DROOGS
An 8-year-old Golden Retriever is presented for generalized peripheral lymphadenopathy. Fine-needle aspirates from multiple lymph nodes reveal a monomorphic population of large lymphocytes. Thoracic radiographs are normal.
Which of the following treatment protocols is most likely to provide the longest median survival time?
A. Prednisone alone
B. Cyclophosphamide, doxorubicin, vincristine, and prednisone
C. Cyclophosphamide, lomustine, vinblastine and prednisone
D. Cyclophosphamide, doxorubicin and lomustine
B.
A 9-year-old Golden Retriever is presented for evaluation of a progressively enlarging, firm, ulcerated mass arising from the rostral maxillary gingiva. The owner reports occasional bleeding from the mouth and halitosis. Thoracic radiographs have not yet been performed.
Which three neoplasms should be considered the most common malignant oral tumors in dogs?
A. Fibrosarcoma, osteosarcoma, and mast cell tumor
B. Osteosarcoma, melanoma, fibrosarcoma
C. Melanoma, soft tissue sarcoma, and squamous cell carcinoma
D. Melanoma, squamous cell carcinoma, and fibrosarcoma
D. Bonus: What staging diagnostic should you prioritize?
Extra Bonus: Which neoplasm has an available vaccine?
A 10-year-old Scottish Terrier presents with pollakiuria, stranguria, and hematuria. Urinalysis reveals hematuria but no evidence of bacterial infection. Abdominal ultrasound reveals irregular thickening of the bladder wall near the trigone, and urothelial carcinoma is suspected.
The owner is concerned about invasive diagnostic procedures. Which of the following is the most appropriate use of BRAF mutation testing?
A. It confirms malignancy and replaces the need for histopathology in all cases.
B. It is used to determine chemotherapy sensitivity.
C. It can detect a mutation commonly associated with canine urothelial carcinoma using urine samples and can support the diagnosis when tumor cells are not obtained.
D. It identifies whether the tumor will metastasize to the lungs.
C. Bonus: What other neoplasia can you use the BRAF test for?
Extra Bonus: What % of dogs that have UC have this mutation?
Name the three most common side effects from chemotherapy
Bone marrow suppression
Alopecia
GI signs
Bonus: How many days after chemo administration would you expect to see a neutropenia?
Name the 6 round cell tumors
Mast cell tumor
Lymphoma
Plasmacytoma
Histiocytoma
TVT
+/- Melanoma
Bonus: Why is melanoma so special?
A 10-year-old Scottish Terrier presents with pollakiuria, stranguria, and hematuria. POCUS reveals a urinary bladder mass. You suspect transitional cell carcinoma (urothelial carcinoma).
Which of the following medications is most appropriate to prescribe at this time because it provides clinical benefit without interfering with potential future treatments or diagnostic evaluation?
A. Prednisone
B. Amoxi-Clav
C. Piroxicam
D. Lomustine (CCNU)
C. UC overexpress COX2 -> Improves peritumoral inflammation and comfort
Bonus: If you DON'T see an evident bladder mass, what PE finding can make you more suspicious it is TCC?
An 8-year-old Golden Retriever is diagnosed with Multicentric B-cell lymphoma. Staging reveals no evidence of distant metastasis, and the owners elect to pursue a CHOP protocol consisting of cyclophosphamide, doxorubicin, vincristine, and prednisone.
The owners ask, "What can we realistically expect if we proceed with chemotherapy?"
Which of the following is the most appropriate response?
A. "About 50% of dogs go into remission and the median survival time is approximately 6–12 months."."
B. "About 80% of dogs go into remission and the median survival time is approximately 10–14 months."
C. "About 90% of dogs go into remission and the median survival time is approximately 20–24 months."
D. "Median survival is approximately 2 years, but most dogs experience severe chemotherapy-related side effects."
B. Bonus: What about with no treatment?
Extra bonus: What about with just pred?
A 5-year-old French Bulldog presents for acute collapse and a distended abdomen. POCUS reveals a moderate amount of free abdominal fluid and a cavitated splenic mass.
Based on the most likely diagnosis, which additional CBC abnormalities would you expect?
A. Non-regenerative anemia, thrombocytosis, and spherocytes
B. Regenerative anemia, thrombocytopenia, and schistocytes
C. Neutrophilia, lymphocytosis, and thrombocytopenia
D. Leukopenia, thrombocytosis, and target cells
B. Hemangiosarcoma! My fav reason for hemoabdomen
Leaky, irregular vessels cause shearing of RBC = fragmentation anemia. Can be either regenerative or non-regenerative. Can also see acanthocytes and nRBCs
Bonus: What arrhythmia would you expect to see with hemangiosarcoma?
