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Sem 6: SAM 2 > Tumors of Appendicular & Axial Skeleton > Flashcards

Tumors of Appendicular & Axial Skeleton Flashcards

1
Q

Small dog OSA has a predilection for ________

A

Axial skeleton (vs appendicular)

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2
Q

What age do dogs commonly get OSA?

A

Bimodal - 1-2 yrs (young) or 7-9 yrs

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3
Q

What dog breeds are more at risk for getting OSA?

A
  • Large/Giant breeds
  • Rotties
  • Great danes
  • Irish wolfhounds
  • Greyhounds
  • Males/Rotties neutered before 1 yr of age
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4
Q

Most common presenting complaint with OSA?

A
  • Lameness
  • Localized limb swelling
  • Occasionally pathological fracture
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5
Q

Ddx list for a neoplastic primary bone tumor?

A
  1. OSA OSA OSA
  2. Chondrosarcoma
  3. Fibrosarcoma
  4. Hemangiosarcoma
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6
Q

Most common locations for OSA of the appendicular skeleton?

A

1. Distal radius
2. Proximal humerus
3. Distal femur
4. Proximal tibia

Away from the elbow, towards the knee

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7
Q

Osteosarcoma in dogs favors development in the ________ of bone

A. Epiphysis
B. Diaphysis
C. Metaphysis
D. Intracapsular space

A

C. Metaphysis

(Usually diaphysis in cats although rare)

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8
Q

What presents similarly and must be ruled out when diagnosing osteosarcoma?

A

Fungal infection (Coccidio, Blasto)

Fungal dogs usually present systemically ill

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9
Q

True or False: LN aspirate is always indicated when working up and staging OSA in a dog

A

False - spreads hematogenously not through lymphatics, 5% incidence of mets to LNs

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10
Q

How to work up and stage for OSA of the appendicular and axial skeleton?

A
  1. CBC/Chem - if inc. ALP = BAD (but non specific to OSA)
  2. FNA cytology with ALP staining > biopsy
  3. Full body CT > Rads bc 90% micrometastasis that can’t be seen on rads
  4. Nuclear scintigraphy (bone scan) to look for bone to bone mets
  5. Limb rads
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11
Q

Radiographic appearance of OSA?

A
  • Mixed lytic to blastic appearance
  • Palisading sunburst effect
  • Codmans triangle
  • Does NOT cross joint space
  • Pathologic fracture
  • Can’t tell border between normal & abnormal
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12
Q

Why doesn’t OSA cross the joint space?

A
  • Cartilage provides barrier due to collagenase inhibitors which inhibits tumor invasion

(If crossing joint space, more likely a synovial cell sarcoma

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13
Q

List indications for limb salvage when treating OSA in dogs

A
  1. Severe osteoarthritis
  2. Neuro disease
  3. Morbid obesity

(when surgical amputation isn’t indicated)

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14
Q

Contraindications to limb salvage for treatment of OSA?

A
  • Inappropriate location of tumor
  • Large lesion > 50% of diaphysis
  • Pathologic fracture
  • Advanced disease
  • Poorly compliant owner
  • Extensive ST involvement
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15
Q

List the anatomic sites where Limb salvage surgery for OSA can be done

A
  1. Distal radius
  2. Distal ulna
  3. Digit or metacarpus/tarsus
  4. Scapula
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16
Q

Gold standard treatment option for OSA? What is the exception?

A

Limb amputation + chemo (Carboplatin)

EXCEPTION: Proximal femoral lesion - requires more aggressive sx - En block acetabulectomy or hemipelvectomy

17
Q

Palliative care with analgesics for treatment of OSA has what prognosis?

A

MST of 1-3 months

18
Q

What is the MST of OSA in dogs (dependent on tx)?

A
  • Palliative care: 1-3 months
  • SRS (Radiation): 4 months
  • Surgery alone: 6 months
  • Surgery + chemo (Carboplatin): 1 yr

KNOW ALL

19
Q

Although rare, Osteosarcoma in cats favors development in the ________ of bone

A. Epiphysis
B. Diaphysis
C. Metaphysis
D. Intracapsular space

A

B. Diaphysis

(metaphysis in dogs)

20
Q

Gold standard tx for OSA in cats?

A
  • Amputation alone can be curative w/o chemo (less aggressive unlike dogs)
  • Amputation + chemo if proximal humerus lesions
21
Q

Chemo of choice for OSA?

A

Carboplatin

22
Q

What palliative therapeutic options are available for treatment of OSA?

A
  • NSAIDs
  • Biphosphonates (Zoledronate + Pamidronate (osteoclast inhibitors)
  • Radiation therapy
23
Q

Osteolytic lesions in multiple areas surrounding the joint space is more likely a __________ than OSA

A

Synovial cell sarcoma

24
Q

What can be used for bone biopsy to work up and stage a bone tumor?

A
  • Jam shedi (preferred) inserted into medullary cavity
  • Michele Trephine (much higher risk of pathologic fracture)
25
Q

What procedure is performed for OSA of the distal radius?

A
  • Surgical excision of distal radius, replaced with implant and pancarpal arthrodesis (fusing radius and carpal bones
26
Q

What complications can arise from limb salvage surgery for removal of OSA?

A
  • Infection most commonly (50% of cases)
  • Implant failure
27
Q

When considering stereotactic radiosurgery for treatment of OSA, what is the best site for this use?

A

Proximal humerus best site for SRS (low fracture rate)

28
Q

What complications can arise from using stereotactic radiosurgery for treatment of OSA?

A
  • Radiation caused bone fractures in 1/3 of cases

best used for OSA of the Proximal humerus

29
Q

What tumor location typically indicates a worse prognosis for patients with OSA?

A

Proximal humerus lesion has a shorter MST

30
Q

A Rottie presenting with right forelimb lameness and swelling around the metacarpus. You suspect OSA. What can be seen on CBC/Chem to help lean towards OSA?

A
  • Elevated ALP (indicates poor prognosis)

Sem 6: SAM 2 (26 decks)

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