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189 Cards in this Set
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What are the top ten canine s/c tumours |
MCT Lipoma Histiocytoma Perianal Adenoma Sebaceous adenoma/Hyperplasia SCC Melanoma Fibrosarcoma Basal Cell Tumour Peripheral Nerve Sheath tumour |
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What are the top ten feline s/c tumours |
Basal cell tumour Mast cell tumour SCC Fibrosarcoma Apocrine adenoma Lipoma Haemangiosarcoma Sebaceous adenoma Fibroma Haemangioma |
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What % of all canine tumours are of the skin |
A quarter of all canine tumours are in the skin and subcutaneous tissues |
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What is the most common tumour location |
The skin |
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What are the proportion of tumours in cats that are in the skin |
1/3 |
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What % of feline skin tumours are malignant |
50-65% |
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What % of canine skin tumours are malignant |
20-40% |
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What is lung digit syndrome |
Metastatic pedal tumours of a lung carcinoma - bronchogenic |
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What can the behaviour of tumours be classified on |
Tissue of origin Cell type Degree of malignancy |
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What are the 3 tissue types of origin |
Epithelial Mesenchymal Round Cell |
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What are the main tumour specific cell types |
Round cell Mast cell Hitiocyte Lymphocyte Melanocyte Plasma cell Merkel cell TVT |
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What would be a typical history for malignant Skin neoplasia |
Commonly owner reported Fast progression of growth and associated signs |
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What would be a typical history for a benign skin neoplasia |
Commonly owner reported Painless, slow growth |
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What does a movable tumour indicate |
More likely benign
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What type of tumours can cause ulceration |
Benign or malignant tumours |
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How do we record an examination |
Measurements, description, mapping, photos Record mass and drainage LN |
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How can we investigate skin tumours |
FNA/impression smear mass and lymph nodes Some masses will require or be amenable to biopsy Clinical signs or cytology might prompt further tests Staging schemes are available |
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What is a common therapy for skin tumours |
Surgery - might be radical and will not always guarantee cure. Debulk/cytoreductive and adjunctive radiation therapy Photodynamic therapy Cryotherapy Laser Hyperthermia |
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What is photodynamic therapy |
Photosensitive drug is given then a laser is shone onto the tumour activating it |
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What is a papilloma |
Benign virally induced and cauliflower like mass |
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Where are papillomas found |
Classically in young dogs mouths |
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How do papillomas resolve |
Spontaneous regression, surgery or immune stim are used in problem cases. |
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What % of canine skin tumours are SCC |
5% |
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What % of feline skin tumours are SCC |
15% |
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What can induce scc |
UV or virus |
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Where are scc usually found in cats |
Nasal planum Pinnae Eyelids
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Whaere are scc usually found in dogs |
Nail bed Scrotum Flank and abdomen Planum |
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What can delay diagnosis of SCC |
concurrent localised inflammation and infection |
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What do scc look like |
cauliflower like and ulcerative in appearence |
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What is bowens disease |
Multicentric SCC in situ with an intact BM |
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What can induce bowens disease |
Papilloma virus |
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What can induce solar keratosis of the pinnae |
UV |
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What does bowens disease look like |
Allopecic, crusted, painful and bleed |
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What are the classifications of basal cell tumours |
Basal cell epithelioma Basal cell carcinoma Trichoblastoma Solid cystic ductular adenoma/adenocarcinoma |
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What spp are basal cell tumours common in |
cats |
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What is it rare for basal cell tumours to do |
metastasize |
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How can we treat bowens disease |
Excision Extensive lesions can be treated topically |
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What are the types of sebaceous lesions |
Basal cell epithelioma, adenoma, hyperplasia, carcinomas |
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How do we treat sebaceous lesions and sweat gland tumours |
Excision is ideal as carcinoma mets are rare |
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What are sweat gland tumours |
