubicin and had no difference
133
Which targeted therapy for hemangiosarcoma shown improvement in ST?
eBAT
MST = 8.5m with 70% survival rate @ 6m
134
What are some alternative therapies for hemangiosarcoma and how effective are they?
- Yunnan Baiyao --> maybe in vitro effectiveness, no in vivo changes noted
- Polysaccharopeptide (PSP) --> modest improvement in MST
135
What's the overall prognosis of dogs with splenic hemangiosarcoma treated with splenectomy only?
19-86d ( <3m)
136
What's the MST for splenic hemangiosarcoma treated with splenectomy and chemo based on stage?
- Stage 1: MST = 239-355d (8-12m)
- Stage 2: MST 120-148d (4-5m)
137
What's the general outcome of splenic hemangiosarcoma treated with splenectomy and chemo?
with doxorubicin based chemo, MST = 5-7m
138
What's the MST of primary renal hemangiosarcoma treated with nephrectomy +/- chemo?
MST ~ 9m
139
What's the MST of primary retroperitoneal hemangiosarcoma treated with nephrectomy +/- chemo?
MST = 37.5d
140
What's the outcome of true cutaneous canine hemangiosarcoma treated with surgery?
overall MST = 780-987d ; 1570d (2-2.7y; 4.3y)
- ventral tumour location MST = 1085d (~3y)
- solar induced MST = 1549d (4.2y)
141
What's the outcome of cutaneous canine hemangiosarcoma with SQ infiltration or SQ/IM HSA treated with surgery?
- Cutaneous with SQ invasion, MST = 539d (~1.5y)
- SQ/ IM MST = 9m - 3y (with chemo)
142
What's the outcome for cardiac hemangiosarcoma?
- no treatment = 2 weeks
- with surgery, MST = 1-3m
- surgery + chemo MST = 2.7 - 4m
143
What's the responsive rate and MST of doxorubicin for cardiac hemangiosarcoma in dogs?
RR = 41%
MST = 4m
144
What's the outcome of stage III splenic hemangiosarcoma treated with doxorubicin and deracoxib?
MST = 149d, similar to MST of 150d for all stages combined (5m)
145
What's the outcome of stage III splenic hemangiosarcoma treated with the DAV protocol or the VAC protocol?
-DAV: RR = 47%, MST - 101d (3.5m)
- VAC: MST = 195d (6.5m), similar to stage I/II (MST = 189d)
146
What's the outcome of feline visceral hemangiosarcoma?
poor, due to high metastatic rate
MST = 77-197d (2-6.5m)
147
What's the outcome of feline cutaneous hemangiosarcoma?
MST 9m-4y
148
What's the outcome of feline cutaneous with SQ invovlement hemangiosarcoma?
- with surgery, 50-94% will be incompletely removed
- 50-80% recurrence
149
What CT differences can be used to differentiate between haert base hemangiosarcoma and neuroendocrine tumour?
Neuroendocrine tumours are more contrast enhancing than hemangiosarcoma and tend to to be associated with mediastinal and peritumoral neovascularization
- cannot distinguish between aortic body tumour and ectopic thyroid carcinoma consistently
150
What's the outcome for feline ventral abdominal angiosarcoma/ lymphagiosarcoma?
Angiosarcoma MST = 166d (~5.5m)
Lymphangiosarcoma MST = 197d (~6.5m)
151
What's the outcome of cats with thymic epithelial tumours treated with surgery? How does the Masaoka-Koga staging effect MST?
- Peri-op mortality rate = 11%
- MST = 897d (~2.5y)
- Stages I and II: MST = 1366d (~3.7y)
- Stages III/IV: MST = 564d (~1.5y)
(Marks et al 2024)
152
What type of tumour has been reported in the tricuspid valve of the dog?
Myxoid tumours - 2/11 had characteristics of malignancy
153
What's the average age of cats diagnosed with histiocytic sarcoma?
5y
154
What's the responsive rate of hemangiosarcoma to carboplatin?
33%, median time to progression for responders = 103d (~3m)
155
What's the general outcome of cats with hemangiosarcoma of the nasal planum treated with surgery and strotium?
prolonged survival (>1y) is possible
156
What features of CFS cytology can support primary histiocytic sarcoma of the CNS rather than secondary?
marked inflammation
(Toyoda et al 2020)
157
How often can neoplastic cells be noted on CSF analysis for CNS histiocytic sarcoma?
58%
(Toyoda et al 2020)
158
What are some predisposed breeds for CNS histiocytic sarcoma?
- Berners, Golden, Rotties, Corgis, Shelties
- Corgis and Shelties - primary only
- Rotties (always disseminated)
159
What are some distinguishing characteristics on CT for mediastinal lymphoma vs thymoma in dogs?
- mediastinal LSA is more likely to be wrapping around the cranial vena cava compared to thymoma
- mediastinal LSA is also more homogenous compared to thymoma
(Reeve et al 2020)
160
What's the outcome of amputation vs RT for periarticular histiocytic sarcoma in dogs?
Amputation MST = 398d (13m)
RT MST = 240d (8m)
- not statistically significantly different
- negative prognostic factors: LN and distant metastasis at presentation
161
What's the general outcome with surgery for dogs with hemangiosarcoma in the urinary bladder, ureter, falciform fat
prolong ST possible (>9m-years)
162
What's the response rate of doxorubicin for canine histiocytic sarcoma?
ORR = 26%
Better for localized vs disseminated (43% vs 21%)
- only CR is with multimodal therapy
- MTTP = 42d
(Doka et al 2022)
163
What's the outcome of dogs with heart base tumour treated with Palladia?
- ORR = 10%
- MST = 823d (2.25y)
- 90% improvement in clinical signs (dyspnea, collapse, cough, lethargy)
- those with metastasis, RR = 28.5%, MST = 796d (2.18y) --> not statistically significant compared to no mets
(Lew et al 2019)
164
What are some features that can help to distinguish between mediastinal lymphoma vs thymic epithelial tumours in dogs and cats?
Dogs:
- at least 2 well defined margins on a lateral view = more likely to be thymic tumour vs lymmphoma
- a rightward shift of the cardiac silhouette on VD/DV also more likely to be thymic tumour
Cats:
- no characteristics found
(Oura et al 2019)
165
What's the outcome of dogs with carcinomatosis and mesothelioma treated with Palladia?
Best ORR = 30.4% (13% CR, 17.3% PR)
SD = 60.8% (14/23)
MST = 301 days
166
What's the outcome of localized splenic histiocytic sarcoma?
MST = 427d (14m)
- 5/14 (35.7%) developed metastatic disease
- 12/14 had CCNU
167
What's the outcome of periarticular histiocytic sarcoma that has not metastasized?
Combo of Sx, RT, Chemo
MST = 980d! (2.7y)
if there is met = 253d (8m)
