Skin masses

Histamine, heparin, proteases, cytokines - GI ulcers, bleeding, poor healing, vasodilation, hypotension, collapse

Great pretender (skin plaque, rash, nodule, lipoma)

Mast cell tumor

Mast cell tumor - breed

Brachycephalics - low to intermediate met risk

Mast cell tumor - diagnosis

FNA for diagnosis

Biopsy for grading

LN aspirate(even if normal palpation) pre-sx

AUS - liver and spleen

Individual round cell, darkly staining granules in cytoplasm in the background, eosinophils common

Mast Cell tumor

Most common dermal malignancy in dogs

Mast cell tumor

Is multiple dermal mast cell tumors at the same time a negative prognostic indicator?

No

Mast cell tumor negative prognostic indicators

Metastasis

Mitotic count >5

Visceral involvement

mucosal/mucocutaneous jxn involvement (more likely to met)

Tumor size, growth rate, kit mutation

Systemic signs (anorexia, diarrhea, vomiting)

Local recurrence

Mast cell tumor Grading

Grade 1 - least likely to met

Grade 2(80% of cases) - ¼ met

Grade 3 - aggressive 50-90% met (MST 6mo-3years)

Mast Cell tumor - gold standard Tx (no mets)

Surgery (2-3cm + 1 fascial plane) - may cure

± radiation with incomplete margins

Mast Cell Tumor - Tx, Grade 3 or high risk grade 2

Chemotherapy - Vincristine or CCNU(lomustine), Palladia(tyrosine kinase inhibitor)

+ Surgery, supportive care ± radiation

Mast Cell Tumor - supportive care

Prednisone

H1 blockers - diphenhydramine

H2 blockers - famotidine

Proton pump inhibitors - omeprazole

Sucralfate

What precent of oral melanomas have no melanin?

1/3

Oral melanoma- diagnosis

Biopsy - distinguish from - SCC and fibrosarc

Min database

Regional lymph aspiration

THX rads

Appears like mesenchymal, epithelial or round cell origin

Oral melanoma

Most common malignant oral tumor

Oral melanoma

Oral melanoma - breeds

**Chow chow**, Golden, poodle, cocker spaniel

Oral melanoma - treatment

Wide margin Surgical excision- may need removal underlying bone (partial mandibulectomy or maxillectomy)

Carboplatin and cisplatin - mild efficacy in shrinking lesions

Oral melanoma - prognosis (MST)

< 2cm MST 17 months,

> 2cm 5.5 months

Oral melanoma met rate

80% metastasize - local lymph nodes then lungs

cutaneous melanoma mostly benign,

nail bed melanoma ½ met

Soft tissue sarcomas - diagnosis,

Very locally invasive, 15% of skin/SQ tumors in dogs

local recurrence with conservative excision

FNA- not often diagnostic

Biopsy - required for grading sometimes for diagnosis

THX - mets - prefer lungs

Soft tissue sarcoma types

Peripheral nerve sheath

Hemangiopericytomas

fibrosarc

liposarcoma

malignant fibrous histiocytoma

myxosarc

rhabdomyosarc

leiomyosarc

Soft tissue sarcomas - prognosis

Biposy for grading; met determined by grade

low/inter <20% met;

High grade 40-50% met

Soft tissue sarcoma - control rates

Incomplete excision + radiation

95% 1 year control

85% 3 year control

75% 5 year control

1/3 die from tumor

Soft tissue sarcoma grading

Differentiation - well, moderte, poorly differentiated

Necrosis - none <50% necrosis, >50% necrosis

Mitotic index <10, 10-20, >20

Soft tissue sarcomas - treatment

CT/MRI for surgical planning

Wide excisison min 3cm margins, amputations not rec unless painful, or open wound

Radiation if surgical margins incomplete/narrow

Chemo- if mets present, high grade, visceral sites (splenic sarc) - doxorubicin

Digit mass, commonly on trunk, limbs, scrotum, lips and anus, chronic sun exposure

Squamous cell Carcinoma

Dogs - most common digit neoplasia,

smooth white papules, plaques or verrucous cauliflower lesions, nose conjunctiva, haired skin

Papilloma

Benign tumor - papullomavirus, young dogs, direct/indirect contact

1-2 month incubation

regress in 3 months - 1yr,

Soft dome-like masses may pedunculate, thorax abdomen and limbs

Lipoma

Common in dogs, uncommon in cats, benign

Dog - nodular solitary, wart-like

Sebaceous gland tumors

Sebaceous adenocarcinoma - malignant rare mets

Sebeaceous epithelioma, adenomas, hyperplasia - benign

common in dogs

Dog - variable - firm to soft, papular to nodular to pedunculate, dermal/SQ or urticarial swelling, trunk perineum and limbs common, fluctuate in size