Benign adenoma Malignant adenocarcinoma |
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What breeds are intracutaneous cornifying epithelium found in? |
Elkhounds and keeshonden |
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What are the types of hair follicle tumours |
Trichoblastoma Trichoepithelioma Pilomatrixoma |
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Are hair follicle tumours benign or malignant |
Benign |
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What % of skin SC masses in dogs are STS |
14% |
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What % of skin SC masses in cats are STS |
7% |
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What are the types of STS |
Fibrosarcoma Haemangiosarcoma Neurofibrosarcoma Haemangiopericytoma Myxosarcoma Peripheral nerve sheath tumour Liposarcoma |
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What is a common factor in the history of STS |
Patient over 9 YO |
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What are the predilection sites for haemangiosarcoma |
Spleen, skin and sc, atrium, liver |
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How can we get a precise diagnosis of a sts |
IHC |
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What does rapid growth suggest with and STS |
Anaplastic |
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How do we remove STS surgically |
Shelling out procedure - not really confined to capsule - infiltrative |
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What % of high grade masses infiltrate |
44% |
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How do we investigate STS |
FNA to exclude differenetials - non diagnostic samples require a follow up biopsy Pre op biopsy - dx and grade, predict metastatic risk and pattern |
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How do STS tend to metastasize |
Haematogenous route |
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What lineages require abdominal ultrasound/ln sampling |
Synovial sarcoma Lymphangiosarcoma
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How can we plan surgical approach |
Local and axial imaging |
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What is the therapy for sts |
En bloc excision Radiation therapy Chemotherapy |
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What decides whether additional therapy is needed for STS |
Diagnosis Grade Margins |
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What is radiation therapy useful for |
effective in controlling recurrence while sparing local anatomy |
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What type of STS is chemo used in |
Poorly differentiated STS and those with mets, subcut haemangiosarc, substitute for radiation therapy |
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What is metronomic chemo used in |
STS and splenic haemangiosarcomas to retard progression |
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What causes most FISS |
Site of previous vaccination with post vaccination inflammation - incompletely understood pathogenesis |
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What do FISS look like histologically? |
Most are fibrosarcomas with necrosis, mitosis, pleomorphism, lymphocyte and macrophage infiltration |
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How do we diagnose FISS |
History of vaccination Incisional biopsy Clinical examination Axial imaging |
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What types of FISS have been reported |
Fibrosarcoma Osteosarcoma Chondrosarcoma Malignant fibrous histiocytoma Undifferentiated sarcoma |
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How do we treat FISS |
Complete excision - 5cm lateral margins and 2 fascial planes deep Ampuation, ostiectomies or body wall reconstruction Pre/Post operative radiation therapy - electrons rather than photons Chemotherapy IL2 based immunotheraputic |
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What % of gross FISS respond to chemotherapy |
50% |
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How do re reduce FISS risk |
Balance risk with the protective effect of vvaccine Can administrate FELV in left pelvic limb - distally Can administate rabies in the right, others in the right thoracic limb to facilitate amputation if needed Owner vigilance and early reporting |
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What signs are suggestive of FISS |
Post vaccination masses for 3 months or more Reach 2cm more in diameter or are still growing one month after vaccination |
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Where do dermal melanomas arise from |
melanocytes in the epidermis |
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Where do subungual melanomas arise from |
the nail bed |
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What are the characteristics of dermal melanomas |
Benign, affect heavily pigmented breeds May be pigmented or amelanotic |
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What are the minimum steps we take when staging dermal melanomas? |
LN cytology and thoracic imaging |
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What are the prognostic indicators of dermal melanomas |
Ki-67 index Invasiveness Pigmentation Lymphatic invasion Nuclear atypia |
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How do we treat small cutaneous dermal melanomas with no suggestion of malignancy |
Excision is curative Histopath to assess risk of aggressive behaviour |
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How do we treat dermal melanomas with features suggestive of malignancy and larger than 2cm |
Wider excision - 3cm margins recommended |
