Miscellaneous Tumors/Topic Flashcards
(118 cards)
1
Q
_____ inactivation was demonstrated in more than 50% of evaluated
canine HSA samples
A
PTEN
2
Q
One study showed the presence of concurrent splenic and cardiac HSA to be ____% whereas a previous necropsy study reported that ___% of dogs with splenic HSA had a concurrent right atrial lesion.
A
~9%
24%
3
Q
Immunohistochemistry for ____ or _____ can be used to demonstrate endothelial derivation and support
the diagnosis of HSA and rule out other sarcomas.
A
Factor III (vWF)
CD31/platelet endothelial cell-adhesion molecule
4
Q
One study reported a sensitivity of ___% for detecting metastatic pulmonary HSA with radiography
A
78%
5
Q
***A study showed that although hepatic lesions that were multiple and/or dark red or black were more likely to be HSA, _____% of grossly abnormal livers were confirmed to contain HSA metastasis. Furthermore, almost ___% of histologically benign lesions were obtained from grossly abnormal livers.
A
50%
60%
6
Q
In a pilot study evaluating hypofractionated RT for canine cardiac HSA reported a reduced frequency of cardiac tamponade, leading to MST of _____.
A
3 months
7
Q
In dogs with splenic HSA, with the addition of chemotherapy, MSTs increase to ____ - ____ and the 12-month survival percentage is ___% or less.
A
5-7 months
10%
8
Q
MST for dogs with splenic HSA treated with surgery + chemotherapy in stage I disease is ____ - ____ and in stage II disease is ____ - _____.
A
MST stage I: 8-12 months
MST stage II: 4-5 months
9
Q
What is the MST of primary renal HSA in dogs reported in one small study?
A
9 months
10
Q
In an older study, retroperitoneal HSA in dogs reported a MST of _____.
A
1 month
11
Q
For true cutaneous HSA in dogs, which includes superficial tumors involving the dermis only, MSTs of _____ - _____ following surgical removal are reported.
A
26 - 33 months
12
Q
In one study, dogs undergoing surgical
removal of dermal HSA were noted to have increased overall survival (MST ______), particularly dogs with ventral tumor location (MST ______), and those with evidence of solar-induced
changes on histopathology (MST ____). Dogs whose cutaneous tumors displayed subcutaneous invasion had a higher chance of developing metastasis (relative risk _____) and a
subsequently poorer longterm survival (MST _____).
A
- oMST: 52 months
- MST ventral abd: 36 months
- MST solar: 52 months
- relative risk: 2.04
- MST SQ invasion: 18 months
13
Q
For dogs with subcutaneous or intramuscular HSA, 2 studies report divergent results. One study reported an MST of _____ for dogs receiving adjuvant DOX after surgical removal of subcutaneous HSA, and _____ for dogs undergoing the same treatment
for intramuscular HSA. The other study reported an overall MST of _____ for dogs with nonmetastatic subcutaneous or intramuscular HSA treated similarly.
A
- MST SQ: >3 years
- MST IM: 9 months
- oMST SQ + IM: 8 months
14
Q
Based on WHO/RECIST response criteria in dogs treated with doxorubicin for nonresectable SQ HSA, the RR was ____% for a median response duration of ____.
A
- RR: ~40%
- 2 months
15
Q
Without treatment, most dogs with cardiac HSA succumb to the disease within _____.
A
2 weeks
16
Q
In a small group of dogs receiving adjuvant chemotherapy after surgical removal of cardiac HSA, a MST of ____ was reported.
A
6 months
17
Q
MST in dogs with cardiac HSA following pericardiectomy is ____ - ____.
A
3-4 months
18
Q
A retrospective study evaluating the use of DOX chemotherapy for dogs with presumptive cardiac HSA documented a ___% objective response rate, PFS of ____, and MST of ____-______.
A
ORR: 41%
PFS: 2 months
MST: 4 -5 months
19
Q
One study evaluating the combination of DOX and deracoxib reported an MST of _____ for dogs with stage III splenic HSA, which was similar to the
MST of ______ for dogs of all stages combined
A
- MST stage 3: 5 months
- oMST: 5 months
20
Q
Dogs with advanced stage HSA treated with a DAV protocol (DTIC, DOX, Vinc) had a response rate of ___% and median time to progression of ____.