Mast cell tumor

• Gastric ulcers/coagulopathies from granules

• Itching, inflammation, hypotension, bleeding bruising poor wound healing

Young dog, Single well circumscribed mass, head pinnae limb

Cutaneous histiocytoma

Benign (reactive hyperplasia) common in dogs rare in cats

Tumors regress spontaneously in three months

Dermal or SQ, irregular or nodular in shape - trunk, distal limb, ear pinnae, vax site

Fibrosarcoma

Common in cats - young cats feline sarcoma virus

Vax - rabies, FeLV, most associated

Cat, solitary well circumscribed, head neck and thorax, sometimes planum and eyelids

Basal cell tumor

most benign,- basosquamous and solid basal aggressive

Common in cats uncommon in dogs

(Variable) depigmentation and ulceration of mucous membranes

plaques, nodules, patches, erythroderma, hyperkeratotic and ulcerated footpads

Cutaneous lymphoma

Malignant neoplasm - T lymphs

Firm pedunculated growths - bony prominences, sternum and trunk

Fibrovascular papulloma (skin tag)

May be due to trauma - large dogs may be predisposed

Cat - variable firm or soft, white to pink plaques to noduels, common on head or neck

Mast cell tumor

Cats - head (nasal planum, eyelids, oral cavity) occasionaly digitChronic sun exposure

Squamous cell Carcinoma

(thx rads to r/o lung digit syndrome)aka primary pulmonary carcinoma

Dog Lumps/bumps found by owner(enlarged LN), general lethargy, low appetite ± PUPD; enlarged liver/spleen

Lymphoma- PUPD if hypercalcemic (usually T cell is hypercalcemic)

Canine Lymphoma types

Systemic disease

Multicentric form (most common distribution) - multiple peripheral LN involved

High Grade (most common) -lymphoblastic (immature, large, lymphoid cells)

Low grade (less common) - small lymphocytes (more indolent)

Canine lymphoma workup

Lymph nodes FNA -

• 50% large immature lymphoid cells

• high nuclear to cyto plasm ratio

• 2-3x RBC size

Biopsy LN or Organ

Canine B cell lymphoma

Better

80% of lymphoma

more responsive to chemo longer remission

Canine T Cell lymphoma

Terrible

less common,

less responsive to chemo

worse prognosis

T Cell (PTHrp) - hypercalcemic

Canine lymphoma diagnostics

Min database - circulating lymphoma cells, hypercalcemia(isothenuria), cytopenia, liver enzymes (if liver involvement

Bone marrow - immature lymphoid cells increased

THX rads - lymphadenopathy, mediastinal mass, intersitial lung patter

AUS - hypoechoic large LN, hypoechoic liver/spleen nodules

Canine lymphoma - Negative prognostic indicators

T cell (less common)

Steroids before chemo

Hypercalcemic

Mediastinal masses

Higher stage

Higher substage (b clinical signs)

Canine lymphoma - MST

No treatment 2-4 weeks

Pred alone 1-3 months

CHOP - 1yr

Canine lymphoma treatment

Tx CHOP (Cyclophasphamide, doxorubicin, vincristine, pred),

L Chop (Lasparaginase)

Most common hematopoetic tumor in dogs

Canine lymphoma

dolicocephalic - epistaxis, sneezing, nasal dx, epiphora (runny eyes) facial changes, mandib LN lrge, decrease nasal airflow, stertor, cough, lethargy, dyspnea, exopthalmos, nasal dx, mouth breathing CNS signs

Nasal tumors

locally aggressive,

varying bony destruction,

sinus involvement and cribiform -

98% turbinate destruction,

most bilateral,

½ change maxillary bones, 20% cribiform plate, 1/3 hard palate

Nasal tumor

Most common respiratory tumor dog

nasal tumor - 2% of dog tumors

Nasal tumor workup

Rule out - other signs

Biopsy- rhinoscopy

Bloodwork

THX rads

CT/MRI (Staging and seeing bony involvement)

Nasal tumor types

Adenocarcinoma most common, SCC (worse less common)

Sarcomas - Chondro sarc, Osteosarc, multilobular osteochondrosarc, fibrosarcoa, round cells uncommon

Nasal tumor - prognosis

No treatment - MST 3mo

Piroxicam (carcinoma) - MST 3 months (50% clinical improvement)

Surgery - MST 3 months

radiation MST 1 year

Malignant, >50% bone involvement, mets occurs in tonsils and regional LN, can have lung mets

