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Onco 6 HSA

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sihirlifil's version from 2018-05-01 21:05

Intro & Canine

Question Answer
(Poster child of hemangiosarcoma)(10-y-o MI GSD, 2d hx of weakness, lethargy, pale mucous membranes)
What do if suspicious of HSA?Stabilize patient!
Complete PE
CBC/Chem/UA
Rectal!
Thoracic rads (3 views)
Abdominal rads +/- US
+/- FNA, biopsy, advanced dx imaging, histopath
**Are additional dx usually done?Not going to change tx! Also sarcomas have low cytologic yields
(What additional diagnostics can be done?)Coag profile
Abdominocentesis?? (Might be cavitary? might hit spleen?)
ECG
How can US be useful?Can see mass, free fluid (tell parents how bad the tumor is)
What do we tell mom & dad?Pretty bad just b/c of origin… blood cells float everywhere
What is HSA?Malignancy of vascular endothelial origin
Aka angiosarcoma, malignant hemangioendothelioma
HSA occurs more freq in who?DOGS! (0.3-2% of all tumors!)
(5% of noncutaneous 1ry malignant tumors, 12-21% of all mesenchymal neoplasms, 2-4% of skin tumors, 45-51% of splenic malignancies)
Etiology of HSAUnknown! Breed association suggests genetic predisposition
Most common locations of HSASpleen 28-50%
Right atrium 3-50%
SubQ 13%
Signalment of visceral HSAAffects almost every dog breed (GSD, golden & lab)
Mid-aged to older dogs, slight male predilection
HIGH fatality
Is HSA metastatic?HIGHLY! Hematogenously/local seeding after tumor rupture --> Liver, omentum, lung, kidney, brain, bone, muscle
Possible presentation?Solitary
Multifocal within an organ
Widely disseminated
Ddx for solitary splenic massesHSA
Hematoma
Hemangioma
Other sarcomas
MCT
(Lymphoma)
What is the ‘Double 2/3 rule’About 2/3 of dogs w/ splenic masses will have a malignant tumor, and 2/3 of those will be HSA
Does size matter?Larger masses are more likely to be BENIGN!
Can still behave malignantly… rupture! Bleeds, can’t stop, so still need sx
CS of HSADepend on location, vague. Usually associated with tumor rupture
Acute collapse, episodes of unexplained weakness, anemia/pale mucus mb, abdominal distention, tachypnea, sudden death
Diagnostic tests for HSAPE, CBC/Chem/UA, Thoracic rads, abdominal rads & US, Echo, histopath
NO CYTOLOGY! doesn’t exfoliate!
What are CBC results like?Anemia
RBC indices: NRBCs, schisocytes, acantocytes
Thrombocytopenia (consumption, microangiopathy, hge)
Spontaneous bleeding, DIC (thrombocytopenia, prolonged coagulation times, increased FDP, increased D-dimer, decreased fibrinogen)
Leukocytosis (LS, monocytosis)
What’s this?
Acanthocytes (altered hepatic lipoprotein metabolism?)
What’s this?
NRBCs (early BM release, or splenic dysfunction)
What’s this?
Schistocytes (Microangiopathic)
(Clinical staging for canine HSA)
TOC for visceral HSASurgery! Splenectomy alone or + Doxorubicin
Survival Splenectomy alone86 day MST. 6% 1 year (stage I & II)
Survival Splenectomy + Doxorubicin141-179 day, <10% survived 1 year
Chemotherapy options for visceral HSAVAC Protocol 180d
AC protocol 179d
Doxorubicin alone
Survival Doxorubicin alone172 day MST if no tumor after sx, 60d if tumor still present. 20% survive 1 year if successful surgery (fewer SEffx, cost, & time constraints)
What’s the protocol for Doxorubicin tx?Every 2 weeks, rather than every 3w for 5 tx. Well tolerated, similar efficacy (257, 210, and 107-day MST for stage II, II, III respectively)
Signalment of cutaneous HSADogs w/ minimal pigmentation, thin hair coats
UV light exposure!
Better prognosis for pure cutaneous or dermal
(Breed predilections for cutaneous HSA)(Whippets, Salukis, Bloodhounds, English pointers, white bulldogs, Beagles)
Prognosis Cutaneous HSASurgical excision is curative
2+ year survival
Prognosis SubQ/intramuscular HSASurgical excision & adjuvant chemo = 6 months :/
Signalement of cardiac HSAMost common heart base tumor
Older dogs (10y), GSD overrepresented (Afghan hounds, Cocker spaniels, Dobies, English setters, Lab retrievers, mini poodles). Intact males > intact females
Is cardiac HSA metastatic?HIGHLY!
What dis
Cardiac HSA
CS of cardiac HSAAcute collapse, cardiac tamponade, lethargy, weakness, sudden death
Tx of cardiac HSASurgery +/- chemo
Survival Cardiac HSA4 months
Surgery + chemo MST = 175d
Surgery alone MST = 42d
What’s this, why is it done?
Pericardectomy may improve survival of cardiac HSA
Other sites for HSA
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Feline

Question Answer
Most common sitesCutaneous > visceral
Mesentary most common of visceral
Behavior of cutaneous HSALess aggressive! Invasive cutaneous/subQ behaves like soft tissue sarcoma
Locally aggressive, local recurrence
Behavior of visceral HSAHIGH metastatic rate --> liver, omentum, diaphragm, pancreas, lung
Signalment of feline HSAOlder (8-12y)
DSH, white hair coat. +/- male predilection
CS of cutaneous HSAUlceration, lameness, subQ bleeding
CS of visceral HSACollapse, dyspnea, episodic weakness, abdominal distention (not as frequent)
What kind of treatment protocol should be considered?Surgical excision & doxorubicin-based for ALL anatomic forms!
Does feline HSA metastasize?Visceral form highly metastatic
Prognosis for splenic/mesenteric HSA2-6 months (no proven efficacy to adjuvant chemo)
Prognosis for cutaneous HSA2 weeks-2 years. (curative)
(Canine & feline novel therapy)(Immunotherapy: L-MTP-PE
Antiantiogenesis: vascular entothelial growth factor (VEGF) (Avastin), FBF, PDGF, integrins; drugs inhibiting endothelial cells (endostatin, antiostatin, thalidomide…); nonspecific angiogenesis inhibitors e.g. COX-inhib)
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