A
RR: 47%
TTP: 3 months
21
Q
Dogs with stage III HSA treated with a VAC protocol (vinc, dox, cyclo) had an MST (____) that was similar to that of dogs receiving the same treatment for stage I/II disease (MST ____).
A
- MST Stage 3: 6 months
- MST stage 1/2: 6 months
22
Q
In cats with visceral HSA, MST range from ____ - ____.
A
3-7 months
23
Q
Cats with cutaneous and subcutaneous HSAs that are treated with aggressive surgery have reported MSTs of approximately _____ - _____.
A
9 months to 4 years
24
Q
Feline HSAs with subcutaneous involvement are associated with higher rates of incomplete excision (____ - ____%) and local recurrence (___-___%)
A
- 50-94% incomplete
- 50-80% recurrence
25
A metastatic rate up to ___% has been reported in cats with cystic thymomas.
20%
26
Myasthenia gravis may occur in up to ___% of dogs with thymoma. Concurrent megaesophagus and aspiration pneumonia has been reported in as many as ___%.
40%
40%
27
Hypercalcemia has been reported in ___% of dogs with thymomas.
34%
28
In one study in dogs with thymoma, neoplastic epithelial cells were cytologically evident in ____% of cases.
61%
29
In one study evaluating flow cytometry in dogs with thymoma vs. lymphoma, all cases of thymoma included ___% or more of lymphocytes coexpressing CD4 and CD8, whereas six of seven lymphomas contained fewer than ___% of CD4+CD8+ lymphocytes.
10% or more: thymoma
<2%: lymphoma
30
In a retrospective study of 11 dogs
and 9 cats with invasive and noninvasive thymomas treated with
surgery alone, the MST was ______ and ________ for dogs and cats, respectively. In another study, the MST for dogs treated surgically was _____, which was significantly better than the MST for dogs not treated surgically (____).
MST dog: 26 months
MST cat: 60 months
MST dog sx: 21 months
MST dog no sx: 3 months
31
In a retrospective study in dogs and cats with thymoma treated with RT alone or as adjuvant therapy, the response rate to RT was ____% with a MST of ____ in dogs and _____ in cats.
- RR: 75%
- MST dog: 8 months
- MST cat: 24 months
32
In a retrospective study of 8 dogs with thymoma treated with hypofractionated RT alone, the ORR was ___% with a 1-year survival rate of ___%.
50%
75%
33
Metastasis occurs in up to ___-___% of dogs with TVT.
5-17%
34
Single-agent vincristine results in a complete and durable response in ___-___% of dogs with TVT.
90-95%
35
Two studies evaluating orthovoltage and megavoltage RT (Cobalt) found a complete and durable response rate of ___% in dogs with TVT.
100%
36
For dogs with TVT, the overall recurrence rate following surgery is reported to be ___-____%
30-75%
37
What breed is overrepresented for sclerosing mesothelioma?
German shepherd
38
In one report, the MST in five dogs with pericardial mesothelioma treated with pericardiectomy was _____. Three of these dogs were treated with adjuvant IV _____ OR ______.
MST 14 months
DOX or mitoxantrone
39
In a study of 58 dogs with idiopathic or malignant pericardial effusion treated with thoracoscopic pericardial window or thoracotomy with subtotal pericardectomy, the DFI and MST for dogs with malignant pericardial effusion was _____ - _____. What surgical technique produced better outcomes?
3-4 months
no difference between surgical techniques
40
HSA and aortic body tumors represent ___-___% and ____-___% of all primary cardiac tumors in dogs, respectively. The most common primary and secondary cardiac tumor in the cat is ______.
HSA: 40-69%
ABT: 8-28%
LSA
41
What is the reported sensitivity for radiographs in the diagnosis of cardiac HSA?
47%
42
In a study of 107 dogs with pericardial effusion, the sensitivity and specificity of echocardiography were ___% and ____%, respectively, for detection of a cardiac mass. The PPV was ___% and the NPV was ___%.
Sensitivity: 82%
Specificity: 100%
PPV: 100%
NPV: 75%
43
What is the detection rate of echocardiography for right atrial vs. right auricular tumors in dogs?
right atrial: 95%
right auricle: 60%
44
In the setting of a patient with pericardial effusion and no obvious cardiac tumor by echocardiography, pericardial fluid cytology may offer a diagnosis in approximately ___% of cases. Improved diagnostic yield of ___% is seen when the pericardial effusion's HCT is less than ___%.
