Hematologic Malignancies Flashcards by D. M.

What is the most common clinical presentation of canine lymphoma?

80% of dogs are stage III or IV, most are substage a
III = generalized peripheral lymphadenopathy
IV = hepatosplenic involvement
a = asymptomatic
STAGE 3A MOST COMMON = GENERALIZED PERIPHERAL LYMPHADENOPATHY, NO SYSTEMIC ILLNESS

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What is the most common site of canine lymphoma?

Multicentric (multiple lymph nodes +/- organ involvement)

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What is the most common histologic grade/morphology of canine lymphoma?

Intermediate to high grade (lymphoblastic cells)
Rapid onset of clinical signs, needs immediate treatment

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What is the diagnostic of choice of canine lymphoma?

Cytology - diagnostic for intermediate - large cell LSA in 80-90% of cases

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What are cytologic feature of canine LSA?

Cells are larger than a neutrophil
Absence of plasma cells
Homogenous population of large lymphoid cells

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Lymphoma

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Reactive lymph node

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What is indicative of canine lymphoma on a CBC/chemistry?

Thrombocytopenia
Lymphocytosis
Hypercalcemia
Hyperglobulinemia
Azotemia
Elevated liver enzymes

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What is seen on thoracic radiographs and abdominal ultrasound with canine lymphoma?

Radiographs: LN enlargement, cranial mediastinal masses
Ultrasound: LN enlargement, splenic infiltration (“swiss cheese”)

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Characteristics: B Cell LSA

Multicentric most common form
Any breed
Excellent response to chemotherapy
Good prognosis

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Characteristics: T Cell LSA

Skin, mediastinum, GI, hepatic
Boxers
Shorter response to chemotherapy
Poorer response to doxorubicin
Poorer prognosis

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What type of immunophenotying?

Cytology only

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What type of immunophenotying?

Immunocytochemistry

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What type of immunophenotying?

Immunohistochemistry

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What samples are required for IHC?

Need histopathology tissue - biopsy

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How does IHC work?

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How does flow cytometry work?

Monoclonal antibodies applied to cells in suspension
Cells pass through measuring system and are analyzed based on label, size, etc.
Cells are sorted into B/T and based on size

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What samples are required for flow cytometry?

Samples in suspension (blood, FNA, fluid)
Cells must be alive (no formalin)

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What samples are required for ICC?

Cells from needle aspirate

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How does PARR work?

PCR reaction that amplifies the conserved regions of T cell receptor or immunoglobulin (B cell) genes

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What are the pros and cons of PARR?

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Pros: confirms clonal population of cells (i.e. cancer, especially if cytology inconclusive), determines if B or T cell
Cons: Does not differentiate cell size

What samples are required for PARR?

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Glass slide of blood smear, effusion, FNA
Cells in suspension, effusion, blood

What are the (3) primary clinical applications for flow cytometry?

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Lymphocytosis (blood) - small lymphocytes (chronic leukemia), immature, blasts (acute leukemia)
Lymphadenopathy (FNA) - known lymphoma (determine phenotype), prognostic information (size)
Mediastinal mass - lymphoma vs thymoma

What are the (2) primary clinical applications for PARR?

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Lymphadenopathy (FNA) - differentiate reactive v neoplastic if cytology inconclusive
Cavitary effusion/BM aspirate

Which immunophenotyping is the best?

**IHC** = gold standard, but requires biopsy (so more invasive and more expensive) **Flow** (best non-invasive), PARR, ICC less invasive (only need FNA)

What is the preference between flow, IHC, ICC, and PARR?

* Flow > IHC (feasibility, less invasive, less expensive) * If biopsy already done, proceed with IHC * If no definitive diagnosis, use PARR to rule in/out clonality * Use PARR if can't ship samples in time for flow * ICC can be add on test if cytology already submitted

What are the treatment options for canine LSA?

**Chemotherapy** Radiation therapy - local or regional disease Surgery - single lesion

What makes up the CHOP protocol?

Vincristine Cyclophosphamide Doxorubicin Prednisone

Prognosis: Canine LSA stages

I/II > III/IV > V

Prognosis: Canine LSA substage

a > b

Prognosis: Canine LSA immunophenotype

B-cell > T-cell *Exception: indolent T cell lymphomas*

Prognosis: Canine LSA hypercalcemia

Poor (T cell)

Prognosis: Canine LSA location

Primary hepatic, GI poor (often T cell)

What are characteristics of canine indolent LSA?

Stage I/II (mandibular +/- superficial cervical lymph nodes), incidental finding, slowly progressive Golden retrievers *No hypercalcemia*

How is canine indolent LSA diagnosed?

*Cytology alone may not be sufficient* Flow can help diagnose T zone LSA If flow not helpful, whole node biopsy +/- IHC

Canine indolent LSA

Treatment: Canine Indolent LSA (Solitary)

Surgical removal of lymph node

Treatment: Canine Indolent LSA (Multicentric)

Hold on staring chemo until clinical signs develop related to enlarged lymph nodes or internal organ involvement, cytopenias develop, or lymphocytes >30k - 60k *Tx is chemo (pred + chlorambucil*

Prognosis: Canine Indolent LSA

Better than aggressive forms

What are the general characteristics of feline small cell LSA?

Most common form Most often in small intestines T cell phenotype Indolent clinical course

What are the general characteristics of feline large cell LSA?

Type 1: T cell, small intestine, 60% large lymphoid cells, aggressive form B cell: multiple tumors in GI tract, large lymphoid cells, aggressive form

Clinical Presentation: Feline Small Cell Lymphoma

Chronic intermittent Month/years: diarrhea, vomiting Weeks/months: hyporexia, weight loss

Clinical Presentation: Feline Large Cell Lymphoma

Acute onset (days to weeks) with acute progression Diarrhea, vomiting, hyporexia/anorexia, weight loss

Abdominal US Findings: Feline Small Cell Lymphoma

Mild diffuse thickening of intestines Mild abdominal lymphadenopathy Mass effect in GI tract

Abdominal US Findings: Feline Large Cell Lymphoma

Focal mass effect in stomach, intestines, ileocecocolic junction Enlarged abdominal lymph nodes Effusion Involvement of other organs

What diagnostics can help differentiate small cell GI lymphoma from IBD in cats?

IHC paired with PARR on histopath samples can detect malignancy in endoscopic biopsy samples

Treatment: Feline Small Cell Lymphoma

*Less intensive* Chlorambucil and prednisolone GI supportive care (novel protein diet, B12)

Treatment: Feline Large Cell Lymphoma

*More intensive* Multi-agent chemo (CHOP) Single agent chemo Palliative prednisolone

Prognosis: Feline Small Cell Lymphoma

90% respond to chlorambucil/pred MST = 2.5 - 3 years

Prognosis: Feline Large Cell Lymphoma

75% response to chemo with MST = 6 - 12+ months 25% no response to chemo with MST <4 - 6 weeks Steroids alone = 1 - 2 months

Hematologic Malignancies Flashcards

(50 cards)