Which of the following clinical abnormalities may occur due to mast cell tumor degranulation?
A. GI ulcerations, perioperative hypotension, and coagulopathies
B. Hypercalcemia, polyuria/polydipsia, and hypertension
C. Bradycardia, hypoglycemia, and seizures
D. Pulmonary fibrosis, anemia, and thrombocytosis
A. Mast cells: histamine, heparin and other vasoactive amines.
Bonus: How do they cause those side effects?
Hyperparathyroidism
Osteolysis
Granulomatous
Spurious
Idiopathic
Neoplasia
Youth
Addisons
Renal disease
Drugs/Vit D toxicity)
Bonus: Name two cancers where you would see a hypercalcemia
A dog with a high-grade mast cell tumor is started on chemotherapy. Which vinca alkaloid is commonly used?
A. Vincristine
B. Vinblastine
C. Methotrexate
D. Cisplatin
B. BLAST that MAST
Bonus: Would you recommend chemotherapy for a completely surgically excised low-grade mast cell tumor?
A 10-year-old DSH cat is presented for evaluation of a newly discovered 2-cm subcutaneous mass on the lateral thorax. The owner reports that the mass has doubled in size over the past month. On physical examination, the cat is otherwise healthy.
Which of the following statements regarding this mass is most accurate?
A. Approximately 15-30% of skin and subcutaneous masses in cats are malignant.
B. Approximately 30-45% of skin and subcutaneous masses in cats are malignant.
C. Approximately 45–65% of skin and subcutaneous masses in cats are malignant.
D. Approximately 70-95% of skin and subcutaneous masses in cats are malignant.
D. Bonus: What is the statistic for dogs?
A 5-year-old Pitbull is presented for evaluation of a rapidly growing, irregular, ulcerated mass on the right shoulder. Fine-needle aspiration reveals round cells containing purple cytoplasmic granules.
Which of the following cell populations would be expected to be also seen on the same cytology?
A. Neutrophils and macrophages
B. Lymphocytes and macrophages
C. Neutrophils and eosinophils
D. Eosinophils and fibroblasts
D. Reactive fibroblasts and collagen strands are commonly seen due to local tissue reaction and collagenolysis induced by tumor degranulation
Bonus: What are the most common sites of distant metastasis for MCT?
Extra bonus: Which lymph node would you be most concerned for regional metastasis in this patient?
A patient undergoing CHOP chemotherapy for B-cell multicentric lymphoma develops pollakiuria and hematuria. Urinalysis reveals normal urine concentration, hematuria, and no bacteria on sediment examination.
What is the most appropriate recommendation?
A. Provide antibiotics for 14 days and recheck urinalysis
B. Discontinue all chemotherapy permanently
C. Discontinue cyclophosphamide and consider switching to another chemotherapy agent
D. Discontinue vinblastine and consider switching to another chemotherapy agent
C. Due to sterile hemorrhagic cystitis
Bonus: What drug is co-currently given during administration of cyclophosmadide to try to mitigate the side effects?
Regarding feline injection site sarcomas, what is the 3-2-1 rule?
Biopsy any injection-site mass that:
Persists >3 months after injection
Is >2 cm in diameter
Is increasing in size 1 month after injection
Bonus: What are the recommended surgical margins for FISS?
Extra bonus: What type of biopsy is recommended in order to definitely diagnose FISS before performing surgery?
Which of the following patients is at the highest risk of developing long-term adverse effects from doxorubicin administration?
A. A 7-year-old Scottish Terrier with T-cell multicentric lymphoma.
B. A 2-year-old Golden Retriever with splenic hemangiosarcoma.
C. An 8-year-old Doberman Pinscher with B-cell multicentric lymphoma.
D. A 10-year-old Pitbull with a surgically excised grade II soft tissue sarcoma.
C. Cumulative cardiodoxitiy: myocardial damage with potential to cause DCM
Bonus: What diagnostic is routinely to performed before administration of doxorubicin?
Extra Bonus: Doxorubicin is also know as these 2 other names
You are discussing risk factors for osteosarcoma with a group of dog owners. Which of the following patients has the highest risk of developing appendicular osteosarcoma?
A. A 2-year-old Labrador Retriever and a 10-year-old Great Dane
B. A 3-year-old Yorkshire Terrier and a 12-year-old Dachshund
C. A 8-year-old Beagle and a 9-year-old Mastiff
D. A 6-month-old Border Collie and a 14-year-old Chihuahua
A. Bimodal age distribution, large or giant breed dogs.
Bonus: Most common location?