8%
20%
10%
45
What is an important biomarker for dogs with cardiac HSA where concentrations higher than _____ are likely to have cardiac HSA. Concentrations higher than _____ may indicate cardiac involvement with confirmed HSA.
cardiac troponin I
0.25 ng/ml
2.45 ng/ml
46
Concurrent splenic masses have been reported in ___% of dogs with suspected primary cardiac HSA with ____% of dogs having metastases to other sites such as the liver, mesentery, omentum, and lungs. Concurrent right atrial lesions is seen in ___% of dogs with primary splenic mass.
29%
42%
8.7%
47
The MSTs in dogs with aortic body tumors undergoing pericardiectomy range from ____-____ vs. those that do not undergo pericardiectomy at _____-_____.
MST pericardiectomy: 22 - 24 months
MST no pericardiectomy: 1-4 months
48
One study evaluating pericardial lymphoma in cats reported an MST of ______.
9 days
49
______ is expressed by Langerhans cells and interstitial DCs. Macrophages predominantly express _____ or ____ in splenic red pulp or bone marrow.
CD11c
CD11b or CD11d
50
Expression of ________ is unique to histiocytomas and can help differentiate histiocytomas from reactive histiocytosis.
E-cadherin
51
What is the immunophenotype for cutaneous and systemic reactive histiocytosis?
- E-cadherin NEGATIVE
- CD1a, CD1b, CD1c, CD11c, MHC class II, Thy-1, CD4, Iba-1 POSITIVE
52
***What breeds are overrepresented for histiocytic sarcoma?
BMD
Flat-coated retriever
Rottweiler
Miniature Schnauzer
Pembroke Welsh Corgi
53
***One genetic study evaluating copy number aberrations in the BMD and FCR found deletions of the tumor suppressor genes _______, _______, and _______.
CDKN2A/B
RB1
PTEN
54
What are some useful markers for the diagnosis of histiocytic sarcoma? Hint: there's 5
CD18
CD204
Iba-1
CD11c
CD1a
55
What is the reported sensitivity and specificity of a CADET histiocytic malignancy assay that evaluates for copy number aberrations, which can be used on cytology or histology samples?
sensitivity: 78%
specificity: 95%
56
***____% of dogs with HS had hyperferritinemia in one study. What are other differentials for hyperferritnemia?
89%
IMHA, liver disease, LSA
57
***In a series of 18 dogs with PAHS confirmed with CD18 staining, the MST for dogs undergoing amputation was ______ and the metastatic rate was _____%
6 months
91%
58
***In one study, dogs with PAHS lived significantly longer than did dogs with non-PAHS, with overall MSTs of _____ and _______, respectively, despite presence of metastasis in majority of cases. Dogs with PAHS with no evidence of metastasis at diagnosis (MST _____) lived significantly longer than those with evidence of metastasis (MST _____).
MST PAHS: 13 months
MST non-PAHS: 4 months
MST no met: 33 months
MST met: 8 months
59
***One study reported a ____% response rate to CCNU in 56 dogs with gross measurable disease with a median
remission duration of ______. The MST of responders was ____ compared with _____ in nonresponders. What were the poor prognostic indicators in this study? In a prospective study of 21 dogs with HS treated with 90mg/m2 CCNU, RR was ___% for a median response duration of ____.
46%
remission duration: 3 months
MST responders: 6 months
MST non-responders: 2 months
- poor prog: anemia, thrombocytopenia, hypoalbuminemia, splenic involvement
2nd study:
- RR: ~30%
- Median duration: 3mo
60
One retrospective study documented an MST of ________ in 16 dogs with localized HS treated with aggressive
combination therapy.
19 months
61
Alternating CCNU and doxorubicin for dogs with histiocytic sarcoma has a reported response rate of ___% with a TTP of ______.
58%
6 months
62
Dacarbazine for treatment of canine histiocytic sarcoma has a response rate of ____% with an EFS for responders of ______.
18%
2 months
63
In a report of 37 FCR with mostly PAHS, dogs undergoing RT lived longer than those not having RT with an MST of _____. Dogs treated with a set combined protocol of a palliative RT and CCNU had an MST of _______.
