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Equine II > Sarcoids > Flashcards

Sarcoids Flashcards

1
Q

Incidence of equine neoplasia

A

Overall incidence unknown but far less common than other species

Most commonly affected body system in integument

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2
Q

Sarcoid incidence

A

Most commonly reported neoplasm (up to 67%)

Overall prevalence is up to 2%

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3
Q

Sarcoid behviour

A

Benign but locally aggressive

Can have significant impact on local structures

Attract flies

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4
Q

Aetiology of sarcoids

A

Neoplastic proliferation of fibroblasts in association with infection with bovine papillomavirus types 1 and/or type 2

Lie-kely that the BPV is spread by flies

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5
Q

What are the 6 ‘clinical forms’ of sarcoids

A

Occult lesions

Verrucose sarcoids

Nodular sarcoids

Fibroblastic lesions

Mixed lesions

‘Malignant’ or ‘malevolent’ lesions

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6
Q

Occult lesions (sarcoids)

A

A hairless area (or area with very little hair) which are usually, but not always circular

Can resemble ringworm

Easy to miss

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7
Q

Verrucose sarcoids

A

Characteristic ‘warty’ appearance

Crusty, grey, dry areas of skin, can appear heavily keratinised

Difficult to treat as topical doesnt penetrate them well and not enough bulk to inject accurately

Can become widespread

May be more likely to recur

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8
Q

Nodular sarcoids

A

Often present as relatively discrete nodule

Freely removable from underlying structures

Can become infiltrative and adhere to underlying structures, especially in periocular region

Discrete lesions usually simple to treat

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9
Q

Fibroblastic sarcoids

A

Ulcerative

Often quite discrete in early stages

Usually easy to treat in early stages but can become very difficult if allowed to grow uncontrollably

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10
Q

Mixed sarcoid lesions

A

Can be challenging because they represent a more mature lesion that has been in situ for a longer period of time

Often affect a wider area

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11
Q

Malignant/malevolent sarcoids

A

Incredibly rare

Spread and invade more widely

Generally have an extremely poor prognosis

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12
Q

Predilection sites for sarcoids

A

Periocular region
Axilla
Inguinum
Sheath

Areas where the hair is thinner or absent

Complications associated with wounds - any non-healing wound should be biopsied to rule out neoplastic involvement

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13
Q

Diagnosis of sarcoids

A

Usually presumptive, visual diagnosis

Rarely achieve a definitive diagnosis as it is unlikely to affect treatment options

Does affect prognosis so biopsy is still recommended

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14
Q

Treatment options for sarcoids

A

In order of effectiveness:

Radiotherapy
Laser surgical resection
Electrochemotherapy
Intralesional treatments
Topical treatments
Other (variable)

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15
Q

Radiotherapy - plesiotherapy for sarcoids

A

A radioactive source is held directly to the lesion

Strontium-90 plesiotherapy reported for sarcoid treatment
- beta source with limited penetration
- only suitable for small, superficial lesions

Reported success rate is excellent

Limited availability (only in cam)

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16
Q

Radiotherapy - brachytherapy for sarcoids

A

Traditional treatment for periocular sarcoids

New system of high dose rate brachytherapy with iridium

Primarily gamma radiation for good penetration

Success rates >90% for periocular lesions

Performed under sedation

Gold standard for periocular sarcoids

17
Q

Radiotherapy - teletherapy for sarcoid teatment

A

Delivered by linear accelerator

Beams of high energy electrons (beta) or gamma rays

Can select the penetrative ability

Requires GA

Rarely indicated for use

Excellent success rates

Limited availability (only in cam)

18
Q

Possible complications of radiotherapy

A

White hair formation anf alopecia

Maybe some scar tissue

Transient self-limiting uveitis

19
Q

Laser surgical excision for sarcoids

A

Most commonly achieved with a diode laser

Practical, effective, readily accessible

Success rates about 80%, less with verrucose lesions

Warn owners that it leaves an open wound left to granulate and heal by second intention

