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Flashcards in 82.Skin dz Deck (81):
1

% of histologically malignant skin tumors in dogs vs cats

20-40% M in dogs50-60% M in cats

2

what is the most important factor in local tumor control

surgical wound margin!1. intracapsular/intralesional (debulking or cytoreductive; leave macroscopic disease)2. marginal (often within pseudo capsule leaving microscopic disease behind)3. wide (removing some normal tissue)4. radical (an entire compartment is removed

3

4 surgical principles for tumor resection

1. early ligation of large tumor vessels to minimize tumor cells entering circulation2. stay sutures, allis tissue forceps to avoid touching tumor3. change instruments/gloves if manipulating tumor4. copious lavage5. remove benign tumors first!

4

tissues most sensitive to chemotherapy and wound healing

intestinal tissues are most sensitivein general start chemo 7-10 days post surgeryneed more research

5

effects of radiation therapy on wound healing

dose-dependent injury to tissuestissue damage is more permanent than that of chemousually advised to start radiation therapy 1-3 weeks post op

6

4 types of radiation therapy injury to local tissues

1. local erythema2. dry desquamation (superficial)3. moist desquamation (loss of basal layer of epidermis) 4. necrosis (dermal destruction/irreversible ulcer)

7

TNM staging system

T tumor size and invasiveness 0, 5 cm, invasionN node involvement 0, 1--ipsi, 2--contra or bilateral, 3--fixedM presence of distant mets 0--no, 1--yes

8

accuracy of FNA for diagnosing neoplasia

90%can be diagnosed cytologically but still need bx for tumor grade and confirmation of tumor origin

9

difference in spread of epithelial vs mesenchymal tumors

epithelial--lymphaticsmesenchymal--hematogenous

10

CT vs radiographs for detection of pulmonary nodules or mets

CT 1 mmradiographs 7-9 mm

11

2 main functions of the lymphatic system

1. transport (lymph,lipids, fluid excess, cell debris/nutrients)2. immune response

12

eventually lymph enters systemic circulation via

thoracic duct

13

cortex and medulla of a lymph node

cortex: contains B cells arranged in follicles with germinal centers (Bcells and plasma cells) that is surrounded by rim of T cellsparacortex: t cells and APC (macros)medulla: cords of lymphocytes, macros, plasma cells; btwn cords are sinuses with discontinuous endothelium

14

how to determine a sentinel LN

blue dye or low dose radio nucleotide and gamma cameramany nodes may be draining tumor area so hard to know which to remove for staging purposes which may or may not be prognostic for the type of tumor in question (controversial)

15

potential benefits of lymphadenectomy

1. possibly slow the rate of mets2. may reduce clinical signs of paraneoplastic syndrome or palliate symptoms3. tumor debulking to increase local control 4. staging of diseaseonly helpful if removing the lymph node draining tumor and multiple LN may be involved

16

causes of lymphadenitis

mycobacteriumbacteriafungiparasites--Brugia (filariasis)cytology, biopsy, culture

17

persistent inflammatory edema from poor lymph drainage can lead to what....

mesenchymal cell proliferation which may cause irreversible thickening of skin and subcutis

18

lymph edema physiology

occurs when interstitial P increases as a result of a fluid imbalance btwn capillary filtration and lymphatic return1. high lymphatic load2. decreased plasma oncotic P3. increased vascular permeability4. obstruction of lymph system

19

histologic findings in chronic lymphedema

1. thicken BM of lymph vessels2. increase macros, fibroblasts3. increase amounts of collagenall of which may lead to fibrosis of SQ with chronic lymph edema

20

4 most common skin tumors in cats vs dogs

DOGSMCT, ST sarcoma, perianal adenoma, SCCCATSSCC, basal cell tumors, MCT, ST sarcoma

21

types of round cell tumors (6)

1. lymphoma2. malignant histocytosis3. TVT4. MCT5. plasma cell tumors6. histocytomas

22

papilloma

BENIGNcauliflower likeassociated with DNA viral causetransmission can occur directly and indirectlymay resolve within 3 months excision or cryotherapy is size or location is causing a problem

23

SCC

most common skin neoplasm in catsmalignantsolar exposure-- non pigmented skin is most commonly affected precursor --actinic keratosispapilloma virus relationship potential can be proliferative or erosiveassociated with mutation in p53 tumor suppressor gene

24

name of multi centric SCC in situ in cats

Bowenoid in situ carcinoma in cats (RARE)multifocal crusted plaques anywhere on body

25

most common location of SCC in dogs vs cats

dogs: subungual, digital, scrotum, legs, anuscats: pinnae, eyes, nose,

26

risk of white cats and SCC

white cats have a 13x higher risk compared to cats with other coat colors

27

MST of SCC following pinnectomy or nosectomy in cats

673 days

28

therapeutic options for SCC

1. cryotherapy (small early lesions, multiple tx, no histo dx)2. plesiotherapy3. radiation therapy (not evaluated in conjunction w sx)4. photodynamic therapy5. chemotherapy (NOT as sole tx, intralesional possible6. immunomodulatory therapy (Imiquimod cream--75% develop new lesions)7. SURGERY (aggressive)