MST 6 months
MST RT + CCNU: 7 months
64
What is the cell of origin for non-hemophagocytic, localized histiocytic sarcoma
interstitial dendritic cells
65
_____ are cytoplasmic structures that are a unique histologic feature of thymoma.
Hassal's corpuscles
66
Perioperative mortality rates in dogs and cats with thymoma are ___-___% and ____-____%, respectively.
- dog: 20-27%
- cat: 11-22%
67
What staging system is used in thymomas?
Masaoka Koga staging system
68
A recent retrospective study evaluating 64 cats with thymic epithelial tumors was performed. The MST was _____. The 5-year survival rates for cats who underwent surgery was ____. Survival time was longer for Masaoka-Koga stage 1 and 2 tumors at _____ compared to stage 3 and 4 tumors at _______. Tumor recurrence was reported to be ____% at a median duration of ______. Metastasis occurred in ___%.
- MST: 30 months
- 5 year survival rate: 66%
- Stage 1 & 2 tumors MST: 45 months
- Stage 3 & 4 tumors MST: 15 months
- Tumor recurrence: 20%
- Median duration: 19 months
- met: 2%
69
A recent study evaluating thymic epithelial tumors in 51 dogs reported _______ was associated with significantly prolonged survival and ____, _____, and _______ were negative prognostic factors.
- Postive prognosis: surgery
- Negative prognosis: MG, Metastasis, and moderate to marked cellular pleomorphism
70
A recent study evaluated an IMRT weekly hypofractionated RT protocol (total dose: 30Gy) for rabbits with thymoma. The PFS was _____, MST was _____, and GTV only significantly reduced after the _____ fraction at an average of ____%.
- PFS: 18mo
- MST: 21mo
- 1st fraction at average of >50%
71
A recent study evaluated outcomes of dogs with thymoma treated with SBRT or non-modulated hypofractionated RT. What were the PFS and MST between the two and the risk of side effects?
PFS:
- SBRT: 4mo
- NMRT: 5mo
MST:
- SBRT: 8mo
- NMRT: 5mo
AE:
- SBRT: 25%
- NMRT: 70%
72
Retrospective study evaluating Palladia for treatment of canine carcinomatosis and mesothelioma found a best overall response rate of ___% with a CR rate of __% and PR rate of ___%. SD found in ___%. PFS was ____ and MST was ____. When evaluating dogs with effusion, PFS was ____ and MST was ____.
- BORR: 30%
- CR: 13%
- PR: 17%
- SD: 60%
- PFS: 6mo
- MST: 10mo
- PFS (effusion): 6mo
- MST (effusion): 9.5mo
73
A recent retrospective study evaluated 27 dogs with presumed or confirmed aortic body chemodectomas treated with Palladia and found a CB of ___% and MST of ____%. Another study of dogs with heart base tumors treated with Palladia reported a MST of ____, MST of _____ for dogs with metastasis, an ORR of ____%, a RR of ____% for dogs with metastasis, ____% improvement in clinical signs and ____% resolution of clinical signs.
1st study:
- CB: 90%
- MST: 16mo
2nd study:
- oMST: 27mo
- MST w/ met: 18mo
- ORR: 10%
- RR w/ met: ~30%
- 90% improved CS
- 80% resolution of CS
74
A recent study evaluated conventional fractionated (50Gy in 20 fractions) and SRT (30Gy in 5 or 24Gy in 3) for treatment of suspected heart-base tumors in 8 dogs. oMST was _____ with NO difference between RT protocols. ___% of symptomatic patients had improved clinical signs, and ___% of evaluated patients had reduction in tumor size. Another recent retrospective evaluating SBRT (mostly 10Gy x3) in 26 dogs with heart base tumors found a MST of ____, PR of ____%, and _____ as only AE. Negative prognostic factors included ________, _________, _______ and _______. Lastly, a slightly older (2018) study in 6 dogs with heart base tumors treated with SBRT (3 x 10Gy) found a tumor volume reduction by ____-____%, possible AEs included _______, _______, ______ and ______.