Extra Bonus: Describe the lesion you would see
A 9-year-old Labrador Retriever has recurrent hypoglycemia (blood glucose 48 mg/dL). Serum insulin concentration is measured at the same time and is within the laboratory reference interval.
Which interpretation is most accurate?
A. Insulinoma is unlikely because insulin is normal.
B. The insulin concentration is appropriately suppressed.
C. Insulin concentration is inappropriately normal in the face of hypoglycemia, supporting insulinoma.
D. Diabetes mellitus is most likely.
C. Bonus: Name two medical treatments you would start if this patient came into the ER due to hypoglycemic crisis
Extra Bonus: What is the most common postoperative risk after removal of insulinoma?
A 7-year-old Pitbull with T-cell multicentric lymphoma is receiving a CHOP chemotherapy protocol. The patient presents to the ER for lethargy and inappetence 3 days after their first chemotherapy administration. He is quiet, alert and responsive with the following vitals: 100 BPM, 32 BRPM, 101.8°F. CBC reveals:
CBC:
What is the most appropriate treatment recommendation?
A. Increased Prednisone dose and recheck CBC in 7 days
B. No treatment is needed, continue to monitor for worsening signs
C. Hospitalize for IV broad-spectrum antibiotics and IV fluids
D. Send home with oral amoxicillin-clavulanate and recheck CBC in 7 days
D. Neutropenia:
<1K but feels good → send home with clavamox
<1K not feeling good, febrile → IV abx and IVF, stay until fever breaks
Within 24 hrs: Need to see them eat, No need to repeat CBC
Bonus: What is your recommendation if their HCT was 28%?
Name prognostic factors for lymphoma
1. Immunophenotype (T-cell vs B-Cell) Bonus: Which one is worse?
2. Clinical substage (a vs b) Bonus: Which one is worse?
3. Histopathologic grade
4. Anatomic location Bonus: Name 3 locations with worst prognosis
5. Prior corticosteroid treatment
Bonus: Describe the stages (1-5)
Match the drug with the toxicity
1. Doxorubicin
2. Cyclophosphamide
3. Cisplatin
4. Lomustine
5. Vincristine
6. L-Asparaginase
A. Sterile Hemorrhagic Cystitis
B. Peripheral neuropathy
C. Anaphylaxis
D. Cardiotoxicity
E. Fatal pulmonary edema
F. Hepatotoxicity
1. Doxorubicin - Cardiotoxicity
2. Cyclophosphamide - SHC
3. Cisplatin - Fatal pulmonary edema
4. Lomustine - Hepatotoxicity
5. Vincristine - Peripheral neuropathy
6. L-Asparaginase - Anaphylaxis
Hemangiosarcoma Speed Rounds!!!
1. Location from most common to least common
2. What percent of grossly abnormal livers contain metastatic HSA?
3. Name the stages
4. What is the 2/3 rule?
1. Spleen > heart (where specifically) > skin (cutaneous)
2. 50%
3. I: unruptured tumor; II: ruptured tumor, III: distant mets
4. 2/3 of splenic masses are malignant; 75% of those that are malignant are HSA
A 9-year-old Labrador Retriever presents with exercise intolerance, generalized weakness, and regurgitation. Thoracic radiographs reveal megaesophagus and a cranial mediastinal mass.
Which diagnostic test is most appropriate to confirm the suspected paraneoplastic syndrome?
A. Serum acetylcholine receptor antibody titer
B. Flow cytometry of the mediastinal mass
C. Serum parathyroid hormone-related peptide (PTHrP) concentration
D. ACTH stimulation test
A. Thymoma
Bonus: What is the drug of choice for long-term management of acquired MG in dogs?
A 9-year-old Great Dane presents for progressive lameness and swelling of all four limbs. The distal extremities are warm, painful, and firm. Radiographs reveal bilateral irregular periosteal new bone formation along the long bones. You diagnose hypertrophic osteopathy.
Which underlying disease is most likely?
A. Renal carcinoma
B. Mast cell tumor
C. Pulmonary neoplasia
D. Lymphoma
C. More than likely mets from OSA
Bonus: What is the proposed mechanism of hypertrophic osteopathy?
In order to diagnose multiple myeloma, you need at least 2 of the following:
1. Bone marrow plasmocytosis
2. Osteolytic bone lesions
3. Monoclonal gammopathy (ICC)
4. Bence-Jones proteinuria