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75 Cards in this Set

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What are presenting complaints of a dog/cat with lymphoma?
HAPPY DOG WITH LUMPS!!!
Also vomiting/diarrhea, PU/PD, bleeding, reduced activity/weight, dyspnea
Which of the following will NOT typically be seen upon physical presentation of a lymphoma case?
a) Hepatosplenomegaly
b) pleural or abdominal effusion
c) cutaneous plaques
d) alopecia
e) petechiae
d) alopecia (probably won't see this)
Will also see: pallor, lymphadenopathy, and maybe big tonsils
What are the anatomic classifications of lymphoma? Which is most common in the dog? The cat?
Multicentric (dog)
Alimentary (cat)
Mediastinal
Extranodal
What lymphoma stage would be given to a sick dog with multicentric lymphoma on the left leg and left inguinal region?
Stage 2b
What lymphoma stage would be given to a happy dog with severely swollen left retropharyngeal lymph node?
Stage 1a
What lymphoma stage would be given to a sick dog with multicentric lymphadenopathies also involving the spleen?
Stage 4b
What are important CBC findings in a patient with lymphoma?
Mild anemia
immature lymphocytes in blood
Thrombocytopenia
What are important chem findings in a patient with lymphoma?
Hypercalcemia
Increased liver enzymes
Azotemia
Protein abnormalities
In a patient with suspected lymphoma, what imaging techniques will you use and what will you be looking for?
Rads (hepatosplenomegaly, ascites, pleural effusion and interstitial pattern; enlarged lymph nodes)

Ultrasound (Ascites, hepatosplenomegaly, enlarged lymph nodes)
T or F:
FNA and cytology is usually diagnostic for lymphoma.
True!
How can T-cell lymphoma be differentiated from B-cell lymphoma?
Immunophenotyping; (CD3 positive = T cell; CD79a = B cell)
What are the clinical signs associated with hypercalcemia with lymphoma?
PU/PD
Anorexia & depression
Vomiting
How does PU/PD occur with lymphoma?
Hypercalcemia blocks ADH, preventing urinary concentration
How does a lymph node aspirate look in a lymphoma case?
60-100% "tumor cells"
Large lymphocytes
Lots of lymphoglandular bodies
How does a lymph node aspirate look in a normal lymph node?
90-95% mature lymphocytes
What are prognostic indicators of canine lymphoma?
Clinical stage/substage
Low MHC II expression
Immunophenotype (T cell worse than B cell)
Histological grade
What does CHOP stand for?
C = Cyclophosphamide
H = Doxorubicin (Hydroxydonamycin)
O = Vincristine (Oncovin)
P = Prednisone
How does Prednisone treat lymphoma?
causes apoptosis of lymphocytes
T or F:
Most dogs on CHOP achieve remission.
True! 70-80%
When should lymphoma be pretreated with glucocorticoids?
NEVER!!! DON'T DO IT!!!
Define leukemia.
Uncontrolled, unregulated, pointless proliferation of bone marrow stem cells.
What are the two classifications of leukemia in terms of age and what is the difference between the two? Which is worse?
Acute (immature cells; AGGRESSIVE)
Chronic (mature cells and less aggressive)
How can leukemia be classified?
Cell age (chronic vs. acute)
Cell line (myeloid vs. lymphoid)
What are general physical findings in animals with leukemia? Which are more common with myelogenous or lymphoblastic leukemias?
General (lethargy, anorexia)
Myelogenous (lameness)
Lymphoblastic (CNS signs & abd pain)
How can leukemias be diagnosed?
CBC
Bone marrow evaluation
How would a bone marrow aspirate look in acute leukemia?
Lots of young cells, normal precursors reduced or absent
How would a bone marrow aspirate look in chronic leukemia?
Lots of mature leukemoid cells; blast cells look normal
Describe the CBC findings in acute leukemia.
Low, normal, to high leukocytes
Normocytic normochromic anemia with anisocytosis
Thrombocytopenia
Young leukemoid cells predominate
Describe the CBC findings in chronic leukemia.
Moderate to marked leukocytosis.
Noderate normocytic, normochromic anemia.
Normal to elevated platelets.
Mature cells leukemoid cells predominate.
What is a leukemoid reaction? How can it be differentiated from leukemia?
Extreme regenerative L shift w/high granulocyte counts;
find underlying medical issue to differentiate!
How long can dog live with appropriate treatment of multiple myeloma? A cat?
Dog - 540d
Cat - 6mos to 1 yr
What is the standard of care for multiple myeloma?
Alkylating agent + Prednisone
How is multiple myeloma diagnosed?
Need 3 of the 4 following criteria:
1) radiographic bone lesions
2) plasmacytosis in bone marrow
3) presence of paraprotein in blood
4) Ig protein in urine
Bleeding due to a hypercoaguability is known as...
...bleeding diathesis
What causes hyperviscosity syndrome?
lots of IgM and polymers of IgA increase plasma viscosity leading to circulatory impairment
What factors lead to bleeding diathesis in multiple myeloma?
Increased coagulation factors + thrombocytopenia
T or F:
Paraprotein and M-protein can be synonymous.
