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Soft Tissue Sarcoma Flashcards

1
Q

What infectious organism can cause sarcoma in dogs?

A

Spirocerca lupi

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2
Q

What’s the % of dogs and cats that have mesenchymal tumours?

A

Dogs = 15%
cats = 7%

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3
Q

How is canine soft tissue sarcoma graded?

A

grade I, II, III

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4
Q

How does fibrosarcoma behave compare to other canine STS?

A
  • fibrosarcoma is more likely to recur after incomplete excision
  • and have higher mitotic rates than other STS
  • BUT, they are more likely to be low grade
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5
Q

Which breeds are predisposed pleomorphic sarcoma?

A

Flat-coated retriever, Rottweilers, Goldens

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6
Q

Where are the common anatomical locations for pleomorphic sarcoma in the dog?

A

SQ of the trunk and pelvic limbs, spleen

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7
Q

Which IHC can be used for pleomorphic sarcoma?

A

vimentin + CD18 - (former name = malignant fibrous histiocytoma)

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8
Q

How does canine pleomorphic sarcoma behave compare to the rest of the STS?

A
  • significantly more likely to be high grade and have metastases at the time of diagnosis compared to the rest of the STS
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9
Q

What’s the typical growth pattern of myxosarcoma?

A

tend to be infiltratie with ill-defined margins

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10
Q

What’s the ICH stain pattern for perivascular wall tumours?

A
  • vimentin +, pan and alpha-smooth muscle actin +
  • smooth muslce cells – smoothelin, heavy caldesmon
  • myopericytes - desmin, calponin
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11
Q

How does perivascular wall tumour behave compare to the rest of the canine STS?

A

they tend to be less aggressive, with significantly lower rates of local recurrence than other histologica subtypes

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12
Q

What are the most common benign canine peripheral nerve sheath tumour?

A

Schwannoma and neurofibroma

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13
Q

What’s the typical growth pattern and behaviour of malignant peripheral nerve sheath tumour?

A

SQ, poorly cirucumscribed, invasive
- associated with high local recurrence, and relatively poor survival times
- modest metastatic potential

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14
Q

What’s the IHC stain pattern for peripheral nerve sheath tumours?

A

positive for: S-100, vimentin, glial fibrillary acidic protein (GFAP), nerve growth factor receptor, neuron-specific enolase
- significantly higher ki-67 index then perivascular wall tumour

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15
Q

What’s the outcome for canine brachial plexus PNSTs treated with limb-sparing compartmental resection?

A

MST = 1303 days
sig better if completely removed = 2227d vs 487 d if not

Van Stee L, Boston S, Teske E, et al.: Compartmental resection of
peripheral nerve tumors with limb preservation in 16 dogs (1995-
2011), Vet Surg 26:40–45, 2017.

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16
Q

What’s the outcome for canine brachial plexus PNSTs treated with SRT?

A

in 10 dogs, all had either partial or complete resolution of neurological signs
- PFS = 240d, OST = 371d
progression reported in 90% of dogs
Local disease = limiting factor

Dolera M, Malfassi L, Bianch C, et al.: Frameless stereotactic volumetric
modulated arc radiotherapy of brachial

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17
Q

Where is the most common place of intermuscular lipoma?

A

between the semitendinosus and semimenbranosus muscles
- can also be in the axilla

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18
Q

What’s the treatment and prognosis of intermuscular lipoma?

A

Tx = surgical resection, use a negative suction drain to minimize seroma formation
- prognosis = excellent, no recurrence in published studies (n = 27)

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19
Q

Can infiltrative lipomas be distinguished from regular lipoma on FNA?

A

No
- will need CT – differentiation based on shape, margins, and type of attenuation

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20
Q

What’s the biological behaviour of infiltrative lipoma?

A

They are considered “benign”, but are locally aggressive/ infiltrative
- can infiltrate adjacent muscle, fascia, nerve, myocardium, joint capsule, and even bone

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21
Q

What’s the treatment of choice for infiltrative lipoma?

A

Amputation (if possible)
RT

Bergman PJ, Withrow SJ, Straw RC, et al.: Infiltrative lipoma in
dogs: 16 cases (1981-1992), J Am Vet Med Assoc 205:322–324,
1994

McEntee MC, Page RL, Mauldin GN, et al.: Results of irradiation
of infiltrative lipoma in 13 dogs, Vet Radiol Ultrasound 41:554–
556, 2000

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22
Q

T or F. Liposarcoma arise from malignant transformation of lipoma?

A

False, etiology unknown
one case of foreign-body induced liposarcoma in the dog

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23
Q

What’s the typical physical characteristic of liposarcoma?

A

firm, locally invasive`

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24
Q

What’s the metastatic potential of liposarcoma?

A

low, likes to go to lungs, liver, spleen, and bone

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25
Q

Where are liposarcomas commonly located?

A

along the ventrum, and extremitis

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26
Q

How do you differentiate between liposarcoma and lipoma?

