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Oncology > Hemangiosarcoma and Mast Cell Tumor > Flashcards

Hemangiosarcoma and Mast Cell Tumor Flashcards

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1
Q

What tissue types are sarcomas in general?

A
  • Connective tissue/mesenchymal tumors
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2
Q

How do sarcomas spread?

A

By blood

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3
Q

Tissue origin for HSA

A
  • Vascular endothelial cells (may be of bone marrow origin)
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4
Q

Signalment of HSA

A
  • Large breed dogs - GSD, golden, and labrador retriever overrepresented
  • Older dogs, but can be young
  • Male predominance?
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5
Q

Where can HSA present?

A
  • Anywhere there is blood
  • Spleen, liver, right atrium are typical
  • Kidney, SC tissues/muscle
  • Oral cavity, urinary bladder, pericardium and peritoneum, bone
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6
Q

How does HSA usually present?

A
  • Sudden collapse, weakness, pallor
  • Sudden enlargement of a mass
  • Sudden cardiac tamponade - weakness and arrhythmia
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7
Q

Biologic behavior of HSA

A
  • EXTREMELY aggressive
  • High rate of early development of metastasis
  • Endothelial cells can go anywhere they want
  • 25% have right atrial involvement at diagnosis
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8
Q

Splenic lesions and malignancy rule

A

2/3 are malignant, and of those 2/3 are HSA

  • Evidence of splenic bleeding or rupture makes it a 75% chance of being a hemangiosarcoma
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9
Q

How do you officially make a diagnosis with HSA?

A
  • Histopathology, but you can have a very high degree of suspicion dependent on the clinical picture
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10
Q

Other clinical suspicion for HSA

A
  • Right atrial masses with pericardial hemorrhage
  • Ultrasound appearance of cellular fluid-filled mass anywhere
  • Aspirate for cytology or biopsy yielding only blood
  • Evidence of DIC (elevated coags or D-dimers or FDPs)
  • Plasma troponin 1 concentration high in the pericardial fluid
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11
Q

Plasma troponin 1

A
  • High correlation with hemangiosarcoma

- Not sure if it’s just a correlation with blood

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12
Q

Staging of hemangiosarcoma

A
  • CBC, Chem, UA

- Thoracic Rads are ESSENTIAL

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13
Q

CBC findings of HSA

A
  • Normocytic, normochromic anemia
  • NRBC
  • Fragmented red cells (schistocytes that are HIGHLY suggestive)
  • Neutrophilic leukocytosis, thrombocytopenia (but not horribly low unelss DIC)
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14
Q

Which cell type on blood smear is very suggestive of HSA?

A
  • Schistocytes
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15
Q

Thoracic rad possible findings with HSA

A
  • Chest mets in most cases

- 47% of cardic lesions present are identified

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16
Q

Additional findings for hSA

A
  • Coagulation panel
  • EKG
  • Abdominal ultrasound
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17
Q

What is the best way to identify a cardiac lesion for HSA?

A
  • Cardiac ultrasound

- About 1/4 will have right atrial involvement at outset

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18
Q

Treatment for HSA

A
  • Surgical removal and systemic therapy
  • Really only able to do with spleens and some SC masses
  • Right atrial masses are quite difficult to remove
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19
Q

Chemotherapy - what’s best for HSA?

A
  • Single agent doxorubicin once every 2-3 weeks

- Can do a combination therapy (Doxo + Vincristine + cyclophosphamide)

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20
Q

Biologic therapy for HSA

A

-Liposome encapsulated muramyl tripeptide

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21
Q

Anti-angiogenesis therapy and HSA

A
  • Low dose chemotherapy is best (cyclophosphamide daily, lomustine daily, or chlorambucil daily)
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22
Q

Which anti-angiogenesis agents probably don’t work as well for HSA?

