Other presentations of High Grade
Lymphoma Dogs & Thymomas in Dogs/Cats & Lymphoma Look-A-Likes!
Lymphoma Dogs & Thymomas in Dogs/Cats & Lymphoma Look-A-Likes!
Primary intestinal high grade lymphoma outcome in dogs
What is: Dogs with primary intestinal high grade lymphoma don't do well. Surgery may be an option. We tend to rule out surgery for lymphoma dogs, but the exception may be for primary intestinal mass. With chemo alone, median survival time is ~ 2 months. Surgery seems to better with more than 2 months but probably less than 1 year.
1.) For the most part, histologies for Hemangiosarcoma, Histiocytic sarcoma, and Osteosarcoma are very aggressive cancers, meaning they have a high _______ potential. Each also has a subset with a more favorable outcome despite being highly metastatic cancers.
2.) This type of bone cancer is the most common in dogs.
3.) Reason why it's important to distinguish between osteosarcoma versus chondrosarcoma in a dog with cancer affecting its bones.
1.) What is metastatic
2.) What is Osterosarcoma
3.) What is Chrondrosarcoma has MUCH BETTER prognosis and median survival times than Osteosarcoma!
1.) True or False. We mostly see osteosarcoma in middle-aged dogs, but don't rule it out necessarily in a young dog.
2.) Common staging process for working up an osteosarcoma case in a dog
3.) Although performed on a case by case basis, this is the reason we don't often perform abdominal imaging or skeletal imaging when working up a case (staging) for osteosarcoma in a dog.
1.) What is True
2.) What is: Radiographs of affected limb, Thoracic imaging (radiograph or CT) to look for lung metastasis, Palpate regional LNs - FNA if abnormal because LN metastasis has a much worse prognosis than lung/other bone metastasis.
3.) What is: Mets can go to abdomen but its rare. You’ll get a suspicious of polyostotic lesions on P.E. and how they patient is moving. Multiple bones are affected in up to ~10% of patients, so you don’t need to have a high level of suspicion and pursue skeletal imaging in most cases since it doesn't happen as often and you may be able to tell from P.E.
1.) This kind of drug should be considered for bone pain, and when they work great, you see visible improvement in comfort/use of the limb within several days of the first treatment for osteosarcoma dogs.
2.) Immunotherapy is an expensive treatment option for osteosarcoma in dogs. Reason it's important to have it planned ahead of time, before surgery, that you're going to do immunotherapy on your patient.
1.) What is Bisphosphonates
2.) What is: Personalized immunotherapy, meaning it utilizes the patient’s tumor. Must plan on this pre-op so that the surgeon doesn't destroy/get rid of the tumor piece you need to do immunotherapy.
1.) Most likely way you're going to see a hemangiosarcoma without actually seeing the hemangiosarcoma.
2.) Hemangiosarcoma is most common in this species.
3.) Reason that visceral hemangiosarcoma most often presents as emergency.
4.) Most common primary organ site for visceral hemangiosarcoma.
1.) What is Hemoabdomen
2.) What is Dogs
3.) What is Due to hemorrhage
4.) What is Spleen
Hepatosplenic lymphoma consists of a special type of nasty T cell (gamma delta T cells) that has a median survival time of ~63 days WITH treatment. Tonsillar lymphoma have short remissions and dogs don't do great. Lymphoblastic leukemia has guarded to grave prognosis. Colorectal lymphoma compares to the above types of lymphoma in that...
What is: Dogs with colorectal lymphoma can do well after chemo treatment alone, with a median survival time of 2-3 years!
1.) True or False. Bone cancer can be primary or secondary metastasis.
2.) These dog breeds are going to commonly be seen with appendicular osteosarcoma. Going further, these breeds seem to have some genetic link/predisposition even though it's not something we can prevent or use to predict outcome currently.