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What % of subungual melanomas have metastasised at presentation |
40 |
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How should you treat subungual melanoma? |
Full staging High digital ampuation and LN removal even if cytology suggests there is no mets present
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When can we consider radiation therapy for melanomas |
Where clients refuse surgery or margins are incomplete
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What are the other therapies for melanomas that we can consider |
Intralesional chemo Photodynamic therapy Hyperthermia Systemic chemo if mets Oncept RTKI |
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What is oncept |
A plasmid based xenogeneic tyrosinase vaccine against some oral melanomas in the US |
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What breeds are over-represented with canine MCT |
Bulldog Brachycephalic Labrador Golden retriever SBT Shnauzer Weimeraner Rhodesian Ridgeback |
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What breed is susceptible to multiple MCT |
Pugs |
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What breed is susceptible to aggressive early onset MCT |
Sharpei |
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What is the peak incidence for MCT |
7-9y |
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What are MCT associated with |
prior inflammation in some cases but aetiology is largely unknown |
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What are the most common MCT |
Dermal |
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What are the slightly less aggressive MCT |
Subcutaneous tumours |
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What types of MCT have a poorer prognosis |
Mucosal/mucocutaneous masses with the exception of conjunctival tumours. Including sublingual, preputial perianal |
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What MCT are inconsistently associated with a negative prognosis |
Muzzle Inguinal Perineal |
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Is there a pathognomonic appearance for MCT |
No, many mimic lipomas |
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What are the hints at a well differentiated MCT |
Solitary Rubbery Hairless Slowly growing Static Mass |
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What % of MCT are independent masses |
25% of cases |
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What suggests aggressiveness in MCT |
Satellite lesions or other recurrent MCT |
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What are the risk factors before surgery of MCT |
Systemic signs due to granule contents are negative signs Lymphadenopathy Hepato/Splenomegaly Recurrent/Satellite lesions Ulceration/Location/Rapid growth
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What are the MCT contents |
Histamine Heparin Proteases Kinases |
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What localised signs can be spontaneous/traumatic in MCT |
Waxing and waning size Flushing Oedema
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What systemic signs can be associated with granule contents |
Comition Melaena Pruritis Flushing Oedema
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How do we examine an animal before surgery with McT |
Characterise mass Palpate lymph nodes and abdominal organs |
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How do we examine an animal before surgery with McT |
Characterise mass Palpate lymph nodes and abdominal organs |
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How do we grade canine MCT |
Patnaik scheme Several cellular and tissue morphological features into a 3 tier system Associated with prognosis |
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What grade is a well differentiated MCT |
1 |
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What grade is a poorly differentiated MCT? |
3 |
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What % of the grade 2 tumours behave aggressively |
20% |
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What are the more recent grading systems for MCT? |
Kiupel 2 system based on more quantitative cytological features. |
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How do we surgically remove low grade MCT |
2cm margins or 2x diameter of the mass and one deep fascias plane |
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What is the mst of 85% of patnaik grade 2 tumours - non agressive |
2y after complete surgery |
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What % of cases to high grade canine MCT metastasise |
55-96% |
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What % of mct recur when the histopathological margins are incomplete <3mm |
At least 23% |
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What are the effects of radiotherapy on MCT |
Ready reduce recurrence in 3-5% of long term Sympathetic surgery Shrink 50% of gross MCT Risk debts bilston |
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How do we investigate canine MCT? |
Aspiration of mass and draining ln Histopathology is the gold standard |
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What is the more sensitive staining technique to use for MCT aspirates? |
Giemsa and met achromatic stains |
Not diff quick |
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What will poorly differentiated McT look like? |
Lack characteristic granules Fried egg appearance |
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What suggests McT over other round cell differentials |
Eosinophils |
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What are the metastatic sites for mct |
Locoregional ln, liver and spleen, bone marrow, lung |
