Neuroendocrine Tumors

What are the perianal glands?

Circumanal glands

What are the circumanal glands?

Sebaceous (non-secretory)

Hepatoid glands

Where are circumanal glands located?

Dermal location around the anus

Scattered in regions of prepuce, tail, pelvic limbs, and trumk

Where are the anal sacs?

Blind cutaneous diverticula at 4 and 8 o’clock sides of anus

What type of glands are anal sacs?

Apocrine sweat glands that are at the apex of the sac

Empty secretions in to the lumen of the anal sacs

What are the tumors of perianal glansd?

Perianal adenomas, circumanal or hepatoid adenomas

Perianal adenocarcinoma

What is the tumor of apocrine gland?

Apocrine gland adenocarcinoma of the anal sac (AGASACA)

Always malignant

T/F almost any tumor can affect perianal region?

True

What are perianal adenomas?

Benign tumors

What stimulates perianal adenomas?

Androgens

Depressed by estrogens

Who is at risk for perianal adenomas?

Older, intact male dogs

How do females get perianal adenomas?

Lack of estrogen from a OHE to suppress growth

Cushing’s due to testosterone secretion but rare

What do perianal adenomas look like on cytology?

Hepatoid

How do you treat perianal adenomas?

Castration will cause regression, but if large might need tumor excision

When do you always need to resect a perianal adenoma?

Males with ulcerated or recurrent tumors

Females

Minimal margins are necessary

What is the signalment for perianal adenocarcinoma?

Older intact, or neutered male or female dogs

Do not appear to be sex-hormone associated

What do perianal adenocarcinoma look like?

Relatively rapid growth, firm, uclerated, adherent, recurrent

What are the C/S of perianal adenocarcinomas?

Presence of masses

Obstipation, dyschezia, perianal discomfort

Obstruction by metastatic lymph nodes

If paraneoplastic can be hypercalemic

How do you diagnose a perianal adenocarcinoma?

Cannot distinguish from perianal adenoma on cytology

Need histopath showing invasion into surrounding tissues

How do you stage perianal adenocarcinoma?

Metastasis occurs late in dz with 15% mets at diagnosis

Goes to regional LN, lung, liver, kidney, bone

Stage with rectal exam, rads, US, CT

What is the benefit fo abdominal rads when staging perianal adenocarcinoma?

Look at lumbar nodes

how do you tx perianal adenocarcinoma?

Not responsive to castration

Aggressive surgical resection is needed

Chemo on a case by case basis (esp if high mitotic rate)

What is the problem with surgical resection of perianal adenocarcinoma?

Not diagnosed usually until marginal excision

Contamination of tissue planes is common

Recurrence is common

What is the prognosis of a perianal adenocarcinoma?

Early diagnosis is most important

<5cm had a 60% 2 year control rate

Lymph node or distant metastasis had a MST of 7 months

What is the behavior or AGASACA?

Malignant w/ 50% metastasis at diagnosis

Regional nodes first and most common mets

What is the signalment for AGASACA?

English cockers

Equal male and female

Older dogs

What are the C/S of AGASACA?

Tenesmus

PU/PD with PTHrp causing hypercalcemia

Incidental finding sometimes

What is on PE for a AGASACA?

Mass at 4 or 8 oclock, can be very large

Enlarged pelvic or lumbar lymph nodes on rectal exam

Might be able to feel mass on abdominal palpation 

How do you diagnose AGASACA?

FNA with cytologic evaluation

Neuroendocrine appearance “naked nuclei in a see of cytoplasm”

What do you need to be mindful of during AGASACA FNA?

Tissue planes as you can seed the tumor deeper on accident

How do you stage AGASACA?

Labwork looking for hypercalcemia

Rectal exam looking for LNs

Thoracic rads

Abdominal imaging

What matters for AGASACA staging?

Size

Regional lymph nodes

Distant metastasis

How do you treat AGASACA?

Surgical resection but recurrence is common with marginal excision

Also remove lymph nodes

When is RT good for AGASACA?

Incompletely resected tumors >2.5cm

What is prognosis of AGASACA?

If caught in stage 1, 2, or 3a or 3b it is very good with tx (metastatis present)

If caught in stage 4 71 days

How good is chemo with AGASACA tx?

Not statistically significant in survival time but local recurrence rate is better

T/F removing affected LN with AGASACA increases survival?

True

What is the efficacy of palladia for AGASACA?

Very good if the disease is not resectable

What is the most common thyroid tumor in dogs?

Nonjunctional carcinoma

Follicular and compact on histo

What is the most common thyroid tumor in cats?

Functional adenoma

When do you think thyroid carcinoma in a cat?

If the thyroid is enlarged

How are thyroid carcinomas characterized?

Histologic appearance and IHC staining

What is the signalment for thyroid CA in dogs?

Older dogs with no sex predilection

Goldens, beagles, boxers, huskies more common

What is on history for a thyroid CA in dogs?

Presence of a ventral cervical mass (usually incidental finding)

C/S of a space occupying mass like dysphagia, voice change, laryngeal paralysis, Horner’s syndrome, dyspnea

What is on PE for a thyroid CA?

Cervical palpation, can be bilateral

Look at regional lymph nodes

Feel for size and mobility

What is on diagnostics for a thyroid CA?

nothing on bloodwork

Euthyroid on thyroid panel

T4 elevation consistent with functional thyroid CA

What are C/S of a functional thyroid mass?

Weight loss and PU/PD

How do you diagnose thyroid CA?

FNA and cytology of ventral cervical mass

What does cytology of a thyroid CA?

Highly vascular tumors, epithelial cells

Naked nuclei in cytoplasm

Tyrosine granules

What should be avoided on a cytology of a thyroid CA?

Needle core or incisional biopsy b/c of hemorrhage risk

What is on staging for a thyroid CA?

Lymphnode evaluation (mandibular, cervical, prescap)

Thoracic rads to look for pulmonary metastasis

Where do thyroid CA like to mets?

Lungs, especially if large

What does US tell you for thyroid CA?

Help with FNA and avoiding cystic areas

Does NOT determine invasiveness

What does CT scan tell you for thyroid CA?

Assess entire cervical region (bilateral possible)

Invasiveness

Confirm thoracic metastasis

How do you tx thyroid CA?

Surgery is good for non-invasive mobiel tumors 36 mo MST
6-12 mo MST if invasive

Always send in for histopathology

Radiation therapy can be added sometimes

When is radiation good for thyroid CA

Helps with non-resectable disease

Helps with incompletely excised tumors

Stereotactic radiation is also helpful

T/F thyroid CA are radioresponsive?

True

How does chemo work for thyroid CA?

Carboplatin has a 50% resposne rate

Palladia is good for macroscopic disease

T/F thyroic CA are chemo receptive?

True