Ch. 83: Spleen Flashcards
Alexander JSAP 2019
The addition of metronomic chemotherapy does not improve outcome for canine splenic hemangiosarcoma
Group 1 vs. 2 treatment?
Median progression free survival G1 v 2?
MST G1 v 2?
- Group 1: splenectomy + max tolerated dose chemo w/ anthracycline, cyclophosphamide or both
- Group 2: splenectomy followed by adjuvant max tolerated dose chemo w/ anthracycline, cyclophosphamide, or both plus metronomic chemotherapy
Median progression free survival 165d Group 1 vs. 185d Group 2
Overall MST was 180d Group 1 vs. 212 Group 2
Story Vet Sx 2020
Outcomes of 43 small breed dogs treated for splenic hemangiosarcoma
Median ST small vs. large dogs?
DFI small vs. large?
how did mets affect ST?
How did chemo affect ST?
Fewer hemoperitoneum in small dogs
The overall median ST was 116 days for small dogs and 97 days for large breed dogs
The disease-free interval (DFI) was 446d for small and 80 days for large breed dogs
Presence of mets = decreased ST small + large dogs
Sx + chemo = increased ST for small dogs
Burgess JAVMA 2021
Development and validation of a multivariable model and online decision-support calculator to aid in preoperative discrimination of benign from malignant splenic masses in dogs
characteristics that make cancer more concerning?
conclusion?
More likely to be malignant:
- number of liver nodules and presence of mesenteric, omental, or peritoneal nodules
- Large amount of abdominal effusion
- Masses <7cm but larger than nodules
- Solitary masses
- Inhomogeneous masses
Specifically: 8 clinical variables used to estimate splenic malignancy probability:
- serum total protein concentration,
- presence (vs absence) of ≥ 2 nRBCs/100 WBCs,
- ultrasonographically assessed splenic mass diameter
- number of liver nodules (0, 1, or ≥ 2)
- presence (vs absence) of multiple splenic masses or nodules
- moderate to marked splenic mass inhomogeneity,
- moderate to marked abdominal effusion
- mesenteric, omental, or peritoneal nodules
The calculator may facilitate owner decisions to elect splenectomy or not and has potential to reduce the risk that an owner will erroneously elect euthanasia for a dog with a benign mass that could have been cured by surgical removal
Panissidi Vet Sx 2021
Development of perioperative premature ventricular contractions as an indicator of splenic hemangiosarcoma and medial survival times
- % HSA?
- % having VPCs?
- VPCs more common with?
- Do VPCs affect survival?
18/45 (40%) had HSA with 13/18 (72%) having VPCs postoperatively
Postoperative VPCs more likely with splenic HSA
Development of VPCs does not affect median survival times
Splenic masses were more likely to be HSA if ruptured but less likely to develop VPCs.
Masyr JAVMA 2021
Retrospective evaluation of thrombocytopenia and tumor stage as prognostic indicators in dogs with splenic hemangiosarcoma
- what stage was negative px indicator?
- thrombocytopenia impact on PFI, OST?
Stage 3 HSA was neg px indicator for progression free interval and overall survival time
Perioperative thrombocytopenia was associated w/ shorter PFI and OST
Millar JAVMA 2022
Premature death in dogs with nontraumatic hemoabdomen and splenectomy with benign histopathologic findings
Nontraumatic hemoab - % malignant? % HSA of malignancy? % HSA of all dogs?
% non-malignant dogs that prematurely died?
4 things that increases risk for premature death?
Histopathologic findings indicated malignancy in 73% dogs with nontraumatic hemoabdomen. Hemangiosarcoma was diagnosed in 88% of those with malignancies and 64.0% of all dogs.
17% of dogs that had non malignancy had adverse outcome and premature death
Increased risk for premature death in dogs with nonmalignant histopathology:
- Higher amount of abdominal blood
- Lower platelet count
- Failure to perform imaging
- Presence of hepatic mass or nodule
Latifi JVIM 2020
Clinical outcomes in dogs with localized splenic histiocytic sarcoma treated with splenectomy with or without adjuvant chemotherapy
MST?