A
  • NSAIDs and Tyrosine kinase inhibitors (although NSAIDs might not be that bad)
  • Minocycline didn’t do anything
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23
Q

Prognosis for HSA in general

A
  • Poor
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24
Q

Prognosis for HSA: surgery alone

A

2-3 months median survival

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25
Prognosis for HSA: surgery + chemotherapy
- 4-6 months (NOT FOR METASTATIC DISEASE)
26
Prognosis for HSA: Right atrial - With doxorubicin, surgery alone, surgery +doxorubicin, radiation
Doxorubicin alone: median survival about 4 months - Surgery about 4 months with doxorubicin - Surgery alone about 1 month - Radiation about 2 months
27
Yunnan Baiyao evidence for helping HSA?
- Limited - seems like it doesn't help
28
SC HSA mass treatment
- May benefit from local palliative radiation in addition to chemotherapy (and surgery?) - Tend to live longer but the disease still USUALLY metastasizes
29
WSU Protocol for HSA
- Control local disease (surgery when possible + palliative radiation) - Doxorubicin x 4 (chemo) - Follow up with metronomic chemotherapy
30
Survival for WSU protocol
- ~6 months
31
Who gets cutaneous hemangiosarcoma?
- Light coat color, thinskin dog and cat disease
32
What likely causes cutaneous hemangiosarcoma?
- Sunlight induce
33
Prognosis for cutaneous hemangiosarcoma
- If it doesn't invade into deeper tissues, this is a surgically curable disease - 1 cm margins
34
What can Mast cell's look like?
- ANYTHING!!!! I REPEAT, anything!
35
What is Darier's sign?
- Tumor disappears | - possible mass that comes and goes could be a mast cell tumor
36
What do mast cell granules contain?
- Histamine - Heparin, - Other bioactive compounds which can cause systemic signs
37
Paraneoplastic syndromes associated with mast cell tumors
- GI ulceration (vomiting blood) - Impaired LOCAL healing - Coagulopathy (locally) - Hypotensive shock (rare) - Urticaria - Eosinophilia, basophilia
38
Breeds who get MCT?
- Boxers! - Boston Terrier - Labrador Retrievers - Schnauzers - Beagles - Pugs - Siamese for cats
39
Age for MCT
- Any age in dog, tend to be older cats | - No gender predilection
40
Dog MCT presentation
- Most are external skin masses | - PRIMARY internal tumors are rare
41
Cat MCT presentation
- Equal numbers of external and internal tumors | - Primary symptom is not always a skin mass and MAY be vomiting in a cat
42
Cytology for MCT
- Round cell, often has granules | - Gives you a good idea it is a mast cell tumor so surgery and staging can be planned
43
Histopathology of MCT
- REQUIRED for grading the tumor - Don't forget to submit margins - Often just take them out
44
Diagnosis of MCT
- Often start with cytology to give you an idea that it's a mast cell tumor so that you can take it off with appropriate planning
45
Grading MCT: Pathologists vs Oncologists
- Pathologists prefer a 2 level grading scheme vs 3 levels - Not truthful for lowest grade 1 tumors, so oncologists prefer having both systems used and then being able to split the grade 2 tumors additionally into high and low grade grade 2
46
Grade 1 MCT prognosis
- Good
47
Grade 2 MCT prognosis
Variable prognosis
48
Grade 3 MCT prognosis
- VERY POOR :(
49
Define a grade 1 MCT
- well differentiated and superficial
50
Define a grade 2 MCT
Well to medium differentiation, SQ involvement
51
Define a grade 3 MCT
- Poorly differentiated
52
Mitotic index of MCT - cut off for likelihood to recur or metastasize?
- <5 mitoses/10 HPF is less likely to recur or metastasize | - >5 mitoses/10hpf is more likely to recur or metastasize
53
What are the gold standards for determining prognosis for canine MCT?