A
  • morphological appearance
  • cytological characteristics (Oil Red O)
  • CT findings (mixed attenuating, heterogneous, multinodular, contrast enhancing)
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27
Q

What’s the prognosis for liposarcoma?

A

Good with appropriate treatment
- wide surgical excision, MST = 1188days (~3y)
marginal = 649 days, vs biopsy = 183 days

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28
Q

What’s the cell origin of rhabdomyosarcoma?

A

myblasts or primitive mesenchymal cells capable of differentiating into striated muscles

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29
Q

What are the most common anatomical location of canine rhabdomyosarcoma?

A

skeletal muscle of the urinary bladder, retrobulbar musculature, larynx, tongue, and mocyardium

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30
Q

What’s the natural behaviour of rhabdomysarcoma?

A

locally invasive with low to moderate metastatic potential

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31
Q

Which IHC stains can be used for rhabdomyosarcoma?

A

vimentin, skeletal muscle actin, myoglobin, myogenin, and myogenic differentiation (MyoD)

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32
Q

What are the 4 histological subtypes of rhabdoymosarcoma?

A

embryogenic, botryoid, alveolar, and pleomorphic

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33
Q

What are the sites of predilection for embryogenic rhabdomyosarcoma?

A

head & neck - tongue, oral cacvity, laryng, and retrobulbar musculature

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34
Q

What are the sites of predilection for botryoid rhabdomyosarcoma?

A

urinary bladder
typically in young, large breeds - St Bernard possibly over-represented

35
Q

What’s the metastatic rate of botryoid rhabdomyosarcoma?

A

27%

36
Q

What’s the metastatic rate for embryonic and alveolar rhabdomyosarcoma?

A

50%

37
Q

Which age group is more likely to have metastatic rhabdomyosarcoma?

A

young
in one report only those <2y had metastasis, and another one found all dogs <4y died of metastatic disease or local tumour recurrence (MST 2.5m)

38
Q

What’s lymphangiosarcoma?

A

rare tumour from lymphatic endothelial cells

39
Q

What are some clinical signs of lymphangiosarcoma?

A
  • extensive edema
  • drainage of lymph through the skin
  • cystic mass
  • non-healing, discharging wound
40
Q

How do you distinguish between lymphangiosarcoma vs HSA?

A

use IHC such as factor VIII and CD 31
- lymphatic vessel endothelial receptor-1 (LYVE-1), propsero-related homeobox gene-1 (PROX-1)

41
Q

What’s the prognosis for dogs with lymphangiosarcoma?

A

MST = 168 days with no treatment
surgery alone = 487 days
Surgery, RT, Chemo = 574 days
all dogs with incompletely removed tumours were euthanized due to recurrent or progressive local disease

Curran KM, Halsey CH, Worley DR: Lymphangiosarcoma in 12
dogs: a case series (1998-2013), Vet Comp Oncol 14:181–190, 2016.

42
Q

What’s a malignant mesenchymoma?

A

rare STS having 2 or more different varieties of other types of sarcoma

43
Q

What’s the prognosis of splenic mesenchymoma?

A

MST 12m

44
Q

What’s the cytological accuracy for correctly diagnosing a STS?

A

63-97%

45
Q

What’s the rate of discrepancy of the histological grade of STS based on biopsy vs definitive surgical removal in dogs?

A

incorrect in 41% of cases
underestimated in 29%, overestimated in 12%

46
Q

What’s the recurrence rate for incompletely removed SQ STS based on grades in a study with 236 dogs?

A

Grade 1 = 7%
Grade 2 = 34%

McSporran KD: Histologic grade predicts recurrence for marginally
excised canine subcutaneous soft tissue sarcomas, Vet Pathol
46:928–933, 2009.

47
Q

What’s the recurrence rate of marginally resected low-grade STS in a study with 35 dogs?

A

11%

Stefanello D, Morello E, Roccabianca P, et al.: Marginal excision
of low-grade spindle cell sarcoma of canine extremities: 35 dogs
(1996-2006), Vet Surg 37:461–465, 2008

48
Q

In a study of 104 STS removed in non-referral practices, what’s the recurrence rate?

A

28%, despite <10% were excised with >3cm lateral margin

Chase D, Bray J, Ide A, et al.: Outcome following removal of
canine spindle cell tumours in first opinion practice: 104 cases, J
Small Anim Pract 50:568–574, 2009.

49
Q

What was the recurrence rate for dogs with perivascular wall tumours?

A

18-20%, despite 60-63% were incompletely removed
only prognostic factor was tumour >5cm

50
Q

What’s the recurrence rate in the study of 350 dogs with STS removed in non-referral practices?

A

21%, only 5% had complete margins

51
Q

Describe staging surgery.

A

for incompletely removed tumour, re-excise <1cm margin around the scar and assess for disease. If there is, then go for wide surgical resection or RT

52
Q

What’s the local tumour recurrence rate for incomplete removed canine STS treated with CFRT?