MST was 427 days
conclusion: dogs w/ localized HS of spleen tx w/ surgery +/- chemo can have MST >1yr
Faulhaber JVIM 2021
Adjuvant carboplatin for treatment of splenic hemangiosarcoma in dogs: retrospective evaluation of 18 cases (2011-2016) and comparison of doxorubicin-based chemotherapy
MST carbo vs doxo?
difference b/w stages of chemo?
MST in relation to monocyte counts?
MST 160 days and 139 days for carboplatin and doxorubicin (not different)
carboplatin stage I had better outcomes than stage II, doxo didn’t have any difference between stage
MST for dogs whose monocyte counts decreased between splenectomy and chemotherapy initiation was 265 days compared to 66 days for dogs with increased monocytes (sig different)
Schick JAVMA 2023
Evaluation of the validity of the double two-thirds rule for diagnosing hemangiosarcoma in dogs with nontraumatic hemoperitoneum due to a ruptured splenic mass: a systematic review
- % malignant vs benign?
- % HSA?
A total of 1,150 dogs were evaluated, with 73.0% (840/1,150) of dogs being diagnosed with a malignant splenic lesion and 27.0% (310/1,150) being diagnosed with a benign splenic lesion.
Of the malignancies, 87% (733/840) were hemangiosarcoma
The double two-thirds rule should be refined when evaluating dogs with nontraumatic hemoperitoneum from a ruptured splenic mass, with more dogs being diagnosed with a malignancy and hemangiosarcoma specifically than the double two-thirds rule indicates.
Phipps JAVMA 2020
Postoperative thrombocytosis and thomboelastographic evidence of hypercoagulability in dogs undergoing splenectomy for splenic masses
Mean platelet count and thrombocytosis increased at all postop assessment points than day 0
1 or more TEG values suggestive of hypercoagulability observed at all time points (increased at all points after day 0)
Sirochman Vet Sx 2020
Influence of use of a bipolar vessel sealing device on short-term postop mortality after splenectomy: 203 dogs (2005-2018)
BVSD mortality?
what factors increased risk for death post-op?
Use of a BVSD did not appear to increase short-term mortality after splenectomy.
Clinical significance: Dogs undergoing splenectomy that require intraoperative or postoperative transfusions, experience intraoperative ventricular arrhythmias, or have prolonged anesthesia may be at risk for death in the short-term postoperative period.
Clarke JSAP 2020
Clinical utility of liver biopsies in dogs undergoing splenectomy
% neoplastic normal vs. abnormal liver?
abnormal liver - odds of dx w/ neoplasia?
liver neoplasia more likely with what other finding?
Neoplastic liver disease was detected on biopsy from 1 of 40 (2.5%) dogs with a grossly normal liver and from 20 of 69 (28.9%) dogs with a grossly abnormal liver.
Dogs with a grossly abnormal liver had a ~ 16 times (95% CI: 2.5-170) higher chance of being diagnosed with liver neoplasia on biopsy.
Haemoabdomen was also associated with an increased likelihood of liver neoplasia on biopsy at the time of splenectomy
Bestwick JVIM 2022
Splenectomy in the management of primary immune-mediate hemolytic anemia (IMHA) and primary immune-mediated thrombocytopenia (ITP) in dogs
% ITP response?
% IMHA response?
% Evan’s syndrome response?
6/7 (86%) ITP dogs were managed successfully with splenectomy as part of their protocol
4/7 (57%) IMHA managed successfully with splenectomy as part of their protocol
Concurrent IMHA and severe thrombocytopenia (CIST) group (aka “Evan’s Syndrome”)
1/3 responded completely to management with splenectomy
Cordella VRU 2020
Splenic extramedullary hematopoiesis in dogs is frequently detected on multiphase multidetector-row CT as hypervascular nodules
what does EMH look like on CT?
the most frequent MDCT aspect of splenic EMH consists of multiple nodules hyperattenuating to normal spleen, best seen on the arterial and portal phases
Specchi VRU 2020
CT angiography identifies collaterals in dogs with splenic vein obstruction and presumed regional splenic vein hypertension
4/21 dogs showed collateral pathways through the left gastroepiploic vein (4/4), left gastric vein (2/4) and splenogonadal vein (1/4)
