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Neurosurgery > Neoplasms of the vertebrae and spinal cord > Flashcards

Neoplasms of the vertebrae and spinal cord Flashcards

1
Q

Cats with lymphoma of the spinal cord are typically positive for which virus?

A

FeLV

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2
Q

Are intradural/extramedullary or intramedullary neoplasms typically associated with a more rapid onset of clinical signs?

A

Intramedullary (longest onset for intradural/extramedullary)

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3
Q

What are the most common clinical signs of vertebral, spinal cord, spinal nerve, or nerve root neoplasms in dogs and cats?

A

Dogs: pain.
Cats: paresis/paralysis

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4
Q

What are some common differential diagnoses for neoplasms of the vertebrae and spinal cord?

A

IVDH, cervical spondylomyelopathy, degenerative myelopathy, degenerative lumbosacral disease.

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5
Q

In which region of the vertebral column do neoplasms most frequently occur in dogs?

A

Cervical

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6
Q

What percentage of tumours occur in extradural, intradural/extramedullary, and intramedullary locations? For each, what are some examples of common neoplasms at these locations.

A

Extradural account for 50%: most commonly vertebral neoplasms, or lymphoma (cats).

Intradural/extramedullary 25-35%: meningioma, nerve sheath neoplasms.

Intramedullary: primary or secondary neoplasms.

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7
Q

What are some diagnostic tests that should be run when vertebral or spinal cord neoplasia are suspected?

A

CBC, biochemistry, urinalysis, FeLV/FIV testing, thoracic radiographs, abdominal ultrasound, CT +/- myelogram, MRI, FNA/biopsy (if possible, normally for vertebral rather than spinal cord lesions)

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8
Q

Based on anatomic location, when can FNA/biopsies of vertebral neoplasms be obtained?

A

Able: Lesions affecting the spinous, transverse or articular processes of most vertebrae,

Unable: Lesions affecting the body of the cervical (due to proximity to the trachea, esophagus, carotid sheath and vertebral arteries), and thoracic vertebrae (proximity to dorsal lungs and ribs). Challenging to obtain samples from the L6/L7 vertebrae due to the ilial wings.

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9
Q

When are early and late effects of radiation therapy expected?

A

Early: start immediately (affect rapidly dividing cells such as epithelium and bone marrow). Normally resolve within weeks of completion.

Late: 6-months to years after therapy. affect non-proliferating tissues such as nervous tissue, vascular tissue, and bone.

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10
Q

What would a typical definitive radiation protocol for neoplasms of the vertebra and/or spinal cord consist of?

A

Daily administration of 18-22 treatments (fractions) for a total administered dose of 45-55 Gy.

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11
Q

What are some newer radiation technologies available to increase the dose of radiation to the neoplasm?

A

Intensity modulated radiation therapy, tomotherapy, stereotactic radiotherapy (or radiosurgery), EDTMP.

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12
Q

What is a unique challenge of treating intradural CNS neoplasms with chemotherapy?

A

Many chemotherapeutic agents do not cross the blood brain barrier

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13
Q

What are some CNS neoplasms that may be primarily treated with chemotherapy?

A

Multiple myeloma, leukemia, disseminated histiocytic sarcoma, lymphoma.

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14
Q

What is the mechanism of action of biphosphanates, and give two examples.

A

Pamidronate and zoledronate (zoledronate is potent, newer generation biphosphanate).

Biphosphanates work by inhibiting osteoclast activity and bone resorption, resulting in decreased osteolysis, improved mineralization and pain relief.

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15
Q

What is the typical signalment of a patient with vertebral neoplasia?

A

Large breed, 5-10 years of age, males>females in some studies.

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16
Q

Are vertebral neoplasms more likely to be primary or secondary?

A

Primary

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17
Q

What is the most common primary vertebral neoplasm in dogs and cats?

A

Osteosarcoma.
Other neoplasms include hemangiosarcomas, fibrosarcomas, chondrosarcomas.

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18
Q

What are the most common metastatic neoplasms of the vertebral column?

A

Vascular (hemangiosarcoma) or epithelial (thyroid, mammary, urinary, prostatic) in origin.

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19
Q

What is the most common clinical sign associated with vertebral neoplasia?

A

Pain

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20
Q

Which neoplasm is associated with multiple punctate areas affecting multiple vertebrae?

A

Multiple myeloma

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21
Q

What are typical MRI findings with vertebral neoplasms?

A

Hypointense lesion of T1W images, hyperintense image on T2W, variability in contrast enhancement after IV contrast.

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22
Q

Is osteosarcoma in cats associated with a high or low metastatic rate?

A

Low (regardless of location)

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23
Q

What is the median survival time of dogs with vertebral osteosarcoma?

A

55-155 days

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24
Q

What adjunctive therapies can be considered in the treatment of vertebral osteosarcoma?

A

Radiation therapy, chemotherapy, biphosphanates

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25
Q

What is the metastatic rate of vertebral osteosarcoma in dogs?

A

40-45%.

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26
Q

What is the survival time of cats with vertebral osteosarcoma?

A

Undetermined, if local control is achieved likely long term survival.

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27
Q

What regions of the spinal cord are most commonly affected by lymphoma in cats?

A

Thoracic or lumbar

28
Q

Is it common or uncommon for lymphoma to involve multiple central nervous system sites in cats?

A

Common (43% of cases involve multiple sites)

29
Q

What percentage of cats with central nervous system lymphoma have involvement of other extraneural sites?

A

> 80%

30
Q

Is extradural, intradural or intramedullary lymphoma most common in dogs and cats?

A

Extradural

31
Q

What is the expected median survival time of dogs and cats with CNS lymphoma?

A

<5 - 7 months (some complete responders survive greater than 1 year).

32
Q

List 7 common extradural neoplasms that may be identified in dogs and cats?