1st study:
- oMST: 26mo
- 83% improved CS
- 80% had reduction in size
2nd study:
- oMST: 13mo
- PR: 25%
- pneumonitis
- neg prog factors: vena caval obstruction, SVT and ventricular arrhthymias, clinical signs, enlarged RLN
3rd study:
- tumor volume reduced by 30-76%
- cough, tachyarrhythmias, CHF, sudden death
75
Administration of a single ____Gy fraction of RT to dogs with right atrial masses and concurrent pericardial effusion appears safe and has shown to decrease frequency of palliative pericardiocentesis.
12Gy
76
What is the MST of dogs with cardiac HSA treated with surgery and adjunctive DOX-based chemotherapy vs. surgery alone?
MST:
- Sx + DOX: 6mo
- Sx alone: 1mo
77
What is the RR of dogs with cardiac HSA treated with DOX alone? What is the PFS and MST for responders?
- RR: 41%
- PFS: 2mo
- MST: 4-5mo
78
TVT can be diagnosed in dogs by identifying the ______ gene sequence with _____.
- LINE-c-myc
- PCR
79
The disease course of TVT in dogs includes a progressive, stationary and regressive phase. In the progressive phase, tumor grows for 3-6mo. Initially, tumor downregulates _________ to evade T cell cytotoxicity by producing high levels of ____. _____ cell is targeted and damaged by TVT cells. Late in the P phase, TILs produce high concentrations of ___, which act synergistically with _____ to antagonize the immunoinhibitory activity of ______ and results in ______ expression in up to ____% of tumor cells and restores NK cytotoxicity. The stationary phase can last ____ or _____. In the regressive phase, a critical threshold level of ____ is secreted by TILs and the tumor spontaneously regresses.
Progressive phase:
- downregulation of MHC class I and II by production of TGFB1
- Targets/damages DCs
- TILs produce IL-6 which act synergistically with IFN-gamma which antagonizes TGFB1 resulting in MHC expression in up to 40% of tumor cells
Stationary phase:
- can lasts for months or years
Regressive phase:
- critical threshold level of IL-6 produced by TILs
80
Most frequent mutations in mesothelioma involve inactivation of TSGs ____, _____ and _____. Production of ____ and ____ may aid in pathogenesis.
TSGs:
- CDKN2A
- BAP1
- NF2
- PDGF and VEGF
81
Mesothelioma can appear as ____, ____ or ______ on histology.
epithelial, mesenchymal, or biphasic
82
Blood monocytes can differentiate into macrophages under the influence of ____ or dendritic cells under the influence of ____ and ______.
- macs: M-CSF
- DCs: GM-CSF and IL-4
83
***Langerhans cells express ____ and dermal interstitial DCs express ______ (how to differentiate them).
- LC: E-cadherin
- dermal iDC: Thy-1 (CD90)
84
The successful interaction of DCs and T cells in response to antigenic challenge also involves the orderly appearance of costimulatory molecules on DCs: _____ and ______ apart of the ____ family, and ligands on T cells: _____ and ______.
- DCs: CD80 and CD86 (B7 family)
- T cells: CD28 and CTLA4
85
***Defective interactions of DCs and T cells appears to contribute to the development of __________.
reactive histiocytosis
86
***Iba-1 is expressed by what type of cells? _____ and ______ are macrophage class A scavenger receptors largely expressed by macrophages in normal tissue.
- Iba-1: macs and DCs
- CD163 and CD204
87
Regression of cutaneous histiocytoma is mediated by what type of cells?
CD8+ alpha-beta T lymphocytes
88
If multiple or metastatic histiocytomas are present, this is usually classified as ___________.
Langerhans cell histiocytosis
89
Cutaneous Langerhans cell histiocytosis is usually limited to the skin in what dog breed?
Shar pei
90
What is the first line therapy for cutaneous histiocytosis in dogs?
systemic corticosteroids
91
***A haplotype spanning _____ and part of _____ was identified in 96% of BMD with HS.
MTAP
CDKN2A
92
A gain of function mutation in _____ was identified in ____% of BMD with HS and ___% in other breeds.
- PTPN11
- BMD: 37%
- Other breeds: 9%
93
FCR are ___x more likely to develop localized HS compared to BMD, and BMD are ___x more likely to develop disseminated HS compared to FCR.
7x
2x
94
What IHC panel is recommended to differentiate PAHS from synovial cell sarcoma?
CD18, cytokeratin, and SMA
95
_____ is a marker that can be used to evaluate both FFPE samples and air-dried cytology samples for diagnosis of HS.
CD204
96
What is the response rate of measurable HS to epirubicin?