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What can be mistaken for McT malignancy at ln |
Normal mast cells trafficking a Normal or reactive locoregional lymph node, number, proliferation, clustering |
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What would we remove at surgery of McT and why |
Cytologyally negative draining lymph nodes as malignant mast cells are better identified by location and alteration of nodal architecture |
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What does thorough staging of McT include |
Abdominal ultrasonography Aspiration of liver and spleen Thoracic radiography - focus on ln |
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What are the indications for staging a McT |
Negative prognostic signs Where radical surgery is necessary to remove the primary mass |
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What are the most common protocols for MCT |
Vinblastine and prednisolone |
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What are the recently licensed TKI for treatment of high grade inoperable gross mct |
Mastinib and toceranib |
C-kit mutation is a requirement |
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What s KIT |
Receptor for stem cell factor |
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What is stem cell factor |
A growth factor necessary for reproduction in several types of cells - melanocytes, germ cells, ICC, matt cells |
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How can we identify C-kit mutations |
PCR and sequencing |
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What is the proportion of MCT with a c Kit mutation |
1/3 |
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What is C-kit associated with |
Worse grade recurrence, dissemination and mct related death |
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What is neoadjuvent therapy |
The use of prednisolone or cytotoxic agents to shrink MCT to make a surgical approach if possible |
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How else can we shrink MCT |
Intralesional steroids Electrochemotherapy Photodynamic therapy - deionised water |
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What other treatments are commonly used in the advance of MCT surgery |
H2 or H1 blockade Acid antagonists Gastroprotectants |
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What age of cat are mastocytic MCTs seen in |
10 years |
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What are the characteristics of cutaneous MCT that are compact |
Well differentiated, tend not to metastesize |
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What are the characteristics of diffuse cutaneous MCT |
Anaplastic Invaade and mets more |
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What age and breed of cat are histiocytic MCT commonly seen in |
Younger cats <3y Siamese |
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What are the characteristics of histiocytic MCT in cats |
Seen on the extremities and the head Multiple Difficult to identify as mast cells Slowly progressive Spontaneous regression |
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How do we remove histiocytic MCT in cats? |
Incomplete resection Wide margins not required |
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How do we investigate mast cell tumours in cats |
Biopsy as some escape diagnosis on aspiration |
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How do we stage MCT in cats |
Minimum database Buffy coat Abdominal ultrasound Locoregional LN aspirate Thoracic imaging |
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When is staging indicated |
Investigation for occult diseaese Visceral involvement and systemic signs Diffuse or multiple MCT |
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What therapy is indicated for cat MCT |
Surgery is curative for compact tumours Wide excision and approach for diffuse MCT - especially histiocytic Radiotherapy less well characterised Chemotherapy if disseminated |
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What RTKI are tolerated well by cats |
Masitinib Tocernib |
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What form of MCT is seen in older cats |
Splenic form |
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What are the clinical signs of splenic MCT |
Malaise, weight loss Vomition - histamine uclers Effusions Marked global splenomegaly |
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What is a risk with splenic MCT |
Anaphylactois reactions |
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How do we treat splenic MCT |
Splenectomy Monitoring resurgent mastocytaemia Lomustine Vinblastine Prednisolone |
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What are intestinal MCT less common than |
Lymphoma and adenocarcinoma |
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What can intestinal MCT cause |
Vomition Weight loss Palpable mass in the small intestine |
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What is the age of cats presenting with intestinal MCT |
13y |
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How can support cats with intestinal MCT |
Prednisolone Vinblasine Lomustine |
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What is the prognosis for cats with intestinal MCT |
Short |
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What is the preferred tx for cats with intestinal MCT |
Wide surgical resection and anastomoses |
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What are histiocytes derived from |
Granulocyte-monocyte stem cells (CD34+) in the bone marrow |
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What can histiocytes differentiate into |
Dendritic cells or macrophages (via CD34- monocytes with cytokines) |