A

Osteosarcoma, lymphoma, histiocytic sarcoma, myxoma, calcinosis circumscripta, infiltrative lipoma, osteochondromatosis

33
Q

What is the median survival time for histiocytic sarcoma of the CNS?

A

3-4 months

34
Q

What are the imaging features of infiltrative lipoma on CT and MRI?

A

Hypoattenuating on CT, hyperintense on T1W and T2W MRI

35
Q

What is the MRI appearance of a myxoma?

A

Hyperintense on T2W and hypointense on T1W, typically enhances on T1W images

36
Q

What is a myxoma?

A

A rarely encountered benign neoplasm arising from the synovium. In the CNS can involve the zygapophyseal joint.

37
Q

What is calcinosis circumscripta?

A

An uncommon disease where there is ectopic mineralization of soft tissues.

38
Q

What are the three classifications of calcinosis circumscripta?

A

Metastatic: secondary to abnormal calcium homeostasis.

Dystrophic: secondary to tissue damage.

Idiopathic.

Idiopathic and dystrophic are most common.

39
Q

What is the typical signalment for dogs with calcinosis circumscripta?

A

Young, large breed dogs. German shepherds appear overrepresented.

40
Q

What is osteochondromatosis?

A

Also known as osteochondroma or multiple cartilaginous exostoses this is a benign lesion involving bones that develop by endochondral ossification.

41
Q

What is the proposed pathogenesis of osteochondromatosis in dogs and cats?

A

Occurs secondary to migration of chondrocytes from the physeal region into the metaphyseal region of the bone.

42
Q

What are the differences between osteochondromatosis in dogs and cats?

A

In dogs typically ceases with skeletal maturity, in cats it continues to progress beyond skeletal maturity and is associated with FeLV.

43
Q

How do osteochondroma and osteochondromatosis lesions differ in cats?

A

Osteochondroma typically used to describe solitary lesions in adult cats. Polyostotic version (osteochondromatosis or multiple cartilaginous exostoses) typically occurs in young adult cats.

44
Q

What is the appearance of the cartilaginous cap in osteochondromatosis on MRI?

A

Hypointense on T1W and hyperintense on T2W

45
Q

What is the prognosis for osteochondroma/osteochondromatosis?

A

Favourable so long as the lesion is accessible for surgical excision.

46
Q

What are the some common intradural/extramedullary neoplasms?

A

Meningioma, nerve sheath neoplasms, extrarenal nephroblastoma

47
Q

What is the most common primary nervous system neoplasm of the spinal cord in dogs?

A

Meningioma

48
Q

Which part of the spinal cord do meningiomas most frequently affect?

A

The cervical spinal cord

49
Q

From where do meningiomas arise?

A

The meningothelial cells of the arachnoid or pia mater

50
Q

What are the reported grades of meningioma, and which is most common in dogs?

A

Grade 1 (benign), Grade 2 (atypical), Grade 3 (anaplastic). Grade 1 and 2 most common.

51
Q

What are the MRI characteristics of meningioma?

A

Iso to hypointense on T1W images, hyperintense on T2W images, strong and uniform contrast enhancement.

52
Q

What is the prognosis for dogs with spinal meningioma?

A

Typically good for dogs improving neurologically and surviving the post-operative period. Reported MST of 19 months.

53
Q

Are meningiomas most common extradural, intradural/extramedullary, or intramedullary?

A

Intradural/extramedullary

54
Q

What is the reported MST in cats with spinal cord meningioma?

A

426 days

55
Q

Do nerve sheath neoplasms frequently metastasize?

A

No, behave similar to soft tissue sarcomas (locally aggressive but low rate of metastatic disease)

56
Q

What is the typical signalment of patients with nerve sheath neoplasms?

A

Middle aged, large breed dogs

57
Q

Are the thoracic or pelvic limbs more commonly affected in patients with nerve sheath neoplasms?

A

Thoracic. Atrophy of the supraspinatous and infraspinatous muscles is common. May also observe Horner’s or absent cutaneous trunci muscle ipsilateral to lesion.

58
Q

What diagnostics can be considered for the work-up of nerve sheath neoplasms?

A

MRI (although can be difficult to differentiate from neuritis), can use fat suppression techniques to help delineate, myelography (may show an extradural, or intradural/extramedullary filling defect), ultrasound (can help to guide aspirates), electrophysiologic testing (can help to differentiate from orthopedic disease).

59
Q

What is the prognosis for nerve sheath neoplasms?

A

Long term survival may be possible following amputation if the neoplasm is located on the distal limb (MST 1416 days), in dogs with lesions involving the spinal nerve or nerve roots MST is 5 months.

60
Q

What has been shown to be prognostic for survival in dogs with nerve sheath neoplasms?

A

Histologic grade.

61
Q

What is the expected signalment in a patient with extrarenal nephroblastoma

A

Normally young (6-36 months) German Shepherds and retrievers.

62
Q

In what vertebral segments are extrarenal nephroblastoma almost exclusively found?

A

T10 - L2 (causing T3-L3 myelopathy). This repeatable location thought to be due to entrapmment of primitive nephrons at this location during embryogenesis.

63
Q

What are the reported survival times for extrarenal nephroblastoma?

A

4 months to > 3 years

64
Q

What are the most common intramedullary spinal cord neoplasms in dogs and cats?

A

Dogs: ependymoma, astrocytoma (other glial cells tumors also possible; oligodendroglioma, undifferentiated glial neoplasms. Primary sarcomas also reported).
Cats: glial.

65
Q

What is the prognosis for intramedullary spinal cord neoplasms?

A

Too few cases have been reported to accurately predict survival (surgical treatment involves laminectomy, durotomy/durectomy and myelotomy).

Neurosurgery (11 decks)

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