Oral melanoma

Oral melanoma workup

Biopsy

THX rads, LN aspirate

Oral melanoma - prognosis

No tx - MST 2mo

Mandibulaectomy/Maxillectomy MST 6-12 months

Chemo(carboplatin and cisplatin) + sx 2 years

Prognosis varies with size, location, stage and local recurrence

2nd most common oral mass dog >70% bone involvement, mets to regional LN

Oral Squamous cell carcinoma

mets to lungs not as common as melanoma

Oral squamous cell carcinoma - Diagnosis

Biopsy

Oral squamous cell carcinoma - treatment

Mandibulectomy/maxilectomy - 18 month MST

Radiation - 18 month MST

Radiation + Sx - 36 MST

chemo doesn’t help

Dog, locally aggressive, slow growing, firm, adherent to underlying tissue, recurrence after surgery (dont remove all)

Soft tissue sacroma, fibrosarc, hemangiopericytoma, peripheral nerve sheath tumor, leiomyosarc, rhabdomyosarc, liposarc

Soft tissue sacroma, fibrosarc, hemangiopericytoma, peripheral nerve sheath tumor, leiomyosarc, rhabdomyosarc, liposarc - histo grading

Grade 1 and 2 - 10-20% metastasize

Grade 3 50% metastasize

Soft tissue sacroma, fibrosarc, hemangiopericytoma, peripheral nerve sheath tumor, leiomyosarc, rhabdomyosarc, liposarc - treatment

Surgery - aggressive wide exicison - gold standard

Radiation - post op if not wide margins

Chemo for grade 3 tumors - doxorubicin

Soft tissue sacroma, fibrosarc, hemangiopericytoma, peripheral nerve sheath tumor, leiomyosarc, rhabdomyosarc, liposarc - workup

Clinical exam

FNA/biopsy

Baseline staging - min database, thx rads

Soft tissue sacroma, fibrosarc, hemangiopericytoma, peripheral nerve sheath tumor, leiomyosarc, rhabdomyosarc, liposarc - prognosis

prognosis variable based on grade, excision and adjuvant therapy

Cat, any injection, 1/10,000 rabies and FELV vax, more invasive and likely to recur after sx, Vax in distal rear limbs

Injection site sarcoma,

Injection site sarcoma - work-up

Biopsy/histo

Min database

THX rad/ AUS

CT/MRI - surgical planning

Injection site sarcoma - tx

Sx - 5cm margins - 2 facial planes - MST 1-1.5 years

Radiation - before or after sx - MST 2 years

Chemo doxorubicin

Injection site sarcoma - 1,2,3 rule

Biopsy lump growing more than 1 month

Biopsy mass greater than 2 cm

Biopsy mass 3 months post vax

Feline large cell lymphoblastic high grade lymphoma - tx/prognosis

more aggressive, discrete masses or severethickening

CHemo(CHOP or COP- cyclo, doxo, vincris, pred)

6-8mo MST with chemo

Feline lymphoma - small cell - prognosis/treatment

Good - guarded prognosis with pred and chlorambucil

MST several years, highly responsive to tx

Feline lymphoma most common type/ location

GI

Small lymphocytic low grade

Cat IBD signs, chronic weight loss, low appetite, vomiting, diarrhea, diffuse intestinal thickening

Feline lymphoma

Feline lymphoma - predispositions

FeLV - associated (improved with vax),

immune suppression,

Feline idiopathic cystitis

renal transplant,

envr factors (tobacco),

siamese and oriental breeds

Most common hematopoeitic cancer in cats

Feline lymphoma

Cat, Thymus and sternal LN, resp distress, pleural effusion

FeLV positive if young cat

Mediastinal Lymphoma

Nodal lymphoma

high grade (large cell lymphoblastic or low grade (lymphocytic small cell

less common

Multiple LN in head and neck

Cat single or regional LN at head and neck

treated with Sx

Hodgkin’s like lymphoma

Cat, renal failure, bilateral in kidneys, mets in CNS, primary or associated with intestinal

Renal lymphoma

Cat, sneezing, epistaxis, nasal discharge, facial deformity

localized, occasionally systemic

Nasal lymphoma

treated with radiation therapy

Cat lymphoma- diagnosis

asp or biopsy of involved organs

CBC to asses anemia, differential counts, blood and platets, CHem, FeLV, FIV, AUS, THx bone marrow asp (full staging if cytopenia)

Lymphoma cat - treatment

CHOP, L-Chop, COP for high grade

L asparginase, Cyclo, doxo, vincristine, pred

Pred and chlorambucil for low grade lymphocytic lymphomas

Sx or radiation ± chemo if localized

Prognosis Cat lymphoma

MST vary by anatomic location and histo , low grade better

Response to therapy - complete response live more than a year

partial response several months, porgressive disease days to weeks

FeLV + cats poor prognosis

T Cell/B cell does not matter