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What are dendritic cells |
Antigen presenting cells - classified as langerhans dendritic cells or interstitial dendritic cells |
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What promotes differentiation of histiocytes |
CM-CSF, TGF-Beta, TNF-alpha, IL4 |
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How can dendritic cells be classified |
Through their surface CD marker repertoire |
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What are other round cell differentials |
Lymphoma Mast Cell tumour Melanoma Plasma Cell Tumour TVT Merkel cell tumour |
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What % of skin tumours are represented by histiocytoma |
14% |
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What is the signalment for histiocytoma |
Under 3 years (esp 1y) |
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What is the cell of origin for histiocytoma |
Epidermal langerhans cells |
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What does cytology of a histiocytoma reveal |
Histolytic features - indented nuclei, vacuolation Major lymphocytic population |
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Why are immunosuppressives contraindicated with |
histiocytoma- can prolong regression |
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How do we treat histiocytoma |
We don't, self limiting usually - unless they don't regress |
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What breed most frequently is affected by cutaneous langerhans cell histiocytosis |
Sharpei |
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How does cutaneous langerhans cell histiocytosis manifest |
Skin lesions that regress over several months May have ln or visceral involvement |
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How does cutaneous langerhans cell histiocytosis affect quality of life |
Progressive ulcerating lesions - euthanasia not uncommon |
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What is canine reactive histiocytosis |
Non neoplastic accumulation of interstitial dendritic cells in the skin and subcutis |
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What are the clinical sings of canine reactive histiocytosis |
Nodules and plaques Around the head and limbs and perineum esp nose
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How do we treat canine reactive histiocytosis |
Immuosuppression - long term steroids |
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What is the signalment for systemic reactive histiocytosis |
3-9 year old larger breeds Bernese mountain dogs |
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What are the additional features of systemic reactive histiocytosis |
Internal dissemination, especially lymph nodes, viscera, joints, cns, eye, nose |
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What is indicated in systemic reactive histiocytosis |
Azathioprine Leflunomide |
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What is histocytic sarcoma |
Neoplasm of histocytic dendritic cells |
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What are the common sites affected by histocytic sarcoma? |
Lungs LN Viscera Joints Cns Eyes nose |
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What breeds are commonly affected by histiocytic sarcoma |
Bernese mountain dogs Flat coated retreivers Rottweilers |
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What are the clinical signs associated with histolytic sarcoma |
Lymphadenomegaly Anaemia Thrombocytopaenia |
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How do we stage histolcytic sarcoma |
Imaging Sampling - liver, ln, spleen bm, other accessable abnormalities |
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What is the least common presentation of histiocytic sarcoma |
Localised form |
90% metastatic rate |
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What form of histocytic sarcoma has the poorest prognosis |
Haemophagocytic variant arising from splenic/BM macrophages which phagocytose blood cells |
1-2mth |
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How can we treat histiocytic sarcoma |
Chemotherapy - lomustine
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What is the more obvious presenttation of histocytic sarcoma |
Periarticular form - investigated and treated at an earlier stage |
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What is the MST of disseminated histiocytic sarcoma with chemotherapy |
3-6m |
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What type of histiocytic sarcoma is more common in the cat |
disseminated disease |
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What is feline progressive histiocytosis |
Feline neoplastic dendritic cell disease |
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How does feline progressive histiocytosis present |
Skin papules and plaques
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How does feline progressive histiocytosis progress |
to LN, lung and visceral disease over mth - years |
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Is excision of early stage feline progressive histiocytosis curative |
no |
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What is necessary for diagnosis of feline histiocytosis |
biopsy |
What |
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What is feline pulmonary langerhans cell histiocytosis |
condition affecting particularly the lungs in cats - infiltrates and respiratory problems |
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What is the prognosis for feline pulmonary langerhans cell histiocytosis |
Poor At diagnosis, the disease is widespread beyond thorax and tx is ineffective |
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