29

redefine basal cell tumors

second most common skin tumor in catsredefined as trichoblastomagenerally benign

30

perianal gland adenoma

3rd most common cutaneous tumor in DOGSperianal hepatoid gland tumorsarise from modified sebaceous glands in dermis surrounding anuspredominately SEX HORMONE DEPENDENT (stimulated by androgens, suppressed by estrogens)INTACT MALES presdisposed90% cured with castration

31

perianal gland adenocarcinoma

NOT hormone dependentrarefaster growth rate, mets occur, more invasive

32

canine anal sac adenocarcinoma (apocrine gland adenocarcinoma of the anal sac)

older female dogs, no hormone dependencemetastatic rate 36-96% (regional sublumbar nodes)paraneoplastic hyperCa 27%complete excision difficult---follow up with chemo (mitoxantrone) and/or radiation therapy

33

percentage of incidental diagnosis of anal sac adenocarcinoma in dogs

up to 39% found as incidentalRECTAL!

34

MST with surgery alone (with or without lymphadenecomy)

8-16 monthsvs 32 months with surgery, mitoxantrone chemotherapy and radiation therapy!dogs with large tumor >10cm2 had shorter survival (292d) than dogs with smaller tumors (584d) in one study

35

how does feline anal sac adenocarcinoma differ from dogs

POOR PROGNOSISeven with surgery only 3 months (surgery not recommended)hyperCa is NOT a general feature

36

ST Sarcoma

2nd most common cutaneous tumor in dogsmesenchymal, slow growing, locally invasive, met slowlydo not exfoliate well (only correct on cytology 70%)

37

rate of mets for ST sarcoma in dogs

depends on gradegrade 1,2 < 13%grade 3 > 40%

38

most important prognostic factor of local recurrence for ST sarcoma

CLEAN SURGICAL MARGINS (and size in cats)recommend 2-3 cm and one fascial plane deep

39

recurrence of ST sarcoma after RE-excision and after radiation therapy

15-17%

40

MST ST sarcoma with surgery (incomplete) and radiation therapy

incomplete sx + radiation 2270dradiation after marginal or debunking results in good clinical outcome

41

in cats with ST sarcoma MST

12-20 monthsSIGNIFICANTLY LONGER IF COMPLETE (>16 months) vs incomplete (9 months)

42

ST sarcoma grade dependent recurrence after marginal excision

grade 1 7%grade 2, 3 34%median time to recurrence 12 monthsrecommend eval q 3 months for the first year and every 6 months after that

43

histologically LOW grade but biologically HIGH grade fibrosarcomas

oral tumor of dogsgaurded prognosiscan affect young dogslocally very invasive

44

hemangiopericytomas act like PNST (all ST sarcomas) but what staining differentiates the two

hemangiopericytoma---NEGATIVE vimentinPNST---POSITIVE vimentin

45

feline injection site associated sarcoma

associated with administration of INACTIVATED vaccines with an increased risk 2-5x for rabies and FeLV vaccines also linked to multivalent vx, long term penicillin injxn, methylpred injxn, and non absorbable suture

46

distinct differences btwn injection site sarcomas in cats versus other ST sarcomas

1. more malignant biological and histological features2. inflammatory component present

47

recommendations for vaccination sites in cats

DISTALrabies--right hindFeLV--left hindother multivalent--right front

48

recurrence of injection site associated sarcoma with marginal excision

70%MUCH HIGHER than ST sarcoma (7-34% depending on grade)median time til recur sign longer is specialist (274 d) vs rDVM (66d)

49

Phelps et al JAVMA 2011 conclusions on recurrence and metastatic rate of injection site sarcomas treated with 5 cm and 2 fascial planes deep exicison

14% recurr20% metastatic ratecats without recurrence and without mets survived longerrecur and mets were significantly associated with less survival

50

types of lipomas

benign lipoma (may or may not be inter muscular)liposarcoma (can met, locally invasive)infiltrative lipoma ( invasive--no capsule; but do not generally met)

51

reported local recurrence rate following surgery for infiltrative lipomas

36-50%in average time of 239 daystherefor slow growth combined with old patient = favorable prognosis

52

stain to ddx liposarcoma from other ST sarcomas

oil red O stain

53

cutaneous HSA in dogs

high metastatic ratecutaneous is better than SUBcutaneous which is better than IM hemangiosarcomacomplete excision followed by adjuvant chemotherapy

54

feline fibropapilloma

feline sarcoidvirus associatedyoungrural or barn catscontact with cattleinfiltrative but not metastatic

55

anatomy of dog vs cat mammary chain

DOG---5 pairs (cr and cd thoracic, cr and cd ab, inguinal)CAT--4 pairs (cr and cd thoracic, cr and cd ab)--lack inguinal