3.) If you're examining a dog you're not sure if they just get hurt or if there is something bigger going on: if there's muscle _____ on that limb, then it's been going on longer, so be very sensitive to that. Because they can subtly change how much they use the affected limb for a while before it's obvious to the owner.
1.) What is True
2.) What is: Any breed, but particularly medium-large breed dogs. Genetic predisposition: 'Hounds' (deer hound, wolfhound, greyhound), Rottweiler, and Great Dane
3.) What is: atrophy
1.) Rate of metastasis in dogs with osteosarcoma and the percentage of those you'll typically be able to detect upon presentation.
2.) Common metastasis locations of osteosarcoma in dogs
3.) List a few negative prognostic factors for osteosarcoma in dogs
4.) Primary treatment strategy for dog with osteosarcoma (especially in the absence of measurable metastasis)
5.) Contraindication(s) for amputating a dog's leg with osteosarcoma
1.) What is: 90% of patients WILL develop metastasis. Only 10% have detectable metastasis at diagnosis.
2.) What is: Lungs/other bones are more common than lymph nodes.
3.) What is: LN metastasis at diagnosis. Humerus location. Elevated ALP (though not payed too much attention to), Young dogs (<5 YO), Metastasis
4.) What is: Amputation
5.) What is: If there are detectable/measurable pulmonary metastases, do not amputate because those metastases are probably going to be aggressive and fast. And you probably won't really have a lot of time anyway, so it's probably not worth it. Grave prognosis.
1.) If we see a primary axial osteosarcoma, usually the prognosis is ______ because we have have less options to deal with the primary tumor itself.
2.) Surgery or Radiation? Most likely treatment option for osteosarcoma on a vertebral body tumor.
1.) What is Guarded
2.) What is: Radiation (not likely going to be able to remove it via surgery)
1.) Most of the type hemangiosarcoma is going to present as visceral in the form of a _________.
2.) You can see hemangiosarcoma present in a variety of different ways: Visceral (spleen, liver, kidney, retroperitoneal, heart), SQ/IM, or even ________ (as very superficial little blood blisters or diffuse superficial little red stuff presumably solar induced).
1.) What is Hemoabdomen
2.) What is Cutaneous
1.) Explain what to do after you aspirate a cranial mediastinal mass in a DOG and get lymphocytes on cytology
2.) 5 ways to characterize lymphocytes (like figure out who or what they are)
1.) Flow cytometry to find out who the lymphocytes are because thymomas have a unique double signature on flow cytometry (>10% coexpression of CD4 and CD8) in DOGS (not cats)
2.) Cytology, Histopathology, Immunostaining, Flow cytometry, PCR for Antigen Receptor Rearrangement (PARR) a.k.a. Clonality Testing
1.) When looking on a radiograph, these are the characteristics of locations we might see long bone osteosarcoma.
2.) If you see a tumor that is associated with a previous implant or fracture site, then this bone cancer is at the top of your differential list.
3.) Reason might prefer to do a bone FNA to diagnose a osteosarcoma in a dog instead of a bone biopsy (if you're not already in surgery and could just grab a piece of bone for biopsy).
1.)What is: ”Away from the elbow, toward the knee”. Front limbs are 2x more likely than hind limbs. Can be proximal humerus, but distal radius is most common. Metaphysis most common. Should not cross joints.
2.) Osteosarcoma
3.) Bone biopsy has a fracture risk that is concerning, and it has relatively low sensitivity. Whereas, a bone FNA can get you a diagnosis 70-80% of the time.
1.) Osteosarcoma lesions are very _____, so amputation surgery sometimes provides immediate pain relief as palliative treatment and can also be performed as a primary treatment option.
2.) Median survival time of a dog with osteosarcoma that underwent amputation
3.) Median survival time of dog with osteosarcoma that underwent Amputation or Limb sparing + Chemotherapy
4.) Median survival time of dog with osteosarcoma that underwent palliative radiation
1.) What is painful
2.) What is 4 months
3.) What is ~10 months
4.) What is 3 months
1.) This is prognosis for a primary rib osteosarcoma in a dog.
