Splenic Masses

Question 1

Lynch, JAVMA, 2017:
What % of the malignant tumors were HSA?
What % of dogs received transfusions?
Which dogs were more likely to receive transfusions?
Overall mortality rate and mortality rates for dogs that received transfusions vs dogs that did not receive transfusions?
The odds of spontaneous death and euthanasia during hospitalization were higher for dogs that underwent transfusion - true or false?

Answer 1

Lynch, JAVMA, 2017:
76% of the malignant tumors were HSA
44% received transfusions
Dogs with malignant disease, especially dogs with HSA, were more likely to receive transfusions
Overall mortality rate: 8%
Mortality rate for dogs that received transfusions: 14%
Mortality rate for dogs that did not receive transfusions: 3%
True

Question 2

Moore, JAVMA, 2017:
Stage II splenic HSA
What % of dogs were anemic before splenectomy?
What was associated with survival time?

Answer 2

Moore, JAVMA, 2017:
85% were anemic before splenectomy
Mitotic score was associated with survival time

Question 3

Ciepluch, Vet Surg, 2018: HSA
What % had gross metastatic lesions?
What factors were associated with a shorter DFI?
What was associated with a longer DFI?
Effect of chemotherapy on DFI?

Answer 3

Ciepluch, Vet Surg, 2018:
45% had gross metastatic lesions

Presence of gross metastatic lesions at the time of surgery and administration of allogeneic blood products were associated with a shorter DFI

Administration of Yunnan Baiyao was associated with a longer DFI

Chemo was not associated with a shorter DFI

Question 4

Fleming
Small vs. Large dogs with hemoperitoneum
VetSurg 2018

Answer 4

Splenic hemorrhage
43% small
61% large

Small dogs Hemorrhage

spleen: Small < Large
liver: Small > Large
another: Small > Large

HSA associated with splenic hemorrhage
Large > Small

cut off 20 kg

Question 5

Story
Small breed dogs splenic HSA
VetSurg 2020

MST?

Answer 5

MST
~small 116d
~large 97d
*metastatic disease decreased survival time

Survival time of surgery and chemo
~small 207d
~large 139d
*administration of chem increased survival time in small breed

DFI
~small 446d
~large 80d
*dog size significant

Question 6

Sirochman
Bipolar sealing device in splenectomy
VetSurg 2020

Short term mortality rate?

Death prior to dc assoc with?

Death prior to suture removal assoc with?

Answer 6

Short term mortality 11%
7% died prior to discharge
3% died prior to suture removal

Prior to discharge associated with
~administartion of blood
~increased duration of anesthesia
~intra-op V-tach

Prior to suture removal associated with
~administration of blood

Question 7

Schick
HSA prediction model
JVECC 2019

Answer 7

Bodyweight
Total Solids
Plt Count
Thoracic Radiographs

Question 8

Clarke
Utility of liver biopsy in splenectomy
JSAP 2020

Answer 8

Abnormalities noted in
normal-appearing liver 3%
abnormal appearing liver 29%

Haemoabdomen associated with an increased likelihood of liver neoplasia on biopsy at the time of splenectomy.

Question 9

Corbin
Splenomegaly in small breed
JAVMA 2017

Answer 9

less than 16 kg
~50/50 malignant

HSA 67% of malignancies

WHWT more likely to have neoplasia

Malignancy & Hemoabdomen
= decreased survival time

Malignancy is not associated with hemoperitoneum

Question 10

Phipps
TEG and splenectomy
JAVMA 2020

Answer 10

Thrombocytosis and TEG suggestive of hypercoagulopathy increased from day 2 after surgery until at least 2 weeks PO

Question 11

Masyr
Prognosis HSA
JAVMA 2021

Answer 11

Thrombocytopenia negative associated with
~Progression Free Interval
~Overall ST

Stage 3 HSA negative associated with
~Progression Free Interval
~Overall ST

Question 12

Burgess
Calculator for splenic mass malignancy
JAVMA 2021

Answer 12

~Serum TP
~Presence of > 2 nRBC/100 WBC
~AUS splenic mass diameter
~# liver nodules 0, 1, >2
~Presence of multiple splenic masses
~splenic mass inhomogeneity
~abdoimnal effusion
~mesenteric, omental, peritoneal nodules

Question 13

Mayhew et al VetSurg 2018

For which cases may single-port laparoscopic splenectomy be appropirate?

Answer 13

smaller dogs

Small to modest (<2cm) splenic masses

Diffuse splenic disese

Not obese patients

Question 14

Del Busto et al JVIM 2020 What factors were associated with increased risk of postoperative death following surgical treatment of insulinoma?

Answer 14

1. Development of post operative pancreatitis
2. Postoperative hypoglycemia
3. Postoperative hyperglycemia

Question 15

Ciepluch et al VetSurg 2018 What factors were associated with decreased survival for HSA? What factors were associated with prolonged survival?

Answer 15

Decreased survival
- presence of metastasis
- administration of blood products

Prolonged survival
- Yunnan Baiyao

Question 16

Sirochman et al VetSurg 2020 What factors were associated with death prior to discharge for splenectomies?

Answer 16

1. Administration of blood products
2. Increasing duration of anesthesia
3. Intraoperative ventricular arrhythmias

Question 17

Fleming et al VetSurg 2018

Describe the differences in sources of hemoperitoneum in small vs large dogs.

Answer 17

Large dogs - more likely to be spleen 61%

Small dogs - more likely to be liver vs spleen

Other sources - retroperitoneal, etc more likely in smaller dogs

Question 18

Story et al VetSurg 2020

How is the survival time for spelnic HSA different for small dogs vs large dogs

Answer 18

Dog size associated
with DFI
Not with ST

Metastasis associated
with decreased ST
all sizes

Chemotherapy associated
with increased ST
in small breed dogs

Question 19

Story et al VetSurg 2020

What is the difference in disease free interval for small vs large dogs with splenic HSA?

Answer 19

DFI 446 days for small dogs, 80 days for large dogs

Chemotherapy improved survival time for small dogs but not larger dogs

Dog size associated with DFI but not surivival time

Question 20

Moore et al JAVMA 2017

What factor was associated wtih prolonged survival for stage II HSA?

Answer 20

Lower mitotic score