A

16.7-36.8%
4-year local control rate up to 80%
median time to recurrence = 412 to 798+ days

53
Q

What’s the meidan time to recurrence for grade III incompletely removed canine STS treated with CFRT?

A

78 days

54
Q

Which of the following groups have been shown to be a prognostic factor for survival times?​
1) AgNOR score 2) Ki067 index 3) Mitotic rate 4) Subtype 5) Grade 6) Location 7) Size​

​

A) 1,2,3,5​

B) 1,2,5,6​

C) 2,3,6,7​

D) 1,2,3,4​

A

A).
Listed in withrow: tumor necrosis, mitotic rate, grade, Ki-67, AgNOR. Others are prognostic factor for local control/mets, not necessary survival

55
Q

Survival has been significantly associated with mitotic rate in one study (Porcellato et al. 2017) of 24 cats with a 994-day MST for cats with mitotic count greater than __ mitoses per 10 HPFs compared with an MST that was not reached in cats with a mitotic rate less than that number of mitoses.​

A

20

56
Q

In a neoadjuvant setting, which of the following drug showed an improvement in survival time for FISS?​
a. carboplatin​

b. doxorubicin​

c. gentamicin​

d. epirubicin

A

d

57
Q

What are some prognostic factors associated with FISS?

A

b. PCV – >25% had a MST of 760d compared to 308 days ​

c. Size - <2cm MST = 643d vs > 5cm MST = 394d​

d. Histo-subtype – FSA MST = 640d vs MFH MST = 290d

58
Q

What’s the 3-2-1 rule recommended by VAFSTF?

A

present for >3m post injection, >2cm in diameter, increasing in size >1m post injection

59
Q

What’s the control rate for RT alone (cumulative dose of 50Gy) for macroscopic canine STS?

A

50% @ 1y, 33% @ 2y

60
Q

What’s the response rate for RT in macroscopic canine STS?

A

one reported 30% CR

61
Q

What’s the response rate for hypofractionated RT for macroscopic canine STS?

A

46-50%

62
Q

What’s the MST for hypofractionated RT for macroscopic canine STS?

A

206-513 days

63
Q

What’s the PFI for hypofractionated RT for macroscopic canine STS?

A

155-419 days

64
Q

What are some prognostic factors associated with hypofractionated RT for macroscopic canine STS?

A
  • location, better for limb ( 466d PFI) vs head or trunk (110d); MST = 579d vs 195d
  • 1 or no Sx (420d) vs 1+ (105 days)
65
Q

In the Cancedda 2016 et al on hypofractionated RT for macroscopic canine STS, what was the result with metronomic chemotherapy?

A

PFI did not improve but MST did - 757d vs 518d

66
Q

What’s the outcome with doxorubicin for canine STS?

A

no different in survival outcomes

67
Q

How effective is metronomic chemotherapy?

A

effective in decreasing the rate of local tumour recurrence and improving DFI

68
Q

What’s the relationship between local recurrence and death for canine STS?

A

5x more likely to die from STS, more difficult to manage a recurred STS
MST 256d

69
Q

What’s the risk of metastasis for canine STS?

A

5x more likely if MC >20

70
Q

With complete resection, what’s the local recurrence rate for FISS?

A

14% @ 3y

71
Q

Can doxorubicin improve ST in cats with FISS as an neoadjuvant therapy to surgery?

A

No

72
Q

What’s the outcome for macroscopic FISS with RT?

A

4x8Gy, PFI = 4m, MST = 7m

73
Q

What’s the outcome of SRT for FISS?

A

3/11 CR, 5/11 PR. PFI = 242d, MST = 301d

74
Q

Does local recurrence of FISS influence ST?

A

No, regardless of timing of RT relative the Sx, MST with 600-1307d still reported

75
Q

How does post-op chemo influence survival for FISS?

A

minimal effect in cats treated with curative intent surgery and RT

76
Q

How dose chemo effect FISS with gross residual disease post-op?

A

MST 29m if treated with RT and chemo vs 5m with post-op RT alone

77
Q

Does Palladia work for unresectable FISS?

A

no

78
Q

What’s the rate of complete histo resection with 5cm lateral margin?

A

95-97%

79
Q

What’s the local recurrence rate for FISS when combined with pre- or post-op RT?

A

28-45%, median DFI 13-37m

80
Q

What are some prognostic factors for local recurrence for FISS?

A
  • tumour size
  • surgical dose
  • histo margin
  • histo grade
81
Q

How common is metastasis for FISS?

A

uncommon, 0-24%
more likely with grade III ISS
0-17%, 15-19%, 22-100% for grade, I, II, and III, respectively

82
Q

What’s the overall MST for FISS treated with wide surgical margin?

A

804-901 days to not reacehd

83
Q

What’s the overall MST for FISS treated with less aggressive surgery?

A

MST > 395d to 608 days

84
Q

What’s the overall MST for FISS treated with surgery and RT?

A

MST 520-1307d

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