2.) The prognosis for a primary rib osteosarcoma in a dog is horrible. It's unusual to be small enough that you actually have a shot at removing it. We can do rib/tumor resections, like big thoracic resections, but often when you find an osteosarcoma, it's huge already or there's a lot intrathoracic involvement (not so much that you can see on the outside), and even with aggressive treatment, outcomes are usually _ _____ or less in dogs.
1.) What is: Horrible
2.) What is: 6 months
1.) This type of cancer is NOT a “soft tissue sarcoma” due to its HIGHLY malignant behavior (*Hint: It also has the tendency to bleeeeeeed!)
2.) This is common surgical strategy for managing cutaneous hamangiosarcoma in dogs.
3.) Cardiac presentation of hemangiosarcoma is going to present as __________.
4.) You may achieve diagnosis of SQ/IM hemangiosarcoma forms with FNA, but these things tend to bleed so the sample may be too bloody/hemodilute. Proceed with caution if you're considering doing a biopsy for a blood skin mass due to these reasons.
1.) What is: Hemangiosarcoma
2.) What is: It's not realistic to get rid of all the little red thigs because it's too diffuse, so take of the big one(s) as they come and monitor the rest
3.) What is Pericardial effusion
4.) What is: Hemorrhage risk (and I guess regional contamination)
1.) Differentials for subcutaneous lymphoma in dogs
2.) Differentials for Chronic Lymphocytic Leukemia (especially in the beginning)
1.) What is: Non-neoplastic dermatopathy and Mast cell tumor
2.) What is Tick-borne diseases
1.) 3 common clinical presentations for appendicular osteosarcoma in a dog.
2.) Interestingly, a lot of the time in pathologic fracture situations from osteosarcoma, the lesion is not necessarily super visible even on your X-ray. Sometimes they're a little more ____ than proliferative. And so sometimes you're in a situation where you honestly don't know if you're repairing over a ____ or not. That's a risk. And if you have a suspicion, and you're going to do the repair, grab a piece of the bone and submit it for _____.
3.) Common radiographic appearance of an osteosarcoma
1.) What is: 1. Super common that a dog will come in with a lameness for a few days, that they were out playing hard or they got knocked sideways or something happened and they came up lame, and they haven't ever had any lameness before. 2. Pathologic fracture (fracture after minor injury, like "my dog fell off the couch and broke his leg" - be very suspicious!). 3. Recurrent/progressive lameness
2.) What is: lytic, tumor, biopsy
3.) What is: Mixed proliferation/lysis at primary site. Cortical bone destruction, so the cortex is thin/non-existent. Irregular new bone proliferation, so the lesion looks ugly.
1.) Dogs develop a variety of histiocytic conditions: A.) This condition is benign and usually regress spontaneously. B.) This condition has various reactions, is poorly understood, and more common in cats. C.) This condition is aggressive malignancy.
2.) We can do limb spares depending on the ______ in dogs with osteosarcoma. The _____ is the most common location where you could remove physically the tumor and put it in a spacer and plate over it. Stereotactic radiation therapy is actually very commonly used now as a limb spare. However, the integrity of the bone in that area from the tumor is certainly disrupted. So most people are preemptively plating across that tumor for structural support, and then they're radiating the heck out of the tumor trying to kill it.
3.) Amputation is probably better than limb sparing on osteosarcoma dogs for these reasons.
1.) What is: A.) Histiocytoma B.) Histiocytic syndromes C.) Histiocytic sarcoma
2.) What is: location, radius
3.) Dogs frequently are chronically lame after limb spare, and there is a risk of serious complications such as implant infections, implant failure, and fracture (all of which could be catastrophic if it occurred). If amputation is tolerable, that is definitely the preferred intervention (and the simplest).
1.) Extraskeletal osteosarcoma, it is a bone tumor, but it's not involving the bone. You can see osteosarcoma of soft tissues. This is the most common location.