Yup.
What is a paraprotein?
Large quantities of monoclonal immunoglobulin.
What are the radiographic signs of multiple myeloma and why do they occur?
Moth-eaten bones on radiography;
MM stimulates RANK ligand which stimulates osteoclasts to resorb bone
What infectious organism may mirror multiple myeloma? Which signs can it mirror?
Erlichia canis infection
(marrow plasma cell infiltration and monoclonal gammopathy)
What pathologies do the paraproteins produced in multiple myeloma cause?
Hyperviscosity syndrome
Bleeding diathesis
Renal dysfunction
Infections
What pathologies does the cellular proliferation in multiple myeloma cause?
Skeletal lesions
CNS signs
Hepatosplenomegaly
Anemia
Lymphadenopathy (rare)
What is the most common malignant skin tumor in the dog?
Mast cell tumor
Which tumor is the "great pretender tumor"?
Mast cell tumor
What grading system is used for mast cell tumors? What are the variables used to grade?
Patnaik grading system
Uses cell differentiation, cellularity, nuclear shape, mitosis, and invasiveness.
A mast cell tumor can be palpably indistinguishable from a ___________.
LIPOMA
Which tissue is of greatest risk for metastasis in mast cell tumors? Which tissue is at least risk?
Lymph nodes (biggest risk)
Lungs (very rarely found)
What systemic pathologies are caused by mast cells and why?
High levels of circulating histimines result in GI ulcers, allergic-like reactions, and slowed clotting in the tumor area.
Which dog breeds are overrepresented with mast cell tumors?
The B's...
Boxers, Bulldogs, and Bostons
What are initial diagnostic procedures when suspecting a mast cell tumor?
Physical
CBC
FNA (give antihistamine before FNA)
How are various grades of mast cell tumors treated?
All treated with surgery and radiotherapy if incomplete excision.
Grade II - add chemo and TKI maybe
Grade III - definitely add chemo or TKI
T or F:
Incomplete excision of a mast cell tumor results in a high rate of recurrence.
False!
17% - 1yr
22% - 2yr
33% - 5yr
What are the prognostic factors of mast cell tumors?
Histologic grade
Location
Clinical stage
Clinical signs
Recent rapid growth/ulceration
Recurrence
What are the chemotherapeutic choices commonly used in treating mast cell tumors?
Pred and Vinblastine
What are the forms of feline mast cell tumors? What is the prognosis for each?
Cutaneous (most benign)
Visceral splenic (good prognosis)
Intestinal mast cell tumor (GRAVE prognosis)
What are the greatest risk factors for development of cutaneous SCC in dogs and cats?
Unpigmented skin + solar exposure
Where does cutaneous SCC happen in dogs? In Cats?
Dogs (nail bed, nasal plenum, scrotum, legs, perianal, flank)
Cat (ears I think...he didn't say)
What is the histologic hallmark for SCC?
KERATIN
What is Bowen's disease?
Multicentric SCC in situ (means hasn't penetrated the basement membrane)
What happens when you use 5-FU in a cat?
FU CAT!!! U GET SEIZURES!!!!
What are typical signs for animals with nasal tumors?
Sneezing
Nasal discharge
Epistaxis
Facial Deformity
How can nasal tumors best be diagnosed?
Imaging (CT or MRI);
Which are acceptable methods for biopsy of nasal masses?
a) "Ram and Jam"
b) "Donkey Punch"
c) "Dirty Sanchez"
d) "The Clam Shell"
e) "The One-Eyed Pirate"
a) "Ram and Jam"
d) "The Clam Shell"
How are nasal tumors treated?
Maybe surgery (tough to get it all)
Radiation is treatment of choice!
What are common complaints associated with dogs with lung tumors?
Paroxysmal, non-productive cough and exercise intolerance
What is one part of the physical exam that should be performed when a nasal tumor is suspected?
Try to retropulse eyes!
Also assess facial symmetry.
What are two important differentials to consider with lung tumors?
Metastatic disease
Fungal disease
Primary lung tumors of cats metastasize to which weird place?
a) your mom
b) distal phalanges
c) lumbosacral intumesence
d) left middle nipple
b) distal phalanges
What is a major negative prognostic indicator in lung tumors that can easily be assessed via physical exam?
Sick dog = bad news
Which paraneoplastic syndrome can be seen with chest tumors?
Hypertrophic osteopathy
How are primary lung tumors treated?
SURGERY followed by Vinorelbine
Where do tyrosine kinase inhibitors have their activity?
a) competition for ligand binding site
b) competition for ATP binding site
c) prevents tyrosine kinase dimerization
d) inhibits clathrin, thus preventing recycling of tyrosine kinases
b) competition for ATP binding site (on the cytoplasmic side)
Which proto-oncogene is often mutated in canine mast cell cancer? What is the result of this mutation?
C-kit (exon 11 encoding for juxtamembrane domain); results in constitutively turned-on tyrosine kinase
Why do mutated tyrosine kinases cause mast cell proliferation?
binds stem cell factor causing activation and proliferation
What molecule can block tyrosine kinases at the ligand site?
Monoclonal antibody