~30%
97
***______ is a neoplasm of DC in cats that occurs initially on the skin and progresses over time to involve multiple organs. Where do skin lesions predominate? What is the median progression period? Is there a sex predilection? What is the treatment?
- feline progressive histiocytosis
- head, feet, legs
- median progression: 13mo
- females > males
- no effective medical treatment, NOT responsive to steroids
98
______ is found on electron microscopy and may be used to diagnose pulmonary Langerhans Cell Histiocytosis in cats.
Birbeck's granules
99
***_______ is associated with a poor prognosis in humans with histiocytic neoplasia, similar to dogs.
hypoalbuminemia
100
Recently, a paper reported a MST of ____ in cats with histiocytic sarcoma and _____ in cats with progressive histiocytosis.
- 5 months
- 16 months
101
A recent study evaluated nimustine for treatment of histiocytic sarcoma in 11 dogs in the primary or adjuvant setting. What was the median dose? What was the MST in the primary and adjuvant settings? What were the two most common AEs?
- dose: 25mg/m2
- MST primary: 4mo
- MST adjuvant: 13mo
- neutropenia > mild GI
102
A recent study evaluated doxorubicin for treatment of histiocytic sarcoma in 31 dogs in the primary or adjuvant setting. What was the ORR? RR for localized and disseminated? TTP and MST?
- ORR: 26%
- RR localized: 43%
- RR disseminated: 21%
- TTP: 1mo
- MST: 6mo
103
What is the MST of dogs with localized splenic HS treated with splenectomy +/- CCNU? What is the met rate?
- MST: 14mo
- met: 36%
104
_____% of flat coat retrievers with localized PAHS treated with palliative intent radiotherapy +/- chemotherapy had improvement in their lameness. What was the most common joint?
- 82%
- shoulder
105
***The outcome for 49 dogs with periarticular HS treated with RT or surgery as primary treatment was compared. All dogs received adjuvant chemotherapy. Was there a significant difference between the treatment groups? What were the TTP and MST b/w each group and the negative prognostic factors in this study?
- no sig difference
TTP:
- RT + chemo: 7mo
- sx + chemo: 11mo
MST:
- RT + chemo: 8mo
- sx + chemo: 13mo
- neg prog factors: LN or distant metastasis increased risk of progression and death
106
***What is the MST of dogs with localized primary pulmonary HS treated with curative-intent surgery and adjuvant CCNU?
MST: 14mo
107
What is the MST of miniature schnauzers with HS (mostly pulmonary/mediastinal)? What is the PR rate and clinical improvement rate to CCNU as sole therapy?
- MST: 4mo
- PR: 83%
- improvement: 85%
108
_____, _____, ____, and ____ have been shown to be overexpressed in HSA compared to hemangiomas or normal tissue.
pRB, cyclin D1, Bcl2, and survivin
109
Dysregulation of angiogenic pathways resulting in abundant expression of what factors in canine HSA?
VEGF, bFGF, PDGR, ANG2, Endothelin-1
110
_____ and _____ are the most common site of HSA in cats.
cutaneous and visceral
111
50% of cats with visceral HSA in one study had an elevated ____ on bloodwork.
AST
112
***_____, ______, and ______ are associated with microangiopathic-associated damage, vasculitis, and acute hemorrhage.
schistocytes, acanthocytes, nRBCs
113
What are potential biomarkers for canine HSA?
- VEGF
- bFGF
- cardiac troponin 1
- thymidine kinase
- collagen XXVII
114
Dogs with HSA treated with DOX, Cytoxan, and L-MTP-PE have a MST of ____ compared to ______ treated with DOX and Cytoxan alone following splenectomy.
MST:
- w/ L-MTP-PE: 9mo
- w/ out: 6mo
115
Treatment of dogs with splenic HSA with eBAT, a bispecific EGF-urokinase angiotoxin, before DOX resulted in a MST of __ and 6-month survival of ____%, which was significantly improved compared to DOX alone.
MST: 9mo
6-month survival: 70%
116
***Does Palladia improve DFI or MST in dogs with stage 1 and 2 HSA after splenectomy and DOX?
Nope
117
What is the MST of dogs with HSA treated with DOX and DTIC combo therapy?
MST = 18mo (not all were splenic)
118
