Neoplasia 2

What is one of the most common neoplasms in the cat?

Feline lymphoma

Name THREE risk factors of feline lymphoma.

1. Tobacco smoke exposure

2. Immunosuppression (renal transpl.)

3. FeLV/FIV

What are the THREE ways feline lymphoma can be classified?

Anatomic location, cytologic/histologic, immunophenotype

What are the FOUR anatomic locations of feline lymphoma?

1. GI

2. Mediastinal

3. Extranodal

4. Nodal

What is the most common anatomic location of feline lymphoma?

GI

Name the THREE common extranodal locations of feline lymphoma and indicate which is the most common extranodal manifestation.

1. Nasal (most common non-GI)

2. Renal

3. CNS/laryngeal/tracheal/ocular/skin

True or False: Cats with GI lymphoma often present with nonspecific GI signs, like weight loss, anorexia, vomiting, and diarrhea that can be either acute or chronic in onset.

True!

What are TWO major PE findings consistent with most feline lymphoma cases in the GI?

1. Decreased BCS/muscle wasting

2. Thickened intestines/abdominal mass on palpation

What are the TWO main forms of feline GI lymphoma and what manifestation of lymphoma are they associated with?

1. Diffuse intestinal thickening- low grade, small cell

2. Discrete GI masses- aggressive, large cell

How do you diagnose either form of feline GI lymphoma?

1. Diffuse intestinal thickening- intestinal biopsy or cytology/PARR

2. Discrete GI masses- cytology or biopsy

What is the major ddx for either form of feline GI lymphoma?

1. Diffuse intestinal thickening- IBD

2. Discrete GI masses- MCT and adenocarcinoma

Which form of feline GI lymphoma is more likely small cell and T-cell in nature?

Diffuse intestinal thickening

Which form of feline GI lymphoma is more likely B and T-cell variants composed of intermediate to large cells?

Discrete GI masses

Which form of feline GI lymphoma is diagnosed usually with FNA and cytology?

Which is done with biopsy and histopathology?

FNA + Cytology: discrete GI masses

Biopsy + Histopathology: diffuse intestinal thickening

True or False: Unlike in dogs, immunophenotype is not prognostic of GI lymphoma like in dogs.

True!

What is the best way to treat HIGH grade feline GI lymphoma?

What is the MST?

CHOP-based protocols

MST: 6-9 months

When would be the only times you would recommend surgery for feline GI lymphoma?

Obstruction or perforation

What is the best way to treat LOW grade feline GI lymphoma?

What is the MST?

Prednisolone and chlorambucil

MST: 2 years +

What are the TWO most important prognostic factors of feline GI lymphoma?

1. Response to treatment

2. Grade

True or False: Mediastinal, nasal, and renal forms of lymphoma in cats are all usually high grade, large cell, aggressive neoplasms.

True!

What TWO clinical signs are consistent with mediastinal feline lymphoma?

Pleural effusion and dyspnea

What is the major differential diagnosis for mediastinal feline lymphoma?

Thymoma

How do you best diagnose mediastinal feline lymphoma?

Cytology of mass/fluid

What is the standard treatment for mediastinal feline lymphoma?

What is the major palliative option?

CHOP +/- radiation

Prednisolone

How does mediastinal feline lymphoma prognosis differ in young, FeLV + cats vs older, FeLV - cats?

Young, FeLV +: poor

Old, FeLV-: MST year with CHOP

True or False: Nasal feline lymphoma is the most common nasal tumor in cats.

True!

Name at least THREE clinical signs of nasal feline lymphoma.

Nasal discharge/epistaxis, sneezing, stertor, facial deformity, decreased flow, hyporexia, increased respiratory effort

True or False: The vast majority of nasal feline lymphoma cases metastasize and have systemic manifestations.

False! Most nasal feline lymphoma is LOCALIZED to the nasal cavity.

What are the TWO most important parts of a nasal feline lymphoma workup?

CT and nasal biopsy

What is the standard treatment for nasal feline lymphoma?

What is the palliative option?

RADIATION +/- CHOP

Prednisolone

What is the prognosis of nasal feline lymphoma?

1 year + with RT +/- CHOP

True or False: Renal feline lymphoma is the most common renal neoplasm in the cat and usually presents unilaterally.

False! Renal feline lymphoma is the most common renal neoplasm in the cat, but usually presents BILATERALLY.

True or False: Renal feline lymphoma usually presents with lethargy, inappetence, and weight loss. Azotemia can occasionally be seen on bloodwork.

True!

How do you treat renal feline lymphoma?