2.) Interestingly, osteosarcoma of the mandible appears to have a much _____ prognosis and a much ____ metastatic rate. It's still 60%, but that's way better than 90%. One publication had them have an average survival time of about 18 months.
1.) What is Mammary.
2.) What is: better, lower
1.) In the staging realm of hemangiosarcoma, especially presenting as hemoabdomen, this is the purpose of ultrasound.
2.) True or False. Abdominal ultrasounds are great for identifying metastasis pre-op.
1.) What is Find the source of bleeding (is it 1 or multiple) and see if it's surgical
2.) What is: False. Appears minimally useful to ID small metastatic lesions in hemoabdomen; the sensitivity of ultrasound to identify metastasis pre-op in a hemo abdomen is very, very, very low.
Differentials for a clonal lymphocytes from a Clonality Testing (or PARR)
Cancer! (Ehrlichia and Rocky Mountain Spotted Fever/Rickettsia rickettsii sometimes)
A bone FNA to try and diagnosis osteosarcoma is going to be a different process for aspirating. For bone, you wanna use a _____ needle. You aim your needle based on the mass location on your X-ray because you can't necessarily feel this lesion. You feel it with your needle tip. ______ bone is super smooth and firm, so a needle won't advance through it. When you stick a needle into a bone tumor, it's a little crunchy and squishy and softer and kind of gross, honestly. You usually will be able to seat the needle into that diseased bone. And then you absolutely will use _____ aspiration (this is not a lesion where you're gonna like do a little woodpecker). This is a lesion where you kind of get it in there and then pull back a few times. You want to see a tiny bit of serous fluid coming up into the hub; you're not trying to get a bunch of fluid though. And then you'll let off the pressure, pull the whole needle out, and put the contents on slides. You're not likely going to get a diagnosis specifically of osteosarcoma off of a cytology, but you're likely to get ________. And then some labs can actually add an alkaline phosphatase stain to confirm osteosarcoma versus not.
What is: bigger (needle), Healthy (bone), active (aspiration), sarcoma
1.) We usually recommend this in dogs with osteosarcoma in order to prolong the tumor-free time in a patient.
2.) We typically use this chemotherapy drug during treatment in osteosarcoma dogs
3.) Main goal for palliative care in osteosarcoma dogs
4.) 4 palliative care options for osteosarcoma dogs
1.) Chemotherapy
2.) Platinum
3.) Reduce bone pain
4.) Amputation (for palliative pain management), Bisphosphonates, Radiation therapy, Oral pain management
Not every bone tumor is osteosarcoma. Another differential could be chondrosarcomas, which have much, much better outcomes. These are the 2 most common locations for chondrosarcomocas.
What is: Ribs and Long bones
Splenic hemangiosarcoma: There are differences in opinion when you're in there, when you're doing the surgery about whether you routinely take a liver biopsy or not. I am a fan of the routine liver biopsy. We've diagnosed a lot of dogs with microscopic metastatic disease in the liver that wasn't visible grossly. Similarly, a lot of lesions that get biopsied at the time of surgery might not be metastatic, so it's useful information. It is possible for chemotherapy to control small metastatic lesions for a period of weeks to months. So, we're gonna usually recommend _________ following _________ because it prolongs survival. And for stage 3 dogs where they have measurable disease elsewhere, they may still do okay.
2.) Reason we tend not to get a diagnosis of cardiac hemangiosarcoma and often lead toward a presumptive diagnosis
3.) General prognosis for cardiac hemangiosarcoma and general treatments applied for palliative care.
1.) What is: chemotherapy, splenectomy
2.) What is: Not likely to get a sample most of the time (mass not seen on ultrasound, difficult location, etc.) and you're not likely to get a diagnosis out of the effusion.
3.) What is: They can be palliated with chemotherapy or radiation for a period of months (MST ~ 4 months) and do okay.