56

blood supply of mammary glands

mainly originates from lateral and internal thoracic arteries AND external pudendal artery1. 3 cranial glands:cr superficial epigastric, lateral internal thoracic, branches of intercostal arteries from internal thoracic artery2. 2 caudal glands: cd superficial epigastric (originates from ext pudendal artery) and deep branches of cranial abdominal and deep circumflex iliac arteries

57

lymph nodes of the mammary chain in dogs

DOGS: cr and cd thoracic mammary glands-->axillary LN (+/- superficial cervical LN, sternal LN)cr and cd abdominal mammary glands --> axillary and inguinal LNcd abdominal mammary gland-->medial iliac LN, popliteal LNinguinal mammary gland --> inguinal LN, medial iliac LN, +/- popliteal LN

58

lymph nodes of the mammary chain in cats

CATS: cr and cd thoracic mammary glands-->axillary LN +/- sternal LNcd thoracic mammary gland --> inguinal LNcr abdominal mammary gland --> axillary LN +/- sternal LNcr and cd abdominal mammary glands --> inguinal LNcd abdominal mammary gland-->medial iliac LN, popliteal LN

59

what is the risk of mammary cancer in dogs in terms of estrus cycle

before first estrus 0.5%after first estrus 8%after second estrus 26%

60

T/Fcanine mammary tumors are hormone dependent, however, loss of hormone dependency frequently occurs in malignant mammary tumors

TRUEestrogen and progestin receptor expresssion is significantly lower in malignant mammary tumors vs benign and normal mammary tissueinflammatory carcinomas (the MOST malignant mammary tumor type) were estrogen receptor NEGATIVE

61

genetic factors involved in mammary tumorigenesis

mutations p53overexpression HER-2 (protooncogene)overexpression COX2

62

inflammatory carcinoma of mammary glands

most malignant formmets vary 8-100%55% bilateral chains affectedhisto: malignant mammary type WITH CHARACTERISTIC INVASION OF DERMAL LYMPHATICSsurgery not recommendedpiroxicam may extend MST

63

T/Fin female dogs the type of surgery does not seem to affect the prognosis as long as complete excision is achieved

TRUE

64

different surgeries for mammary tumors

1. lumpectomy--nodulectomy; small <0.5cm, benign, marginal excision2. simple mastectomy--mammectomy, 1 gland removed but achieves 2-3 cm margins, difficult if glands are confluent3. regional mastectomy--en bloc of gland 1-3 and 3-5 glands; INCLUDE inguinal LN if possible4. chain mastectomy--mets based on lymph drainage is unpredictable, if multiple tumors, third gland, or large take chain.

65

T/F58% of dogs develop new tumor in the remaining ipsilateral glands after regional mastectomy for one mammary tumor

TRUEand new tumor is likely to be malignant if located near the previously excised malignant one

66

T/Fthe risk of malignancy increases with increasing size of mammary tumor

truemalignant tumors 4.7 cm diameterbenign tumors 2.1 cm diameterresected smaller tumors have a longer survival

67

recurrence rates of mammary tumors in dogs with and without evidence of LN mets

with LN mets recur 80% within 6 mowithout LN mets recur < 30% within 2 yrs

68

what is the benign differential for a feline mammary mass

fibroadenomatous hyperplasiaGOES AWAY WITH OHE

69

where do mast cells originate

CD34+ cells from the bone marrow

70

relative risk of boxers having MCT

16.7 x

71

percentage of canine MCT affected by c-kit mutations

15-40%

72

Darrier sign

edema, erythema, inflammation of the tumor and surrounding tissueslocal changes are associated with a worse prognosis

73

MST after surgery of MCT based on grade

1. >1300 days2. 800 days3. 300 days

74

negative prognostic indicators for MCT

1. grade 32. MM location

75

locations associated with poorer prognosis with MCT

preputialscrotalcanine muzzlevisceral

76

feline MCT

50-90% well differentiatedregress spontaneouslybehave more benignlybut poorly differentiated behave malignantly

77

most common splenic disease in cats

MCTvisceral MCT is more common in cats than dogs and is NOT associated with cutaneous MCT in cats; mets are common with visceral formsdid not have ckit mutations

78

top three intestinal tumors in cats

1. LSA2. AdCa3. MCT

79

with malignant melanoma, what is an important prognostic factor

LOCATIONhaired--act benign--favorable pxoral, MM, nail bed--malignant--guarded px

80

how does the melanoma vx work

xenogeneic (human, murine) DNA vaccineencodes for human, murine tyrosinasesand then Ab are made against tumor tyrosinases (antityrosinase Ab) potentially therapeutic (immunomodulating)

81

most common nail bed tumors in dogs

SCC (blk labs and poodles)malignant melanoma (guarded px, Scottish Terrier)55% malignant25% inflam16% benignbone lysis 75%

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