Ch 82 MCT Flashcards

Question

prognosis | feline

Answer 1

- histologic grading of feline mast cell tumors is not prognostic - Local recurrence after surgical resection has been reported to be 0% to 33% (margin not matter) - Mitotic index seems to be the most effective prognostic factor - mutiple tumors possibly associtaed with reduce MST - splenic mast cell tumor, long-term survival of 12 to 19 months reported after splenectomy - intestinal MST generally poor progosis (<2mths), possibly prologed with multimodal tx (sx + chemo_)

Answer 2

- **cutaneous histiocytoma** (benign skin tumor of Langerhans cells, young, spotaeous regress 1-2mths or sx curative) - **reactive histiocytosis** (cutaneous > benign condition in which aggregates of histiocytes form infiltrative nodules, plaques) and (systemic > nonneoplastic disease of proliferative histiocytes in Bernese Mountain Dogs, Rottweilers) - **histiocytic sarcoma** (Bernese Mountain Dogs; Flat-Coated, Golden, and Labrador Retrievers; and Rottweilers (disseminated form has a poor prognosis) whereas (localized cutaneous commonly more favorable with surgical excision)

Answer 3

- epitheliotropic T-cell lymphoma (also termed mycosis fungoides) or nonepitheliotropic lymphoma, - localized cutaneous lesions to multifocal or generalized (nodules, plaques, ulcers, and erythematous or exfoliative dermatitis) - generally treated systemically, except in rare cases of a solitary cutaneous mass

Answer 4

excision of cutaneous MCT with lateral margins equal to tumour diameter up to max 2cm → 95% complete excision – no association with tumour grade or size - recurrence rate 3/100 (3%), de novo development 5/65 (7.7%) - recurrence rate associated with high-grade MCT regardless of margin status - post-op metastasis 3/65 (4.6%)

Answer 5

20mm margins for MCT + 1 fascial plane tumor-free margins measured <1 mm in 21 of 52 (40%) MCT Two of 50 (4%) low-grade MCT were diagnosed, with local recurrence Two of 36 (6%) dogs with low-grade MCT developed visceral metastasis Local recurrence rates among predominantly low- to intermediategrade MCT and STS were low, despite a high prevalence of histologic tumor-free margins <1 mm.

Answer 6

After varying treatment protocols, all patients were alive and disease free at a median of 1115 days after diagnosis. Four cutaneous mast cell tumours were described as high-grade (Patnaik or Kiupel) and nine were Patnaik grade II The prognosis of mast cell tumours in dogs less than a year old appears better than the adult counterparts

Answer 7

Most (56.6%) studies reported the status of histologic margins dichotomously as “complete” or “incomplete.” only 7.5% of articles used quantitative methods. A universal system may support more consistent reporting of neoplastic biopsy specimens and allow for more meaningful comparisons across research studies.

Answer 8

Median PFS was 1474 days. Median DFI was not reached at .1968 days. Overall median survival time was not reached at 1968 days. mitotic index were negatively prognostic for PFS cutnaeous: Kiupel proposing a two-tier grading scheme found high-grade tumors to have at least one of the following: seven or greater mitotic figures in 10 high-power fields (hpfs); at least three multinucleated (three or more nuclei) cells in 10 hpf; at least three bizarre nuclei in 10 hpf; and karyomegaly unknown if the Patnaik or two-tier grading scheme can be appropriately ap plied to this subset of tumors

Answer 9

retrospectively review - Recurrence rate was 15% - 63% of evaluated lymph nodes were consistent with early/overt metastasis. - MST 83-1357 days - median time to progression 14-1357 days) were not reached. - Factors predictive of shorter survival: older age, clinical signs, mitotic count >4, multinucleation our study suggests that dogs with SC MCTs, in the absence of negative prognostic factors, may have a prolonged survival when treated with surgery alone. Further studies are needed to clarify the role of adjuvant treatment for biologically aggressive SC MCTs in dogs

Answer 10

Retrospective study Residual MCT was found (27%) resected scars. Seven (8%) scars with residual MCT had incomplete (<1mm) or narrow margins (<3mm). Local recurrence (4%) (14.5%) regional or systemic metastasis Margin status and presence of MCT in the resected scar were not associated with local recurrence or disease progression recurrence and mets siginficantly more likely with grade IIII recurrence was uncommon after surgical revision

Answer 11

Overall, 22 (10.7%) patients had metastasis, with 21 (10.2%) and 13 (6.3%) having spleen and liver metastasis, respectively, and 12 (5.9%) having both. negative spleen cytology had a higher predictive value (0.99) than a positive cytology spleen cytology is predictive of liver cytology in staging of canine MCTs, and increasing tumor size and presence of local or systemic signs are associated with an increased risk of visceral metastasis suggesting that adequate staging may be achieved with spleen cytology alone