- Grade and mitotic index** | - There are other helpful markers too (c-Kit, AgNOR's, Ki-67)
54
Staging for a grade 1 and lower grade 2 MCT
- Lymph node check and possible imaging - CBC/Chem - Buffy coat smear
55
Staging for a higher grade 2 and grade 3 MCT
- Lymph node check and possible imaging - CBC/Chem - Buffy coat smear - Abdominal ultrasound +/- spleen and liver aspiration (EVEN IF NORMAL APPEARING) - Bone marrow aspirate
56
Staging MCTs
0 = one tumor, already excised I = one tumor II = one tumor with regional LN involvement III = multiple dermal tumors, large infiltrating tumors, with or without lymph node involvement IV = any tumor with distant metastasis or recurrence with metastasis
57
Is LN involvement really bad with MCT?
- No
58
Symptomatic therapy for MCT (not always needed)
- H1 blocker (diphenhydramine) - H2 blocker (cimetidine, ranitidine, famotidine) - Prednisone
59
H1 blocker function in MCT
- Prevent bronchoconstriction, vasodilation
60
H2 blocker function in MCT
- prevent gastric ulceration | - Could give omeprazole too
61
Prednisone function with MCT
- Shrink the tumor prior to surgery
62
General treatment for MCTs
- Surgery - Electrochemotherapy - Radiation - Traditional chemotherapy
63
Surgery for MCTs
- 3 cm margins in ALL directions
64
Electrochemotherapy for MCT - when to use?
- Small low grade tumors
65
Radiation therapy for MCT - when to use?
- Local disease | - Best if minimal disease
66
Traditional chemotherapy for MCT - when to use?
- Used ONLY for high stage/systemic disease (all grade III) | - Minimally effective alone
67
Chemo for canine MCT
- Traditional - Prednisone, vinblastine, lomustine (huge) - Vinblastine, bred - Vinblastine, cyclophosphamide, prednisone - Hydroxyurea
68
WSU protocol for canine MCT?
- Vinblastine and lomustine
69
Tyrosine kinase inhibitors for MCTs
- Save for aggressive tumors; about 50% respond for about 2 months - There are toxicities - NOT a benign tumor - On it for life
70
RTK combination therapy either vinblastine/toceranib or palliative radiation and toceranib for MCT (all grades)?
- Not sure - Might be helpful? - Might not be helpful?
71
Grade 1 MCT prognosis
- Most cured with surgery - Don't use palladia or chemo with these! - can irradiate or use electrochemotherapy when surgery not possible
72
Grade 2 MCT prognosis
- Surgery CAN be curative - Often need radiation as follow up - Low grade grade 2 electrochemo to follow up - Some require systemic therapy (traditional chemo or TK inhibitor)
73
Grade 3 MCT prognosis
- Surgery rarely curative - Can irradiate if no confirmed metastasis - ALL require systemic therapy - Slow progression, not curative - In addition to local therapy - Best case is surgery, irradiation, and chemotherapy
74
Feline MCT on skin - malignant or benign?
- Usually benign | - Cured with surgery often
75
Feline MCT internally - malignant or benign?
- More aggressive!
76
Two forms of internal feline MCT
- Lymphoreticular | - GI
77
How do cats with internal MCT present?
- Vomiting (often still eating) | - Mass in abdomen, aspirate yields mast cells (solid sheets or pretty normal mast cells)
78
Diagnosis of feline MCTs
- Aspirate of mass in abdomen yields mast cells | - Often circulating mast cells in blood (buffy coat smear on CBC)
79
Treatment for feline internal MCT
- Symptomatic treatment important - Corticosteroids, H1, and H2 blockers - Splenic form may stop therapy after surgery? - Intestinal form may require therapy for life - Remove tumor from spleen or intestine
80
TKI and feline internal MCT
- Beneficial but not often necessary
81
Prognosis for feline internal MCT
- Prolonged for splenic (>3 years) - Less for GI (11 months) - If you can take the spleen out, they often do quite well

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