CHOP, pred palliative

What is the prognosis of renal feline lymphoma?

Poor- few months of survival despite chemo

What neoplasm originates in the bone marrow and can have systemic involvement, bulk the bulk of the disease remains in the marrow?

Leukemia

How do you differentiate a leukemic phase of lymphoma from leukemia?

Leukemic phase of lymphoma: giant lymph nodes, mild lymphocytosis

Leukemia: mild lymph nodes, marked lymphocytosis

What are the TWO major diagnostics of leukemia?

Bone marrow cytology and flow cytometry

True or False: Flow cytometry is useful in differentiating lymphoma type. It can be submitted off of whole blood or bone marrow in a lavender top. On blood, anything atypical is >10,000.

True!

Name the TWO major lymphoproliferative leukemias and indicate how they differ in classifcation.

1. Acute lymphoblastic (ALL): aggressive; large lymphocytes

2. Chronic lymphocytic (CLL): low-grade; indolent; small

Name the THREE major myeloproliferative leukemias and indicate how they differ in classification (for the major two).

1. Acute myeloid (AML): aggressive; large

2. Chronic myeloid (CML): low-grade; small

3. Polycythemia vera

What is needed to differentiate acute lymphoid vs myeloid origins?

Flow cytometry

True or False: Acute leukemias are often sick at diagnosis, have cytopenias secondary to myelopthisis, and may have involvement of lymph nodes, spleen, and liver.

True!

What is the prognosis of acute leukemias?

Poor- days to weeks even with chemo (TREAT ASAP)

What is the most common type of leukemia is dogs?

Canine Chronic Lymphocytic Leukemia (CLL)

True or False: CLL is often asymptomatic at diagnosis and mature, small cell lymphocytosis is usually seen on CBC. Mild splenomegaly or LN enlargement is typical.

True!

How do you treat canine CLL?

Active surveillance or chlorambucil/prednisone

What is the prognosis of canine CLL?

Good (few years)

Plasma cells come from the --- progenitor and its major function is to ------------------------.

Lymphoid

Make antibodies

Myeloma-related disorders arise from --- --- or --- producing mature --- cell lymphocytes.

Plasma cells

Immunoglobulin

B-cell

What are the TWO major forms of myeloma-related disorders and how do they differ?

1. Multiple myeloma- systemic (bone marrow)

2. Extramedullary plasma cell tumor- localized (out of marrow)

What happens in multiple myeloma?

Clonal plasma cells secrete the same antibody

______: overabundance of a single type or component of an immunoglobulin

M component

The M component can be either a ------------------- (most common) or ----------- (rare).

Heavy chain (IgA or IgG)

Light chain

True or False: Both heavy chain and light chain can be detected in the blood.

False! Heavy chain can be detected in the blood, but light chain is excreted in URINE- called BENCE-JONES PROTEINURIA.

How does multiple myeloma most present on SPE?

Monoclonal gammopathy

What are the THREE major clinical findings of multiple myeloma?

1. Bleeding diathesis (inhibit PLT aggregation, interfere clot)

2. Hyperviscosity syndrome (bleeding/neuro/hypertension/renal/retinal)

3. Organ infiltration (liver/spleen; bone marrow (cytopenias)

What are the THREE major consequences of increased M component in the body?

1. Osteolytic lesions

2. Hypercalcemia

3. Renal disease

What would you see on minimum database with multiple myelomas?

CBC: anemia, decreased platelets

Chem: hyperglobulinemia, hypoalbuminemia, hypercalcemia, azotemia

UA: proteinuria

What are FOUR other diagnostics you can perform with multiple myelomas and what would be consistent findings there?

1. Skeletal rads (osteolytic lesions)

2. Bone marrow aspirate/biopsy (plasmacytosis)

3. Urine/protein electrophoresis (monoclonal gammopathy; Bence Jones proteinuria)

4. Liver/spleen aspirates (plasma cell infiltration)

How many of the 4 major criteria for diagnosis are required for multiple myeloma?

2

Name the FOUR criteria for diagnosis of multiple myeloma.

1. Bone marrow involvement

2. Osteolytic lesions

3. Liver/spleen involvement

4. M component on serum or urine

What are the TWO major treatment protocols for myeloma?

1. Chemo- melphalan and pred

2. Supportive care- address pain from lytic bone disease, hypertension, etc.

What is the prognosis for myeloma in dogs?

What is the MST?

90% (if chemo-responsive)

1.5 years

True or False: Both canine and feline myeloma are equally common.

False! Feline myeloma is VERY RARE- less responsive to chemo, shorter duration response