Answer 12

In recent years, many techniques for mapping the lymphatic draining of a tumour and to individuate the sentinel lymph node have been investigated. These include using contrast-enhanced CT or ultrasound and intra-operative procedures such as gamma scintigraphy (Worley 2014, Brissot & Edery 2017, Fournier et al. 2021). Interestingly, in the study by Fournier et al. clinicians predicting the draining lymph node of an MCT based on anatomical position were correct in only 54–58% of cases. This suggests lymphoscintigraphy may be suitable for tumour located in “zones of ambiguity” where the RLN cannot be easily predicted, for example, MCTs of the head and neck, and that reliance of lysosome maps of healthy dogs may not take into consideration the potential for aberrant lymphatic drainage in the tumour microenvironment (Fournier et al. 2021). Subcutaneous MCT The majority of dogs with subcutaneous MCTs have a favourable prognosis with extended survival times from good local tumour control and low rates of local recurrence or metastasis subcutaneous MCTs with an increased Ki-67 (>23) are significantly more likely to locally reoccur and metastasise challenges associated with interpretation of MCT margins Donnelly et al. (2015) demonstrated that regardless of histologically tumour-free margins in high-grade Kiupel MCTs there was 36% recurrence rate compared to only 4% in low-grade tumours.

Answer 13

TT poses as an attractive alternative treatment for MCTs in locations that are not amenable to wide surgical excision or in patients who may have comorbidities that pose a high risk for general anaesthesia; however, limitations include the lack of histopathological tumour grading, reported margins and documented long-term responses. most suited to stage 0 MCTs that display traits of being more likely to behave in biologically low-grade manner.

Answer 14

- recurrence: local 8/45 (17.8%), metastatic recurrence 5/45 (11.1%) - local recurrence → MST 551d (80-2050) vs 1722 (10-1722) - LN metastasis 12/45 (26.7%) → mDFI 194d (18-1864) vs mDFI not reached - correlated with recurrence, shorter DFI, decreased survival - infiltrative tumour → mDFI 268d (3-1722) vs not reached at median 1864d (10-1864) - overall MST 1139d - correlated with mass size (>3cm → 1059d vs <3cm 1722d) - more aggressive in this study than previously reported - previous report: local recurrence 7-9%, metastatic recurrence 2-6%

Answer 15

Prospective. 20. indirect computed tomographic lymphography and near-infrared fluorescence sentinel lymph node mapping Nineteen out of 20 (95%) dogs had HN2-3 LN > Although most MCT were classified as intermediate to low grade, Lymph nodes containing metastasis would have been missed in 4/20 (20%) with excision of either the ALN, ICTL-SLN, or NIRFSLN. ICTL and NIRF frequently detected SLN other than the ALN. As most SLN in our subset of dogs were metastatic, we caution surgeons relying exclusively on the ALN for staging considering the high risk of leaving undetected met

Answer 16

- MCT: 6-10mm measured lateral margins → 7% R1, 0-5mm → 55% R1 - no association between histologic grade and R1 margins (no high grade in study)

Answer 17

Twenty-one dogs were included. All dogs underwent surgical excision and two dogs received adjuvant radiotherapy. None of the patients developed local recurrence. Three dogs (14.3%) developed metastatic disease. The DFI of these dogs was 141, 186 and 223 days. Median follow-up period of the whole study population was 1112 days (358–2619). MST for patients with metastatic disease was 417 days. MST of the whole group was not reached. One-year and 2-year survivals were 95.2% and 90.5%, respectively. Conclusions and clinical relevance This study population had low rates of tumour recurrence and improved survival compared to previously published data of similar population of dogs with low MI/high Ki67 MCT without adjuvant chemotherapy.

Answer 18

10/17 (59%) cats were affected by nodal metastasis in our population h cutaneous MCTs that had undergone lymphadenectomy of enlarged and non-enlarged lymph nodes.

Answer 19

CT findings were deemed insufficient for curative surgical planning in 13 of 16 due to inadequate definition of tumor depth, compartment boundary (fascial plane) or MCT margins. The use of CT for presurgical planning of SC/InterM/IntraM MCT dogs has limitations, especially when differentiating MCT from the adjacent muscle.

Answer 20

SLN mapping: optimal scan time 10m post-contrast injection - SLN differed from regional LN in 5/18 - metastasis detected on histology of SLN in 9/20 vs 1/20 cytology → 8/20 change stage/tx

Ch 82 MCT Flashcards

(49 cards)