Soft Tissue Sarcoma

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Soft tissue sarcoma

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umbrella of tumors (not hemangiosarcom. not OSA)
15% of all cutaneous and SQ neplasm
middled aged to older dog
in very young dogs are very aggressive

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History of STS

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insidious onset (inconspicuous)
can grow to very large before animals are presented
in location not interfere with normal organ function
may be for months as soft fluctuant SQ mass before recognized as clinically significant

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diagnostic for STS

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1. min. database (wnl or hypoglycemia with paraneoplastic syndrome)
2. Thoracic rads: <25% mets to lung
3. ultrasound helpful in examining intrab LN, CT/MRI determine local extent
4. FNA- may not exfoliate well, if inflam present (neut, macrophafe), don't interpret meschymal cell, will reveal meschymal cell with malignant features. Can rule out MCT
5. Biopsy= excisional biopsy needed to grade, both incisional and excisional can be used for ddx

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Histo grading

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cannot be grade with incisional bopsy
need to remove it, low METS, if grade 3, 40% mets
grade by score

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Histo type of STS

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SIMILAR BIO BEHAVIOR so classified together
fibrosarcoma, hemagiopercytoma, neurofibrosarcoma, liposarcoa, malignant fibrous histocytoma
SPECIAL STAIN FOR DIFF KIND, WANNA KNOW CAUSE DIFF ONE RESPONSE TO DIFF TX

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Bio behavior of STS

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REMEMBE: false appearance of encapsulation but actually tumor and normal cell compressed together
LOCALLY INVASIVE: have fingers
SLOW TO METS: mets predicted by grade
USUALLY DIE OF LOCAL DZ

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Treatment and prognosis:
Surgery

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Treatment of choice (cause usually die of local dz)
WIDE WIDE WIDE MARGIN cause locally invasive
REMOVE EN BLOCK, AGGRESSIVE
if margin dirty, consider immediate 2nd surgery or RT

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RT for STS

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can be curative if cut to microscopic size (adjuvant therapy)
NOT SUCCESSFUL IF AS SOLE THERAPY
80-98% 1 yr, 60-89% 3 yr

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Chemo for STS

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DOES NOTHING TO BULK TUMOR (if not surgical, won't response well to chemo)
considered for mets, incomplete resected dz, GRADE 3 tumor

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MOST STS CAN BE CURED

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once removed, get accurate grade and plan on whether to do chemo

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Vax assoc. sarcoma (VAS)

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1/1000 cats got RV get SQ sarcoma
this tumor type has not been observed n location that do not vx regularly for RV or FeLV
tumor primarily assoc. with killed vx
see weired meschymal cell and some adjuvant in it
keep good records: vx type, manufacturer, location
use non adjuvant vx
mas identified anywhere from 3m to 3yr post most recent vx
vx RV and FeLV if outdoor

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PE of VAS

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subQ, firm, broad- based non- painful irregular mass
appreance of encapsulation deceiving

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Diagnostic of VAS

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1. cytology of primary lesion: aspirate and reveal large, spinloid meschymal cell with wide plemorphism and high nuclear to cyto raito, may contain multinucleated giant cell
2. thoracic rads: mets to lung uncommon
3. HISTOLOGY FOR DEFINITIVE DDX: spindle cells, giant cells, pleomorphic cells, may see lymphocte, may see adjuvant (foreign material)
fibrosarcoma most common, may be others but behavior similar

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Tumorigenesis

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occur due to localized highly concentrated Ag deposition or from residual adjuvant
2 vx most common: Rv and FeLV, both inactivated with adjuvant

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Bio behavior of VAS

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3m to 3 yr post vx
LOCALLY VERY INVASIVE- WIDE MARGIN
mets late in course ( lungs> regional ln)

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VAS prognostic factor

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highly pleomorphic or anaplastic(return to primitive form) tumor bad
affected anatomy: if wide margin possible, head, neck and prox limb bad, distal limb good

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Treatment for VAS

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REMEMBER: NOT ENCAPSULAED, NOT EASY TO REMOVE
SURGERY, SURGERY, SURGERY with WIDE WIDE WIDE margin
send to surgeon, longer survival than removed by general practice surgery
Chance for control BEST WITH 1ST SURGERY so radical excision

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RT for VAS

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NOT WORK WELL IN CAT, recurrance common

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Chemo for VAS

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may prolong survival but not curative

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BOTTOM LINE FOR VAS

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if tumor not completely excisable with WIDE margin, then usually ultimately fatal

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Accountability of VAS

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vx approved be USDA so vx manufacturer not liable for effects to pt
if vet failed to warn client about potential side effect of vs, vet held liable

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Current vx recommendation for vx admin in cats

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ctas indoor do not need FeLV
need RV (non adjuvant over leg)