Effectively forms a burn

May take weeks to months to heal

20
Q

Possible complications of laser resection for sarcoids

A

Development of a non-healing wound and recurrence of the sarcoid

Occasionally aggressive transformation os the lesion has been noted

21
Q

Electrochemotherapy for sarcoid treatment

A

Used in conjuction with intralesional cisplatin, and often also with aser resection

Requires GA

ECT enhances the penetration of cisplatin to improve success rates

May lead to necrosis of the treated area and a wide slough, severe oedema and pain

22
Q

Intralesional therapy for sarcoids

A

Need enough lesion (bulk) to go into

Not suitable for lesions without reasonable bulk, verrucose or occult lesions, or those with indistinct margins

Can use:
- Cisplatin
- Carboplatin
- Mitomycin C
- Tigilanol tiglate
- Immunocidin Equine

23
Q

Cisplatin/carboplatin for intralesional sarcoid therapy

A

Reported success rate in literature >90%, in reality <70%

Significant health and safety concerns - platinum based chemotherapy. Serious risk of human exposure

24
Q

Mitomycin C for intralesional sarcoid therapy

A

Very limited literature

Nodular and fibroblastic lesions

Leads to skin necrosis and sloughing

Success rates?

25
Q

Tigilanol tiglate for intralesional sarcoid therapy

A

Stelfonta - licened for MCT in dogs

Very limited literature

Tumour ‘agnostic’

Causes haemorrhagic lesions and immune stimulation

Leads to necrosis and sloughing which can be extensive

26
Q

Immunocidin Equine for intralesional sarcoid therapy

A

Mycobacterium cell wall product

Causes immunostimulation

Abscessation, swelling, and pain are common

Use with adjunctive NSAIDs

Simple to perform - standing sedation with LA

Success rates around 50-60%

27
Q

Topical treatments for sarcoids

A

5-fluorocil

AW5

Imiquimod

Bleomycin

Tazarotene

Blood root ointment

Acyclovir

28
Q

5-fluorocil as a topical treatment for sarcoids

A

DNA damaging chemotherapy cream

Apply 2x day for 5-10 days

Success rates between 27-60%

Lesion will get sore and crusty, skin scalding common

Useful and simple treatment for certain lesions

29
Q

AW5 cream as a topical treatment for sarcoids

A

AKA Liverpool cream, LUDES

Top secret formula

Success rates 60-70%

Absolutely contraindicated around the eye or over the facial nerve

Expected complications include:
- wide local slough
- pain
- oedema

Other complications include:
- joint sepsis
- evisceration (eroded through abdominal wall)

Less popular now

Occasional indications but needs consult with its producers

Proceed with caution!

30
Q

Imiquiqod as a topical treatment for sarcoids

A

An immune modifier

Good for very superficial lesions

Should be applied 3x a week

Area must be cleaned before each teatment - very painful

Makes horse sore and resentful

Reported success 60-84%

Extensive scalding is expected

Owner can apply it themselves

31
Q

Bleomycin as a topical treatment for sarcoids

A

Only useful for occult lesions

DNA damaging chemotherapy cream

Extremely limited evidence

Penetration is poor

Success rate is around 44%

Get irritated skin and become sore

32
Q

Tazarotene as a topical treatment for sarcoids

A

Retinoid cream

Limited evidence

Reported success rate about 20%

Mainly used for verrucose lesions prior to other agents to remove some of the crust and improve penetration

33
Q

Blood root ointment as a topical treatment for sarcoids

A

Sanguinaria candensis extract with zinc extract

Owner applied

Limited evidence

Success ratse may be as high as 50% for small superficial lesions

34
Q

Acyclovir as a topical treatment for sarcoids

A

Antiviral that inhibits viral DNA polymerase

Not effective against papillomavirus

Illogical to use in sarcoid treatment

Not generally recommended

35
Q

When are topical sarcoid treatments suitable?

A

For superficial lesions

36
Q

When are intralesional sarcoid treatments useful?

A

When there is tumour bulk to inject into

37
Q

Which location of sarcoids are often the most invasive and extensive?

A

Periocular lesions

Must preserve eyelid margin and avoid damage to the eye

38
Q

Which is a good cost effective first line treatment for many sarcoids?

A

Laser resection

Equine II (28 decks)

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